CESR - a comprehensive guide for clinical oncologists
- August 18, 2022
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
A large NHS teaching hospital in the East Midlands is looking for a Consultant in Clinical Oncology with an interest in lung, gynaecology, and/or colorectal cancer. The oncology department comprises a team of over 20 consultants and is supported by a large team of specialty doctors and junior trainees.
Anyone requiring portfolio support (formally known as CESR) can have their required support discussed on a case by case basis.
JOB REQUIREMENTS AND DETAILS
This Clinical Oncology job is open to both international applications and UK-based doctors, though those with European Specialist Registration or FRCR are most encouraged to apply.
FRCR (or equivalent) and extensive oncology experience are required for this role, and anyone with an interest in lung, gynaecology, and/or colorectal cancer should apply. The salary will be between £105,504 and £139,882 dependent on experience or grade.
CORE DUTIES OF THIS ROLE
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Provide comprehensive non-surgical oncology services, including radiotherapy and chemotherapy clinics, for patients across lung, gynaecology, and/or colorectal tumour sites.
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Participate in the oncology on-call rota (1:12) and provide reciprocal cover for colleagues during periods of leave.
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Support the education and training of junior doctors, specialty doctors, ACPs, and medical students.
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Contribute to clinical governance, service development, and research initiatives across the Trust.
LIFE IN THE EAST MIDLANDS
This role is based in the East Midlands, a region that offers the perfect balance of urban convenience and rural charm. Residents can enjoy city living in Derby or find quieter settings in the nearby countryside and villages. The area boasts outstanding schools, excellent transport links, and a wide variety of cultural, sporting, and outdoor activities. With its strong ties to Britain’s industrial heritage and the beautiful Peak District on its doorstep, the East Midlands is a popular choice for healthcare professionals relocating to the UK.
HOW WILL IMG CONNECT SUPPORT YOU?
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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 to your new role including:
-
Document gathering and checking
-
COS and Visa Application support if applicable
-
Support sourcing short- and long-term accommodation
-
Travel Arrangements
An NHS teaching hospital in Kent is looking for a Consultant in Clinical Oncology with an interest in urology. The Oncology department comprises a team of over 40 Clinical and Medical Oncology consultants and is supported by a large team of middle-grade doctors, fellows, and trainees.
Anyone requiring portfolio support (formally known as CESR) can have their required support discussed on a case-by-case basis.
JOB REQUIREMENTS AND DETAILS
-
This Clinical Oncology job is open to both international applications and UK-based doctors, though those with European Specialist qualifications or FRCR are most encouraged to apply.CCT in Clinical Oncology or equivalent experience, including CESR pathway candidates.
-
The salary will be between £105,504 and £139,882 dependent on experience or grade.
CORE DUTIES OF THIS ROLE
-
Provide high-quality specialist care to melanoma patients attending the Kent Oncology Centre.
-
Attend relevant MDT meetings and coordinate treatment planning with other specialists.
-
Participate in departmental research initiatives and contribute to national and local clinical trials.
-
Contribute to training and supervision of junior doctors and participate in clinical governance activities.
Life in Kent
The area offers the best of both worlds: urban living in towns like Maidstone and Tunbridge Wells, and tranquil countryside villages such as Lenham or Goudhurst.
Kent boasts a wide range of excellent primary and secondary schools, including several grammar schools, and is well connected to London via high-speed rail and road. Residents enjoy easy access to historic castles, the coast, national parks, shopping, and outdoor activities—perfect for both adults and families.
Known as the “Garden of England,” Kent holds historical significance with its Roman heritage, medieval cathedrals, and coastal defense legacy, offering a unique blend of culture and natural 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 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
This oncology job is open to both international applications and UK-based doctors, though those with European Specialist registration or FRCR are most encouraged to apply.
Anyone with an interest in gynae and upper GI oncology should apply.
The salary will be between £105,504 and £139,882 dependent on experience or grade.
CORE DUTIES OF THIS ROLE
Provide systemic therapy services for patients across UHMB sites.
Participate in multidisciplinary team meetings and support associated administrative duties.
Lead and contribute to acute oncology services across the Trust (no on-call required).
Support teaching, supervision, and mentorship for junior medical staff and trainees.
LIFE IN LANCASHIRE AND SOUTH CUMBRIA
The area is rich with excellent schools, convenient rail and road links, and beautiful scenery for outdoor enthusiasts. Historically, the region has played a key role in British shipbuilding and industrial development and today combines coastal charm with cultural heritage and modern living.
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 to 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 teaching hospital, in Kent is looking for a Consultant in Medical Oncology with an interest in Melanoma. The Oncology department comprises a team of over 40 Clinical and Medical Oncology consultants and is supported by a large team of middle-grade doctors, fellows, and trainees.
Anyone requiring portfolio support (formally known as CESR) can have their required support discussed on a case-by-case basis.
JOB REQUIREMENTS AND DETAILS
-
This Medical Oncology job is open to both international applications and UK-based doctors, though those with European Specialist qualifications or MRCP are most encouraged to apply.CCT in Medical Oncology or equivalent experience, including CESR pathway candidates.
-
The salary will be between £105,504 and £139,882 dependent on experience or grade.
CORE DUTIES OF THIS ROLE
-
Provide high-quality specialist care to melanoma patients attending the Kent Oncology Centre.
-
Attend relevant MDT meetings and coordinate treatment planning with other specialists.
-
Participate in departmental research initiatives and contribute to national and local clinical trials.
-
Contribute to training and supervision of junior doctors and participate in clinical governance activities.
Life in Kent
The area offers the best of both worlds: urban living in towns like Maidstone and Tunbridge Wells, and tranquil countryside villages such as Lenham or Goudhurst.
Kent boasts a wide range of excellent primary and secondary schools, including several grammar schools, and is well connected to London via high-speed rail and road. Residents enjoy easy access to historic castles, the coast, national parks, shopping, and outdoor activities—perfect for both adults and families.
Known as the “Garden of England,” Kent holds historical significance with its Roman heritage, medieval cathedrals, and coastal defense legacy, offering a unique blend of culture and natural 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 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 specialist cancer centre in Lancashire and South Cumbria is looking for a Consultant in Medical Oncology with an interest in upper and lower GI cancers. The oncology department comprises a team of 8 consultants and is supported by a large team of middle grade doctors.
Anyone requiring portfolio support (formally known as CESR) can have their required support discussed on a case by case basis.
JOB REQUIREMENTS AND DETAILS
This oncology job is open to both international applications and UK-based doctors, though those with European Specialist registration or MRCP are most encouraged to apply.
Anyone with an interest in upper and lower GI oncology should apply.
The salary will be between £105,504 and £139,882 dependent on experience or grade.
CORE DUTIES OF THIS ROLE
-
Provide systemic therapy services for patients with upper and lower GI cancers across UHMB sites.
-
Participate in multidisciplinary team meetings for lung and upper GI cancer and support associated administrative duties.
-
Lead and contribute to acute oncology services across the Trust (no on-call required).
-
Support teaching, supervision, and mentorship for junior medical staff and trainees.
LIFE IN LANCASHIRE AND SOUTH CUMBRIA
The area is rich with excellent schools, convenient rail and road links, and beautiful scenery for outdoor enthusiasts. Historically, the region has played a key role in British shipbuilding and industrial development and today combines coastal charm with cultural heritage and modern living.
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 to 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