In this article, we’ll be taking a closer look at the specific guidance on NHS applications for entry onto the Specialist Register through the Certificate of Eligibility for Specialist Registration (CESR) for psychiatrists.
We’ll cover the eligibility criteria, application process, and most importantly the required evidence, along with some other topics, summarised in the headings below:
Skip ahead to the relevant section if you know what you’re looking for.
The CESR, or Certificate of Eligibility for Specialist Registration, is the route to specialist registration for psychiatrists who have not completed a GMC-approved training programme but who are able to demonstrate that their specialist training, qualifications and experience are equivalent to the requirements for the award of CCT in the UK.
CESR holders can be appointed to substantive (or permanent) consultant positions in the NHS. As a psychiatrist, attaining specialist registration will mean you are qualified to practice independently as a psychiatry consultant in the NHS.
Psychiatrists must satisfy the GMC that their specialist training or specialist qualifications, when considered together, are equivalent to a CCT in the specialty in question. Doctors who have undertaken a minimum of 6 months training or obtained a specialist qualification and acquired specialist medical experience or knowledge as a psychiatrist within a non-training post, and are currently practicing, may apply to the GMC for assessment of their competencies.
Overseas doctors do not require CESR before moving to the UK to work in the NHS. Often, experienced psychiatrists will secure a post in the UK, and work towards CESR whilst in post. Typically, CESR is a preferred route towards specialist registration for overseas trained psychiatrists.
An overseas psychiatrists training may not have covered all the ground of the CCT curriculum, but they may be able to show competence in the missing area through experience in a fixed term Specialty Doctor, Specialty Grade, Associate Specialist, or Acting Consultant post in the NHS. In this case, overseas psychiatrists will likely complete the MRCPsych exams to gain GMC registration and start working in the NHS, before completing CESR.
Overseas doctors looking to join the Specialist Register are not required to have completed the Royal College postgraduate exams. In this case, MRCPsych is only a requirement for doctors looking to attain Specialist Registration via the CCT route.
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.
However, if CESR applicants have not successfully completed MRCPsych, they must provide alternative evidence that demonstrates equivalent knowledge to psychiatrists who have passed the 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 of the evidence presented.
This is not to be confused with the requirements for registering for a full licence to practice with the GMC – many overseas applicants choose to complete MRCPsych.
Specialist Registration is additional to full registration with the GMC and is therefore not required to practice as a psychiatrist in the UK.
You can read more about the full MRCPsych examination suite in our IMG Resources library.
Equivalence refers to 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:
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.
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 & 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
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.
Domain 1 – Knowledge, skills and performance
Qualifications
Assessments and appraisals
Logbooks, records of daily clinical practice and portfolios
Details of posts and duties (including both training and experience posts)
Research, publications and presentations
CPD and CME
Domain 2 – Safety and quality
Participation in audit, service improvement
Safety
Domain 3 - Communication, partnership and teamwork
Communication
Partnership and teamwork
Domain 4 – Maintaining trust
Acting with honesty and integrity
Relationships with patients
Additional areas of evidence
Topics Covered in the MRCPsych Exams
Paper A:
Paper B:
Organisation and delivery of psychiatric services
General adult psychiatry
Old age psychiatry
Psychotherapy
Child and adolescent psychiatry
Substance misuse/addictions
Forensic psychiatry
Learning disability
Research methods, statistics, critical review and evidence-based practice
Evaluation of performance
All these topics covered in the MRCPsych exams can be found in the Core Training in Psychiatry curriculum.
For more guidance on the different types of evidence, see the specialty specific guidance from the GMC for psychiatry.
Validating the evidence
Original documents which are on headed paper with a hospital stamp and original signatures do not need additional validation.
All photocopied evidence should contain a hospital stamp on every page of each document, the validator’s name (printed and in full), job title (printed and in full) and original signature.
All CESR applications are submitted online via GMC Online and if you have not already created an account, you can find a guide on how to do so here.
Electronic evidence is required for each of the different evidence sections of the CESR application. Once started, the online application remains open for 12 months, meaning that it can be used as a portfolio to gather evidence against each of the different sections.
Your electronic evidence can be in any of the following formats:
Formats outside of these are unlikely to be accepted.
The Online Application
You will be required to complete the following sections once you begin your application:
Additional Evidence
Once an Adviser on the Specialist Applications Team has reviewed your initial evidence, they will provide you with information on:
You’ll have up to 60 days to provide additional documentary evidence in support of your application (30 days if you’ve submitted a Review application).
For further information about the online application process, see the GMC’s User Guide.
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.
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.
It is important to note that you can apply for more senior psychiatry roles such as a specialty doctor (SAS), specialist grade or acting consultant without being on the Specialist Register.
Similarly, overseas doctors do not require CESR before moving to the UK to work in the NHS.
When compared to a trainee post, you will likely receive better pay and responsibilities that are more appropriate to your level of experience. While working in these positions, you can collect evidence of your competences, particularly those specific to the UK psychiatry curriculum.
Across the UK there are several NHS Trusts with well-established CESR programmes of support for psychiatrists who have taken up a fixed term post with the view to completing CESR.
These positions also facilitate a faster route to working in UK and attaining Specialist Registration when compared to making an application for CESR from overseas, which can take an additional amount of time.
Attaining Specialist Registration through the CESR pathway can be a long but very rewarding process. Look at our introduction to CESR for psychiatrists for a full overview.
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.
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A new role as Specialty Doctor in inpatient child and adolescent mental health service at a Trust rated \"Outstanding\" by the CQC has just opened for both UK based and overseas candidates. Based in a city just north of London the trust supports doctors looking to build experience before entering ST4 or to support with CESR applications.
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.
ELIGIBILITY FOR THE ROLE:
Non-EEA:
Discover an exceptional opportunity for a Specialist Doctor in General Adult Psychiatry at an NHS Trust in London. This dynamic role caters to overseas specialists aspiring to join the NHS, accepting applications from EEA-specialized candidates and experienced IMGs pursuing CESR.
As part of the highly diverse General Adult Psychiatry Department, you\'ll work in various mental health services, contributing to the well-being of over 800,000 individuals. The department functions as a cohesive team of doctors built on mutual respect and trust. It offers a comprehensive range of services, including adult mental health, crisis resolution, home treatment teams, community integrated mental health teams, eating disorders, liaison psychiatry, personality disorder services, and psychological therapies.
There will be a CESR support, Section 12, and AC are provided, fostering career development. Enjoy a vibrant life in London, while advancing your career in this exceptional NHS job opportunity.
ARE YOU ELIGIBLE FOR THIS ROLE?
EEA Candidates:
Experience of working in General Adult Psychiatry (essential)
Non-EEA Candidates:
MRCPsych or PLAB (essential)
Experience of working for General Adult Psychiatry (essential)
UK based applicants
Experience of working in General Adult Psychiatry(essential)
An excellent job opportunity for either experienced Specialist grade (Associate Specialists) or Consultants in General Adult Psychiatry working in the community across five boroughs of Greater Manchester. The Trust\'s vision is for a happier and more hopeful life for everyone in their communities and their staff work hard to deliver the very best care for the people who use their services. They are really proud of their people, and continue to do everything they can to make sure that they are a great place to work.
The post is suitable for candidates holding specialisation in the EEA, or for experienced IMGs looking to complete CESR.
WHAT IS THE NHS FOUNDATION TRUST LIKE?
The NHS Foundation Trust serves a population of 1.3 million and their vision is a happier and more hopeful life for everyone in their communities. The Trust has more than 3,600 dedicated and skilled staff deliver care from 88 different locations in six boroughs. The Trust\'s mental health teams provide care and treatment for people with mild to moderate conditions such as depression, anxiety or dementia, or more serious mental health illnesses such as schizophrenia and bi-polar disorder. They run \"Healthy Minds\" (psychological therapies), drug and alcohol services, psychiatric intensive care, rehabilitation services, military veterans\' services and many more.
The Trust\'s learning disability services are for people with a moderate to profound level of learning disability, such as those with downs syndrome. The Trust has an updated strategy (2022-2025) that confirms their commitment to being a specialist mental health, learning disability and autism provider, while recognising the impact of the pandemic and the changes within the health and social care system.
WHAT IS THE DEPARTMENT & TEAM LIKE?
The service (generally for people aged 16 to 64) has been running since 2008, according to a model whereby their team of consultants are deployed as follows: three consultants work exclusively in the community and outpatient areas, one consultant works with the Early Intervention Service, two consultants cover the inpatient area and one works with our Home Treatment and A&E Liaison Team. Within this arrangement, the consultant appointed to this post will work with other sector consultants (East, West and South sector community outpatients).
WHAT IS LIFE LIKE IN THE REGION?
Situated in the east of Greater Manchester, between the City of Manchester and the Pennines National Park, the area offers a wonderful mixture of city and famously beautiful countryside. Manchester is one of the main cities of England, with all the benefits that brings including vibrant social and entertainment options in a vibrant city centre. The region enjoys excellent transport connections both international through the airport and local, via the M62, and M60 motorways and the Metrolink tram system. Approximately 22.5% of the population are from ethnic minority groups.
WHAT OPPORTUNITIES ARE AVAILABLE TO YOU?
If you are a new consultant you will receive mentoring and support from medical leads as well as access to a large peer group of enthusiastic and high-caliber Consultants.
ARE YOU ELIGIBLE FOR THIS ROLE?
EEA Candidates:
Non-EEA Candidates:
UK based applicants
This is a great opportunity for any experienced General Adult Psychiatrists and including those working towards CESR or specialist registration in the UK.
The NHS Foundation Trust is currently looking for a Specialist in Inpatient Adult Psychiatry. This is an outstanding opportunity for experienced Consultants Psychiatrists, Associate Specialist (Specialist Grade) and Specialty Doctors who is looking to work toward Specialist Registration through the CESR pathway.
The post is suitable for candidates holding specialisation in the EEA, or for experienced IMGs ideally with MRCPsych and overseas consultant or specialist experience looking to complete CESR.
WHAT IS THE NHS FOUNDATION TRUST LIKE?
The NHS Trust provides mental health services to all age ranges and supports people with a range of mental health problems whether they are mild, moderate or severe. The NHS Trust employs over 9,000 people who deliver support for the patient services. In addition to providing a wide range of patient services, we also contribute to training the next generation of nurses, doctors and therapists and conduct research that will help to advance clinical practice and treatments in the future.
WHAT IS THE DEPARTMENT & TEAM LIKE?
The Department is a 14 bedded ward which admits adults of working age. The district covers a largely rural area of 285 square miles with a population of approximately 114,000. There are 275 admissions per 100,000 adult population in Somerset. Over the last three years there was an average of 223 admissions per year with bed occupancy being lower than the national average. The majority of the patients admitted were given a diagnosis of a psychotic illness, followed by a mood disorder and then personality disorders.
The post holder will be part of the team which consists of a ward manager 0.5WTE, a deputy ward manager 1WTE, a trainee doctor 1.WTE, a medical secretary 0.4WTE, a ward administrator 1.0WTE, a ward psychologist 0.5WTE, three occupational therapists, 11 staff nurses, 17 health care assistants, and 6 service assistants.
The post holder will also be responsible for conducting Mental Health Act assessments for adults of working age admitted to the ward. Other Mental Health Act assessments for adults of working age in Mendip will fall to the community adult consultant psychiatrists. The post holder may be invited to contribute.
WHAT IS LIFE LIKE IN THE REGION?
Based in the South West, the trust is located between various areas of outstanding natural beauty and the idyllic rolling hills of Exmoor, featuring national hotspots for cycling, surfing, and climbing. There’s plenty to keep you occupied alongside the abundance of music festivals and local traditions.
WHAT OPPORTUNITIES ARE AVAILABLE TO YOU?
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.
If you are a new consultant you will receive mentoring and support from medical leads as well as access to a large peer group of enthusiastic and high-caliber Consultants.
ARE YOU ELIGIBLE FOR THIS ROLE?
UK based candidates:
An excellent job opportunity for either experienced Specialist grade (Associate Specialists) or Consultants in Learning Disability Psychiatry that continuously provide high quality mental health and learning disability services, both inpatient and in the community across five boroughs of Greater Manchester. The Trust\'s vision is for a happier and more hopeful life for everyone in their communities and their staff work hard to deliver the very best care for the people who use their services. They are really proud of their people, and continue to do everything they can to make sure that they are a great place to work.
The post is suitable for candidates holding specialisation in the EEA, or for experienced IMGs looking to complete CESR.
WHAT IS THE NHS FOUNDATION TRUST LIKE?
The NHS Foundation Trust serves a population of 1.3 million and their vision is a happier and more hopeful life for everyone in their communities. The Trust has more than 3,600 dedicated and skilled staff deliver care from 88 different locations in six boroughs. The Trust\'s mental health teams provide care and treatment for people with mild to moderate conditions such as depression, anxiety or dementia, or more serious mental health illnesses such as schizophrenia and bi-polar disorder. They run \"Healthy Minds\" (psychological therapies), drug and alcohol services, psychiatric intensive care, rehabilitation services, military veterans\' services and many more.
The NHS Foundation Trust aims to deliver mental health through services based in each Borough and in conjunction with local Commissioners and local social service departments. The Trust\'s learning disability services are for people with a moderate to profound level of learning disability, such as those with downs syndrome. The Trust has an updated strategy (2022-2025) that confirms their commitment to being a specialist mental health, learning disability and autism provider, while recognising the impact of the pandemic and the changes within the health and social care system.
The Trust made the list of the top 120 best places to work in 2015, as compiled by HSJ and Nursing Times, in association with NHS Employers. 5 The list is a celebration of NHS organisations that have worked hard to promote great staff engagement and create an environment where people can enjoy their work. The Trust is accredited with a ‘two ticks’ symbol to ensure that people with disabilities are afforded equal opportunity to enter employment and progress if and where possible.
WHAT IS THE DEPARTMENT & TEAM LIKE?
The Department is a team of kind, fair & determined doctors. In the context of a Specialist Community Learning Disability service model these values translate into principles which drive their vision and work. The team is committed to building upon the evidence base which informs the delivery of safe, caring, responsive and well led services. Their network of teams benefit from sharing learning from quality initiatives, research, compliments, complaints and incidents which in turn drive locality developments and the plans they share. Their service model will be supported by Quality Improvement forums and Research and Innovation hubs, these groups will work across disciplines, organisations and geographical boundaries.
The service model provides a platform from which their multi-disciplinary teams deliver a broad spectrum of pathways. Each pathway is flexed to meet the individual needs, skills and circumstances of the client. A client’s pathway may vary in the range of reasons for involvement, the setting of the intervention, the approach taken, even the number of disciplines involved. The population of Oldham is around 238,722, with a growth projected increase to 246,645 by 2025 (2.18%). At present, around 5156 people, within the borough of Bury, have a known learning disability, with the five year forecast showing this to increase to 5536 by mid-2025.
The post holder will provide psychiatric input to adults with learning disabilities of 18 years and older within the area. The post holder will be a key member of the team and will have access to clinical space at the clinic. It is also expected that psychiatric assessment, advice and liaison will be given in a variety of community locations. For example: The post holder is expected to carry out assessments of complex cases and support development of multi-disciplinary management plans.
WHAT IS LIFE LIKE IN THE REGION?
Oldham is a town with considerable geographical, cultural and ethnic diversity, situated in the northeast part of Greater Manchester, between the City of Manchester and the Pennines. The town enjoys excellent transport connections via the M62, and M60 motorways and the Metrolink tram system. The population of Oldham Borough is 227,312, of whom 62.1% are aged between 16 and 64 (OMBC 2013 mid-year estimate). Approximately 22.5% of the population are from ethnic minority groups.
WHAT OPPORTUNITIES ARE AVAILABLE TO YOU?
If you are a new consultant you will receive mentoring and support from medical leads as well as access to a large peer group of enthusiastic and high-caliber Consultants.
ARE YOU ELIGIBLE FOR THIS ROLE?
EEA Candidates:
Non-EEA Candidates:
UK based applicants
This is a great opportunity for any experienced General Adult Psychiatrists working towards CESR or specialist registration in the UK, whilst working as a specialty doctor in the NHS.