Correspondence with RCGP

Emails between myself and the RCGP, to date:

From: ronald@rmacd.com
Sent: 09/06/2025 11:23
To: info@rcgp.org.uk

Good morning,

I am informed by my deanery that it is mandatory for all GPSTs to have membership of the RCGP.

However, I cannot find this information on your website. My understanding was that this is in fact optional (though very much recommended).

Can you please point me in the direction of the policies pertaining to membership of RCGP while a GPST?

I fully intend on meeting the requirements as set out my the training programme but am not in a position to afford membership of the college.

Many thanks.

RM

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From: membership@rcgp.org.uk
Sent: 18/06/2025 08:46
To: ronald@rmacd.com

Good Morning Ronald,

Thank you for getting in touch.

Can you please confirm are you looking to start GP training in the UK soon.

Further details on GP Registrar’s can be found on our website.

We look forward to hearing back from you.

Kind regards,
[redacted]

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From: ronald@rmacd.com
Sent: 18/06/2025 11:19
To: membership@rcgp.org.uk

Good morning,

Yes I am starting in August.

Are you able to confirm whether membership is mandatory, or if this is only so that I have access to your portfolio platform? (Which is effectively making membership mandatory)

Best wishes,
Dr R MacDonald

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From: membership@rcgp.org.uk
Sent: 18/06/2025 14:31
To: ronald@rmacd.com

Good afternoon Ronald,

Thank you for coming back to us.

Membership with the College is not mandatory. However, you will need access to the TP via the RCGP, to complete your training, receive support and for us to recommend you to the GMC on completion of your training.

There are two options available for gaining access:

Option 1: RCGP Membership - Become an GP registrar member

Having membership with the College means you have access to our journals, GP self test, discounts on exam preparation events, faculty support, online learning resources and so much more.To become an GP registrar member you will need to pay an initial registration fee of £291 and then a membership fee in April each year from April 2026. Your fee is based on your training pathway (for more information visit membership fees). You can also claim your tax back (up to 40%) from HMRC to reduce your membership fee even further.

Option 2: Portfolio access - Pay a one off fee to cover 3 years access

For TP access only there is a one off fee of £935, which gives you 3 years of access. This fee is broken down into an admin fee for the account creation, maintenance and storage of your information, plus support and guidance from the GP Specialist Applications team (they recommend you to the GMC for certification and provide support along the way with any issues, including those with your deanery) and TP access for the 3 years.

This fee is not tax deductible as the government guidelines only allows you to claim back professional membership fees and this is not a membership. Furthermore, if you do need to extend training after the 3 years there will be an additional cost.

Overall, becoming an GP registrar with the College is financially and developmentally more beneficial and of course you can claim back part of the subscription fee on tax. You can also pay the initial registration fee in monthly installment from now until 31 March 2025 to help you spread the cost.

Please do let us which option you would like to proceed with.

Do let me know if you have any questions or I can be of further assistance.

Kind regards,
[redacted]

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From: ronald@rmacd.com
Sent: 18/06/2025 14:36
To: membership@rcgp.org.uk

Good afternoon [redacted],

I am looking through the requirements on your website and it would seem that I would be able to still meet the requirements of the programme without access to TP, as long as the TP enables me to record the same information as the official portfolio.

In other words, as long as the portfolio meets your requirements, I do not necessarily have to use the portfolio platform which has been set up by the RCGP.

Are you able to please confirm whether my understanding of this is correct?

Many thanks,
Ron.

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From: membership@rcgp.org.uk
Sent: 18/06/2025 14:55
To: ronald@rmacd.com

Good afternoon Ronald,

Thank you for coming back to us.

As a GP Trainee in the UK you do require access to your training portfolio through FourteenFish, this is mandatory. Please accept my apologies if there is anything on our website which is not confirming this for you.

The training platform is continually used by GP trainees and their supervisors throughout their training period.

Further details on our GP Registrar’s can be found on our website.

Do let me know if you have any questions or I can be of further assistance.

Kind regards,
[redacted]

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From: ronald@rmacd.com
Sent: 18/06/2025 17:42
To: membership@rcgp.org.uk

Thanks [redacted] but I think it’s still a little unclear:

Assuming I have access to an alternative platform which provides precisely the same functionality as FourteenFish but at reduced cost, is it the position of the RCGP that this platform cannot be used? That, in effect, the RCGP forces its trainees to use FourteenFish, even where an alternative platform is able to provide the same functionality?

Many thanks,
Ron.

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From: ronald@rmacd.com
Sent: 30/06/2025 19:05
To: membership@rcgp.org.uk

Good evening,

Are you able to please get back to me on the below?

Best wishes,
Ron.

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From: membership@rcgp.org.uk
Sent: 01/07/2025 11:15
To: ronald@rmacd.com

Good Morning Ronald,

Thank you for coming back to us.

Just to confirm when you are a GP trainee in the UK the training portfolio is required as part of your training. The options I provided to you on one of my previous emails is what we offer to get the access for FourteenFish.

Do let me know if you have any questions or I can be of further assistance.

Kind regards,
[redacted]

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From: ronald@rmacd.com
Sent: 01/07/2025 11:22
To: membership@rcgp.org.uk

Thanks [redacted],

I think we’re at cross-purposes here: I recognise that a training portfolio is part of the requirements and am certainly not disputing this.

However, I am asking whether the RCGP is forcing doctors in training to use FourteenFish specifically (which is only accessible by paying at least £800-900/year to the College), or whether another platform – which meets all the same technical requirements and does precisely the same thing as FourteenFish, but at a fraction of the cost – can be used.

Please let me know if this needs further clarification. I look forward to your reply.

Many thanks,
[redacted]

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From: membership@rcgp.org.uk
Sent: 03/07/2025 08:32
To: ronald@rmacd.com

Good Morning Ronald

Thank you for coming back to us.

I have escalated your query onto our portfolio team, however can you please provide the name of the weblink and the platform you are referring to.

We look forward to hearing back from you.

Kind regards,
[redacted]

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From: ronald@rmacd.com
Sent: 03/07/2025 08:44
To: membership@rcgp.org.uk

Hi [redacted],

I’m writing my own portfolio platform (OpenCPD) which will meet all of the necessary requirements; it’ll be published on OpenCPD.uk within the next couple of weeks.

Best wishes,
Ron.

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From: membership@rcgp.org.uk
Sent: 03/07/2025 15:56
To: ronald@rmacd.com

Good afternoon Ronald,

Thank you for coming back to us.

After escalating your query to our portfolio team they have advised unfortunately you are unable to use your own training platform. FourteenFish is the required platform to be used as a GP trainee given the integrations to other systems and roles.

Hope this clarifies your query.

Do let me know if you have any questions or I can be of further assistance.

Kind regards,
[redacted]

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From: ronald@rmacd.com
Sent: 03/07/2025 16:40
To: membership@rcgp.org.uk

Thanks [redacted],

Are you able to please put me in touch directly with those responsible for this decision.

Best wishes,
Ron.

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From: ronald@rmacd.com
Sent: 04/07/2025 15:13
To: membership@rcgp.org.uk

Hi [redacted],

Further to below, are you able to advise whether this has been forwarded to those on the Portfolio Team, as I would like to follow up with them as to next steps.

I have also been in touch with my deanery about this as I would like some transparency on the matter; I do not think it is appropriate or justifiable to expect trainees to pay a large sum of money for access to a system that is required as part of their professional training.

Best wishes,
Ron.

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From: membership@rcgp.org.uk
Sent: 07/07/2025 08:27
To: ronald@rmacd.com

Good Morning Ronald,

Thank you for coming back to us.

I did escalate your query to our training portfolio team at RCGP who advised you are unable to use your own training platform, however if you want further clarification on this please email them on: tp@rcgp.org.uk.

Do let me know if you have any questions or I can be of further assistance.

Kind regards,
[redacted]

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From: ronald@rmacd.com
Sent: 09/07/2025 17:18
To: tp@rcgp.org.uk

Good afternoon,

I have been advised to get in touch with you regarding trainee portfolios for GPST.

Are you able to please address the queries below?

Please can you also point me in the direction of the list of requirements for the portfolio for GPST so that I can be sure these are all met despite not using 14Fish.

Best wishes,
Dr R MacDonald

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From: ronald@rmacd.com
Sent: 12/07/2025 19:24
To: tp@rcgp.org.uk

Good afternoon,

I am still waiting for a reply to below.

RM

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From: tp@rcgp.org.uk
Sent: 16/07/2025 13:03
To: ronald@rmacd.com

Dear Dr MacDonald,

Thanks for your email.

I can confirm that FourteenFish is the only platform currently approved by RCGP for use in GP training. This is due to its integration with other systems and roles involved in the training process.

Kind Regards,
[redacted]

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From: ronald@rmacd.com
Sent: 16/07/2025 15:32
To: tp@rcgp.org.uk

Hi [redacted],

I don’t think it’s reasonable for a mandatory training platform to cost trainees a minimum of £900+. If the RCGP insists on using FourteenFish exclusively, then access should be provided free of charge.

Saying it’s down to “integration” doesn’t justify locking trainees into a single, paid provider. Integration can be built into any system if you allow competition. Right now, every GP trainee is expected to pay this fee just to progress. With around 3,500 new trainees each year, that’s at least £3m/year going to the RCGP and UnitedHealth (owners of FourteenFish), through a closed and compulsory setup.

This isn’t right. It places an unfair financial burden on trainees and offers no transparency around procurement, tendering, or whether alternatives were even considered. It appears blatantly anti-competitive and raises serious questions about how this arrangement came to be.

Can you let me know who within the RCGP I should raise this with?

Best wishes,
Ron.

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From: tp@rcgp.org.uk
Sent: 16/07/2025 16:00
To: ronald@rmacd.com

Dear Dr MacDonald,

Thank you for your email.

If you wish to raise your concerns formally, you can do so via the RCGP complaints and feedback process. The College operates a two-stage approach:

• Stage 1 – Concern: An opportunity to raise issues informally. This can be submitted via our online form found here: https://www.rcgp.org.uk/contact-us.

• Stage 2 – Formal complaint: If your concern isn’t resolved to your satisfaction, you may escalate it as a formal complaint using the same route. You’ll receive an acknowledgement within 3 working days and a full response within 20 working days.

Kind regards,
[redacted]

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From: ronald@rmacd.com
Sent: 17/07/2025 17:40
To: [stage one complaints: online form]

Full details of concern

I am raising a concern about the RCGP’s policy requiring all GP trainees to use the FourteenFish platform. This is not presented transparently but is, in effect, compulsory. Trainees are required to pay £963 for access over the course of training, with no alternative permitted.

Despite early responses from the membership team suggesting that College membership is optional, it has since been confirmed that FourteenFish is mandatory and that no other portfolio system may be used, even if it meets all training requirements.

This creates a closed arrangement where trainees are forced to pay nearly £1,000 to a single commercial provider (owned by UnitedHealth) simply to complete their training. There is no transparency about how this provider was selected, whether a fair procurement process took place, or whether alternatives were considered. The justification given – that FourteenFish is integrated with other systems – is not a valid reason to block all competition. Any suitable platform could integrate if given access.

This policy places an unjust financial burden on trainees, offers no meaningful choice, and appears anti-competitive. It raises serious concerns about fairness, transparency, and governance.

How can we help resolve the issue?

I would like a clear explanation of:

1. Why FourteenFish is the only platform permitted

2. Whether a competitive tender or open procurement process took place

3. Whether alternative platforms have ever been considered

4. What the process is for reviewing this arrangement in future

I believe trainees should be permitted to use alternative portfolio systems, provided these meet the same educational and technical standards. The current arrangement should be reviewed in the interests of fairness, transparency, and cost to trainees.

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From: membership@rcgp.org.uk
Sent: 11/08/2025 14:26
To: ronald@rmacd.com

Good afternoon Ronald,

Thank you for sharing your concerns about the mandatory use of FourteenFish for GP trainees. We appreciate your feedback and understand the importance of transparency, choice, and value for money in your training experience, and we aim to address each of your points below.

Why FourteenFish Is the Only Platform Permitted

We’ve standardised on FourteenFish to ensure a secure, consistent, and integrated portfolio system across all UK training regions. Integrates seamlessly with deanery records, ARCP panels, and educational supervisors’ dashboards. This helps reduce administrative errors and ensures compliance with GMC requirements.

Procurement and Tender Process

FourteenFish was selected through a competitive and transparent procurement process in 2019, evaluated against strict technical, financial, and governance criteria, with input from trainees and educators. Key steps included:

• Publication of a Request for Proposal (RFP) in accordance with public sector procurement regulations

• Evaluation of bids from all interested vendors against pre-defined technical, financial, and governance criteria

• Shortlisting and product demonstrations by the top vendors, with input from trainees, educators, and IT specialists

We previously hosted the training portfolio system internally. However, as trainee numbers grew and expectations for a seamless, high-quality experience increased, we made the decision to move to an external provider. This allowed us to offer a more robust, scalable, and user-friendly platform that better supports trainees and educators across the UK.

Consideration of Alternative Platforms

We reviewed several options during the tender phase. While many had strengths, none met all the integration and governance standards required. Each was assessed against functionality, technical capability, total cost and vendor track record in healthcare education.

Acquisition by United Health

We’re aware of the acquisitions involving FourteenFish. Due diligence was carried out, and we’ve received assurances that data protection standards remain high, with no changes to operations or data sharing outside the EU.

Future Review and Governance

We recognise the importance of periodic reassessment to ensure fairness, cost-effectiveness, and innovation. We regularly monitor the performance of our commercial provider, not just in providing a solution to our members, but also in providing a solution for other colleges. We also discuss and keep up to date on the full range of providers used across the sector.

GP Registrars membership:

While RCGP membership isn’t mandatory, use of FourteenFish is. Non-members pay a portfolio-only fee, which covers broader training support—not just the platform. We regularly review these fees to ensure fairness and value. We constantly keep the fees we charge all registrars under review to ensure they are as low as possible and provide value for money.

The GP registrar membership fee also includes:

• Access to GP SelfTest is the RCGP’s feature packed learning needs assessment tool for GPs at all career stages
• One Day Essentials conferences: One Day Essentials are full-day online clinical conferences – broadcast live – developed and delivered by leading experts in the field.
• InnovAiT journal: Designed to support GP registrars and early-stage career GPs, each issue contains articles and educational scenarios on clinical diagnosis and management, MRCGP preparation, and features covering the whole of the RCGP curriculum.
• Support from the GP registrar community group
• Access to local and national courses and events: We provide a wide range of high-quality online events to support our members’ continuing professional development.
• And so much more

We hope we have addressed all of your questions. If you require any further information please do not hesitate to reach out.

Kind regards,
[redacted]

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From: ronald@rmacd.com
Sent: 11/08/2025 14:26
To: membership@rcgp.org.uk
CC: president@rcgp.org.uk; wes.streeting.mp@parliament.uk; [redacted]

Dear RCGP,

I am escalating my Stage 1 concern to a Stage 2 formal complaint regarding the RCGP’s decision to mandate use of UnitedHealth’s “FourteenFish” platform for all GP trainees across the UK, at significant personal cost and with no alternative option. This arrangement creates a monopoly, locks trainees into repeated fee increases, and forces every GP trainee to use a platform owned by a foreign corporation with a long record of fines, lawsuits and regulatory action for conduct harmful to patients, healthcare providers and fair competition.

The Stage 1 reply asserts that the RCGP “understands the importance of transparency, choice, and value for money” yet provides no substantive evidence of these principles being met.

1. Lack of transparency in procurement

• The RCGP states UnitedHealth’s “FourteenFish” platform was selected via “competitive and transparent procurement” in 2019, evaluated against “strict technical, financial, and governance criteria.”
• No evidence of these criteria has been provided. I request a copy in full.
• No copy of the 2019 Request for Proposal (RFP) has been provided. I request this.
• The RCGP refers to input from trainees and educators during shortlisting and demonstrations. I request a written summary of that input and how it influenced the decision.

2. Lack of choice for trainees

• UnitedHealth’s “FourteenFish” platform is the only platform permitted. This is a monopoly arrangement imposed on trainees.
• There is no opt-out or alternative mechanism to meet GMC training requirements without paying for FourteenFish access.

3. Value for money

• Current costs approach £1,000 over the course of training, with increases again this year.
• No cost-benefit analysis, benchmarking, or justification for fee rises has been provided.
• The “portfolio-only” fee for non-members is said to cover “broader training support” without itemisation.

I have also referred this matter to the Competition and Markets Authority, as I believe the RCGP’s conduct meets the CMA’s criteria for investigation into anti-competitive behaviour. Specifically:

• Abuse of a dominant position: mandating a single supplier and preventing access to any alternative eliminates competition in the market for GP training platforms.
• Restriction of competition: the contractual arrangement forecloses the market to other platforms, preventing innovation and price competition.
• Detriment to consumers: GP trainees are a captive audience, facing repeated price increases and no ability to switch to other platforms.

These concerns are magnified by the fact that UnitedHealth has a documented record of conduct that mirrors the very behaviours the CMA exists to challenge, including where they were:

• Found by a Nevada jury to have acted with oppression, fraud and malice against a healthcare provider network, resulting in punitive damages of c. £44 million.^{1 2}
• Accused in US federal investigations of inflating patient diagnoses to overbill the public Medicare programme by c. £6.4 billion in a single year, now subject to criminal and civil proceedings.³
• Revealed to have secretly paid US nursing homes to block transfers of critically ill residents to hospital and pressured staff to obtain “do not resuscitate” orders.⁴
• Required to settle for c. £259 million after allegations of manipulating reimbursement databases to underpay medical claims.⁵
• Fined c. £128 million in California for 900,000 breaches of state insurance law.⁶
• Forced to dismiss its former CEO over stock-option backdating, where he was forced to subsequently repay c. £346 million and received a ten-year ban from corporate office.^{7 8 9}

That the RCGP is content to embed this corporation into the very infrastructure of UK GP training is extraordinary. The College should be holding itself to the highest standards in its choice of commercial partners, not tying every GP trainee’s progress to a platform controlled by an organisation with such a sustained record of grave misconduct.

In doing so, the RCGP risks bringing itself into disrepute and is signalling that ethical considerations are secondary to administrative convenience. By compelling every GP trainee in the UK to transact through a UnitedHealth-controlled platform, the RCGP is mandating participation in a monopoly market that directly benefits a morally bankrupt behemoth whose track record reads like a checklist of CMA enforcement priorities.

Next steps

If the RCGP insists on this particular portfolio platform being mandatory, it must be provided free of charge to trainees. This could be funded from existing RCGP resources (RCGP total income for the year ending March 2024, per annual returns to the Charity Commission: £51.4m) [sic; is in fact £51.5m] or negotiated within the contract with the provider. Anything less leaves the monopoly intact and continues to impose an unjustifiable financial burden on trainees.

While the above is the primary outcome sought, in the interests of transparency, I also request:

• The full “strict technical, financial, and governance criteria” used in the 2019 tender.
• A copy of the 2019 RFP.
• A written summary of trainee and educator input during the tender process.
• A breakdown of the portfolio-only fee for non-members.
• Details of formal review processes, including the date of the next competitive market test.

I have previously corresponded with the Secretary of State for Health on this matter and am therefore copying him, along with the President of the Academy of Medical Royal Colleges and members of the GP Training Deanery in Scotland.

I look forward to the RCGP’s formal Stage 2 response within 20 working days.

Yours sincerely,
Dr Ronald MacDonald
GMC 7998867

Further updates will be added here in due course.