CESR - a comprehensive guide for psychiatrists
- January 20, 2022
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.
Here we explore specialist registration in psychiatry for overseas consultant psychiatrists and specialists more closely. We’ll cover the Certificate of Eligibility for Specialist Registration (CESR) in more detail, including the application process, costs, and eligibility criteria, along with some other topics, summarised in the headings below:
- What is Specialist Registration?
- What route to Specialist Registration is best for me as an overseas psychiatrist?
- Do I have to complete CESR before I can work in the UK?
- Do I need MRCPsych for Specialist Registration?
- What is the CESR equivalence process?
- What evidence do I need to submit for a CESR in psychiatry?
- How much does CESR cost?
- How long is the CESR application process?
- #IMG Tips
- How do I get started?
Skip ahead to the relevant section if you know what you’re looking for.
Specialist Registration
Specialist registration in any specialty means that you can be appointed to a substantive (permanent) consultant position in the NHS. All psychiatrists who wish to take permanent consultant roles in the UK must show evidence of skills, knowledge, and experience in order to apply for Specialist Registration.
For psychiatrists, attaining specialist registration will mean you are qualified to practice independently as a consultant in the NHS.
Specialist Registration is additional to full registration with the GMC and is therefore not required to practice as a psychiatrist in the UK.
Routes to Specialist Registration
There are three types of certificates issued by the GMC for specialist registration, and the type of certificate you receive depends on which training route you followed.
For overseas doctors who have completed their full training outside a GMC-approved training programme, CESR is the route they will usually take towards attaining specialist registration. This route does not require further training, rather the submission of an application.
Doctors who have trained outside the UK or Switzerland, but within an EEA country, will be awarded CCT (Certificate of Completion of Training) after a successful specialist registration application. Specialist Certifications from across the EU are deemed as equivalent by the GMC, and therefore a straightforward application can be made. You can read more about this in the Specialist Registration section under your country on the GMC website here.
Psychiatry Positions in the NHS without CESR
It is important to note that you can apply for more senior psychiatry roles such as a specialty doctor (SAS), specialist grade or a locum consultant without being on the Specialist Register.
Similarly, overseas doctors do not require CESR before moving to the UK to work in the NHS.
In these NHS roles, you will have better pay and responsibilities that are more appropriate to your level of experience compared to a trainee. While working in these positions, you can collect evidence of your competences, particularly those specific to the UK psychiatry curriculum.
These positions also facilitate a faster route to the UK than the CESR route, which can take a substantial amount of time.
MRCPsych for Specialist Registration
Whilst it is always beneficial to complete MRCPsych, overseas doctors looking to join the Specialist Register do not necessarily need to have completed the Royal College postgraduate exams.
The standard test of knowledge in the CCT curriculum is the MRCPsych exam, so passing these exams confirms the attainment of the competencies of the Core Curriculum.
MRCPsych is only a requirement for doctors looking to attain Specialist Registration via the CCT route.
However, if CESR applicants have not successfully completed these exams, they must provide alternative evidence that demonstrates equivalent knowledge to psychiatrists who have passed the MRCPsych exams.
Even if the competencies covered by the exam require something that someone in your position would not routinely undertake (in your sub-specialty for example), you must still provide evidence of it – as the evaluators will not make assumptions outside the evidence presented.
CESR Equivalence Process
Equivalence describes the process of assessing an overseas applicant’s training and experience against the current psychiatry training programme requirements, in order to be awarded CESR.
The equivalence process involves submitting a written body of evidence to the GMC, consisting of:
- training and/or competence
- skills and knowledge
The Royal College of Psychiatrists will assess each 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.
Evidence Requirements for CESR in Psychiatry
Skills & Experience: The evidence provided for a CESR application in psychiatry must cover the knowledge, skills, and qualifications to demonstrate the required competencies in all areas of the General Psychiatry Curriculum, and the Advanced Module in the sub-specialty you are applying in. If evidence is missing from any area of the curriculum, the application will fail.
Primary Evidence: To demonstrate that you can do what is required by the curriculum, you need to submit primary evidence of your clinical practice which shows how you work on a day-to-day basis: letters, reports, assessments etc. References, retrospective case summaries, and reflective notes can all be used in a CESR application, but by themselves they are not sufficient.
Audit and Governance: You are required to submit evidence of your active leadership in audit, including evidence that you have completed at least one audit cycle
Currency of evidence: Your evaluators will be looking for evidence of current competency, generally defined as within the last five years. If you have completed training before this point, it is crucial that you provide evidence of maintaining competency across the whole area of the curriculum.
The GMC asks that only evidence that is strictly relevant is sent as it will help them to process the application quicker. The guidance on compiling your evidence will help you to decide what is relevant and what is not – you can find this on the GMC website here.
As a general guide, the GMC usually expects to see about 800-1200 pages of evidence, divided into four different domains, reflecting those of Good Medical Practice. The GMC recommends that you apportion the evidence provided as shown below:
- Domain 1 - Knowledge, skills, and performance
- Domain 2 – Safety and quality
- Domain 3 – Communication, partnership, and teamwork
- Domain 4 – Maintaining trust
Please note, you cannot compensate for evidence lacking in one area by providing more evidence in another area.
The full list of evidence required for each domain can be found on the GMC website here.
The Cost of CESR Applications
All psychiatrists applying for Specialist Registration must pay a fee. For CESR, this fee is £1,676. For CESR-CP and CCT, the cost is £439.
How long does is the application process for CESR in Psychiatry?
The GMC estimate that it can take between six and eight months to receive a decision, from the date you submit your CESR application.
As there is a substantial amount of evidence to gather for a CESR application, the process of preparing all the necessary documentation and applying for CESR can take even longer than this, and a typical candidate will usually set out to complete this within 1 – 3 years.
It is worth noting that more senior psychiatrists, such as consultants, are more likely to have achieved all the competences outlined in the curriculum.
The indicative period of training for a CCT in psychiatry is six years, so it is highly unlikely that you would achieve the competencies required for a CCT in a shorter period of time. Therefore, CESR is not suitable for more junior psychiatrists.
#IMG Tips
- Research/think about the types of evidence you will need and begin to gather your evidence well in advance of making your application.
- Gather evidence prospectively – this is much easier than retrospectively trying to pull together the evidence under additional pressures.
- Make sure that your evidence is of the highest possible quality and is current – you will be assessed against the most recent curriculum.
- Ensure that the evidence you collect demonstrates your competence across the whole of the psychiatry curriculum, not just your sub-specialty.
- Remember to refer to the most up-to-date Psychiatry CCT Curriculum and Specialty Specific Guidance for the evidence requirements in your specialty.
- Create a CESR ‘to-do list’ with sections under the GMC’s 4 domain headings – organise your evidence directly into these sections to manage your progress.
- Do not submit original documents – all your copies, other than qualifications you’re getting authenticated must be accompanied by a proformas signed by the person who is attesting to the validity and accuracy of your evidence (your verifier).
- Ask an IMG Connect recruitment specialist about NHS psychiatry 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.
- Join the IMG Psychiatrists community – as well as support on Royal College exams, our online community of international psychiatrists and dedicated psychiatry recruiters offers guidance on other aspects of working in the UK, including finding NHS posts and CESR.
Getting started
Many psychiatry IMGs likely haven’t completed a UK-approved training programme, but you could be eligible for Specialist Registration with the GMC via the CESR route. Take a look at our guide to CESR applications for psychiatry 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.
To receive the latest news and updates on all things psychiatry, including the Royal College, GMC registration and the NHS, follow us on social media and join the conversation.
Relevant Jobs
Consultant Psychiatrist (General Adult Psychiatry) – Republic of Ireland
Location: Republic of Ireland - South
Salary: €222,215 to €266,925 per annum
Organisation: Health Service Executive (HSE), Ireland
Specialism: General Adult Psychiatry
Job Type: Inpatient and Community Services
A trust in the South of the Republic of Ireland is seeking a Consultant Psychiatrist with expertise in General Adult Psychiatry to lead a multidisciplinary team delivering both inpatient and community mental health services. The psychiatry department consists of a diverse and well-established team, including Consultant Psychiatrists, Nurse Team Leads, Community Mental Health Nurses, Occupational Therapists, Psychologists, Support Workers, and other allied health professionals.
This role offers an excellent opportunity to work across varied settings, contributing to high-quality care for adults with complex mental health needs. Applicants with European Specialist qualifications or UK CCT are strongly encouraged to apply, and both internationally based and Ireland-based doctors are welcome.
Job Requirements and Details
- Consultant-level experience in General Adult Psychiatry.
- Eligible for Medical Council of Ireland (MCI) registration with an equivalent European or UK specialist certification.
- Prior experience in adult mental health services is essential.
- Salary ranges from €222,215 to €266,925, depending on experience and qualifications.
Core Duties of the Role
- Provide clinical leadership in General Adult Psychiatry across both inpatient and community settings.
- Supervise and support the development of junior doctors and multidisciplinary colleagues.
- Deliver patient-centred care in collaboration with a skilled multidisciplinary team.
- Contribute to ongoing service development and quality improvement within the department.
Life in the Republic of Ireland – South Region
The South of Ireland is known for its high quality of life, combining vibrant urban life with the tranquillity of coastal and rural living. The region offers beautiful landscapes, excellent schools, rich cultural traditions, and a welcoming community. Well-connected transport links and a variety of recreational and family-oriented opportunities make it a fantastic place to live and work.
How IMG Connect Will Support You
By applying through IMG Connect, you will benefit from dedicated support throughout your relocation and recruitment journey, including:
- CV and application preparation tailored to Irish medical systems.
- Interview preparation, including two in-depth coaching sessions.
- Contract and salary negotiations to ensure you receive the best relocation package.
Once placed, our relocation team will assist with:
- Document collection and verification
- Visa and work permit guidance
- Short- and long-term accommodation solutions
- Travel planning and pastoral support for you and your family, including school search and local integration
This is an exciting opportunity to join a progressive and supportive mental health service, delivering high-impact care in General Adult Psychiatry within one of Ireland’s most scenic and vibrant regions.
Consultant Psychiatrist (Old Age Psychiatry) – Republic of Ireland
Location: Republic of Ireland - South
Salary: €222,215 to €266,925 per annum
Organisation: Health Service Executive (HSE), Ireland
Specialism: Old Age Psychiatry
Job Type: Inpatient and Community Services
A trust in the South of the Republic of Ireland is seeking a Consultant Psychiatrist with expertise in Old Age Psychiatry to lead a multidisciplinary team providing both inpatient and community services. The psychiatry department consists of a diverse team of professionals including Consultant Psychiatrists, Nurse Team Leads, Community Mental Health Nurses, Healthcare Support Workers, Care Home Liaison Nurses, Young Onset Dementia Nurses, Occupational Therapists, Psychologists, Dementia Post-Diagnostic Support, Care Managers, and other support staff.
This role offers a unique opportunity to work across both inpatient and community services, allowing for a broad and varied clinical experience in the field of old age mental health care. The position is open to both international applicants and those already based in Ireland, and those with equivalent qualifications such as a European Specialist qualification or CCT in the UK are strongly encouraged to apply.
Job Requirements and Details
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Consultant level experience in psychiatry.
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Eligible for Medical Council of Ireland (MCI) registration with equivalent European certification.
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Prior experience in Old Age Mental Health is essential.
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Salary will range from €222,215 to €266,925 depending on experience and qualifications.
Core Duties of the Role
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Provide clinical leadership in Old Age Psychiatry services across both inpatient and community settings.
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Supervise and support the training and professional development of junior doctors.
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Work collaboratively with the multidisciplinary team to provide high-quality care to patients.
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Participate in the development and improvement of services within the department.
Life in the Republic of Ireland - South Region
The South of Ireland offers a wonderful blend of vibrant urban areas and peaceful rural settings. With stunning coastlines, charming villages, and bustling cities, it’s an ideal location for both professional and personal life. Major cities offer excellent cultural, recreational, and family-oriented opportunities.
Transport links are efficient, and the region is home to highly regarded schools, a wealth of outdoor activities, and a rich cultural scene. Ireland\'s unique history and traditions provide a welcoming and enriching experience.
How IMG Connect Will Support You
When applying through IMG Connect, you’ll receive the full support of an expert recruitment team who will be your recruitment and relocation partners throughout the process. We will support you with:
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CV preparation with a bespoke session with one of our specialists.
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Application support with expert knowledge of Irish medical specialties and recruitment processes.
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Interview preparation including at least two video calling interview sessions.
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Contract and salary negotiations for the best possible relocation package, including accommodation and other benefits.
Once you have accepted your new role, IMG Connect’s relocation team will guide you through the entire transition, including:
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Document gathering and verification.
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Visa and work permit assistance if required.
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Accommodation support for both short- and long-term housing.
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Travel and relocation assistance, including support for your family in finding local schools or any other necessary pastoral care.
This is an exciting opportunity to join a dynamic team and contribute to the ongoing development of services in the field of Old Age Psychiatry in the Republic of Ireland\'s South Region.
A Health Board on the South Wales coast is seeking a Consultant Psychiatrist to join a central clinic as part of an evolving mental health service committed to delivering a 24-hour single point of admission, supported by two treatment wards and five dynamic community mental health teams.
This is a fantastic opportunity to lead clinical change within a supportive and multidisciplinary environment, where collaboration with management and clinical colleagues is highly valued.
This opportunity is open to both UK-based and international doctors, with CESR portfolio support available to help progress toward specialist registration.
Job Requirements and Details
Qualifications: Full GMC registration with a licence to practise, MRCPsych preferred, CCT or equivalent specialist qualification and training in Psychiatry.
Experience: Applicants must have significant experience in general adult psychiatry.
Desirable: Previous leadership roles, community mental health experience, and involvement in service development or clinical governance.
Salary: £106,000 to £154,760 per annum, dependent on experience and length of service.
Core Duties of This Role
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Take overall clinical responsibility for outpatient care, including the development and oversight of Care and Treatment Plans.
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Provide leadership and supervision to the multidisciplinary team, with clear delegation of responsibilities.
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Contribute to service planning in line with the strategic direction of the Health Board.
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Provide educational supervision to junior medical staff, supporting training and development in line with Royal College guidelines.
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Actively participate in quality assurance, clinical governance, risk management, and clinical audit processes.
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Fulfil on-call commitments on a 1:14 rota, with prospective cover across the SBUHB area.
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Engage in continuous professional development, including annual job plan review and maintenance of Royal College CPD requirements.
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Opportunities for involvement in research and innovation are encouraged and supported.
Living and Working on the South Wales Coast
The South Wales coast offers a unique blend of coastal beauty and urban convenience. With stunning beaches, nearby national parks, and a thriving cultural scene, the region provides a high quality of life for professionals and families.
The area is well connected, with excellent schools, vibrant communities, and strong transport links to Cardiff, Bristol, and London. Whether you\'re seeking outdoor adventure or a peaceful place to call home, the South Wales coast offers an ideal setting for both work and leisure.
How Will IMG Connect Support You?
When applying with IMG Connect, you’ll have the full support of an expert recruitment team who will be your recruitment and relocation partners throughout the process. We will assist you with:
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CV preparation with a bespoke session from one of our NHS recruitment specialists.
-
Application support tailored to psychiatric roles and NHS expectations.
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Two comprehensive video interviews to prepare for your NHS panel.
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Contract negotiation including salary, relocation, and service expectations.
Post-offer, your IMG Connect relocation executive will guide you through:
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Visa sponsorship (including COS and application support).
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Accommodation search assistance.
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Family relocation support (schools, childcare, etc.).
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Local area orientation and integration advice.
A trust in the West Midlands is looking for a Specialist Doctor in Child and Adolescent Mental Health with an interest in community-based care for children and young people. This exciting role supports the a CAMHS team, providing vital services to a diverse population across both urban and rural settings. The multidisciplinary team includes mental health practitioners, psychologists, psychotherapists, social workers, occupational therapists, and administrative support staff.
This opportunity is open to both UK-based and international doctors, with CESR portfolio support available to help progress toward specialist registration.
Job Requirements and Details
Qualifications: Full GMC registration with a license to practice and at least six years of CAMHS experience.
Desirable: Experience working with children and young people in mental health or multidisciplinary settings.
Salary: £96,990 - £107,155 per annum, dependent on experience.
Core Duties of This Role
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Comprehensive psychiatric assessment, care planning, and evidence-based treatment for children and adolescents.
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Leadership and consultation within a multidisciplinary team, with opportunities for supervision and teaching.
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Liaison with professionals in education, paediatrics, social care, and adult mental health services.
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Contribution to clinical governance, service development, and quality improvement.
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Participation in clinical audits, peer reviews, and regular MDT meetings.
Life in the West Midlands
The West Midlands offers a blend of vibrant towns and peaceful countryside, giving professionals and families the flexibility to choose a lifestyle that suits them. The region features outstanding schools, excellent transport links (M5, M50, and nearby airports), and a wealth of leisure activities, from historical landmarks to outdoor exploration in areas like the Malvern Hills.
With strong educational institutions and a rich cultural history, the West Midlands supports both personal and professional growth in a balanced and welcoming environment.
How Will IMG Connect Support You?
When applying with IMG Connect, you’ll have the full support of an expert recruitment team who will be your recruitment and relocation partners throughout the process. We\'ll support you with:
-
CV preparation with a bespoke session with one of our specialists.
-
Application support with expert knowledge of NHS specialisms & recruitment practices.
-
At least two video calling interview preparation sessions.
-
Contract and offer negotiations for salary, relocation packages, tenure, and more.
Once you’ve accepted your new role, you’ll be guided by one of our dedicated relocation executives who will assist you all the way to starting your new role, including:
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Document gathering and checking.
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COS and Visa application support, if applicable.
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Assistance with finding accommodation.
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Family support for schools and pastoral care.
A UK-based mental health service is seeking a Consultant Child & Adolescent Psychiatrist to join their Neurodevelopmental Team. This is a part-time (0.8 FTE), permanent post, offering an exciting opportunity to take on a senior clinical leadership role within a well-established specialist service for children and adolescents with complex neurodevelopmental conditions.
The team operates within a multidisciplinary framework, delivering comprehensive assessments, pharmacological treatment, and evidence-based care for young people. The role is ideal for experienced consultants looking to shape service delivery while maintaining strong clinical involvement.
This opportunity is also open to international applicants, particularly those eligible for inclusion on the GMC Specialist Register and who will be applying via CESR.
JOB REQUIREMENTS AND DETAILS
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Job Title: Consultant Child & Adolescent Psychiatrist – Neurodevelopmental Team
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Contract: 8 Programmed Activities (PAs) per week – Part-Time
- Contract Type: Permanent
- Salary: £105,000 – £139,000 (pro rata, dependent on experience)
Applicants must have:
- Full GMC registration with a licence to practise
- GMC Specialist Register in Child & Adolescent Psychiatry
- Section 12(2) MHA approval, or a willingness to complete this upon appointment
- Experience working in child, adolescent, or neurodevelopmental psychiatric services
- Strong leadership, multidisciplinary collaboration, and communication skills
- The ability to travel independently across service sites, including schools and service users\' homes
CORE DUTIES OF THIS ROLE
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Lead on psychiatric assessments, diagnosis, and pharmacological treatment planning for young people with complex and/or high-risk neurodevelopmental presentations.
- Provide consultation and guidance to the multidisciplinary team, as well as external agencies including paediatrics, schools, Tier 4 providers, and primary care.
- Maintain clinical oversight for young people under the care of the team, participating in emergency assessments and the consultant out-of-hours rota.
- Attend and contribute to weekly multidisciplinary team meetings and clinical formulations.
- Collaborate with carers, families, and professionals to co-create effective, evidence-based care plans.
- Support transitions from child to adult mental health services in line with protocol.
- Fulfil duties under the Mental Health Act, including conducting assessments and contributing to reports and tribunals as required.
- Maintain clear and timely medical documentation and support audit and quality improvement initiatives.
MANAGEMENT & STRATEGIC RESPONSIBILITIES
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Provide senior clinical leadership in partnership with the non-medical Clinical Team Lead.
- Contribute to the development of service-wide clinical guidelines and care pathways.
- Support service planning and transformation initiatives based on emerging need.
- Actively participate in governance activities, clinical audit, and performance monitoring.
- Engage with stakeholders and external partners at strategic and operational levels.
LIFE IN THE REGION
This role is based in a well-connected and scenic part of the UK, ideal for those who enjoy a balance between urban accessibility and countryside living. With excellent road and rail links, London is just 1 hour by train and car, offering easy commuting and travel.
The area is highly attractive for families, with access to top-rated schools, green open spaces, and a vibrant local community. Whether you\'re seeking historic towns, cultural attractions, or tranquil rural retreats, this region offers something for everyone.
HOW WILL IMG CONNECT SUPPORT YOU?
When applying with IMG Connect, you’ll have the full support of an expert recruitment team who will be your recruitment and relocation partners throughout the process. We\'ll support you with:
- CV preparation with a bespoke session with one of our specialists.
- Application support with expert knowledge of NHS specialisms & recruitment practice.
- At least two video interview preparation sessions.
- Contract and offer negotiations for salary, relocation packages, tenure, and more.
Once you have accepted your new role, you’ll be supported by one of our dedicated relocation executives, who will guide you through the process, including:
- Document gathering and checking.
- COS and Visa Application support, if applicable.
- Support sourcing short- and long-term accommodation.
- Travel arrangements and family support for finding schools and other aspects of pastoral care.