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
The Simulated Consultation Assessment (SCA) is the clinical skills component of the MRCGP examination, run by the Royal College of General Practitioners (RCGP). It is the final clinical exam standing between you and your Certificate of Completion of Training (CCT) as a fully qualified GP in the UK.
The SCA replaced the Clinical Skills Assessment (CSA) — which was sat in person in London — and the interim Recorded Consultation Assessment (RCA), which was introduced during the COVID-19 pandemic. The current SCA format launched in November 2023 and combines the rigour of a structured clinical exam with the flexibility of a remote, online format.
What Is the SCA?
The SCA tests your ability to integrate and apply clinical knowledge, professional judgement, and communication skills in realistic simulated GP consultations. You are assessed not just on what you know, but on how you consult — how you gather information, form a diagnosis, manage complexity, and relate to the patient in front of you.
The standard you are being held to is that of a newly qualified GP. This is not a specialist exam. You are expected to demonstrate the safe, patient-centred, evidence-based consulting of a competent general practitioner on their first day as a principal.
Exam Format
- 12 clinical cases, each lasting 12 minutes
- Cases are drawn from the RCGP Clinical Experience Groups — the same areas tracked in your training portfolio
- Each case involves a trained role-player (actor) connecting with you via the Osler Online platform
- A remote examiner observes and marks the consultation in real time
- There is no physical examination component — this is assessed separately through Workplace Based Assessment (WPBA)
- There is no BNF access during the exam
- You sit the exam from a local GP surgery — in most cases, your own practice
This is one of the most significant differences from the old CSA: there is no travel to a central exam centre. You sit in a familiar clinical environment, on your own equipment, using the Osler platform.
The Three Marking Domains
Every case is marked across three domains. Understanding these is not optional — they define exactly what the examiner is assessing in every minute of your consultation.
| Domain | What It Tests | Key Behaviours |
|---|---|---|
| Data Gathering and Diagnosis | Systematic, focused information gathering and clinical reasoning | Open questions first, targeted narrowing, and — critically — verbalising your working diagnosis out loud. If the examiner doesn't hear it, they cannot award the mark. |
| Clinical Management and Medical Complexity | Safe, evidence-based management plans that reflect current guidelines and acknowledge complexity | Involving the patient in decisions, referencing NICE guidance where relevant, safety-netting clearly, and agreeing a follow-up plan |
| Relating to Others | Communication, empathy, shared decision-making, and patient-centred consulting | Acknowledging emotions, exploring ICE, responding without judgement, and building rapport from the first sentence to the last |
The Clinical Management and Medical Complexity domain carries slightly more weight overall, as it is linked to a greater number of assessed capabilities. However, domain weighting varies between individual cases. The RCGP advises candidates not to try to predict or game this — demonstrate all three domains in every case and you will not be caught out.
Each domain is graded on a four-point scale: Excellent (above the standard of a newly qualified GP), Pass (at the expected standard), Needs Further Development, or Unsatisfactory. These grades convert to a cumulative score that determines your overall result.
The pass mark is set using Borderline Regression — an established psychometric method that adjusts fairly based on the overall performance of all candidates in that diet. There is no fixed pass mark per case, and you do not need to pass a set number of individual cases. Your result is based on cumulative performance across all 12 cases.
The 12-Minute Structure — Time Management Is Everything
Twelve minutes sounds generous. In practice, the most common reason trainees underperform in the SCA is spending nine or ten minutes on history and leaving almost no time for management. The examiner cannot award Clinical Management marks for a plan you never reached.
The structure that works is straightforward:
- First 60 seconds: Open properly. Find out what the patient wants from today — this sets up your ICE exploration and starts building the Relating to Others domain from the very first moment.
- Minutes 1–6: Data gathering. Open questions first, then narrow down systematically. Explore ICE naturally during this phase. By the six-minute mark, verbalise your working diagnosis out loud — the examiner needs to hear your reasoning, not infer it.
- Minutes 6–12: Clinical management. Present options, involve the patient, reference relevant guidelines, safety-net specifically, and confirm a clear follow-up plan.
- Final 30 seconds: Close well. Check understanding, address any remaining concerns, and summarise the agreed plan.
Relating to Others is not a phase — it is a thread that runs through the entire twelve minutes. Empathy, active listening, and shared decision-making must be present throughout, not saved for one moment at the end.
Exam Diets and Dates
The RCGP runs nine SCA diets per year, spread across the year. Each diet typically runs over three to four examination days. You are allocated to either a morning or afternoon session — you cannot choose your specific day or time. Your allocation is confirmed approximately four weeks before the exam.
Diet dates are published on a rolling basis and are subject to change. The only reliable source for confirmed, up-to-date SCA diet dates is the RCGP's MyRCGP portal — log in, select "My Exams," and check the current schedule there. Do not rely on third-party websites for specific dates, as these are not always accurate or updated promptly.
If a diet you want is full, you can join the RCGP's official SCA waiting list via the waiting list form on the RCGP website.
Eligibility
- You must be in ST3 (or beyond) to sit the SCA
- Your MRCGP membership must be active — resigned, lapsed, or suspended membership will prevent booking
- Your training records must be current and accurate — gaps in your portfolio will block the booking process
- Most trainees sit the SCA after passing the AKT, though this is not a formal requirement
- You can reserve a place up to 12 months in advance
How to Book
Since December 2025, all SCA bookings are made exclusively through the MyRCGP portal. FourteenFish is no longer used for exam reservations.
- Check eligibility. Confirm your training year, MRCGP membership, and portfolio records are all in order before attempting to book.
- Reserve your place. Log into MyRCGP and select "My Exams." Reserve a diet up to 12 months in advance. A real-time availability indicator shows whether spaces are good, limited, last few, or full.
- Receive your booking link. Seven weeks before the exam, the RCGP emails you a unique booking link. At this point you confirm your booking and complete payment.
- Receive your allocation. Four weeks before the exam, you are informed of your specific day and session (morning or afternoon). This cannot be changed except in genuinely exceptional circumstances, and any requests must be submitted before the allocation date.
- Complete the platform walkthrough. Approximately two weeks before the exam, you receive login details for the Osler Online platform and must complete a mandatory device check and rules video — this is a requirement, not optional.
Costs and Staged Payments
The SCA examination fee is £1,207 per attempt, as confirmed by the RCGP from August 2025 onwards. The fee applies equally to first attempts and re-sits — there is no discount for repeat candidates.
From 1 April 2026, staged payments are compulsory for all SCA bookings. The structure is:
- Payment 1 (~£302): 25% of the fee, due six months before the exam — or at the point of booking if you are within six months of the exam date
- Payment 2 (~£302): A further 25%, due twelve weeks before the exam
- Payment 3 (~£603): The remaining 50%, due at the point of final booking confirmation, seven weeks before the exam
The first two payments are refundable if you cancel before the final booking deadline, giving you flexibility to reserve a place without committing the full fee immediately.
The SCA fee cannot be claimed from your NHS study budget. However, tax paid on examination fees is reclaimable through your annual HMRC self-assessment tax return — contact HMRC or a tax adviser for guidance specific to your circumstances.
Results
Results are released approximately five weeks after the exam diet, at 17:00 on the published results date, via your MyRCGP portal. Your results include:
- An overall pass or fail outcome
- Feedback statements for each of the three domains across all 12 of your cases
- The RCGP's published educational notes for each feedback statement, explaining what the markers were looking for and how to improve
Results can occasionally be delayed — if this happens, the RCGP publishes an update on their website.
Attempts
The number of permitted attempts depends on when you entered GP Specialty Training:
- Entered training before 2 August 2023: maximum of 4 attempts
- Entered training on or after 2 August 2023: maximum of 6 attempts
An exceptional fifth attempt policy exists for candidates who entered before August 2023 and can demonstrate additional educational attainment. Full details and the application form are available on the RCGP website.
Pass Rate
Since launching in November 2023, the SCA pass rate has been approximately 67% — lower than both the RCA (around 75%) and the previous CSA (around 79%). The most common reasons for failure are not poor clinical knowledge, but poor time management, insufficient coverage of the clinical management phase, and consultation styles that do not reflect UK patient-centred standards.