CESR - a comprehensive guide for clinical oncologists
- May 16, 2023
Overseas doctors from any country in the world can apply for Specialist Registration in the UK, provided certain eligibility criteria are met, though there are different routes available based on the doctor’s qualifications and training.
In this blog we’ll be exploring Specialist Registration in clinical oncology for overseas clinical or radiation oncologists more closely. We’ll look at all aspects of Specialist Registration, focusing more closely on the Certificate of Eligibility for Specialist Registration (CESR), 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 oncologist?
- Do I have to complete CESR before I can work in the UK?
- Do I need FRCR (Oncology) for Specialist Registration?
- What is the CESR equivalence process?
- What evidence do I need to submit for a CESR in clinical oncology?
- 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 CCT specialty means that you can be appointed to a substantive (or permanent) consultant position in the NHS. All clinical oncologists who wish to take permanent consultant roles in the UK must show evidence of skills, knowledge, and experience equivalent to a CCT in order to apply for Specialist Registration.
For clinical oncologists, 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 clinical oncologist 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 the training route you followed.
CCT for UK-trained Oncologists
For doctors who have completed a GMC-approved training programme, an application must be made to the GMC for a CCT in their specialty within 12 months of their completion date in order to qualify. After this point, they will be required to use the CESR route to apply directly to the GMC if they wish to attain Specialist Registration.
CCT for EEA-trained Oncologists
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.
CESR-CP for doctors who have completed only part of a GMC-approved training programme
CESR(CP) is a simplified route to Specialist Registration 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.
For overseas doctors who have completed their full training outside of 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.
Clinical Oncology Positions in the NHS without CESR
It is important to note that you can apply for more senior oncology 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 clinical oncology curriculum.
These positions also facilitate a faster route to the UK than the CESR route, which can take a substantial amount of time.
Get in touch with us to find out more about senior positions in the NHS with CESR support.
FRCR (Oncology) for Specialist Registration
Whilst it is always beneficial to complete FRCR (Oncology), particularly for doctors who have trained outside the UK or an EEA country, overseas doctors looking to join the Specialist Register do not need to have completed the Royal College postgraduate exams.
The standard test of knowledge in the Clinical Oncology curriculum are the FRCR (Oncology) exams, so passing these exams confirms the attainment of the competencies of the core curriculum.
FRCR (Oncology) is only a requirement for doctors looking to attain Specialist Registration via the CCT route.
Similarly, UK trainees would have completed MRCP (UK) before beginning their clinical oncology training, which is also not required for oncologists going through the CESR route.
However, CESR applicants who have not successfully completed these exams must provide alternative evidence that demonstrates equivalent knowledge to oncologists who have passed the FRCR (Oncology) exams and the appropriate level of non-oncology expertise and that you can appropriately manage the acutely unwell patient.
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 of the evidence presented.
You can read more about the evidence required in the specialty specific guidance here.
CESR Equivalence Process
Equivalence describes the process of assessing an overseas applicant’s training and experience against the current clinical oncology training programme requirements, in order to be awarded CESR.
The equivalence process involves submitting a written body of evidence to the GMC, consisting of:
The Royal College of Radiologists 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 Clinical Oncology
Skills & Experience: The evidence provided for a CESR application in oncology must cover the knowledge, skills, and qualifications to demonstrate the required competencies in all areas of the Clinical Oncology Curriculum. 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 - 1000 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 oncologists applying for Specialist Registration must pay a fee. As of 1st April 2022, for CESR, this fee is £1,727. For CESR-CP and CCT, the cost is £452.
How long does it take to complete an application for CESR in Clinical Oncology?
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 oncologists, 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 clinical oncology is seven 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 oncologists.
#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 Clinical Oncology curriculum, not just your sub-specialty.
- Remember to refer to the most up-to-date Clinical Oncology 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 pro formas 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 oncology posts with CESR support. These are not always advertised by a Trust, but we can help you find a role which aligns well with your career goals in the NHS.
- Join the online community - join the IMG Oncologists Facebook group for access to a community of like-minded clinical and radiation oncology CESR aspirants and dedicated oncology recruiters.
In this group you will find tailored resources for oncology, including guidance on CESR applications, completely free to all doctors.
You can access our IMG Oncologists community here.
Sources
https://www.rcr.ac.uk/clinical-oncology/careers-and-recruitment/specialist-registration-cesr
https://www.gmc-uk.org/-/media/documents/sat---ssg---clinical-oncology---dc3556_pdf-48456770.pdf
Getting started
Many oncology 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 oncology 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:
Relevant Jobs
An exciting NHS job opportunity is open for a Consultant Clinical Oncologist specializing in Lung & Breast Cancer at an NHS Trust that has been rated \"good\" over all by the CQC. This NHS Trust has undergone significant development, emphasizing patient and community care excellence. With £58 million in national funding, the Trust boasts a University Hospital status, prioritizing research, education, and training. The Care Quality Commission (CQC) lauds the Trust\'s outstanding performance, with 992 beds and 92% patient recommendation, serving a population of 675,000.
This position aims to strengthen the Oncology team, focusing on lung cancer care and Stereotactic Ablative Body Radiotherapy (SABR). Situated at the dynamic centre within the \"good\"-rated trust, the role contributes to systemic treatment advancements and ongoing research. The Oncology Department at the Combined Haematology Oncology Centre caters to 1-1.5 million residents. Designated as a Cancer Centre since 1996, the Centre collaborates with neighboring hospitals, fostering a multidisciplinary approach. The purpose-built Cancer Centre, equipped with advanced imaging, provides nurse-led services, chemotherapy units, and home-delivered immunotherapy.
The post holder is expected to:
- Participate in all facets of departmental activity.
Career development at the Trust includes access to CESR support, specialty training, and opportunities for external duties. The forward-thinking Oncology department initiated SABR practices in 2021 and maintains a dynamic research team supporting various clinical trials.
Life in the area, a historic home of the Royal Navy, offers cultural richness and proximity to scenic countryside. A thriving artistic community, excellent schools, and various development projects contribute to the vibrant atmosphere. The area combines city conveniences with picturesque villages, making it an excellent place to raise a family!
This comprehensive opportunity integrates the Consultant role, SABR RT specialisation, CESR support, and coastal life in the UK, creating a fulfilling and enriching professional and personal experience.
AM I ELIGIBLE FOR THIS ROLE?
EEA Candidates:
- Recognised European Medical Degree or Specialist Qualification
Non-EEA Candidates:
- FRCR or equivalent qualification
UK Based Candidates:
- FRCR qualification
This is a great opportunity for any experienced consultant clinical oncologist working towards CESR in Clinical oncology specialist registration in the UK.
This is a high performing and supportive department for overseas doctors new to the NHS, or UK-based doctors looking to further careers in the UK, and a great opportunity for any overseas oncologists looking for CESR support and great career development in a beautiful part of England, filled with sandy beaches and offering vibrant city living.
What is the Welsh Health Board like?
The Health Board are one of the biggest healthcare groups in the UK, providing primary, community, mental health and acute hospital services for the population of around 390,000. They have a budget of around £1bn and employ approximately 12,500 staff. Besides their three major hospital sites, they are also responsible for community hospitals, health centres, clinics, mental health units, community teams, GP practices and other services provided by dentists, opticians and pharmacists. Their mission is to improve the health, wealth and wellbeing of the people of Wales and the rest of the world.
What is the Oncology Department like?
This Cancer Centre provides a high degree of specialisation for all the major cancers. It has one dedicated ward of 30 beds (with scope to increase to 36 beds at periods of high demand) for both oncology and haematology patients, together with a chemotherapy and haematology day unit, and an aseptic unit on site. There are also two laminar flow rooms for patients requiring bone marrow/stem cell transplantation and one dedicated room for radioactive isotope therapy.
There is a state of the art telemedicine facility allowing regular multi-professional meetings between oncologists, physicians, surgeons and AHPs in Wales. The system has the capacity to transmit and view both high quality radiological images and histopathological slides.
The staff are highly experienced, consisting of nurses, radiographers, research officers and admin staff. The new consultant will be joining a friendly and forward-thinking consultant team of clinical and medical oncologists who are committed to delivering highest standards of cancer care, alongside a large team of other clinical and non-clinical professionals.
What Career Development and Opportunities are available?
The Cancer Centre is heavily involved in training which takes place at all levels from undergraduate lectures and clinical teaching, through to Foundation and Core Medical trainee clinical and educational supervision, and higher specialist training. They will also provide excellent CESR support.
Life in South Wales
Based in South Wales, the area is fast becoming one of the most popular places to live in the UK. This waterfront location is actually Wales’s second most populated city and county, offering all the benefits and amenities of a built-up urban environment, alongside a 5 mile stretch of a pristine, sandy coastline.
The city is home to multiple live music venues, showcasing everything from small gigs to orchestral performances. Annually, the city hosts a number of different festivals, attracting artists from across Wales and the UK. Today, new regeneration is planned which will only increase its popularity, amenities, and modernity. The city is experiencing a period of development and a resurgence of new business and investment, with the city council focusing on creating a culture of creativity and an emphasis on attracting tech led businesses.
The area also has good travel links. It is an easy drive to Port Talbot and Cardiff and you can get to London via the M4, and around Wales on the A48. There are also regular trains to Cardiff, Newport and London. For international and domestic flights, Cardiff Airport is just 44 miles away.
Am I eligible for this role?
EEA candidates:
• Recognised European Medical Degree or Specialist Qualification in Medical Oncology
• Extensive experience in AOS/Melanoma oncology
Non-EEA candidates:
• MRCP
• Extensive experience in AOS/Melanoma oncology
UK-based candidates:
• Extensive experience in AOS/Melanoma oncology
• Within 6-months of CESR or CCT in Medical Oncology
This is a great job for any experienced overseas Medical Oncologists working towards CESR and specialist registration in the UK.
This is a high performing and friendly department for overseas doctors new to the NHS, or UK-based doctors looking to further careers in the UK, and a great opportunity for any overseas consultant oncologists looking for CESR support and great career development in a beautiful part of England.
What is the NHS Trust like?
This NHS Trust is the first NHS Trust on the English mainland to provide community, mental health and acute hospital services. It was formed from the merger of two trusts on the 1st April 2020. Now, they are preparing to merge with another trust so that they are better able to support the health of all the people in the area.
The trust provides a range of services from 13 community hospitals including outpatient and diagnostic services, 190 inpatient beds and seven Minor Injuries Units. They also provide specialist mental health services, healthcare for adults with learning disabilities, medical and surgical care, maternity services and cancer treatment services. The trust\'s facilities for the treatment of cancer have undergone a major expansion, culminating in the opening of the Cancer Centre in May 2009.
What is the Oncology Department like?
The Oncology Department provides Clinical and Medical Oncology inpatient and outpatient services as well as radiotherapy and chemotherapy to all common tumour sites. The new appointee will be joining an ambitious team of 12 Consultant Oncologists (8 Clinical & 4 Medical), 1 Associate Specialist (Medical Oncology), 3 Speciality Doctors, and a rotation of junior doctors who cover the inpatient ward. There are also two Clinical Oncology ST3 doctors. It is a research orientated department with a dedicated clinical trials team and are one of the highest recruiters within the South West and nationally for a number of trials.
The new consultant will be working within the Cancer Centre which provides cancer care to a population of approximately 500,000. It has received a number of accolades since opening in 2009 for the high quality care delivered. These include CHKS ISO 9001 accreditation, Macmillan Quality Environment Mark score of 5 (out of 5) on all principles and in the 2018 National Cancer Patient Experience Survey, the Beacon Centre was ranked third overall which is an excellent reflection of the patient centred care delivered.
What Career Development and Opportunities are available?
There is real opportunity to progress through CESR at pace at this trust, with a strong desire for newly-qualified consultants to develop their specialty areas of interest and undertake in various cancer trials and research projects where possible. Research is encouraged here, particularly when this is appropriate to professional development and to the service development of the department. Opportunities are available with applications for funding co-ordinated by the Trusts Medical Directors and clinical trial recruitment to International, National and Regional trials is active in all tumour sites. This trust was also rated as an area of Outstanding Practice by CQC (2016), and with the highest GMC score in the South West for training.
Life in the area:
This area has diverse shopping, restaurants, and regularly hosts international music and sporting fixtures. It is located between various areas of outstanding natural beauty, featuring national hotspots for cycling, surfing, and climbing. There’s plenty to keep you occupied alongside the abundance of music festivals and local traditions. The area is in close proximity to both the beaches of North Devon and Cornwall, while also being less than two hours from the city of London.
It also offers some of the best schools in the country. Ranging from public institutions to award winning state schools with one being ranked in the top 10 of A-level providers nationally for the last eight years.
Am I eligible for this role?
Non-EEA candidates:
- FRCR (Clinical Oncology)
EEA candidates:
- Recognised European Qualifications
UK candidates:
- Within 6 - 12 months of completing CCT
Are you a Clinical Oncologist looking for a rewarding opportunity in the UK? An excellent NHS Foundation Trust is seeking a talented professional to join their oncology team. With a commitment to collaborative working, this NHS Foundation Trust provides excellent oncology services and ample opportunities for training, research, and career development. The trust is supportive of CESR applications.
The Oncology Department takes a collaborative approach to cancer care, with teams in two sites working together to provide comprehensive and sustainable services. Equipped with state-of-the-art technology, the Cancer Centres offer a multidisciplinary approach, supported by Acute Oncology Teams and a skilled team of healthcare professionals. The post holder will have the opportunity to immerse themselves in an NHS Role as part of a well-equipped, modern oncology department.
The department sits within an NHS Trust that is known to be the leading healthcare provider in East Anglia, serves a population of nearly 800,000 residents across two main hospitals, six community hospitals, and various clinics. With a budget exceeding £650 million, the NHS Foundation Trust invests in enhancing their hospitals and creating an ideal working environment. They prioritise the well-being of their staff and patients, offering exciting prospects for development, innovation, research, education, and training.
Additional to the opportunity of working for a great NHS Foundation Trust, living in the area offers a diverse and vibrant lifestyle. Essex, with its stunning coastline, beaches, and countryside, provides a great environment for families. The county offers a range of housing options, urban or rural, at affordable prices. With excellent transport links to London, you can enjoy the benefits of both city and countryside living. Furthermore, Essex boasts good schools and a high quality of life, making it an ideal place to settle and explore nature\'s playground.
Join them to make a significant impact in the field of oncology while enjoying a fulfilling career and a balanced lifestyle in a beautiful region of the UK.
AM I ELIGIBLE FOR THIS ROLE?
To be eligible for this vacancy you will need the following:
EEA Candidates:
- Recognised European Medical Degree or Specialist Qualification in Clinical Oncology
- IELTS or OET
Non-EEA Candidates:
- MRCP/FRCR/PLAB qualifications
- Experience in Oncology
- IELTS or OET
UK-Based Candidates:
- MRCP or equivalent MD qualification
- 2 years post-registration clinical practice
This is a great opportunity for any experienced Oncologist working towards CESR in the UK and Specialist Registration in Oncology. There will be opportunity to develop and lead on sub-specialist areas of cancer care.
This specialist cancer centre are looking for full-time, permanent or fixed-term Medical Oncology Consultants specialising in Sarcoma Cancers primarily, though they will be flexible across a wide range of cancer sites. The trust is considering either UK or Overseas trained doctors for these posts and will support with CESR for those that need it. A full induction programme is provided and is well set-up for any doctors new to the NHS. This is a high-performing and supportive department for cancer specialists to develop and grow in a highly specialised NHS setting.
THE HEALTH BOARD
It is a highly-respected specialist treatment, teaching, research and development centre for non-surgical tertiary and secondary oncology services. It is proud of its reputation for providing a first-class patient experience where the patient are at the centre of everything it does. It has created an environment of compassion and care, where staff go the ‘extra mile’ to meet the needs of patients, families and carers. The first Cancer Patient Experience Survey produced by the Welsh Government and Macmillan Cancer Support highlighted it as one of the best in the UK.
THE ONCOLOGY DEPARTMENT AND TEAM:
The department is responsible for SACT services for adults with solid tumours in the region of Wales. The majority (60%) of day-case services are delivered on site, while there is a long-established network of outreach sites in LHB acute and community hospitals, and based with 3rd-sector providers.
Based on its professional and public reputation for delivering excellence in terms of patient and staff experience, the Trust has has been selected to lead the ‘Transforming Cancer Services’ programme and to build a new hospital. The new site will be a £200million pound development and will open in the coming years. It will be nearly twice the size of the current hospital and will be equipped with brand new, state-of-the-art diagnostic and treatment facilities
The new site will have 10 new linear accelerators, 2 CT and 2 MRI scanners to support precision image-guided and adaptive radiotherapy. There will be a dedicated clinical trials treatment unit including a 10-bedded early phase trials unit, and 2 isotope cubicles for molecular radiotherapy treatments.
LIFE IN WALES:
Wales has a lot to offer, and the local area has recently beaten off popular regions of the North West and South West to be awarded the city with the “Best Quality of Life”. The City is easily accessible via motorway, and London is a comfortable drive away. It has rail links to the rest of the UK and has good international access.
There is also spectacular countryside, a National Park and Area of Outstanding Natural Beauty and a beautiful coastline.
The people of Wales are immensely proud of our rich history and culture, which can been seen throughout our many castles and museums, and of our ancient language which you can try out for yourself. Above all else, they are proud of their friendliness and welcome (and singing ability!). The area has been assessed as one of the top cities in the UK and compares very favourably with many larger cities for house price growth, the cost of renting, average salaries and quality of life. There is a wide choice of schooling including English- and Welsh-medium schools at all levels. The local University offers a wide variety of highly rated courses and ensure that the city is is a thriving city for young people.
AM I ELIGIBLE FOR THIS ROLE?
To be eligible for this vacancy you will need the following:
EEA Candidates:
- Recognised Specialist Qualification in Medical Oncology
- IELTS or OET
- Experience or interest in Sarcoma
Non-EEA Candidates:
- MRCP (Full) Qualification
- IELTS or OET
- Experience or interest in Sarcoma
UK-Based Candidates:
- Experience or interest in Sarcoma
- Experience at Consultant Grade
This is a great opportunity for any experienced Medical Oncologist working towards CESR in the UK and Specialist Registration in Oncology in the UK. There will be opportunity to develop and lead on sub-specialist areas of cancer care.