Test of Competence

Around 75% of the people who take the test of competence (TOC) are successful. Candidates who have taken the test have told us that it is challenging. It takes a significant amount of time to collate the required documentation and prepare for the interview.

We encourage you to read this document, which gives some insight into the TOC process from individuals that have experienced it first-hand.

We therefore encourage applicants to apply as soon as possible to allow us enough time to check the completeness of applications and to gain a place at the next available test of competence interview date.

Visit our ‘support for applicants’ section in the page below for useful information and resources that will help you to pass the test of competence.

The TOC process is based on ensuring that you know and understand the Code. By demonstrating your understanding of the standards outlined in the Code, we can be sure that you meet the requirements to be able to practise safely in the UK.

Applying for the test of competence

1. Applications for the TOC are accepted on a first come first served basis as we only have a limited amount of spaces available for each interview. You are encouraged to send us your application as soon as possible to increase your chances of being accepted on your chosen date. All spaces may be filled before the closing date 

2. Please read all the information carefully before you complete and submit your application

3. Please do not send us a paper copy of any documents. Send all of the documents listed below by email only to [email protected]. Please email them to us all at the same time, failing to do so will result in your application taking longer to process and, as a consequence, you may miss your first choice interview date

4. If any of your documents are not in English, you must enclose a certified translation of the document with the original. For the purposes of registration, certified translations can only be provided by translators who are members of the Institute of Translation & Interpreting, consular officials or similar

5. Submit all the documents and payment from points numbered 1-9 below. 

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Information required to apply for the TOC

1. Transcript from the educational institution which awarded your chiropractic qualification

The transcript must give details of how it meets the registration requirements and include:

• your full name
• your chiropractic qualification
• the date you achieved your qualification
• a list of course codes and names
• the total number of study hours (this is not the grades or points), this can include clinic hours and nominal hours allocated for self-directed learning. If this does not appear on the transcript, you will need to provide an additional letter from the college giving the total course hours. We cannot accept course or module descriptions with the study hours, we need confirmation that you have actually done the study hours. 

Please refer to our rules on the qualification requirements for overseas applicants here.

If the hours you have completed are below the requirement as set out in the above guidance document you may still be able to apply, however, in such circumstances we will review each application on a case by case basis.

2. Test of competence - syllabus mapping form 

You must complete a form that maps the outcome of the modules/ courses you took as part of your chiropractic degree course against the General Chiropractic Councils education standards.

A learning outcome is the standard that you would have had to achieve for each module before passing it. This will help you to identify any potential differences between what is required for all chiropractors in the UK and the requirements of chiropractors in the country in which you studied and/or practised. This should be available from the educational institution which awarded your chiropractic degree.  

We have produced an example mapping document here, which we hope will help you complete your own. 

3. Confirmed module learning outcomes

Send us a copy of the list of module/course learning outcomes relating to the chiropractic course you studied and that you used for filling out your syllabus mapping form above. This could be a course guide or handbook. If you do not have this, you should be able to obtain this information from your educational institution for the specific years that you studied. 

4. The evidence of practice questionnaire

The evidence of practice questionnaire provides us with evidence of how you meet the standards in the Code. The questionnaire forms a key part of your application and will be assessed by the Test of Competence Assessment Panel.

The evidence of practice questionnaire includes the following sections:

• Section 1: Profile of your caseload
• Section 2: A neuromusculoskeletal case presentation    
• Section 3: A case presentation in which the patient was considered unsuitable for chiropractic treatment/ was referred to another healthcare practitioner
• Section 4: A case presentation in which you concluded that certain techniques were unsuitable (contra-indicated)
• Section 5: Definition of Acronyms and Abbreviations if used
• Section 6: Application of patient management through the completion of a table showing the different forms of assessment and care you use
• Section 7: Learning undertaken in the last three years.

As well as documenting your past or current practice, the replies that you give in your evidence of practice questionnaire should also outline how you intend to ensure compliance with the Code in similar circumstances. You should give enough detail to reassure the panel that you understand the actions you took, can reflect on why you took these particular courses of action and any issues that may have arisen.

5. Anonymised patient records

To support your answers to sections 2, 3 and 4 of the evidence of practice questionnaire you must email anonymised patient records. Patient records are a compulsory part of your supporting evidence and you will not able to attend the TOC interview without it. 

Please remember that when submitting your records:

• Each patient record must be submitted as one document rather than single, individual pages. Patient records not collated will be rejected. 
• You must clearly label each record to show the section of the evidence of practice questionnaire to which it refers. 
• Please ensure all references relating to patient names, date of birth, addresses, your name and licence number are all redacted (removed).

If you are an educationalist not treating patients we will accept the clinical cases of chiropractic students you have supervised rather than those you have assessed or cared for directly. In this case you must make sure your role and the actions you took in relation to the patient are made clear.

If you are a recent graduate we will accept patient notes taken as part of your supervised practical sessions within your course. 

We recommend that you obtain real anonymised patient records where possible. We will accept patient records taken while observing or shadowing chiropractic care. You may create patient records based on real cases only if you have exhausted all other options of obtaining real records; however, please ensure that you make explicit on your application that you have not provided real patient records and also be aware that you will be subject to a longer, more intensive, interview to ensure that you meet the standards. 

The General Chiropractic Council provides information for overseas educational institutions and employers who may hold responsibility for the patient records that you wish to submit.

The General Chiropractic Council stipulates that patient confidentiality must be protected by anonymising patient records. Applicants must therefore ensure that all personal data within the records are redacted or deleted before being submitted to us. All anonymised records are used for the sole purpose of the test of competence. The General Chiropractic Council does not use these records for any other purpose, nor are they shared with third parties. 

6. CV/Resume

You must provide an up-to-date copy of your CV/resume that includes all of your work history, especially related to chiropractic.

7. Passport copy

Send us a copy of the pages from your passport that has your photo and personal details.

8. Diversity monitoring form

Please fill in the diversity monitoring form [link to attachment - here] and send this along with the rest of your application.

9. Pay the test fee of £2,000

It is a requirement of the TOC interview that the fee of £2,000 is paid before your place is confirmed. It is not possible to pay the fee after the interview or by instalments. Fees are reviewed annually and subject to change.

You can pay by card or electronic bank transfer.

If you make an electronic payment to us direct from your bank, please include your surname and reference ‘TOC’ so that we can easily trace your payment.

If you are paying by card, please complete the card payment form and return to us

We will take the fee once a place on the TOC interview has been confirmed. Please note we will not notify you beforehand. If you do not give us your credit card details, you will receive a request for payment once we have confirmed your interview date. Please do not attempt to make any payments before we have confirmed your place on the TOC.

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After we have received your information

Once we have received all of your paperwork by email, we will check it to ensure it is correct and fully complete. If there are any missing parts, or if the information required has not been fully provided we will let you know. Please note that in the case that we have not received all the required information, your application will be delayed.

Withdrawal and refunds

You should only apply for the TOC if you are confident that you will be prepared in time and you will be able to attend an interview day.

If you withdraw your application for the TOC after your place has been confirmed anytime up to 1 day before the closing date, we will refund 50% of your fee.

If you withdraw your application on or after the closing date, no part of your fee will be refunded unless we agree that you have an exceptional mitigating circumstance, in which case a full refund will be given.

After you have sent us the evidence of practice questionnaire and supporting documentation, the next step is for you to attend a TOC assessment interview. The interview panel will comprise of three chiropractors.

We will send you information on the date, time and location of your interview after the closing date for applications has passed and once we have received all of the information that we require. The interview will take place at the General Chiropractic Council office in London.

Previous candidates who have taken the TOC have commented that while the assessors on the panel are friendly and supportive, the interview is challenging and that, to be successful, you are going to need to spend a significant amount of time preparing for the interview. You can read about some of their experiences here.

We strongly recommend that you read what previous candidates say to get an idea of how best to prepare and stand the greatest chance of success.

It is also worth noting that while we use a standardised criteria for the interviews, half of the questions that you will be asked will be specific to the answers that you give in your evidence of practice questionnaire.  

What does the interview cover?

The interview will:

• Explore the information contained in your evidence of practice questionnaire: you must be able to explain and/or justify the evidence of how you have practised in the past (while practising in another country or in a student clinic) that you have presented in your questionnaire.

• Investigate how you would address an ethical dilemma: you will be asked a series of questions based on a hypothetical situation presented to you by the assessment panel. These questions will assess how you prioritise patient wellbeing, handle your professional responsibilities, deal with conflicts of interest, work within professional boundaries, understand and uphold patient consent and confidentiality, as well as fulfil the duty of candour.

• Assess your awareness of the  differences between how chiropractic is practised in the UK and elsewhere: we have analysed the main differences between our criteria and other regulatory authorities, so expect to be asked about issues such as:
  • The involvement of patients and carers as partners in the care process and providing feedback on their care and its outcomes, as well as patient involvement in education – in the teaching, learning and assessment of students as well as in programme evaluation
  • The use of research evidence in influencing practice
  • Applying continuous quality improvement in practice
  • Identifying and understanding the implications of the provision of chiropractic care for a patient on clinically relevant medications, whether prescribed or bought
  • Evaluating the chiropractic care given and modifying the care plan as a result, including ceasing care
  • The role of chiropractors in the healthcare system in the UK and their relationship with other healthcare professionals
  • The nature of professional accountability and ethics in the UK context and the duty to protect and promote the interests of patients, including professional boundaries, raising concerns about others and the various GCC requirements (e.g. the professional indemnity insurance rules) 
  • UK legislation including: the Equality Act 2010, the Data Protection Act 1998, the Children Act 2004, Mental Capacity Act, Health and Safety at Work Act 1974, Ionising Radiation (Medical Exposure) Regulations 2018 (IR(ME)R18) and Ionising Radiation Regulations 2017 (IRR17), Safeguarding regulations
  • The use of wellness care and how this relates to the need to evaluate and review plans of care.

At the Interview

Your interview will take place at the General Chiropractic Council’s office in London. Ensure that you arrive in plenty of time as if you are late you will not be able to sit the interview and will forfeit the fee. We ask that you arrive 15 minutes prior to the start of your interview.

We do not allow friends or family to wait for you at our reception.

When you arrive, you will be greeted by a General Chiropractic Council staff member, who will check the documents you have been asked to bring and explain what will happen during the test.

Next you will be interviewed - for around 90 minutes - by a panel of three TOC assessors.

We are not able to give you a result on the day as the assessment panel only agrees a recommendation to be made to the Registrar. It may take up to 10 working days for the Registrar's decision.

You should expect to be with us for no longer than three hours.

What must I bring with me?

1. Identification: we will check your identity before your interview. The following are the only forms of identification we will accept:

• your passport
• your UK Immigration and Nationality Department identification document
• your Home Office travel document
• your UK driving licence
• your EU identity card

Whichever you choose, it must be original, current and include a recent photograph of you.

If the name on your identification document is different from that on the confirmation you receive from us offering you an interview, you must provide original evidence that you are the person named in the letter. We will accept:

• your marriage certificate
• a declaration from the awarding body which granted your primary medical  qualification, stating that both names relate to you

If you do not bring one of the documents listed above, or if the document does not include your photograph, you will not be allowed to sit the interview.

We will return your identification document to you after your interview as we need to take a photocopy for our records. We will also require you to complete a feedback form before you leave.

2. A copy of your evidence of practice questionnaire and patient records: This is because you may need to refer to them when answering the interview questions.  

What if I am absent or sick on the day of the interview?

If you are unable to attend the interview because of serious illness or another overwhelming problem, we will make a full refund of your fee.

However, for us to refund your fee, you must tell us as soon as possible, and provide the following evidence to us:

• illness - a medical certificate or a letter on appropriate headed paper covering the day of your interview
• death or serious injury of a family member - a death or medical certificate as appropriate
• immigration difficulties such as refusal of your visa - a document from the UK Border Agency
• any other difficulty you could have not foreseen - a letter from an appropriate person (such as an employer, for example)

What if something outside of my control has put me at a disadvantage?

You will need to apply for an exceptional mitigating circumstance. To do this you will need to read our policy and complete the form included.

What if I have a disability?

If you have a disability within the scope of the Equality Act 2010, we may be able to make reasonable adjustments to the interview. We may be able to make adjustments to the arrangements if, for example, you have dyslexia, or a visual or motor impairment. Please read our reasonable adjustments policy.

You will be informed in writing of the outcome of your TOC application within 10 working days of your interview.

The outcome will be one of the following:

• Pass - this means you have supplied sufficient evidence to be eligible for registration
• Further evidence required - there is insufficient evidence in a number of specific area(s) to pass, but you may submit further evidence in relation to those specific area(s) which, if sufficient, will allow registration to be granted
• Fail - this means there is insufficient evidence in the majority of areas and you will need to make a new application and resit the whole TOC again.

The GCC does not enter into correspondence on outcomes of the test of competence, but does provide feedback to candidates on those aspects of the Code not demonstrated.

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Deadline for submitting further evidence

If the result of your TOC is 'further evidence required' you will be asked to provide the further evidence within 6 months of sitting the TOC interview. We will send you information on the areas that you need to address.

Despite this deadline, we have found that applicants who supply this evidence within 3 months of the TOC interview have a much better chance of passing than those who take longer.

Application for registration

After passing the TOC and before we grant you registration, you will need to make sure that your application for registration is complete. Our registrations team will normally get in touch with you once they have received notification of your pass.

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Test of competence complaint procedure

We have a complaints procedure in place where a test of competence (TOC) candidate has concerns that processes, either for the TOC or the TOC administration, have not been fully followed. These are set out below.

Stage 1: If you have a complaint about the test of competence, in the first instance, you should put your complaint in writing, addressed to:

Registrations Manager - [email protected]

Stage 2: Following stage 1 and where you are unsatisfied that due process has been followed, or you wish to make a complaint about an administration matter, you may take a complaint to the Registrar. This must be made in writing and addressed to:

Chief Executive and Registrar - [email protected]

Stage 3: There is no formal right of appeal against the Registrar’s decision to accept a TOC assessment panel’s recommendation about passing/not passing the TOC. If you wish to challenge such a decision, you would need to apply to the Court for permission to have the decision judicially reviewed.

If you are unsatisfied by the Registrar’s response to a complaint about the TOC process, you may wish to make a complaint to the Chair of the Education Committee. Such a complaint represents the final stage of our internal complaints process about such matters. If you remain unsatisfied following the Chair of the Education Committee’s consideration of your complaint, you may wish to raise your concern with the body that oversees the work of the UK regulators of health and care professionals, the Professional Standards Authority.

Before going through the test of competence process, we highly recommend that you review the following information. This page contains information and recommended resources that will help you to maximise your chances of success.

The Code and education standards

The Code outlines the standards that chiropractors must meet if they wish to join and remain on our register, and call themselves a chiropractor in the UK. It is important that all those wishing to sit the TOC are familiar with and fully understand the principles and standards within the Code and are able to apply it to their practice.

In order to pass the test of competence, candidates are expected to have the same level of knowledge as a newly qualified UK practitioner. Our education standards set out the criteria that chiropractic students in the UK must meet in order to qualify. 

The chiropractic professional organisations

There are five organisations in the UK that provide support and advice to chiropractors. These include the four professional associations which are:

• The British Chiropractic Association (BCA)

• The McTimoney Chiropractic Association (MCA)

• The Scottish Chiropractic Association (SCA)

• The United Chiropractic Association (UCA)

The profession also has a royal college; the Royal College of Chiropractors (RCC).

Useful courses and modules

The Royal College of Chiropractors has developed online modules that are primarily designed to assist those preparing for the TOC. These can be found on the RCC’s website here.

Information on practising in the UK

In addition to the evidence that you present to us in your evidence of practice questionnaire and supporting documents, the TOC will focus on the differences between the General Chiropractic Council’s criteria and those of other regulatory authorities around the world. These differences have been identified as:

• The involvement of patients and carers as partners in the care process

• The use of research evidence in influencing practice

• Applying continuous quality improvement in practice

• Identifying and understanding the implications of the provision of chiropractic care for a patient on clinically relevant medications, whether prescribed or bought

• Evaluating the chiropractic care given and modifying the care plan as a result, including ceasing care

• The role of chiropractors in the healthcare system in the UK and their relationship with other healthcare professionals

• The nature of professional accountability and ethics in the UK context and the duty to protect and promote the interests of patients, including professional boundaries, raising concerns about others and the various GCC requirements (e.g. the professional indemnity insurance rules) 

• UK legislation including: the Equality Act 2010, the Data Protection Act 1998, the Children Act 2004, Mental Capacity Act, Health and Safety at Work Act 1974, Ionising Radiation (Medical Exposure) Regulations 2018 (IR(ME)R18) and Ionising Radiation Regulations 2017 (IRR17), Safeguarding regulations

• The use of wellness care and how this relates to the need to evaluate and review plans of care.

We have gathered views here from one of the TOC assessors on how candidates should best prepare themselves for the TOC.

This section provides some background on the test of competence, which was developed as a route to registration for applicants with a non-EU overseas qualification, not recognised by the General Chiropractic Council.

Rationale

There are three principles that we have used in the development of the latest form of the TOC:

• our responsibility as a regulator to enable our registrants and potential registrants to meet good standards of practice in order that we might better protect patients and the public
• our wish to ensure that all our registrants and potential registrants actively engage with our standards of good practice as set out in the Code
• our acknowledgement that chiropractic as a profession has a history of setting standards for practice and education which have broad international comparability.

These principles have influenced the assessment process within the TOC itself as well as our broader approach to applicants from overseas.

We developed an evidence of practice questionnaire to be used a part of the assessment process. This gives us an insight into how the individual practises chiropractic. Importantly, it also emphasises to individuals the importance of the Code and their need to use it as the basis of their standard of practice within the UK.

Read our TOC 'myth buster'

We have developed our myth buster which looks at some of the most common misconceptions about the test of competence. It also gives a good overview of the overall process and what is required by those applying.

Accreditation Standards

The chiropractic profession has a history of self-regulation and the promotion of standards of education and practice. Chiropractic authorities are predominantly based in those parts of the world where English is the first or a main language.

There is an international coordinating body (Councils on Chiropractic Education International - CCEI) which sets chiropractic accreditation standards as the basis of a minimum framework from which other accrediting bodies can further develop their own accreditation standards.

Four other accrediting organisations across the world – in Europe, the USA, Canada and Australasia – have developed their own standards based on these international standards.Our development work for the current form of the TOC compared our then accreditation standards against the accreditation standards of the other accreditation agencies to identify where there are differences. The outcomes of the comparisons can be found here.

We did this because:

• all previous applicants to join the register holding overseas qualifications not recognised by the General Chiropractic Council (except one who applied through the EC route) graduated from chiropractic programmes recognised by one of the other worldwide chiropractic accrediting authorities
• individuals who have taken the previous version of the TOC usually gain a pass although this is sometimes on the second or third attempt
• our analysis of the fitness to practise cases considered by the General Chiropractic Council suggests that there are no specific risks associated with individuals who gained their chiropractic qualifications from educational establishments overseas
• we wished to develop a proportionate approach to regulation using right-touch principles.

The comparison of the different worldwide chiropractic authorities’ accreditation standards and competences against ours revealed a significant degree of similarity between the different sets of standards in relation to the outcomes of the degree programme, as well as requirements related to the nature of the degree programme and programme providers. 

Those identified differences now feed directly into the TOC process, with candidates assessed on these areas both via the evidence to practice questionnaire and during the TOC interview.

Test of competence reports are compiled annually for the Education Committee by the independent Test of Competence External Examiner.