Test of Competence

To protect patients and the public, the GCC has a duty to check that all chiropractors, including those from outside the UK, are properly qualified and are fit to practise. Applicants with foreign qualifications are required to take a Test of Competence (TOC) to satisfy the Registrar that they have reached the required standard of proficiency, and are able to practice in accordance with The Code and supporting Guidance. In addition, applicants must have a satisfactory command of the English Language.

The TOC requires applicants to complete an Evidence of Practice Questionnaire which provides an insight into how they practise, as well as highlighting the importance of The Code in defining the required standards of practice in the UK. Applicants then have a TOC Assessment Interview with a panel of three experienced chiropractors.

Around 75% of the people who take the 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. Applicants are strongly encouraged to read the Support For Applicants section, which provides a wide range of supporting information, including insight into the process from individuals that have experienced it first-hand.

The dates on which interviews are held are advertised in advance, together with an application deadline. However, places are allocated on a “first come, first served” basis, so applicants are advised to apply as soon as possible to maximise the opportunity of securing their preferred TOC interview date.

The current format of the TOC was developed in 2014, following a comparison of the UK education standards in place at the time (found here), with the international standards of the Council on Chiropractic Education International (CCEI) and the four other accrediting organisations across the world (in Europe, the USA, Canada and Australasia). The outcomes of these comparisons can be found here. Although there was much similarity between the different sets of standards, the differences identified were incorporated in the new Test of Competence. A summary of these differences is provided in the Support For Applicants section.

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.

The TOC has an independent Test of Competence External Examiner appointed specifically for the TOC, and who has a key role in processes relating to quality assuring and enhancing the TOC. In addition to the TOC Annual Report prepared by the GCC, the External Examiner complies a separate Annual Report for the Education Committee (all TOC reports can be found here).

We recommend that you review the information below, which is provided to help you maximise your chances of success, before preparing for the TOC.

Previous candidates have commented that while the assessors on the panel are friendly and supportive, the TOC interview is challenging and that, to be successful, you will need to spend a significant amount of time preparing for the interview. We strongly recommend that you read the following blogs and interviews with past candidates, and an assessor, to get an idea of how best to prepare:

Taking the TOC in a Pandemic - a Registrant Blog

Experiences of three TOC Candidates

Experiences of a TOC Assessor

The Code outlines the standards that chiropractors must meet if they wish to practice 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.

We also publish a range of additional guidance and information which include important professional requirements to help chiropractors remain compliant with The Code. This can be found at the Registrants Resource Centre.

In order to pass the TOC, candidates are expected to have the same level of knowledge as a newly qualified UK chiropractor. Our Education Standards set out the criteria that chiropractic students in the UK must meet in order to qualify. 

The Royal College of Chiropractors have developed an online module specifically aimed at those preparing for the TOC. The Royal College has also published a series of chiropractic standards that may provide further assistance for those preparing to work in the UK.

In addition to the evidence that you present in your Evidence of Practice Questionnaire and supporting documents, the TOC will focus on the differences between UK education standards and those of other regulatory authorities around the world. These differences have been identified as:

1. The involvement of patients and carers as partners in the care process (including consent)

2. The use of research evidence in influencing practice

3. Applying continuous quality improvement in practice, and the management of clinical risk

4. Understanding the implications on providing chiropractic care for patients on clinically relevant medications

5. Evaluating the effectiveness of chiropractic care and modifying care plans

6. The role of chiropractors in the UK healthcare system and relationships with other healthcare professionals

7. The nature of professional accountability and ethics, and the duty to protect and promote the interests of patients (including professional boundaries, raising concerns about others, and the various GCC requirements)

8. UK legislation, including: the Equality Act 2010, the Data Protection Act 2018 and UK GDPR, the Children Act 1989 and Children Act 2004, Mental Capacity Act 2005, Health and Safety at Work Act 1974, Ionising Radiation (Medical Exposure) Regulations 2017 and IR(ME)R 2018 (Amendment), and local safeguarding regulations

9. The use of wellness care and how this relates to evaluating care and reviewing care plans

Chiropractic Associations

There are four UK chiropractic professional associations that provide support and advice for their membership:

The British Chiropractic Association (BCA)

The McTimoney Chiropractic Association (MCA)

The Scottish Chiropractic Association (SCA)

The United Chiropractic Association (UCA)

• The number of places for each TOC interview date are limited and applications are accepted on a “first come, first served” basis. Early applications are therefore encouraged to increase the chances of being accepted on your chosen date.
• Please read all the information carefully before you complete and submit your application. You are strongly advised to refer to the Support for Applicants Section for further information and advice.
• In the first instance, please email us to tell us you would like to take the Test of Competence and we will set up a profile so that you can apply via our application portal. You can then upload all of the necessary documents securely online. Please do not email or send paper copies of any documents. 
• If you would like a member of the team to call you to discuss your application and you do not have a UK telephone number, please email us so that we can arrange a Microsoft Teams or Zoom call. 
• 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.
• You need to upload all the documents, and pay online, listed below. 

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.

2.  The Evidence of Practice Questionnaire (EPQ)
The Evidence of Practice Questionnaire (download here) provides evidence of how you meet the standards in The Code, benchmarked at the level of the learning outcomes detailed in the GCC Education Standards. 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 (to be accompanied by anonymised patient records)
• Section 3: A case presentation in which the patient was considered unsuitable for care and/or was referred to another healthcare practitioner (to be accompanied by anonymised patient records)
• Section 4: A case presentation in which you concluded that certain techniques were unsuitable / contra-indicated (to be accompanied by anonymised patient records)
• 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
• Section 8:  Details about the anonymised patient records that you have submitted
• Section 9:  Declarations

As well as documenting your past or current practice, the responses that you give should also outline how you intend to ensure compliance with The Code in similar circumstances. Give enough detail to reassure the panel that you understand the reasons behind your practice and the rationale for any care you provided.

3. Anonymised patient records

You must upload an anonymised set of patient records to support your answers to Sections 2, 3 and 4 of the Evidence of Practice Questionnaire. These must include everything that is part of the patient record, including details of the initial consultation, all the subsequent treatment notes, any reports, images or letters, as well as any intake or administrative forms that the patient was provided with.

Patient records are a compulsory part of your supporting evidence. You will not be able to attend the TOC interview without providing them.
Requirements for Patient Records:

• Patient records must be no more than 24 months old and include the complete patient record (as detailed above).
• The cases provided must meet the specific clinical requirements of each Section (as detailed on the Evidence of Practice Questionnaire) and, where stipulated, must include a course of treatment involving multiple interactions with the patient.
• The patient records for each Section of the EPQ must be submitted electronically as a single compiled document, and clearly labelled to show which Section of the EPQ to which it refers.
• Patient notes must be indexed in the correct chronological order and the pages numbered.
• Any handwritten notes submitted must be accompanied by a typed transcript.
• All references relating to patient names, dates of birth, and addresses must be redacted (removed), as well as your name and licence number. However, please ensure that the patient's gender, age, occupation and appointment dates are still visible.

Patient records not prepared and collated as detailed above will be rejected.

The expected source of patient records are real notes, written by the candidate, while in independent chiropractic practice, within the previous 24 months. It is recognised that there are some circumstances where this is not always possible, and details of acceptable modifications are provided in the Anonymised Patient Records Policy.

Educationalists: 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.

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

If patient records that have been taken while you were not working in the capacity of a registered chiropractor, these may be accepted, as long as certain criteria have been met. In these circumstances, an explanation of the circumstances would be required in the application.

It is expected that, wherever possible, you obtain real anonymised records for patients that you have cared for (if necessary, the General Chiropractic Council can provide information for overseas educational institutions and employers who may hold responsibility for the patient records that you wish to submit). If necessary, 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.

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

5. Passport Copy
Upload a copy of the pages from your passport that contain your photo and personal details.

6.  Diversity

You are invited to complete the online ethnicity and diversity form as part of the application.

7. 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 will be prompted to pay the fee at the end of your online application. Please note that the TOC fee must have been paid before you take the test.

English Language Skills

There are some circumstances, such as if the chiropractic programme you attended was not conducted in English, when we will ask you to provide evidence that you meet the English Language requirements (see our Guidance on English language skills for applicants). Please ensure you review the guidance to ensure your application is not delayed.

After Receiving your Information

Once we have received your application and the test fee, we will check to ensure that you have provided all the information that is requested. We will then confirm an interview place or let you know if any information is missing. Any request for further information may result in a delay to your application, and you may miss the closing deadline.

Withdrawal and Refunds

Once you have had a TOC interview place confirmed, a withdrawal of your application up to 24 hours before the closing date will result in a 50% refund of your fee. No refund will be provided after the closing date, unless we agree that you have an exceptional mitigating circumstance.

Confidentiality

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.

After you have uploaded your completed application to our portal, including the Evidence of Practice Questionnaire, you will be required to attend a TOC Assessment Interview. We will send you information confirming the date and time of your interview after the closing date for applications has passed. The interview panel will be made up of three experienced chiropractors, and the interview will take place remotely using Microsoft Teams. A link will be provided for you to join at the appropriate time.

The role of the interview panel is to assess whether you have the knowledge, skills, understanding and attitudes to practice in accordance with The Code and supporting Guidance, benchmarked against the programme outcomes in the Education Standards. While we use a standardised criteria for the interviews, a significant number of the questions that you will be asked will be specific to the answers that you provided in your Evidence of Practice Questionnaire.

To help you prepare for the interview, it is strongly recommended that you review the additional information (including experiences of past applicants) that has been provided in the Support For Applicants section.

What to Expect at the Interview

You should allow up to 2 hours for the interview. This will include sufficient time to deal with potential internet connectivity issues which may increase the length of interview. The interview itself will consist of three separate parts:

1. The Evidence of Practice Questionnaire

The panel will ask questions to explore the information that you have provided in your Evidence of Practice Questionnaire. You will need to be able to explain the rationale behind how you have practised in the past, and to reflect on what changes you might make if you were to practice in the UK. This section will comprise at least 50% of the interview.

2. An Ethical Dilemma

The panel will then provide you with a hypothetical situation to explore how you would approach an ethical dilemma. You will be given plenty of time to read and consider the scenario, before being asked some questions by the panel. This section is intended to investigate how you would handle a challenging situation, which may address areas such as: prioritising a patient’s wellbeing, handling your professional responsibilities, dealing with conflicts of interest, working within professional boundaries, consent and confidentiality, or fulfilling the duty of candour.

3. The Code and Practice in the UK

In the final section of the interview, the panel will ask a series of questions to assess your knowledge and understanding of The Code and supporting Guidance, and of the healthcare environment in the UK. The questions are heavily influenced by the result of analysis carried out to identify the main differences between the UK standards, and those of other regulatory authorities around the world (details of these areas are provided in the Support For Applicants section).

The interview will be held remotely, and we will send you a Microsoft Teams link in advance of the interview. We will need to carry out an identity check prior to the interview starting (please see below for the documents required), therefore please use the link to connect to Microsoft Teams 5 minutes before the interview is due to begin. You will initially enter a virtual lobby until the panel is ready.

IMPORTANT: There are a few things that you need to arrange before the interview starts:

• A good broadband connection will be necessary, as you will need both your camera and microphone to be switched on during the interview (if your internet is unreliable, you may find it helpful to connect your device directly to the router).
• You must be in a room on your own, where you will not be disturbed, and you must not be in contact with anyone else.
• You will need a copy of your completed Evidence of Practice Questionnaire and anonymised patient records, as you may need to refer to them. However, you must not refer to any other material during the course of the interview.
• It is not permitted to record the interview. If the interview is recorded it will be treated as serious and you will automatically fail the TOC, or be treated as a disciplinary matter if you have been registered.
• You must have identification with you, which we will need to visually check before your interview can begin. The following are the only forms of identification we will accept, and they must be original, current, include a recent photograph, and be the same as the document you provided as part of your TOC application:
  • your passport
  • your UK Immigration and Nationality Department identification document
  • your Home Office travel document
  • your UK driving licence
  • your EU identity card

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 chiropractic qualification, stating that both names relate to you

If you cannot provide the necessary document(s), you will not be allowed to sit the interview.

Additional Information

When will I know the result?

We are not able to give you a result on the day, as it is the role of the assessment panel to provide a recommendation to the Registrar. It may take up to 10 working days for the Registrar's decision.

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:

• 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
• 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 on Exceptional Mitigating Circumstances and complete the form included in the document.

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. Read our Policy on Reasonable Adjustments for Disability to see what we can do if, for example, you have dyslexia, or a visual or motor impairment.

Will the panel be different if I have the resit the TOC?

If you fail the Test of Competence and subsequently apply to resit, there is a possibility that you may be assessed again by one of the same panel members. While we do our best to ensure you are assessed by different assessors this is not always possible.

We will inform you of the outcome of your Test of Competence (TOC) application by email within 10 working days of your interview. The outcome will be one of the following:

• Pass - you have supplied sufficient evidence of meeting the standards set out in The Code, and are therefore eligible to apply for registration.
• Further Evidence Required - there is insufficient evidence of meeting the standards in one or more specific areas. However, following the submission of satisfactory further evidence (specified by the panel) you will then be allowed to pass and proceed to registration.
• Fail - there is insufficient evidence of meeting the standards in a large number of areas, and/or concerns about patient safety, and you will need to make a new application and resit the whole TOC.

The GCC does not enter into correspondence on outcomes of the Test of Competence, but does provide feedback to candidates.

If the result of your TOC is 'Further Evidence Required', you will be given specific details of what you need to do. This further evidence must be provided within 6 months of the TOC interview. Despite this deadline, we have found that applicants who supply this evidence within 3 months of the interview have a much better chance of passing than those who take longer.

After passing the TOC, you will need to apply for registration. 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.

We have a complaints procedure in place where a 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 TOC, in the first instance, you should put your complaint in writing, addressed to the Registrations Lead (toc@gcc-uk.org).

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 the Chief Executive and Registrar (chiefexec@gcc-uk.org).

Stage 3: There is no formal right of appeal against the Registrar’s decision to accept a TOC assessment panel’s recommendation about the outcome of a 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 GCC 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.

This section puts the resources listed in the sections above in one place to assist candidates in preparing their application.

Standards

• The Code
• GCC Guidance
• Education Standards
• Registration Resource Centre

TOC Forms

• Evidence of Practice Questionnaire (EPQ)

TOC Advice / Information

• Myth Buster
• Experiences of the TOC (Candidates)
• Experiences of the TOC (Assessor)
• Taking the TOC in a Pandemic

TOC Courses / Modules

• RCC Online TOC Modules

GCC Policies / Guidance

• Anonymised Patient Records Policy
• Policy of Reasonable Adjustments for Disability
• Policy of Exceptional Mitigating Circumstances
• Plagiarism and Collusion Policy and Procedures
• Guidance on English Language Skills for Applicants
• Registration Information for International Applicants

UK Legislation

• The Equality Act 2010
• Data Protection Act 2018 / UK GDPR
• Children Act 1989 / Children Act 2004
• Mental Capacity Act 2005
• Health and Safety at Work Act 1974
• Ionising Radiation (Medical Exposure) Regulations 2017
• Ionising Radiation (Medical Exposure) Regulations 2018 (Amendment)

Quality Assurance

• TOC Annual Reports

UK Professional Associations

• The British Chiropractic Association
• The McTimoney Chiropractic Association
• The Scottish Chiropractic Association
• The United Chiropractic Association

Other Professional Bodies

• The Royal College of Chiropractors
• Professional Standards Authority
• Councils on Chiropractic Education International (CCEI)
• Institute of Translating & Interpreting