The recent case of Karmakar & Anor v Royal College of General Practitioners was a significant legal challenge to the policies and practices of the Royal College of General Practitioners (RCGP) regarding the Applied Knowledge Test (AKT), a mandatory exam for General Practitioners. The case was heard in the UK High Court in August 2024 and involved two GPs who argued that the RCGP’s policies were unfair and discriminatory. The decision has significant implications for medical training in highlighting the necessity for inclusivity of candidates with disabilities.

 

Factual Background

The case involved two claimants: Dr. Marwa Karmakar, a trainee GP, and the British Medical Association (BMA). Dr. Karmakar challenged the RCGP’s decision to refuse her a further attempt at the AKT. The RCGP had a policy which allowed a maximum of four attempts at the AKT, with a fifth attempt granted exceptionally based on additional educational attainment. Dr. Karmakar had failed the AKT three times before being diagnosed with a neurodiverse condition requiring reasonable adjustments, including extra time. While she was granted a fifth attempt on these grounds, she failed again and was refused any further attempts.

The BMA challenged the lawfulness of the RCGP’s policy on retake attempts for the AKT and the Recorded Consultation Assessment (RCA), specifically concerning candidates diagnosed with disabilities after exhausting their initial attempts.

 

Judgment

The court held that the RCGP, deriving its power from Royal Charter rather than statute, had broad discretion in setting membership criteria, including the number of attempts allowed. However, the court emphasised that any such criteria must be rational.

Analysing the RCGP’s rationale for its policy, the court found it wanting. The RCGP’s arguments regarding patient safety, GMC expectations, training duration, and financial implications were all rejected as unjustified or irrelevant. Notably, the court highlighted the RCGP’s inconsistent approach of allowing extra time for known disabilities but not accommodating those diagnosed later.

The court ultimately ruled that the RCGP’s blanket refusal to consider further attempts based on late disability diagnoses was irrational, quashing the relevant policy and decision affecting Dr. Karmakar.

 

Implications Going Forward

Karmakar has significant implications going forward, underscoring the importance of balancing high professional standards with fairness and inclusivity in medical education and training and in the face of evolving legal and regulatory landscapes. For clinicians it provides vital protection for those with disabilities. It emphasises the need for Royal Colleges to adopt fair and flexible examination policies that accommodate late diagnoses, and could lead to similar challenges against other Royal Colleges and examining bodies with similar policies. The RCGP and similar organisations must review and revise their examination policies to ensure they are rational, non-discriminatory, and consider the needs of disabled trainees.

 

For legal guidance, please contact Ellen Dalzell, Alistair Wilson or any member of our Healthcare team.

While great care has been taken in the preparation of the content of this article, it does not purport to be a comprehensive statement of the relevant law and full professional advice should be taken before any action is taken in reliance on any item covered.