CESR - a guide for overseas doctors

  • October 26, 2022

Here we look briefly at the CESR route available to overseas consultants and exerienced senior doctors who wish to secure a job in the NHS and relocate to the UK.

Many IMGs have recently asked if they would be eligible for the CESR route to Specialist registration. International Medical Graduates (IMGs) from any country in the world can apply for CESR, provided certain eligibility criteria are met.

To help answer this question we have put together a short article to explain further, including the following topics: 

CESR is suitable for those who have already been practising overseas for many years. 

What is CESR? 

The CESR is for doctors who wish to join the GMC (General Medical Council) Specialist Register, and whose specialist training, qualifications or experience was partly or completely acquired outside an approved CCT (Certificate of Completion of Training) programme in the UK.
It is equivalent to a CCT and certifies that the recipient has all the competences defined in the CCT curriculum, known as specialist registration. 

What is the Equivalence process?

Equivalence describes the process of assessing an overseas applicant’s training and experience against the current training programme requirements, in order to gain a Certificate of Eligibility for Specialist Registration (CESR) for the Specialist Register held by the General Medical Council.

The process involves submitting a written body of evidence to the GMC of:

  • training and/or competence
  • skills and knowledge

Each Royal College will assess the application against the relevant Curriculum before providing a recommendation to the GMC, who will then make a decision.

Please note that Equivalence procedures are the responsibility of the GMC. 

Applications are made through their Certification Department and initial enquiries should be directed there.

Who is the CESR for? Who can apply? 

If you have training, qualifications and experience in a CCT specialty but have gained these partly or completely outside an approved CCT training programme (for example, you have trained outside the UK or EEA), you may apply for a CESR in a CCT specialty.

What does the CESR route involve? 

In a nutshell, you will need to compile a portfolio of evidence to prove you have achieved the equivalent skills and experience of a doctor who has completed a full GMC-approved training programme. 

You can collect this evidence prospectively through non-training jobs.

Is it the right route for me? Yes, if…

  • You have already completed specialty training back home

If you have already completed Specialty Training, then you’re unlikely to want to repeat it. 

  • You haven’t completed training, but you have too much experience in your specialty to apply for training posts. 

In both scenarios, even if you are willing, you may be overqualified to apply for training.

Doctors who have complete specialist training overseas or via a non-CCT pathway may be eligible for entry without further training. You can check using the guidelines below: 

You will need to demonstrate all specialty learning outcomes specified in the relevant CCT curriculum.

Are there other senior NHS positions available?

It is important to note that you can apply for more senior roles such as a SAS doctor, specialty doctor or a locum consultant (locum consultants are not required to be on the Specialist Register). 

This way you will have better pay and the roles and responsibilities are more appropriate to your level of experience compared to a junior trainee. While working in these jobs you can collect evidence of your competences. 

This is also a quicker route to the UK than the CESR route, which can take a substantial amount of time. 

Legal requirement before taking a substantive, honorary or fixed term NHS consultant post in the UK: 

It is a legal requirement that doctors must have their names entered on the General Medical Council's (GMC's) Specialist Register before taking up substantive NHS consultant posts in the UK. 

What are the achieved standards? 

To apply you will need to have either a specialist qualification or have undertaken a period of specialist training (not less than 6 months anywhere in the world).

Your application is measured against the GMC standard. 

The GMC break down the standard into four domains mirroring the headings of Good Medical Practice

The GMC recommend that you allocate the evidence you provide with your application in the following way:

Domain 1: Knowledge, Skills and Performance - 75%

Domain 2: Safety and Quality - 20%

Domain 3: Communication, Partnership and Teamwork - 5% (combined for

both domains 3 & 4)

Domain 4: Maintaining Trust - 5% (combined for both domains 3 & 4)

The full list of evidence needed for each specialty is provided here.

How can I prepare my evidence for CESR applications? 

As CESR applications are currently a completely paper-based process it is important to think about the evidence you present. You should:

  • Research/think about the types of evidence you will need and begin to gather your evidence well in advance of making your application.
  • Make sure that your evidence is current and of the highest possible quality.
  • Always note any curriculum changes – you will be assessed against the most recent one 
  • Ensure that the evidence you collect demonstrates your competence across the whole of the curriculum, not just your sub-specialty.  
  • Throughout your application you should refer to the Specialty Specific Guidance in your specialty (or the most relevant if applying in a non-CCT specialty). 
  • You should also refer to the relevant CCT curriculum in your specialty; as this is the standard that all CCT applicants will be measured against.
  • Look thoroughly at the GMC guidance available and get advice on your application from the GMC before you apply.
  • Remember to refer to the relevant CCT Curriculum and Specialty Specific Guidance for the evidence requirements in your specialty.    

The GMC has strict guidelines for presenting evidence, including verification, anonymising and translating documents. We strongly advise all IMGs to take a look here and familiarise themselves with the criteria.

What if my application is not successful? 

Following an unsuccessful application, you can apply for a review within 12 months of receiving your decision from the GMC. You can apply for a review of the GMC’s decision on the grounds that: 

  • You now have additional evidence to submit that addresses the areas of your application in which you were previously unsuccessful 
  • You believe that there has been a procedural error or unfairness in the processing of your original application. 

Please refer to the GMC guidance for further information on applying for a review. 

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