Printed on: October 18th, 2024

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Workplace-based assessment (WPBA) demystified

Workplace-based assessment (WPBA) demystified

Our Red Whale programme directors and GP trainers work in various schemes across the UK. These may be organised and run differently, but there are some common ways trainees need to manage their time.

One of these is completing ALL the necessary steps for the portfolio to achieve the Certificate of Completion of Training (CCT). It can feel baffling and overwhelming!

So, we got our training heads together, read through the RCGP guidance, got hints and tips from our trainers and programme directors, and have put together this ‘demystified’ resource. We hope it will be useful for trainees, but also GP trainers and GP colleagues who support trainees in their learning.

We hope you enjoy using this resource and find it a valuable tool throughout your GP training. And, like any good educator, our programme directors would welcome feedback. Please let us know how we could improve these resources, and what other resources you would value to support you with your training!

And remember, goalposts can change frequently. For the most up-to-date information on this topic, you should always look at the official MRCGP website which can be found here.

We start with a map to help guide trainees over the 3 years. This includes the elements of the workplace-based assessment (WPBA) that are required to achieve your Annual Review of Competency Progression (ARCP) for each year.

We have based this guide on a full-time trainee completing training over 3 years. If you are Less Than Full Time (LTFT), you will need to adjust this pro rata.

But before we dive in, we need to talk about acronyms (there’s a lot!!!).

You’ll hear a lot of acronyms during your GP training. Here is a handy list until you find your feet!

We now explain all the necessary components of WPBA, arranged alphabetically.

Basic life support with an automated external defibrillator (BLS/AED)

• From August 2022, trainees have been required to have evidence of hands-on BLS training, with AED, for adults, children and infants.
• If trainees have attended an ALS (advanced life support) course, they are usually issued with a certificate for 3–4 years. For clarity, even if a trainee has attended an ALS course, BLS and AED training will still need to be updated every 12 months by attending an appropriate course, with evidence logged in the portfolio.
• Certificates should be added to the portfolio as a ‘supporting document’ and be linked to the ‘compliance passport’ section. When logged correctly, it will show as ‘up to date’ in the compliance passport section.

The CAT replaces case-based discussions in the ST3 year. The CAT includes case-based discussions, but also encompasses evaluation of wider capabilities that demonstrate professional judgement.  

The RCGP has suggested that CATs can be:

• Case-based discussions, as was done in ST1 and ST2.
• Random case reviews.
• Leadership activities.
• Prescribing assessment follow-up. 
• Consultation assessments (which are not COTs).
• Referrals review.
• Other, e.g. debriefs, review of investigation or imaging use, follow-up of QIP.

These are structured oral interviews that assess a trainee’s professional judgement by reviewing a case that a trainee manages independently.

• The case should be written up and shared with your supervisor before the assessment. The supervisor will then spend up to 30 minutes discussing the case with you and triangulating it with the portfolio capabilities.
• The RCGP has produced useful question generators for supervisors to use. These are also useful for trainees to get an idea as to the type of questions that may be asked. There are themes of questions for GP supervisors and hospital supervisors to consider.
• Trainees are encouraged to submit cases that cover the breadth of the capability areas, as well as cases with varying complexity.

Guidance for CEPS has recently been updated and can be found here.

Over the 3 years of GP training, all trainees should demonstrate capability in a range of examinations. The GMC mandates that competency in 5 intimate skills must be signed off, and the educational supervisor would also need to assess a ‘range’ of other skills and sign off the trainee as being competent.

• Prioritise being signed off for ALL the intimate skills and as many of the suggested skills as possible in order to demonstrate broad competency. The RCGP guidance states that being graded as “able to complete unsupervised” in all of the 7 system CEPS in addition to the mandatory CEPS would provide strong evidence of competency, and strong evidence that a trainee has met the CEPS requirements for WPBA. 
• Consider how you might do this, e.g. joint clinics with your supervisor, outpatient opportunities. Pace yourself through the 3 years: you should be completing some, relevant to post, CEPS in each training year (ST1 and ST2); without this, you would not meet the requirements for ST1 or ST2.  
• A suitably trained professional will need to observe and document your performance on a CEPS evidence form. If it’s a doctor who is not a GP, they need to be at least ST4.

COTs can be done for any of the following type of consultation:

• In person (live).
• In person (recorded).
• Virtual consultation (live).
• Virtual consultation (recorded).
• Audio COT.

COTs are carried out during a GP post. Your supervisor will grade each section of your consultation and provide feedback and recommendations.

It is encouraged that trainees do a mixture of different types of consultations for their COTs.

The key difference here is that in non-primary care (e.g. hospital) placements, trainees are assessed against the expected level for a GP trainee at this stage in training; however, in primary care placements, trainees are assessed against a trainee at the point of Certificate of Completion of Training (CCT).

An educational supervisor’s review is completed twice a year.

• At the midpoint of the year, if the trainee is progressing satisfactorily and everything is on track, a shorter interim ESR review can be completed.
• If there are any concerns about the trainee’s performance or they have had either an unsatisfactory or developmental outcome in their previous ARCP, the full ESR will be required.

This is an activity undertaken during the ST3 year.  Following this activity, a leadership MSF should also be conducted in the second half of the ST3 year to receive specific feedback on leadership skills.

Examples of leadership activities given by the RCGP are:

• Chairing a meeting (you will find a handy article to help with this on Red Whale Knowledge).
• Quality improvement project (many of our articles suggest ideas that may inspire a QI project).
• Wellbeing project (to enhance the wellbeing of the practice team).
• Clinical protocol (review/creation) (you could look at our range of GEMS for inspiration).
• Practice leaflet review.
• Website design review.
• Fresh pair of eyes exercise (where the trainee reviews the practice organisation from an objective viewpoint).
• Trainee’s own idea.

You can find more information about these examples on the RCGP portal.

In each training year, at least one learning event analysis should be undertaken.

These are events where lessons can be learnt, but that don’t necessarily meet the threshold for a significant event analysis (where they reach the GMC threshold for harm).

The LEA should be written up and shared with the team.

Trainees should also reflect any further learning and development in the PDP.

Trainees should have a range of log entries that are about patients they have seen. The majority should be logged as clinical case reviews (CCRs), aiming for at least three CCRs a month (pro rata for LTFT).  

In addition, other learning logs (e.g. supporting documentation) can be recorded to demonstrate evidence of capabilities such as organisation, management and leadership.

A great tip here, to make it easier for your ESRs, is that each capability should be covered at least once in each 6-month review period.

The RCGP has produced a helpful guide with worked examples of different log entries, with supervisor examples included.

A MiniCEX is an assessment during a hospital post where a trainee and patient interaction is observed.

It is the equivalent of the COT which is undertaken during a GP post!

Like a COT, it should cover a range of capabilities. It is recommended that the MiniCEX assessment is carried out by your hospital clinical supervisor, but it could also be completed by doctors who are ST4 or above, or speciality and associate specialist doctors with equivalent experience and who have met the GMC assessor requirements.

Trainees are required to do an MSF in every year of training.

Each MSF should have a minimum of 10 respondents, 5 of whom are clinical and 5 non-clinical.

This is anonymous feedback, enabling you to view your colleagues’ opinions on your clinical performance and professional behaviour. Following the MSF, trainees should review the data and reflect on what their next steps might be.  

• A good tip here is to be proactive with the MSF – don’t leave it until the end of your post.
• This will give you adequate time to get enough respondents, and will also provide an opportunity to discuss and reflect on the feedback with your supervisor.
• As trainers and programme directors, we’ve gone through lots of MSFs for trainees. Although, most of the time, the comments are positive and constructive, some unexpected feedback can occasionally be received. Discussing your thoughts about the feedback with your supervisor is just as important as receiving it from others.  

During the ST3 year, there will be an additional leadership MSF that is done after the ST3 leadership activity.

These meetings should be done at the beginning of your post with your named clinical supervisor. This is a great opportunity to look at any educational objectives for the post, in addition to a discussion to identify the specific opportunities that would be relevant to primary care.

Some schemes have 2 x 6-month rotations, while others may have 3 x 4-month rotations, so it’s important that a placement planning meeting is held with each new named clinical supervisor.

During the ST3 year, a prescribing assessment which reviews 50 retrospective prescriptions and includes a reflection on any potential errors should be undertaken.

• A much-loved tip here is to make it simple to find the prescriptions trainees have generated. Did you know that EMIS, SystmOne and Vision have inbuilt tools to automate the search and not make it a laborious process?! Find the information, guides and templates on the RCGP site.
• And a prescribing assessment can actually help! Trainees can really benefit from identifying their personal prescribing trends, reflecting on errors and putting learning plans in place to improve future prescribing.

A PSQ provides the opportunity for patients to provide feedback on empathy and relationship-building skills during consultations, and one should be undertaken after the midpoint of the ST3 year.

A PSQ can be done electronically or in paper form (uploaded to the portal by a practice administrator). They comprise 9 questions that patients are asked after their consultation with the trainee, and each question has 5 options for them to choose from.

34 responses are required for the PSQ to be completed. It can then be discussed with your ES to plan any action or celebrate the feedback!

The GMC requires that all doctors demonstrate involvement in a quality improvement activity at least once a year.

During GP training, a QIP (see below) should be done during the ST1 or ST2 year.

QIAs should be done in the years in which you do not do a QIP.

Having said that, we generally advise our trainees to get involved in some form of quality improvement regularly, and this can be carried forward post-CCT into future years as a GP.

The RCGP has a detailed description of what types of activities could be undertaken for a QIA; these all involve taking action as a result of data:

• A review of personal outcome data through case reviews, e.g. referral review.
• Involvement in a large-scale national audit with data collection at an individual/practice level.
• Small-scale data searches, which could include reviewing prescribing (separate to the prescribing assessment).
• Small, specific QIP using plan/do/study/act (PDSA) cycles.
• Writing or revising a practice policy.
• Monitoring and evaluation, e.g. patients on DMARDS or warfarin, using PINCER data.
• ‘Search and do’ activities involving information collection and analysis.

The RCGP does note that a LEA, reflection on feedback and leadership project do not count as a mandatory QIA .

During the ST1 or ST2 year, a quality improvement project should be undertaken while in a primary care placement. QIPs should have a clear aim, data collection, sufficient engagement with the team and other stakeholders, and a reflection on the changes or what was learnt.

• Identify a need in your training practice and then use the ‘model for improvement’ suggested by the RCGP. You can find details of this in our Red Whale Knowledge article Improving your practice.
• If you’re struggling for ideas for your QIP, look at some of the GEMS on Red Whale Knowledge for inspiration.

At the beginning of ST1, trainees will usually complete a level 3 adult AND child safeguarding course; evidence that this is complete needs to be logged in their portfolio.

This will be valid for 36 months and requires updating if a trainee extends training for any reason.

Top tip: we advise our ST3s to formally complete this again towards the end of training, before CCT; this will ensure it carries you over your CCT period. 

In addition, every 12 months, all trainees need to have:

• A safeguarding knowledge update AND
• At least one clinical case review.

Both of these must be documented in a learning log entry. It is recommended that these are linked to the clinical experience group 'People with health disadvantages and vulnerabilities'.

A safeguarding knowledge update could be demonstrated by:

• Attending face-to-face training.
• Attending webinars.
• Attending safeguarding practice meetings.
• Completing eLearning.
• Repeating the level 3 safeguarding training!

When documenting the knowledge update within the learning log entry, it must include a demonstration of knowledge gained, key safeguarding information discussed and appropriate action to take if there are any concerns.

The clinical case review could be:

• A patient interaction that demonstrated the application of safeguarding knowledge.
• Group case discussion (e.g. at VTS).
• Discussing a case at a practice safeguarding meeting.

If a significant event occurs that meets the GMC threshold of potential or actual serious harm to patients, this should be logged in the portfolio and declared on the Form R. This should also be considered for any fitness to practice issues.

Always discuss cases that you are unsure about with your educational supervisor. If still in doubt, it’s always better to declare a significant event and go through the analysis.

If you made it this far, phew – well done! We now offer a roadmap for each year, with a suggestion of how you might be able to fit all this in!

Welcome to GP training!

The biggest tip for our ST1s is to get to grips with the portfolio early on so that you can maximise the educational benefit and avoid rushing through outstanding assessments towards the end of the year.

Meet your educational and clinical supervisors early and ensure that they are linked to you on the portfolio.

So, what do you need to complete this year? Our Red Whale trainers and programme directors have come up with a suggested guide to help you through – with the least amount of stress and maximum benefit!

There are a few assumptions we’ve made here. Firstly, this guide is for a full-time trainee; if you are LTFT, the information here would need to be considered pro rata. In addition, this is designed for 2 x 6-month posts for every training year so, again, this may need adjusting for your local scheme.

By this year, you will have got the ball rolling with your portfolio, and should now be aware of any gaps within your capabilities and competencies.

With your learning logs, focus on the areas with gaps. Look to evidence the capabilities and competencies as best you can to provide an even distribution of evidence as you complete this year.

There are a few assumptions we’ve made here. Firstly, this guide is for a full-time trainee; if you are LTFT, the information here would need to be considered pro rata. In addition, this is designed for 2 x 6-month posts for every training year so, again, this may need adjusting for your local scheme.

So, what do you need to complete this year? Here’s our guide:

Here we are – the last year of training before CCT. How are you feeling? Excited? Apprehensive?

This is quite a busy year, so plan it early and discuss your plan with your trainer at your placement planning meeting. Think about what gaps you may have in your evidence. Have there been any issues in your ARCP that you can learn from?

Aim to distribute the WBPA capabilities through each month of training to ensure a smooth and unrushed finish!

So, what do you need to complete this year? Here’s our guide:

	Workplace-based assessment demystified Plan your GP training over 3 years. To get the most out of training, ensure that you don’t rush your WPBA towards the end of the year. Use the tables above as a guide to support your planning.
	Useful resources: Websites (all resources are hyperlinked for ease of use in Red Whale Knowledge) For the most up-to-date information on WPBA and the MRCGP, always refer to the official sites: RCGP – Workplace-based assessment (WPBA) guide RCGP - Trainee portfolio guidance MRCGP exam – key dates and applications