The challenge
The Royal College of General Practitioners (RCGP) needed to transform the way it assessed the clinical skills of doctors completing GP training.
The existing centre-based clinical examination was constrained by physical capacity, could accommodate only 72 candidates per day and required candidates, examiners and role players to travel to a central examination venue. With growing demand for GP training, the model could not provide the capacity required for the future.
CX Works founder Liam Wynne led the digital and operational transformation programme to implement the new Simulated Clinical Assessment (SCA) — creating a scalable national assessment model that allows GP registrars to take their clinical examination from the GP practices where they work.
The challenge went far beyond moving an examination online.
The new assessment needed to preserve the authenticity and rigour of a high-stakes clinical examination while operating across more than 5,000 GP training practices, each with different technology, networks, security arrangements and local infrastructure.
Candidates needed a consistent and accessible experience wherever they were based. Hundreds of practising GPs needed to be recruited, trained and calibrated as examiners. Professional role players needed to deliver cases consistently across multiple simultaneous circuits. New approaches were also required for invigilation, technical support, incident management, recording, marking and results.
Most importantly, the assessment needed to be sufficiently resilient for candidates to rely on it at a critical point in their medical careers.
Designing the end-to-end candidate experience
Candidate experience was treated as an integral part of the assessment design rather than simply the interface used on examination day.
RCGP worked with the GP Registrars Committee to shape candidate-facing elements of the platform, communications and preparation materials. A nationwide technical sampling exercise examined broadband, operating systems, browsers and local permissions within GP practices before minimum technical standards were established.
More than 5,000 training practices were incorporated into the readiness process, with connection checks completed ahead of live delivery.
Pilots tested technical performance, usability, accessibility, case presentation and the complete candidate journey. Feedback resulted in changes to the consultation interface and invigilation processes, while comprehensive onboarding and live technical support helped candidates prepare before examination day.
The result was a candidate journey encompassing communication, preparation, technical readiness, onboarding, assessment delivery, support and recovery when things went wrong.
Building a new national operating model
Technology was only one component of the transformation.
A new end-to-end operating model brought together assessment delivery, professional role players, invigilation, technical support, case management, examiner management, asynchronous marking, quality assurance and results.
Following competitive procurement, Osler and PRP were selected to support delivery and development of the new model. The platform incorporated candidate allocation, assessment delivery and recording, case management, asynchronous marking and results analysis, with integration into RCGP systems.
Extensive piloting and stress testing were undertaken before national rollout. The programme also established the operational controls required to manage a distributed high-stakes examination in real time, including technical monitoring, trained reserves, escalation processes and provision for candidates affected by technical disruption.
From implementation to continuous improvement
Successful launch was not treated as the end of the transformation.
Performance was reviewed after each examination diet, using operational data, candidate and examiner feedback, incident analysis and completion rates to identify where the experience or operating model could be improved.
This created a continuous improvement cycle: deliver, measure, learn, refine and test again.
Candidate and examiner experience were monitored alongside technical and operational performance. Recurring issues could therefore be identified and addressed through changes to technology, processes, guidance, training or support rather than becoming accepted features of delivery.
Completion and disruption were particularly important measures. Technical incidents and reruns were tracked to understand both individual failures and wider patterns, with improvements prioritised according to their impact on candidates.
The same approach was applied to the wider experience. Candidate feedback informed changes to preparation, communications, consultation and invigilation processes, while examiner feedback and performance data supported improvements to calibration, marking and quality assurance.
This turned the SCA from a transformation programme into an evolving national assessment service, with evidence from each live examination feeding directly into the next cycle of delivery.
Accessibility by design
Moving assessment into candidates' workplaces created opportunities to improve accessibility as well as capacity.
The platform can simultaneously accommodate different timing profiles, including additional reading or consultation time and extra breaks. Consultation formats can also be adjusted for candidates with particular accessibility requirements.
Candidates can use established workplace adjustments such as specialist monitors, magnification software or adapted equipment within their own GP practice. Alternative arrangements, including onsite invigilation and printed materials, can be provided where required.
This helped make accessibility part of the core operating model rather than a separate assessment process.
The impact
84% of candidates rated their experience positive or neutral, 92% of examiners rated their experience positive or neutral, and the new model operated at approximately one-fifth of the carbon footprint of the previous assessment model.
The transformation increased capacity while maintaining assessment standards and created a more distributed, accessible and sustainable model capable of supporting the future GP workforce.
The CX Works perspective
The SCA reflects the approach CX Works brings to assessment transformation.
Start with the experience, not the technology. Understand the complete candidate and user journey before designing the solution around it.
Design the operating model as well as the platform. Technology only succeeds when people, suppliers, processes, support, governance and operational controls work together.
Use evidence to drive improvement. Establish meaningful measures, listen to candidates and examiners, analyse incidents and performance, and turn that evidence into practical changes.
Keep improving after go-live. High-stakes services are rarely perfect at launch. The objective is to create an organisation and operating model capable of learning quickly and improving continuously.
CX Works combines assessment expertise, digital transformation and operational delivery to help organisations design better assessment experiences, implement them successfully and continually improve them once they are live.