Specialist Registration - CCT vs CESR vs CESR-CP 

  • May 02, 2022

Here we take a closer look at the routes available to overseas consultants & experienced doctors who wish to join the GMC’s Specialist Register.  

IMGs from any country in the world can apply for Specialist Registration, provided certain eligibility criteria are met, though there are different routes available based on a doctor’s qualifications and training. 

To shed some light on the routes to Specialist Registration, we've put together a short article to explain further, including the following topics: 

Skip ahead to the relevant section if you know what you’re looking for. 

Specialist Registration

All doctors who wish to work as permanent consultants in the UK must show evidence of skills, knowledge and experience in order to apply for Specialist Registration. This registration in any specialty means you can be appointed to a substantive consultant post within the NHS. 

Specialist Registration is additional to full registration with the GMC. 

The 3 Types of Specialist Registration

There are three types of certificates issued by the GMC, and the type of certificate you will receive at the end of your training defines which training route you are on. 

The Certificate of Completion of Training (CCT) 

The CCT is the route to specialist registration for doctors who have completed a GMC-approved, specialty training programme through the relevant Royal College. 

To be eligible for CCT, an applicant’s entire training (including any core years) must have taken place within UK-approved training posts. Please see our blog on career pathways for a UK doctor in training

The Certificate of Eligibility for Specialist Registration - Combined Programme (CESR (CP))  

CESR(CP) is a simplified route for doctors who joined their specialty training programme after ST1, and therefore do not meet the requirement of 4 years duration in GMC-approved training on completion, as they began their training overseas and completed it in the UK. 

Doctors on the CESR(CP) route count a combination of approved training and previous experience in non-approved posts (overseas) towards their training time. 

The Certificate of Eligibility for Specialist Registration (CESR) 

CESR is the route to specialist registration for doctors who have not completed a GMC-approved specialty training programme – doctors who have trained outside of the UK, Switzerland, and the EEA. 

These doctors apply directly to the GMC to demonstrate that their specialist training, qualifications, skills, knowledge and experience are equivalent to the requirements for CCT in the UK. 

Doctors who have completed their specialist training in the EEA or Switzerland are eligible for direct entry onto the Specialist Register through their Relevant European Qualification (REQ). 

For an in-depth guide to CESR, take a look at our blog for overseas doctors here


Eligibility for Specialist Registration depends on your nationality, qualification and experience.  

To meet the minimum eligibility requirements to apply you must have either: 

A specialist qualification in the specialty you’re applying in


At least six months continuous specialist training in the specialty you’re applying in 

You’ll need to provide evidence of how you’re eligible as part of your application. This could be a copy of your qualification or evidence of your employment.  

In your application you must show that you meet the requirements of the CCT curriculum in your specialty.  

The CESR certificate is awarded only on the written evidence provided by the applicant. It is not granted on the basis of references or experience. 

Applications and Evidence for Specialist Registration


Once you have been issued with your Outcome 6 has been issued, you must complete and return the relevant CCT/ CESR(CP) notification to your Royal College along with the following documents: 

  • Copies of any ARCPs that are not on your ePortfolio 
  • ARCPS/evidence of successful progression for any LAT/FTTA/SHO posts counting towards your training (this applies to doctors who were appointed above ST1 only) 

You will also need to complete an online GMC form. The link to this form will be emailed to you by the GMC and you should contact your Royal College if you do not receive it.  

The GMC has created a guide for each CCT specialty with the relevant royal college or faculty. You can see this here

You will need to apply to the GMC, who will then send your application to the Royal College for evaluation. The application process for CESR can be lengthy and potentially stressful, so it is important that you read the GMC’s general guidance and specialty-specific guidance before starting to put together an application.  

You will need to provide a portfolio of evidence demonstrating that your specialist training or qualifications are equivalent to the award of a CCT in your specialism in the UK. This information is available for each specialty and Royal College on the GMC website here

If you apply for an NHS post which provides CESR support, your hospital should assist you in this process. 

Once the GMC has sent you a letter informing you that your application is complete and has been sent to your Royal College for assessment, the College is not permitted to discuss your case with you until the GMC has sent you a letter informing you of the decision. 

Benefits of Specialist Registration

Specialist registration allows doctors to take up permanent or substantive consultant positions. Without CCT, CESR or CESR-CP, a doctor may only take a Trust locum or fixed-term consultant posts. 

Fixed-term and locum posts offer of course offer less stability than permanent consultant posts and require extension. 

It is a legal requirement before taking a substantive, honorary or permanent NHS consultant post in the UK that doctors have their names entered on the GMC's Specialist Register. 

Senior Positions in the NHS

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

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

These positions also facilitate a faster route to the UK than the CESR route, which can take a substantial amount of time. 


All doctors applying for Specialist Registration must pay a fee. The fees for 2021 are as follows: 

  • CCT - £439 
  • CESR-CP - £439 
  • CESR - £1,676 

#IMG Tips

  1. Research/think about the types of evidence you will need and begin to gather your evidence well in advance of making your application. 
  2. Make sure that your evidence is of the highest possible quality and is current – you will be assessed against the most recent curriculum. 
  3. Ensure that the evidence you collect demonstrates your competence across the whole of the curriculum, not just your sub-specialty.   
  4. Remember to refer to the relevant CCT Curriculum and Specialty Specific Guidance for the evidence requirements in your specialty.  
  5. Ask an IMG Connect recruitment specialist about NHS posts with CESR support, these are not always advertised by a Trust, but we can help you to find a role which aligns well with your career goals in the NHS. 

Most IMGs likely haven’t completed a UK-approved training programme, but you could be eligible for Specialist Registration with the GMC via the CESR or CESR-CP route. Take a look at our in-depth CESR overview for more information on how to apply and what to expect. If you have any further questions about Specialist Registration, your route to the UK, or would like guidance in finding NHS posts which offer CESR support, please get in touch with us here

Follow us on social media through the links below for regular news and updates on the Royal Colleges, relocating to the UK and working in the NHS: 



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