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
A leading NHS mental health hospital in the East of England is looking for a Consultant Psychiatrist in Old Age Psychiatry with a focus on functional illness within inpatient care. The service sits within a well-integrated healthcare system combining mental and physical health services. The post is based on a 22-bed ward, supported by a multidisciplinary team including psychologists, occupational therapists, physiotherapists, and speech and language therapists. This Old Age Psychiatry job is open to both international and UK-based doctors, with MRCPsych or EEA specialist certification most encouraged to apply.
Anyone requiring portfolio support (formally known as CESR) can have their required support discussed on a case-by-case basis.
JOB REQUIREMENTS AND DETAILS-
Consultant level experience in old age psychiatry
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Be eligible for GMC registration, either with MRCPsych (Full), or EEA specialist certification
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Consultants with an interest and prior experience in old age psychiatry and inpatient functional illness should apply
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The salary will be between £105,504 to £139,882 dependent on experience or grade
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Provide medical oversight and psychiatric input for 22 beds (14 for functional illness, 8 for organic illness) on an inpatient ward
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Conduct psychiatric assessments, care planning, and contribute to regular MDT reviews
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Supervise junior doctors and support their training and development
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Collaborate with community teams including the Crisis Resolution and Home Treatment Team for Older People (CRHTT-OP)
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Liaise with other services such as social care, physical health teams, and voluntary sector partners to ensure coordinated care
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Engage in clinical documentation, audits, research, and educational activities
LIFE IN THE REGION
This region offers a balance of vibrant urban living and tranquil countryside settings. From lively city centres with extensive amenities to quiet villages rich in charm, there’s something for everyone. The area benefits from excellent rail and road connections (50 minutes to London) high-performing schools, and a diverse mix of leisure and cultural attractions.
Steeped in history, the region is known for its architectural heritage and community spirit, making it a highly desirable location for professionals and families alike.
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 calling interview preparation sessions
-
Contract and offer negotiations for salary, relocation packages, tenure, and more
Once you have accepted your new role, you’ll then be supported and led throughout by one of our dedicated relocation executives who will guide you all the way to starting your new post, including:
-
Document gathering and checking
-
COS and Visa Application support if applicable
-
Support sourcing short- and long-term accommodation
-
Travel arrangements
-
Family support for finding schools and any other aspects of pastoral care
An NHS Board in Eastern Scotland is looking for a Consultant Psychiatrist with experience in Old Age Psychiatry to lead an outpatient community team.. The Psychiatry department comprises a team of psychiatrists and multidisciplinary professionals including Nurse Team Lead, Community Mental Health Nurses, Community Mental Health Nurses, Healthcare Support Workers, Care Home Liaison Nurses, Young Onset Dementia Nurse, Occupational Therapists, Psychologist, Dementia Post Diagnostic Support, Care managers, DPDS Link Worker, Alzheimer Scotland Link Worker.
This Psychiatry job is open to both international applications and UK-based doctors, though those with European Specialist or MRCPsych or equivalent are most encouraged to apply.
Anyone requiring portfolio support (formally known as CESR) can have their required support discussed on a case-by-case basis.
JOB REQUIREMENTS AND DETAILS
-
Consultant level experience in psychiatry
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Be eligible for GMC registration, either with MRCPsych (Full), or EEA specialist certification
-
Prior experience in Old Age mental health care.
Anyone with consultant experience in old age psychiatry should apply. The salary will be between £107,144 - £142,369 per annum, dependent on experience or grade.
CORE DUTIES OF THIS ROLE
-
Provide clinical leadership and management in Old Age Psychiatry services.
-
Supervise junior doctors and contribute to their training and professional development.
-
Work closely with multidisciplinary teams to deliver high-quality patient care.
-
Participate in service development and improvement initiatives within the department.
LIFE IN SCOTLAND
This location offers a blend of urban convenience and rural tranquillity, with easy access to major cities such as Edinburgh, Dundee, and Glasgow. Whether you prefer city living with vibrant culture and nightlife or coastal and countryside retreats with stunning landscapes, there are plenty of options.
The region has excellent transport links, making commuting easy, and offers high-quality schools and a wealth of recreational activities, including outdoor pursuits, cultural festivals, and family-friendly attractions.
Scotland is steeped in history, known for its ancient castles, famous universities, and contributions to global innovation. The country provides a unique cultural experience, rich in traditions and scenic beauty.
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 calling interview preparation sessions
-
Contract and offer negotiations for salary, relocation packages, tenure and more
Once you have accepted your new role, you’ll then be supported and led throughout by one of our dedicated relocation executives who will guide you through all the way to starting your new role including:
-
Document gathering and checking
-
COS and Visa Application support if applicable
-
Support sourcing short- and long-term accommodation
-
Travel arrangements
-
Family support for finding schools and any other aspects of pastoral care
Anyone requiring portfolio support (formally known as CESR) can have their required support discussed on a case-by-case basis.
JOB REQUIREMENTS AND DETAILS
- Consultant level experience in psychiatry
- Be eligible for GMC registration, either with MRCPsych (Full), or EEA specialist certification
- Prior experience in adult community mental health care is desirable.
Anyone with an interest in community or inpatient psychiatry should apply. The salary will be between £107,144 - £142,369 per annum, dependent on experience or grade.
CORE DUTIES OF THIS ROLE
- Provide clinical leadership and management in General Adult Psychiatry services.
- Supervise junior doctors and contribute to their training and professional development.
- Work closely with multidisciplinary teams to deliver high-quality patient care.
- Participate in service development and improvement initiatives within the department.
LIFE IN SCOTLAND
This location offers a blend of urban convenience and rural tranquillity, with easy access to major cities such as Edinburgh, Dundee, and Glasgow. Whether you prefer city living with vibrant culture and nightlife or coastal and countryside retreats with stunning landscapes, there are plenty of options.The region has excellent transport links, making commuting easy, and offers high-quality schools and a wealth of recreational activities, including outdoor pursuits, cultural festivals, and family-friendly attractions.
Scotland is steeped in history, known for its ancient castles, famous universities, and contributions to global innovation. The country provides a unique cultural experience, rich in traditions and scenic beauty.
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 calling interview preparation sessions
- Contract and offer negotiations for salary, relocation packages, tenure and more
Once you have accepted your new role, you’ll then be supported and led throughout by one of our dedicated relocation executives who will guide you through all the way to starting your new role including:
- Document gathering and checking
- COS and Visa Application support if applicable
- Support sourcing short- and long-term accommodation
- Travel arrangements
- Family support for finding schools and any other aspects of pastoral care
An NHS mental health hospital in the North West of England is looking for a Consultant in Old Age Psychiatry, with an interest in both functional and organic disorders. The Mental Health department is part of a well-established multidisciplinary team, working alongside Consultants, Specialty Doctors, and various healthcare professionals. This psychiatry job is open to both international applicants and UK-based doctors, though those with MRCPsych (Full) or an EEA equivalent qualification are most encouraged to apply.
Anyone requiring portfolio support (formally known as CESR) can have their required support discussed on a case-by-case basis.
JOB REQUIREMENTS AND DETAILS
- Minimum of two years\' experience in old age psychiatry.
- UK applicants with CTT and S12 and AC status preferred
- Be eligible for GMC registration, either with MRCPsych (Full) or an EEA qualification.
- Prior experience in old age inpatient mental health care is desirable.
- The salary will be between £105,504 - £139,882 per annum, dependent on experience or grade.
CORE DUTIES OF THIS ROLE
- Provide psychiatric care and assessments for adult and older adult patients with both functional and organic mental health conditions.
- Work closely with other Consultants, specialty doctors and the multi-disciplinary team to support care planning and patient management.
- Run inpatient services and contribute to continuity of care between community and inpatient settings.
LIFE IN THIS UK REGION
This region offers a mix of urban and rural living, with bustling towns and peaceful countryside options for residents. The area boasts excellent transport links, making it easily accessible from major UK cities. There are highly rated schools, a variety of leisure facilities, and plenty of green spaces, making it a great location for professionals and families alike. Historically, the region has played a key role in British heritage, with significant contributions to industry, culture, and transportation.
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 calling interview preparation sessions.
- Contract and offer negotiations for salary, relocation packages, tenure, and more.
Once you have accepted your new role, you’ll then be supported and led throughout by one of our dedicated relocation executives who will guide you through all the way to starting your new role, 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 any other aspects of pastoral care.
Anyone requiring portfolio support (formally known as CESR) can have their required support discussed on a case-by-case basis.
JOB REQUIREMENTS AND DETAILS
- Candidates must hold MRCPsych (or equivalent) and be eligible for GMC registration with Specialist Registration in General Adult Psychiatry or within six months of gaining CCT.
- Prior experience in community or inpatient psychiatry is required.
- The salary will be between £105,504 - £139,882 per annum, dependent on experience.
- Provide clinical leadership for the Intensive Service team, ensuring high-quality home-based crisis care.
- Assess and treat patients referred to the Intensive Team, contributing to care planning and management discussions.
- Collaborate with inpatient services, community teams, and crisis services to support effective patient care.
- Participate in the teaching and development of junior doctors and multidisciplinary colleagues.
This region offers a balance of rural and urban living, with access to beautiful countryside, historic landmarks, and well-connected towns. Professionals moving to the area benefit from excellent schools, transport links, and a range of cultural and outdoor activities.
The region has a rich historical significance, featuring historic towns, world-renowned heritage sites, and a vibrant local community. It is a desirable location for families and professionals looking for a high quality of life.
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 calling interview preparation sessions.
- Contract and offer negotiations for salary, relocation packages, tenure, and more.
- Document gathering and checking.
- COS and Visa Application support if applicable.
- Support sourcing short- and long-term accommodation.
- Travel arrangements.
- Family support for finding schools and any other aspects of pastoral care.