The SCA Exam Explained: Format, Marking, Dates, and Everything You Need to Know
Your complete guide to the MRCGP Simulated Consultation Assessment — from the 12-case structure and three marking domains to how to book, what to expe
1. What Is the SCA?
The Simulated Consultation Assessment (SCA) is the clinical component of the MRCGP examination, run by the Royal College of General Practitioners (RCGP). It is one of three mandatory requirements — alongside the Applied Knowledge Test (AKT) and Workplace Based Assessment (WPBA) — that must be passed to achieve a Certificate of Completion of Training (CCT) and become a fully qualified GP in the UK.
The SCA replaced the Clinical Skills Assessment (CSA), which was held in person in London, and the interim Recorded Consultation Assessment (RCA) introduced during COVID-19. The current SCA format launched in November 2023 and combines the rigour of a structured clinical examination with the flexibility of a remote, online setting.
In essence, the SCA tests whether you can consult safely and competently as an independent, newly qualified GP — not just whether you know the facts.
The SCA is not a knowledge test. It is a performance assessment. Reading alone will not prepare you — you must practise live consultations, regularly and with feedback.
2. Exam Format at a Glance
| Element | Detail |
|---|---|
| Number of cases | 12 simulated consultations |
| Duration per case | 12 minutes, preceded by 3 minutes of reading time (15 minutes per station in total) |
| Total exam time | Approximately 3.5 hours (including breaks and transitions) |
| Format | Remote online — mostly video consultations; some cases are audio-only |
| Platform | Osler Online (accessed from your GP surgery) |
| Who plays the patient? | Trained role players — not actors, not colleagues |
| Who marks you? | A remote RCGP examiner observing in real time |
| Physical examination | Not part of the SCA — assessed separately via WPBA |
| Notes permitted? | No — fully invigilated; no notes or electronic devices allowed |
| When is it sat? | During ST3 (final year of GP training) |
| Sittings per year | 9 diets, published on the RCGP website |
| Booking | Via MyRCGP portal (since December 2025; FourteenFish no longer used) |
| Fee (from Aug 2025) | £1,207 per attempt — not reclaimable from NHS study budget |
| Staged payments | Compulsory from 1 April 2026: 25% at reservation (or six months before the exam, whichever is later), remainder closer to the exam date |
Each case begins with a 3-minute reading period — a brief clinical vignette describing the patient and reason for contact — before the 12-minute consultation begins. You must manage the full consultation within that 12-minute window: opening, exploring, gathering, managing, and closing safely. There is a comfort break after the first six cases.
3. Exam Conditions & Setting
The SCA is a remote, invigilated examination. You sit it at your own GP surgery, in a private room you have booked in advance. You use your own computer and the Osler Online platform. A remote invigilator monitors throughout.
This format was designed to reflect modern UK general practice — where telephone and video consultations are routine — and to remove the geographic and financial burden of attending a central exam centre.
Permitted during the exam
- Your own computer (must pass a pre-exam device check)
- Headphones
- Water and snacks
- Medicines and medical devices (e.g. inhalers, hearing aids, glasses)
Not permitted
- Notes of any kind
- Mobile phones or any additional electronic devices
- Another person in the room
Book your room at your GP surgery as early as possible — demand is high on exam days. Run the Osler device check well in advance and test your internet connection, camera, and microphone.
4. Attempts Allowed & Pass Rates
The number of attempts you are permitted depends on when you entered GP Specialty Training:
| Entry Date | Attempts Allowed |
|---|---|
| Entered training before 1 August 2023 | Maximum 4 attempts (a 5th may be granted in exceptional circumstances) |
| Entered training on or after 1 August 2023 | Maximum 6 attempts |
There is no discount for resits — the full £1,207 fee applies each time. If you fail and resit, you must re-book through MyRCGP and pay again.
Recent pass rate data from the RCGP (2024–2025):
| Diet | Pass Rate |
|---|---|
| November 2024 | 68.4% overall; 73.1% for first-time candidates |
| January 2025 | 64.9% overall; 69.2% for first-time candidates |
| February 2025 | 70.2% overall; 73.5% for first-time candidates |
| March 2025 | 69.4% overall |
The approximate overall pass rate hovers around 65–77% depending on the diet. First-time candidates consistently outperform repeat candidates, reinforcing the importance of thorough, structured preparation before your first attempt.
5. Marking Criteria — The Three Domains
Every case is marked across three domains. Understanding these is non-negotiable — they define exactly what an examiner is assessing throughout every consultation.
Domain 1: Data Gathering and Diagnosis
This domain assesses how effectively you elicit relevant clinical information and form a safe, accurate clinical assessment.
What examiners look for (Good performance):
- A systematic yet flexible history that prioritises relevant positives and negatives
- Exploring the patient's ideas, concerns, and expectations (ICE) — and doing so naturally, not mechanically
- Assessing psychosocial context: impact of symptoms on the patient's life, work, and relationships
- Recognising red flags and urgent features promptly
- Using appropriate cue-following — picking up on verbal and non-verbal signals
- Forming a clear, safe working diagnosis or differential
Common failure reasons in this domain:
- Asking closed questions only — missing the hidden agenda
- Skipping or rushing ICE — asking it at the wrong moment or as a box-tick
- Failing to assess psychosocial impact ('how is this affecting your life?')
- Not following up on important cues (e.g. patient sighing, hesitating, or volunteering something significant)
Domain 2: Clinical Management and Medical Complexity
This domain has historically been the one candidates most commonly fail. It assesses your ability to offer a safe, patient-centred management plan — including navigating complexity.
What examiners look for (Good performance):
- A management plan that is evidence-based, guideline-aligned, and tailored to the individual patient
- Recognition and management of multi-morbidity and polypharmacy
- Shared decision-making — explaining options, risks, and benefits clearly
- Appropriate safety-netting: who to contact, when, and why
- Follow-up planning proportionate to clinical risk
- Appropriate use of investigations and referrals
Common failure reasons in this domain:
- No safety-netting, or safety-netting that is vague or generic
- Failing to adjust the management plan for comorbidities (e.g. continuing an NSAID in a patient with CKD)
- Offering a plan without checking patient understanding or agreement
- Over- or under-investigating — not proportionate to the clinical scenario
Domain 3: Relating to Others
This domain assesses communication, rapport, professionalism, and your ability to conduct a patient-centred consultation throughout — not just in isolated moments.
What examiners look for (Good performance):
- Active listening and non-verbal attentiveness (even on video)
- Empathy that is genuine — not formulaic ('that must be really difficult for you')
- Explanations delivered in plain language, free of jargon
- Respect for patient autonomy and cultural considerations
- Professional conduct, including appropriate responses to challenging patients
- Smooth transitions between consultation phases without the patient feeling rushed
Common failure reasons in this domain:
- Being overly clinical or robotic — missing the human element
- Interrupting the patient or redirecting too early
- Explanation that is too medicalised — patient cannot follow what is being said
- Visible distress when faced with a difficult or aggressive patient
The RCGP advises candidates not to try to predict which domain matters most in any individual case. Demonstrate all three domains in every case and you will not be caught out. Domain weighting is determined separately for each exam — you cannot game it.
The Overall Case Judgement
Within each case, every domain is given one of four grades:
| Judgement | Description |
|---|---|
| Clear Pass | Clearly above the standard for an independent, newly qualified GP. Positive behaviours are consistently and proficiently demonstrated. |
| Pass | Meets the standard for an independent, newly qualified GP. Sound grasp of the domain, though not necessarily fluent or sophisticated. |
| Fail | Below the standard for safe independent practice. Positive behaviours are not consistently demonstrated, and gaps or errors are present. |
| Clear Fail | Clearly below the standard. Minimal evidence of the expected behaviours, and/or the patient has been placed at risk of harm. |
How the Pass Mark Is Set
There is no fixed pass mark for the SCA. The pass mark is calculated using the Borderline Regression Method: examiners identify borderline candidates at the borderline of passing, and the average score of those candidates across all stations becomes the pass mark for that sitting. This means the standard is consistent across diets, even if the raw pass mark varies slightly between them.
The maximum possible score is 126 (12 cases × 10.5 points each). High scorers in recent diets have achieved around 114–118.5 out of 126.
6. High-Yield Topics
The RCGP SCA is designed to reflect the breadth of UK general practice — so in theory, any topic from the RCGP curriculum can appear. However, certain case types recur consistently based on their prevalence in primary care and their suitability for testing consultation skills. The following are the highest-yield categories:
Mental Health
Mental health cases are among the most commonly encountered in the SCA. They demand excellent data gathering, safety assessment, and empathic communication — making them ideal for testing all three domains simultaneously.
- Depression — including PHQ-9 use, safety-netting, and medication counselling
- Anxiety disorders — GAD, panic disorder, health anxiety
- Stress and burnout — especially work-related
- Suicidal ideation and risk assessment — requires careful, structured exploration
- Postnatal depression and perinatal mental health
- Psychosis and first-episode presentations
- Substance use and dependency — alcohol, cannabis, opioids
Chronic Disease Management
Long-term conditions are bread and butter for UK GPs — and SCA cases frequently involve patients with established diagnoses requiring a management review, escalation, or complication discussion.
- Type 2 diabetes — HbA1c review, medication change, complication counselling
- Hypertension — initiation, titration, side-effect management
- Asthma and COPD — inhaler technique, exacerbation management, step-up therapy
- Heart failure and atrial fibrillation
- Hypothyroidism and hyperthyroidism
- Chronic kidney disease — safe prescribing, sick day rules
- Osteoporosis and fracture risk assessment
Acute and Urgent Presentations
The SCA will test your ability to recognise and safely manage acute problems — including time-critical decisions about escalation.
- Chest pain — ACS, pulmonary embolism, musculoskeletal, GORD
- Dyspnoea — acute asthma, COPD exacerbation, heart failure, PE
- Abdominal pain — across the full differential
- Headache — including red flag assessment (subarachnoid haemorrhage, meningitis, giant cell arteritis)
- Urinary tract infections — including upper tract and in special populations
- Back pain — with red flag recognition (cauda equina, malignancy, infection)
Women's Health and Sexual Health
- Contraception — including emergency contraception, IUD/IUS counselling
- Cervical screening — non-attendance, abnormal result discussion
- Menopause — HRT counselling, risks and benefits discussion
- Pelvic inflammatory disease and STI management
- Breast symptoms — including cancer concern counselling
- Pregnancy complications — ectopic, miscarriage, pre-eclampsia concerns
Paediatrics
- Febrile child — safety netting is paramount; NICE traffic light system
- Childhood asthma and wheeze
- ADHD and neurodevelopmental concerns
- Safeguarding and child protection — subtle presentations
- Vaccination concerns and hesitancy
Palliative Care and End of Life
These cases test your ability to have sensitive, honest, and structured conversations about prognosis, preferences, and dying.
- Breaking bad news — structured approach (e.g. SPIKES framework)
- DNACPR discussions
- Advance care planning and lasting power of attorney
- Symptom control in the dying patient
Ethical and Professional Dilemmas
These cases are unique to the SCA and require professional judgement alongside consultation skill. They often have no 'right' clinical answer — the examiner is looking for your reasoning process.
- Capacity and consent — including the Mental Capacity Act 2005
- Confidentiality dilemmas — third-party requests, Caldicott principles
- Fitness to drive — DVLA guidance, patient refusal to notify
- Domestic violence — safe enquiry, signposting
- Colleague concerns — GMC duties and professional responsibility
- Prescribing pressures — managing unreasonable patient requests
Musculoskeletal
- Knee, hip, shoulder, and lower back pain
- Gout — management and lifestyle counselling
- Rheumatoid arthritis — diagnosis, DMARD initiation, monitoring
- Fibromyalgia and chronic pain management
Dermatology and Minor Surgery
- Skin lesion assessment — including suspicious mole (2WW referral)
- Eczema and psoriasis management
- Acne — including discussion of retinoids and pregnancy prevention
Do not try to cram every topic. Focus your preparation on case types that require excellent consultation skills — mental health, chronic disease, ethical dilemmas, and breaking bad news. These are the cases where most marks are won or lost.
7. How to Prepare for the SCA
The SCA is a performance exam, not a knowledge exam — so preparation should follow a clear progression, from understanding the format through to full timed practice, rather than relying on reading alone. The steps below are a practical sequence to work through.
Step 1: Start with the Free Foundation Course
Before working through cases, it helps to have a solid grounding in what the SCA actually expects, how consultations are structured, and how examiners think. SimsBuddy's SCA foundation course is completely free and is a genuinely strong starting point, covering the exam format, the three marking domains, and the fundamentals of a well-structured consultation before you commit time to full case practice.
Do not skip this step even if you feel clinically confident. A clear foundation in what examiners are actually scoring makes every hour of case practice afterward more effective.
Step 2: Work Through the Case Bank
Once the basics are in place, build familiarity with real consultation scenarios. The SimsBuddy SCA case bank covers the full range of high-yield case types — mental health, chronic disease, acute presentations, ethical dilemmas, and breaking bad news — mapped against the RCGP curriculum. The goal at this stage is breadth: get comfortable with the shape and pacing of as many different case types as possible before moving into timed practice. SimsBuddy also offers free SCA revision notes, which are worth working through alongside the case bank to consolidate the clinical knowledge underpinning your consultations.
Step 3: Practise Out Loud, With a Colleague and with AI
Reading a case is not the same as performing it under pressure. Practising with a colleague, taking turns as candidate and role player, is genuinely valuable, and pairing that with the case bank and SimsBuddy's AI-powered patient technology gives you a second, always-available practice partner. Running consultations against the AI lets you rehearse as many times as needed, at any hour, without needing to coordinate a study partner's schedule — often the biggest practical barrier to getting enough repetition before exam day.
Alternate between AI practice and live peer practice where possible. AI practice builds repetition and confidence with the structure; a real colleague adds the unpredictability and natural conversational flow that mirrors an actual role player in the exam.
Step 4: Start Taking Mock Exams Under Time Pressure
Once individual cases feel familiar, move on to running full circuits under real exam conditions rather than practising cases in isolation. SimsBuddy's mock exam replicates the 3-minute reading window and 12-minute consultation format across a full circuit, so you get used to the specific pacing pressure of moving from case to case, which is very different from practising cases one at a time.
Many candidates who know the material well still struggle on exam day simply because they never rehearsed the cumulative pressure of 12 consultations in a single sitting. Full timed mock exams are what close that gap.
Step 5: Bring in an Individualised Tutor if You Need Extra Support
If you are still struggling with a specific domain — whether that is data gathering, clinical management, or relating to others — individualised feedback from an experienced tutor can help identify blind spots that are hard to see on your own. SimsBuddy's tutor directory connects candidates with independent tutors who have been vetted specifically for SCA preparation, so you can book targeted sessions around the areas where you need the most support.
Start with the free foundation course to understand what is actually being tested, build breadth with the case bank and free revision notes, add repetition through peer role-play and AI-powered patient practice, stress-test yourself with full timed mock exams, and bring in a vetted tutor if a specific domain still needs work. Followed in order, this sequence takes a candidate from first exposure to exam-ready without wasted effort.
8. Final Advice
The SCA is passable — and passable on the first attempt — with the right preparation. The candidates who struggle are almost always those who revise in isolation, read rather than practise, or underestimate the importance of genuine patient-centred consulting.
The candidates who pass comfortably are those who:
- Start practising early — ideally 4 to 6 months before the exam
- Practise live consultations regularly, with feedback from peers or tutors
- Use real surgeries as preparation — every patient encounter is an SCA case
- Know the three domains inside out and demonstrate all three in every case
- Safety-net specifically and consistently
- Read the RCGP marking descriptors and genuinely understand what 'good' looks like
- Review their own performance critically — video recordings if possible
The SCA is the final clinical milestone of your GP training. It deserves the same seriousness as your AKT, your WPBA, and your daily clinical practice. Approach it with structure, preparation, and confidence.
Good luck. You can do this.