SCA vs CSA: how the MRCGP clinical skills exam changed
The CSA (Clinical Skills Assessment) is no longer held. The RCGP says the CSA ran until 2020, when COVID-19 stopped it; the Recorded Consultation Assessment (RCA) replaced it temporarily, and the Simulated Consultation Assessment (SCA) replaced the RCA permanently from November 2023. The CSA was 13 cases of 10 minutes at the RCGP's assessment center; the SCA is 12 cases of 12 minutes with simulated patients, sat remotely from a GP surgery, mostly on video and some audio only.
Last checked Nov 1, 2026 against the RCGP pages and reports listed under Sources.
The short version
- CSA: face-to-face, 13 cases, "Each case lasts 10 minutes (plus two minutes marking/changeover time)", at a purpose-built RCGP assessment center (RCGP annual reports).
- The CSA stopped in 2020. The RCGP: "delivery of the Clinical Skills Assessment (CSA) was interrupted in March 2020 by the COVID-19 pandemic". The RCA, using recorded real consultations, replaced it as a temporary exam.
- SCA from November 2023: "a permanent replacement for the Recorded Consultation Assessment (RCA)", approved by the GMC in March 2023.
- SCA format: 12 simulated consultations of 12 minutes, 3 minutes' reading for each, sat in a local GP surgery via the Osler platform; most cases on video, others audio only.
- New domain names: CSA used Data gathering, technical and assessment skills / Clinical management skills / Interpersonal skills; the SCA uses Data gathering and diagnosis / Clinical management and medical complexity / Relating to others, and weights the clinical management domain.
- Physical examination: the CSA assessed it; the SCA doesn't (it moved to WPBA).
- First-attempt pass rates rose (RCGP interim report): UK graduates 90.80% (CSA) to 94.27% (SCA); IMGs 43.03% to 51.52%.
Timeline (RCGP)
| When | What happened | RCGP source |
|---|---|---|
| Until 2020 | "Until April 2020 this was done through the Clinical Skills Assessment (CSA)." | MRCGP regulations 4.5 |
| March 2020 | "delivery of the Clinical Skills Assessment (CSA) was interrupted in March 2020 by the COVID-19 pandemic" | 2022–23 annual report |
| From 2020 | "During the period of Covid-19 disruption, the Recorded Consultation Assessment (RCA) was introduced as a temporary emergency examination to replace the CSA." | MRCGP regulations 4.5 |
| March 2023 | "The SCA was approved for delivery in March 2023 by the GMC." | 2022–23 annual report |
| September 2023 | "The RCA concluded in September 2023" | 2022–23 annual report |
| November 2023 | "...and was replaced by the Simulated Consultation Assessment (SCA) in November 2023." | 2022–23 annual report |
The two RCGP documents give slightly different months for the end of the CSA (the regulations say "until April 2020", the annual report says delivery was "interrupted in March 2020"). Both agree COVID-19 ended it.
SCA vs CSA side by side
| CSA (until 2020) | SCA (from November 2023) | |
|---|---|---|
| Cases | 13 cases or "stations" | 12 consultations |
| Time per case | "10 minutes (plus two minutes marking/changeover time)" | 12 minutes, plus "3-minutes reading time at the start of each case" |
| Patients | In person at the assessment center | Simulated patients (role-players) on video or audio only |
| Where | "a purpose-built assessment centre in the College's headquarters building in Euston" (2014–15 report; in 2010 the center was in Croydon) | "a local GP surgery via the Osler examination platform. In most cases, this will be your own surgery" |
| Video / audio | In person | "In the majority of these you will be able to see the simulated patient. Others will be audio only." |
| Domains | Data Gathering, Technical and Assessment Skills · Clinical Management Skills · Interpersonal Skills | Data gathering and diagnosis · Clinical management and medical complexity · Relating to others |
| Grades per domain | "Clear Fail – Fail – Pass – Clear Pass" | CF, F, P, CP (against "a newly qualified, independent GP") |
| Scoring and weighting | "The domain grades awarded on a case are given a numerical equivalent (zero to three, respectively)" and added up over the 13 cases, with no extra weight for any domain described | Clinical management and medical complexity "is weighted in comparison to the other two domains"; marks out of 126 |
| Standard setting | "the borderline group method" | Borderline regression; "there is no fixed pass mark for each case"; aggregate of 12 cases |
| Physical examination | Part of the CSA: one CSA feedback statement read "Does not undertake physical examination competently, or use instruments proficiently" | "Physical examinations will not be assessed within the SCA, and instead will be covered within WPBA." |
| Fee | Not in the RCGP sources we read | £1,207 (2026 diets); £1,238 (Jan–Jul 2027) |
| Sittings a year | Seven in 2017–18 ("three diets of the AKT and seven of the CSA") | Nine diets |
| First-attempt pass rate | UK graduates 90.80%, IMGs 43.03% (all CSA exams since 2014, per the RCGP interim report) | UK graduates 94.27%, IMGs 51.52% (Nov 2023–Jun 2024, same report) |
Where a cell says "not in the RCGP sources we read", we didn't find an RCGP statement, so we don't fill it in. The CSA details come from RCGP annual and statistics reports for 2014–15 and 2017–18; the SCA details from current RCGP pages.
And the RCA in between
The RCA was the bridge. According to the RCGP's 2022–23 annual report, it used pre-recorded video or audio consultations with real patients, and "Initially candidates were permitted to submit thirteen consultations". The RCGP's SCA introduction lists, among its reasons for the new exam, "To provide a standardised examination which didn't require candidates to collect cases from within your surgeries."
Why the RCGP changed it
The RCGP's "Drivers for change" for the SCA, in its own words:
- "To provide a standardised examination which didn't require candidates to collect cases from within your surgeries."
- "To reduce the time taken in preparing for your examinations."
- "To have cases which reflected the prevalence of conditions seen in the UK."
- "To have cases which reflected the type of work done in UK general practice."
- "To champion accessibility, convenience, time saving, cost saving, and sustainability."
- "To have more opportunities to sit within the year."
Pass rates: CSA vs SCA
From the RCGP's SCA performance interim report (first attempts):
| Group | CSA (all exams since 2014) | SCA (Nov 2023 to Jun 2024) |
|---|---|---|
| UK graduates | 90.80% | 94.27% |
| International medical graduates | 43.03% | 51.52% |
The report puts it as: "Pass rates for the SCA have increased by 3.47 % for UK Graduates compared to those undertaking the CSA. The SCA pass rate has increased by 8.49 % for International Medical Graduates." Those are percentage-point differences. The gap between UK graduates and IMGs is smaller with the SCA but still large. Every SCA diet since: SCA pass rate.
Using older CSA material for the SCA: a checklist
Checklist written by Confetto (our advice, not RCGP guidance). Books, videos and case banks written for the CSA can still help with consultation skills, but check each against the SCA's rules:
- Timing: CSA cases were 10 minutes. Re-time every practice case to 12 minutes, with 3 minutes' reading first, and aim to finish data gathering by about 6–7 minutes (an RCGP toolkit global skill).
- Format: the SCA is remote. Add audio-only cases; practice picking up cues you can only hear.
- Examination: the CSA assessed physical examination; the SCA doesn't. Any material built around examining a role-player needs reworking into what you'd ask, observe on video, or arrange.
- Domain names: mark yourself with the SCA domains and the RCGP's 26 SCA feedback statements, not CSA terms.
- Case mix: cover all 12 SCA blueprint groups, including "Professional conversation / Professional dilemma" and "Investigation / Results".
- Guidance: clinical content must be current (NICE, CKS, BNF in 2026), not what was right when the book was written. And note the RCGP rule: no BNF access during the SCA.
- Old passes: the RCGP says "CSA, RCA and SCA passes are valid for seven years" (MRCGP regulations 4.7).
Practice this case with an AI patient
Confetto isn't affiliated with the RCGP.
Frequently asked questions
Is the CSA exam still running?
No. The RCGP says the CSA was used until 2020, the RCA replaced it temporarily during COVID-19, and the SCA has been the permanent clinical skills assessment since November 2023.
What replaced the CSA?
First the Recorded Consultation Assessment (RCA), as a temporary emergency exam, then the Simulated Consultation Assessment (SCA) from November 2023 (RCGP).
Is the SCA harder than the CSA?
The RCGP doesn't compare difficulty. Its interim report shows higher first-attempt pass rates for the SCA than the CSA: 94.27% vs 90.80% for UK graduates and 51.52% vs 43.03% for IMGs.
How long were CSA cases compared with SCA cases?
CSA: 10 minutes per case plus two minutes of changeover, 13 cases. SCA: 12 minutes per case with 3 minutes' reading, 12 cases (RCGP).
Is my old CSA pass still valid?
The RCGP's regulations say "CSA, RCA and SCA passes are valid for seven years", with a longer period for one cohort affected by COVID-19. Check the regulations for your case.
Are the SCA domains the same as the CSA domains?
No, they were renamed: the SCA uses Data gathering and diagnosis, Clinical management and medical complexity, and Relating to others. The CSA used Data gathering, technical and assessment skills; Clinical management skills; and Interpersonal skills.
Sources
Read on November 1, 2026.
- Introducing the SCA (incl. "Drivers for change"), RCGP
- Full MRCGP exam regulations (4.5, 4.7), RCGP
- MRCGP Annual Report 2022–23, RCGP
- MRCGP Annual Report August 2017 – July 2018, RCGP
- MRCGP Statistics 2014–15, RCGP
- SCA performance interim report, RCGP
- Marking and results for the SCA, RCGP
- Applying for the SCA, RCGP
- MRCGP important info and admin (fees), RCGP
- Preparing for the SCA (blueprint), RCGP