CESR - a comprehensive guide for psychiatrists

  • April 06, 2023
 

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: 

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 

  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. Gather evidence prospectively – this is much easier than retrospectively trying to pull together the evidence under additional pressures. 
  3. Make sure that your evidence is of the highest possible quality and is current – you will be assessed against the most recent curriculum.  
  4. Ensure that the evidence you collect demonstrates your competence across the whole of the psychiatry curriculum, not just your sub-specialty.    
  5. Remember to refer to the most up-to-date Psychiatry CCT Curriculum and Specialty Specific Guidance for the evidence requirements in your specialty.  
  6. 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. 
  7. 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). 
  8. 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. 
  9. 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

52,530 - 82,240

An outstanding opportunity for a psychiatrist to join Forensic Psychiatry Department as Specialty Doctor that has received outstanding ratings from the CQC on three occasions. You will offer psychiatric input and conduct assessments, both psychiatric and physical, for patients on two wards. One ward is a self-contained low secure rehabilitation unit situated away from the main hospital premises, while the other is a medium secure rehabilitation ward. This role offers exposure to a broad spectrum of clinical presentations, including personality, affective, anxiety, psychotic, neurodevelopmental, and substance-related disorders. Moreover, it provides a platform for developing knowledge and understanding of forensic mental health sections. This position also offers CESR support for those seeking progression within the UK NHS Jobs system.

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

What is the NHS Trust like?

The Mental Health NHS Trust is a leading provider of mental health service serving a population of 1.2 million. With five main inpatient sites and 25 community locations, they offer comprehensive support for both mental and physical health needs, catering to young people and adults alike. From managing phobias and anxiety to addressing conditions like bipolar disorder and schizophrenia, their services are diverse and inclusive. They integrate community health services with mental health care, enabling simultaneous treatment of conditions such as diabetes and mental health issues, promoting holistic patient care.

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. 

The inpatient service consists of one acute assessment and treatment medium secure male 4 4 ward, four treatment and intervention medium secure male wards, one female medium secure ward, one medium secure and one low secure male learning disability ward, one low secure male FICU ward and 4 low secure male wards. There are currently 25 Consultant Forensic Psychiatrists in post, working with 5 senior psychiatric trainees who rotate with posts at other forensic psychiatric services in the region. There are 5 junior psychiatric trainees, coming from the UCH training schemes. The service currently employs 10 specialty doctors, working in the prisons and in the rehabilitation parts of the service.

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.

ARE YOU ELIGIBLE FOR THIS ROLE?
EEA Candidates:

  • Experience of working in Forensic Psychiatry (Desirable)

Non-EEA Candidates:

  • MRCPsych
  • Experience of working in Forensic Psychiatry (Desirable)

UK based applicants

  • Experience of working in Forensic Psychiatry (Desirable)
93,666-126,281

An excellent opportunity for an experienced Consultant Old Age Psychiatrist to join an established NHS community clinic in London. The post if suitable for overseas psychiatrists, including candidates who are pursuing CESR. Specialists in Psychiatry, holding a specialist certification would be suitable for this post, based on experience entering at either Specialty Doctor or Consultant grade. 

WHAT IS THE DEPARTMENT & TEAM LIKE? 

The post offered is that of Specialist Psychiatrist in Older Adult Psychiatry, working in both the community mental health team and the memory clinic. In addition to this post, three additional CMHTs make up the older adult community service for the borough. The personnel of the CMHT include: medical staff, Community Psychiatric Nurses, Occupational Therapist, and Psychiatric Social Workers. There is a Psychological Therapy Department which provides therapy for older adults and which works across CMHTs in the Borough as does the Occupational Therapy Service.

The post holder will have responsibility for the diagnostic assessment and treatment of older adult psychiatric patients from the designated catchment area referred to and accepted by the service. Outpatient clinics and domiciliary visits in the community will constitute the majority of the direct clinical care provided by the post holder.

WHAT IS LIFE LIKE IN NORTH LONDON FOR PSYCHIATRISTS? 
This great world city is far more than just the capital of the United Kingdom of Great Britain and Northern Ireland. London is bustling, vibrant, multicultural and cosmopolitan. London is both old and new, a place where traditional pubs rub shoulders with the newest cocktail bars. Its most ancient castle is right next door to its newest skyscrapers. London\'s energy, as 8.6 million people go about their everyday lives, is tangible in every journey on the Underground, every stroll through a market and every walk along the banks of the River Thames. From the royal parks to the theatre stage, London really does have it all.

Working as a psychiatrist in London brings a range of exciting prospects. You will have the opportunity to work in some of the best mental health trusts in the UK, who will offer you the opportunity to constantly grow your medical and scientific knowledge and skills. In London you will have the opportunity to work in a wide range of settings, and as you progress through your career, you will have more opportunity to shape the way you work; you can develop research, work part time or full time and can combine your career with a wide range of other interests.


WHAT OPPORTUNITIES ARE AVAILABLE TO YOU AT THE TRUST?
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.

ARE YOU ELIGIBLE FOR THIS ROLE?
EEA Candidates:

  • 6 years experience of working in Older Adult Psychiatry

  • Board Certified Specialist in Psychiatry (desirable)

Non-EEA Candidates:

  • MRCPsych (desirable)

  • 6 years experience of working in Older Adult Psychiatry

UK based applicants

  • 6 years experience of working in Older Adult Psychiatry

  • S12 (desirable)

83945 to 95275

An NHS job opportunity is available for an ambitious and passionate General Adult Psychiatrist to join a trust rated \"Outstanding overall\" CQC. This position presents an ideal prospect for psychiatrists from overseas who aspire to establish themselves within the UK\'s NHS system and progress toward a consultant-level career. It is well-suited for candidates seeking support to achieve Certificate of Eligibility for Specialist Registration (CESR). Doctors must have 6 years work experience after finishing core psychiatry training or equivalent international qualification to be considered for this opportunity. 

What is the department & team like?

The department boasts a comprehensive General Adult Psychiatry department, equipped to deliver exemplary mental health care. Staffing includes a proficient team of consultants and dedicated junior doctors committed to providing superior patient care and support. The department\'s activity is marked by a wide spectrum of cases, ranging from common mental health disorders to more complex presentations. Patients receive tailored treatment plans incorporating evidence-based therapies, medication management, and holistic approaches to ensure comprehensive care.

Facilities within the department are modern and conducive to patient well-being, fostering an environment conducive to recovery and healing. Patients benefit from comfortable inpatient units, outpatient clinics, therapy rooms, and recreational spaces. On average, the department manages a significant caseload of general adult psychiatry cases annually, indicative of its pivotal role in addressing mental health needs within the community. The team\'s dedication to excellence and patient-centered care underscores the department\'s status as a leading provider of psychiatric services in the region.

What is the area like?

Location in a beautiful part of the south of England with easy links to London and Cambridge. Housing options range from historic cottages in quaint villages to modern developments, catering to diverse lifestyles. The location truly provides a balanced living experience, combining natural beauty, cultural richness, and modern comforts.

ELIGIBILITY FOR THE ROLE: 

Non-EEA: 

  • MRCPsych (Desirable)
  • 6 years specialist experience in General Adult Psychiatry
EEA: 
  • Specialist certification in psychiatry (desirable)
  • 6 years specialist experience in General Adult Psychiatry
UK based: 
  • 6 years Specialty Doctor experience in General Adult Psychiatry
52530 - 82400

Join an Older Adult Community Mental Health team led by experienced consultants and supported by a dynamic team of Specialty Doctors. This NHS Trust, rated \"Good\" overall by the CQC, prioritizes staff support and offers a flexible training program for career advancement and work-life balance. Ideal for overseas Consultants and specialists seeking to establish themselves in the NHS and also Junior Doctors or Specialty Doctors already in the UK. MRCPsych is essential for mosts doctors trained outside of Europe. European doctors would need specialisation in psychiatry with ideally expertise in old age. 

The post holder is expected to provide direct psychiatric services through the comprehensive evaluation, diagnosis, treatment planning, and treatment of patients assigned to him/her. The post holder is expected to be involved in discussions about assessments, treatment and risk management of patients in accordance with medical standards. The final decision rests with the consultant.

Life in the West Midlands

The West Midlands offers a blend of rural charm and urban amenities, catering to diverse preferences of residents. Its picturesque countryside provides opportunities for outdoor activities such as hiking, cycling, and exploring historic landmarks like Worcester Cathedral. The area boasts reputable schools and universities, ensuring quality education for families. Transportation links are convenient, with access to major cities like Birmingham and Bristol, as well as airports for domestic and international travel. Housing options range from quaint cottages in rural villages to modern developments in bustling towns, accommodating various lifestyles and preferences.

Career Development & Opportunities Available

The NHS Trust provides an environment that actively supports career development and offers various opportunities for professional growth. Staff members have access to ongoing training and development programs to enhance their skills and stay abreast of the latest advancements in healthcare. The Trust encourages and facilitates career progression, with opportunities for staff to take on additional responsibilities and roles within their specialties. Continuous professional development is promoted, ensuring that individuals can advance their careers and contribute effectively to patient care.

For those seeking further qualifications or specialization, the Trust may provide support for relevant educational pursuits, contributing to the professional development of its staff. CESR is a key feature of this role, with a current cohort of candidates working through CESR you will benefit from excellent support. 


ARE YOU ELIGIBLE FOR THIS ROLE?

EEA Candidates:

  • Specialist Qualification in Old Age Psychiatry

Non-EEA Candidates:

  • MRCPsych (Desirable)

  • Experience of working in Old Age Psychiatry (essential)

UK based applicants

  • Experience of working in Old Age Psychiatry (essential)
  • MRCPsych (desirable)
  • Section 12 (desirable) 
93,666 - 126,281

An exciting opportunity for an experienced Consultant in Child & Adolescent Psychiatry to join an award winning CAMHS inpatient unit. The team supports each other in balancing high quality patient care while you are pursuing your own special interests. The team is part of an NHS Foundation Trust that is a leading Trust in mental health research. The Trust was rated as \"good\" overall by the CQC in 2019. The post if suitable for overseas consultants, including candidates who are pursuing CESR. Specialists in Child & Adolescent Psychiatry holding a specialist certification would be suitable for this post, based on experience entering at either Specialty Doctor or Consultant grade. 

Overseas applications from experienced Specialty Doctors and Consultants are welcomed. 

WHAT IS THE NHS FOUNDATION TRUST LIKE? 

The NHS Foundation Trust is the leading trust in mental health research. They provide excellent opportunities for professional development. The NHS Foundation Trust provides a broad range of community and inpatient mental health services, community services (including therapies), learning disability services, healthy lifestyle support and addictions services to a population of 765,000 people of all ages who live within areas of more than 4,700 square kilometres.

The Trust employs approximately 2,800 staff across more than 79 sites at locations throughout 4 towns. Their budgeted income for 2022/2023 is £186m. The NHS Foundation Trust works closely with major academic partners which ensures the nurturing of workforce of tomorrow\'s doctors, nurses and other health professionals. They aim to be a leading provider of integrated health services, recognised for the care compassion and commitment of their staff and known as a great employer and a valued partner.

The way they deliver their services has a direct bearing on their patients and carers’ experience of the Trust and, most importantly of all, their health. The Humber Teaching NHS Foundation Trust aim to provide the best services they can and constantly look at how they can improve them aspiring to excellence and be the best that they can be. They offer a wide range of benefits to help support a healthy work-life balance and support their employees\' overall health & wellbeing.

WHAT IS THE DEPARTMENT & TEAM LIKE? 

The service is a team of excellent and forward thinking doctors consisting of: psychiatrists, psychologists, nurses, creative therapists and family therapists. There is currently funding for 4.8 WTE Community Consultant Child & Adolescent Psychiatrists. The service aims to keep children and adolescents at home with increased support if possible. The Trust provides a comprehensive Specialist Child & Adolescent Mental Health Service for young people that are 19 years and under. 

The department has a Crisis Team that operates 24 hours a day, 7 days a week. While the Home Treatment (Intensive Intervention Team) aims to work from 8AM to 6PM, 7 days a week. The services is provided at various locations across the town in order to be able to offer families an accessible and convenient service within a less stigmatising and less threatening environment. There is also a team that works with people aged between 14 and 65, who are experiencing their first episode of psychosis or might be at risk of developing psychosis.

The post holder expected to make assessment of referrals/admissions. The post holder will liaise and collaboratively work with other services/agencies. The successful candidate is expected to have a care plan and treatment formulation, guidance on evidence-based treatment and effectiveness.


WHAT IS LIFE LIKE IN THE AREA? 

Blessed with rural beauty, bustling towns and a dramatic coastline, the town makes a wonderful place to call home. Affordable property prices make living here even more appealing, with luxurious city-centre apartments, quiet suburban new builds and charming country cottages to choose from. Some of the UK’s finest beaches are located right here. Affordable property prices make living here even more appealing, with luxurious city-centre apartments, quiet suburban new builds and charming country cottages to choose from. 

The town is known for its quirky narrow streets and bustling harbour overlooked by the striking Gothic ruins. It is a fascinating town, unlike any other. You will enjoy the quirky fishing villages, the unspoilt sandy beaches, the staggering views from the clifftops, and the popular seaside resorts. You will enjoy the 800km of bridleways that weave through the peaceful and colourful countryside of the North York Moors National Park.

WHAT OPPORTUNITIES ARE AVAILABLE TO YOU AT THE NHS FOUNDATION TRUST?

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

Participation in research and educational activities will be encouraged.


ARE YOU ELIGIBLE FOR THIS ROLE?

EEA Candidates:

  • Experience of working in Child & Adolescent Psychiatry
  • Board Certified Specialist in Child & Adolescent Psychiatry

Non-EEA Candidates:

  • Experience of working in Child & Adolescent Psychiatry

UK based applicants

  • Experience of working in Child & Adolescent Psychiatry
  • Within 6 - 12 months of completing CCT

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