A group of Indian-origin physicians has launched a legal action against the regulatory body for doctors in the UK, alleging that the exam, which confirms a doctor has satisfactorily completed speciality training and is competent to enter independent practice, is flawed and discriminates against international trainees.
The British Association of Physicians of Indian-Origin (BAPIO) claims there is a "significant difference in pass rates" between UK and international graduates, including those of Indian origin.
Their lawyers have started a legal bid against the regulator, the General Medical Council (GMC), and standards body, the Royal College of General Practitioners (RCGP).
"BAPIO is seeking a Judicial Review of the way the RCGP conducts the MRCGP exam. Our lawyers claim there is a significant different in pass rates which cannot be explained by a lack of any knowledge, skill or competency on the part of the International Medical Graduates (IMGs), which include those of Indian origin," Ramesh Mehta, president of BAPIO said in a statement on Sunday.
The BAPIO argues that these graduates will have already passed the GMC's PLAB test (which includes an English language test and demonstrates that graduates have the necessary skills and knowledge to practise medicine in the UK), a rigorous examination for entry into GP training and on-going assessments.
RCGP figures show that 65.3% of IMGs failed their first attempt at the Clinical Skills Assessment (CSA) component of the MRCGP exam in 2011/12, compared with 9.9% of UK graduates.
In 2010/11, 59.2% of IMGs failed at the first attempt, compared with 8.2% of UK graduates.
In 2008, 43% of IMGs failed the CSA compared with 8.3% of UK graduates.
These doctors are failed in spite of the fact that they will have had supervised training for three years during which time each of them would have seen on an average 3,000 patients without any complaints.
To reach this stage they would also have had good feedback from trainers and colleagues and would have passed the theory test.
BAPIO says increasing numbers of GP trainees have been contacting them regarding concerns about the CSA. This exam is intended to mimic practice as a GP and test a trainee's clinical skills.
Each candidate is required to see a number of patients, each of whom is an actor role-playing to present a clinical case. BAPIO's lawyers argue that opportunity for bias arises in the face-to-face assessment trainees undergo during the mock consultation.
It appears that during the exam a physician's intellectual ability is judged on the basis of how well he or she speaks native English.
BAPIO's case will be that for these reasons the differential pass rates demonstrate unlawful discrimination under the Equality Act 2010. Negotiations with the RCGP have so far failed to resolve BAPIO's concerns.
BAPIO is also pursuing Employment Tribunal action against the RCGP for individual GP trainees who have failed the CSA and been removed for training.
It says IMGs who fail are left with bleak career prospects.
Once trainees have exhausted the number of attempts allowed at the MRCGP examination they are then ejected from the training programme leaving them with no career prospects in general practice.
Dr Ramesh Mehta, President of BAPIO said: "Patient safety is paramount. These doctors have had extensive interaction over a period of many years with their trainers and patients without significant concerns.
"For them to be judged to be so grossly incompetent in a short exit exam either reflects poorly on years of training, which is unlikely, or it is because the exit exam is flawed".
"Training a doctor to be a GP costs the UK tax payer £488,730 which seems a profligate waste of resource considering that an estimated 300 doctors have been removed from training because of their failure to pass the CSA.
Legal remedy has always been our last resort.
We hope that the Judicial Review will help to expose flaws in the system.
Professor Rajan Madhok, Chairman of BAPIO said:"...Our QC feels that BAPIO has a strong case, and hopefully justice will be done and allow these doctors to help the NHS in these hard times. Racial discrimination in the NHS is a lose: lose proposition, and the sooner it is addressed the better it will be for the patients, the exchequer and the society at large."
Currently there are over 40,000 doctors of Indian-origin working in the NHS.