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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Don’t hesitate to get in touch using the buttons above (and below) to discuss doctor job options in the NHS, including discussions regarding a typical doctor salary in the UK, CESR and the most suitable hospital locations for you.


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A Welsh Health Board are looking to appoint an experienced consultant histopathologist to work in a joint clinical and educational supervisor to four innovative CESR Fellows, all FRCPath Histopathology holders. 

This is a unique opportunity to work in a developing initiative that will bring immense social good to the local the people of Wales. 

Short / mid / long-term ambitions for this role.

Short-term, there is the opportunity to work a close group of four international doctors, with specialist qualifications in histopathology including FRCPath. You\'ll have the opportunity to shape the careers of hungry pathologists ready to absorb all the knowledge and experience from an experienced NHS colleague like yourself.

Mid-term you\'ll be jointly responsible for the successful portfolio submissions for these individuals, helping the laboratory at Glangwili General Hospital to establish a newly qualified consultant team to provide stability and excellent pathological services for the patients of Wales, UK.

Long-term, the potential is enormous. As part of ‘A Regional Collaborative for Health’ or ARCH a regional hub for South and West Wales is being built in Swansea, to house a 30-35 consultant lead service for histopathology alone. Fully digitalised regional services for half the Welsh landmass would be provided via one central and digitalised hub. 

Life in the area

It\'s a beautiful life with Wales offering beaches, beautiful forest, lakes and mountains all available to you in your free-time. It\'s a low cost of living and a a bit of a dream for the right person. We can chat more about that over our call. 
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IMG Connect are representing a Southern-based molecular oncology facility with a fully equipped laboratory, integrated process platforms, an in-house bioinformatics team, and a huge genetic database for precise and updated reporting.

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What is the NHS Trust like?

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Forensic Psychiatry Team & Department

The Forensic Service enjoys a stellar reputation, earning an \'Outstanding\' rating from the Care Quality Commission. The Forensic Service delivers care in low and medium secure environments, featuring specialized facilities such as the National Stalking Clinic and the Fixated Threat Assessment Centre (FTAC). These services focus on evaluating and managing risks for prominent individuals. 

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Life in the area

The area offers a blend of urban and suburban living, providing both rural escapes and city conveniences. Residents can explore scenic parks or enjoy activities at different parks. The area boasts a range of quality schools and easy access to universities like Middlesex University. Transport links are excellent, with frequent trains to central London and nearby cities, as well as efficient connections to major airports. Housing options vary from historic cottages to modern apartments, catering to diverse preferences and lifestyles.

Career Development and Opportunities Available

With an extremely active education/teaching programme supported by the consultant team, there is opportunity to work towards and complete CESR, RCPsych exams, get involved in active research and many aspects of CPD. 

Participation in research and educational activities will be encouraged.

EEA Candidates:

  • Experience of working in Forensic Psychiatry (Desirable)

Non-EEA Candidates:

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  • Experience of working in Forensic Psychiatry (Desirable)

UK based applicants

  • Experience of working in Forensic Psychiatry (Desirable)
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An excellent opportunity to join the dynamic team at an esteemed organization recognized for its excellence by the CQC. This is an opportune moment to become part of the Acute Medicine and Medicine Specialties Teams. With a strong history of achievements, they are committed to delivering exceptional patient-centered care. They seek a passionate and driven Acute and General Physicians to contribute to their mission of providing top-tier medical care across various clinical settings. This is a high performing and supportive department for overseas doctors new to the NHS, or UK-based doctors looking to further careers in the UK.

This is a great opportunity for overseas Consultants who want to establish themselves in the NHS, and grow their consultant career. The post is suitable for candidates holding specialisation in the EEA, or for experienced IMGs looking to complete CESR.

What is the NHS Foundation Trust like?

The NHS Foundation Trust stands as one of the nation\'s largest integrated healthcare organizations, delivering both hospital and community services to a populace exceeding 650,000 individuals. Renowned for their ambition and innovation, they boast a skilled workforce comprising over 7,000 dedicated colleagues. Operating across two acute sites for hospital services and encompassing centers and community hospitals in six towns for planned care, they extend their services even to patients\' residences.

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Within this NHS Foundation Trust, medical professionals are presented with a plethora of career prospects and exposure to diverse care settings rarely encountered elsewhere. Additionally, they have the opportunity to reside and practice in some of the most culturally rich and picturesque locations across the country!

What is the Department & Team like?

Within the Trust, there are 5 Care Groups: Urgent & Emergency Care, Integrated Medical Specialties, Surgery, Family Health, and Clinical Specialist Services. The Acute Care Team is housed under the Urgent & Emergency Care division. The Acute & General Medicine Department prides itself on delivering comprehensive and compassionate care to patients across a wide spectrum of medical conditions. Staffed by a dedicated team of consultants and junior doctors, the department ensures round-the-clock coverage to meet the needs of their patients. Their department handles a diverse range of cases, including but not limited to respiratory illnesses, cardiovascular conditions, gastrointestinal disorders, and infectious diseases. With access to state-of-the-art diagnostic and treatment facilities, including advanced imaging technologies and specialist clinics, they are equipped to provide timely and effective care to their patients.

The Acute & General Medicine Department boasts modern and well-equipped facilities, designed to optimize patient care and comfort. They have a 30-bedded Acute Medical Assessment Unit. On average, their department handles a significant number of acute and general medicine cases each year, reflecting the trust and confidence placed in their services by the community they serve. They prioritize patient safety, quality of care, and efficient service delivery, ensuring that each patient receives personalized attention and tailored treatment plans to facilitate their recovery and well-being.

The unit is adequately staffed and the working shifts are designed to ensure more doctors are present during the busy period of the day i.e. late evenings. They address the busy winter months by arranging extra locum cover during this busy period. In addition to the acute medicine registrar(s), there is a middle grade doctor, 1 IMT doctor and 4 FY1 doctors with staggered shifts throughout the day. In addition, there will be an on call registrar and 2 on call IMT doctors with staggered shifts. The night team comprises of one registrar, two FY2/IMT and one FY1 supported by an outreach nurse on most nights. 

What is life like in the area?

The North East of the UK offers a diverse mix of rural and urban settings, providing doctors with a range of living options. Residents can explore stunning coastal areas like Northumberland\'s beaches or venture inland to scenic national parks such as the North Pennines. The region is home to respected schools and universities, including Newcastle University. Transportation links are robust, with efficient road and rail networks connecting residents to major cities like Newcastle, Durham, and Sunderland, as well as international airports. Housing options range from quaint cottages in picturesque villages to modern apartments in vibrant city centers, catering to various lifestyles.

Career Development & Opportunities Available

EEA Candidates:

  • Experience of working in Acute & General Medicine

Non-EEA Candidates:

  • MRCP
  • Experience of working in Acute & General Medicine

UK based applicants

  • Experience of working in Acute & General Medicine

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