About This Tool
This is a reflection aid to help GP trainers think systematically about registrar progress. It is based on published research including Paice's warning signs and current UK deanery guidance.
This is NOT an assessment tool. It does not replace or replicate formal Deanery processes:
- It prompts reflection — helping you notice patterns, not make formal judgments
- It supports early conversations — before issues escalate to formal processes
- It complements WPBA — the formal capability assessment remains with ESR and ARCP
- It stores nothing — all selections remain in your browser only
Remember: With early identification and good support, 90% of registrars in difficulty successfully remediate. Your observations matter.
How to Use This Tool
When to use:
- When you have concerns about a registrar's progress
- Before a supervision meeting to structure your thinking
- As a periodic "check-in" (e.g., mid-placement review)
- When preparing to discuss concerns with your TPD
Steps:
- Review each category — click to expand and tick any indicators you've observed
- Be specific — think of concrete examples, not general impressions
- View the summary — click "View Summary & Next Steps" for tailored guidance
- Print if needed — create a record for your own notes or discussion with TPD
UK Support Pathway for Registrars in Difficulty
If you have concerns, the escalation pathway is straightforward. The simplest first step is to contact your Training Programme Director (TPD).
Share your observations supportively. Explore their perspective. Document in ePortfolio educators' notes.
Your Training Programme Director is the key point of contact. They can advise on next steps, involve the wider training team, and coordinate support. This is the simplest and most important step.
Specialist confidential support available in all regions. Offers coaching, mentoring, careers advice, and specialist assessments. Self-referral is encouraged — registrars can refer themselves, or you/TPD can refer with their knowledge.
For serious or ongoing concerns requiring formal oversight. This is a supportive process to ensure appropriate measures are in place.
Key principle: Early, informal discussion is better than waiting for problems to escalate. Your TPD would much rather hear from you early than late.
Understanding the Formal Framework
This tool complements — but does not replace — the formal assessment processes managed by your Deanery and RCGP.
How Formal Assessment Works
The GP Curriculum defines 13 professional capabilities (e.g., Clinical Management, Communication, Fitness to Practise). Each has formal "Indicators of Potential Underperformance" (IPUs) used in assessment.
Formal assessments (COT, CBD, Mini-CEX, MSF, PSQ) map to the 13 capabilities. These provide the evidence base for progression decisions.
The ESR rates progress against capabilities. The Annual Review of Competency Progression (ARCP) panel makes formal outcome decisions based on all evidence.
For trainees needing additional support, the PSW service uses the NCAS Performance Triangle (Health, Behaviour, Clinical Competence, Environment) to categorise issues and provide targeted interventions.
Where This Tool Fits
This tool sits before formal processes. It helps you:
- Notice patterns that might warrant a supportive conversation
- Structure your thinking before speaking with your TPD
- Identify concerns early — when support is most effective
You observe. The Deanery assesses. Your role is early identification and support — the formal capability assessment remains with WPBA, ESR, and ARCP processes.
Attendance & Reliability
Based on Paice's "Disappearing Act" warning sign. Patterns of absence or unreliability may indicate underlying difficulties.
Work Rate & Engagement
Based on Paice's "Low Work Rate" warning sign. May indicate knowledge gaps, confidence issues, or external stressors.
Interpersonal & Behaviour
Based on Paice's "Ward Rage" and "Bypass Syndrome" warning signs. Interpersonal difficulties often signal underlying issues.
Clinical Performance
Clinical safety is paramount. These indicators may suggest knowledge gaps or skills requiring development.
Insight & Response to Feedback
Based on Paice's "Insight Failure" and "Rigidity" warning signs. Lack of insight often compounds other difficulties.
Career & Exam Progress
Based on Paice's "Career Problems" warning sign. May indicate knowledge gaps, exam anxiety, or uncertainty about career choice.
Health & Wellbeing
Health issues (physical or mental) may underlie other difficulties. A supportive, non-judgmental approach is essential.
📚 Evidence Base & References
▼This tool draws on peer-reviewed research and established UK training guidance. Click to expand the full reference list.