CESR Applications for Clinical and Radiation Oncologists
- December 09, 2022
This article delves into the specific guidance on GMC applications for entry onto the UK Specialist Register through the Certificate of Eligibility for Specialist Registration (CESR) for clinical oncologists.
We’ll cover the eligibility criteria, application process, and most importantly the required evidence, along with some other topics, summarised in the headings below:
- What is CESR and who is it for?
- Do overseas oncologists need FRCR (Oncology) for CESR?
- What is the CESR equivalence process?
- What evidence is required for a CESR in clinical oncology?
- Where will I find this evidence?
- How do I submit a CESR application?
- How long does it take to complete?
- How much does CESR cost?
- How long does it take to receive a decision?
- Do I have to complete CESR before I can work in the UK?
- #IMG Tips
Skip ahead to the relevant section if you know what you’re looking for.
An Introduction to CESR
CESR, or the Certificate of Eligibility for Specialist Registration, is the route to specialist registration for doctors who have not completed a GMC-approved training programme, but can demonstrate that their specialist training, qualifications and experience are equivalent to the requirements for the award of the CCT in the UK.
CESR holders can be appointed to substantive (or permanent) consultant positions in the NHS. As a clinical or radiation oncologist, attaining specialist registration will mean you are qualified to practice independently as a consultant in the NHS.
Oncologists must prove to the GMC that their specialist training or specialist qualifications, when considered together, are equivalent to a CCT in the specialty in question.
In order to be eligible for CESR, doctors should have undertaken a minimum of 6 months training or obtained a specialist qualification and acquired specialist experience or knowledge as a clinical oncologist within a non-training post.
Overseas doctors do not require CESR before moving to the UK to work in the NHS. Often, experienced oncologists will secure a post in the UK, and work towards CESR whilst in post.
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 is the FRCR 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 the evidence presented.
You can read more about the evidence required in the specialty specific guidance here.
The CESR Equivalence Process
Equivalence refers to 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:
- training and/or competence; AND
- skills and knowledge
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.
Gathering Evidence for a CESR Application
Domain 1 – Knowledge, skills and performance
Qualifications
- Primary Medical Qualification (PMQ)
- Specialist medical qualification(s)
- Curriculum or syllabus (if undertaken outside the UK)
- Specialist registration outside the UK
- Honours and prizes
- Other relevant qualifications
Assessments and appraisals
- Appraisals and assessments
- RITAs, ARCPs and training assessments
- 360˚ and multi-source feedback
- Awards and discretionary points letters
- Personal development plans (PDP)
Logbooks, records of daily clinical practice and portfolios
- Logbooks
- Consolidation, cumulative data sheets, summary lists and annual caseload statistics
- Medical reports
- Case histories
- Referral letters discussing patient handling
- Patient lists
- Departmental (or trust) workload statistics and annual caseload statistics
- Rotas, timetables and job plans
- Courses relevant to curriculum
- Portfolios (electronic or revalidation)
Details of posts and duties (including both training and experience posts)
- Employment letters and contracts of employment
- Job descriptions
- Job plans
Research, publications and presentations
- Research papers, grants, patent designs
- Publications within specialty field
- Presentations, poster presentations
CPD and CME
- CPD record certificates, certificates of attendance, workshops and at local, national and international meetings or conferences
- CPD registration points from UK Medical Royal College (or equivalent body overseas)
- Membership of professional bodies and organisations
- Teaching timetables
- Lectures
- Feedback or evaluation forms from those taught
- Letters from colleagues
- Attendance at teaching or appraisal courses
- Participation in assessment or appraisal and appointments processes
Domain 2 – Safety and quality
Participation in audit, service improvement
- Audits undertaken by applicant
- Reflective diaries
- Service improvement and clinical governance meetings
Safety
- Health and safety
Domains 3 - Communication, partnership and teamwork
Communication
- Colleagues
- Patients
Partnership and teamwork
- Working in multidisciplinary teams
- Management and leadership experience
- Chairing meetings and leading projects
Domain 4 – Maintaining trust
Acting with honesty and integrity
- Honest and integrity
- Equality and human rights (including disability, human rights, race, religion and ethnicity awareness and equal opportunities)
- Data protection
Relationships with patients
- Testimonials and letters from colleagues
- Thank you letters, cards from colleagues and patients
- Complaints and responses to complaints
For more guidance on the different types of evidence, see the specialty specific guidance from the GMC for clinical oncology.
Validating 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.
Application Submission
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:
- .doc
- .ppt
- .xls
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:
- Specialty details
- Qualification details and professional experience
- Details of your referees
- Registration and licensing history
- Evidence summary
- Details of your verifiers
- Final declaration and payment
Additional Evidence
Once an Adviser on the Specialist Applications Team has reviewed your initial evidence, they will provide you with information on:
- What evidence they’ve accepted
- What evidence they’re unable to accept (including the reasons for this)
- Advice and guidance on how your application could be strengthened
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.
How long does it take to complete?
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 (not including Foundation Training), 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 clinical or radiation oncologists.
Cost of CESR Applications
All oncologists applying for Specialist Registration must pay a fee. For CESR, this fee is £1,727.
For CESR-CP and CCT, the cost is £452.
How long does it take to receive a decision?
The GMC estimate that it can take between six and eight months to receive a decision, from the date you submit your CESR application.
Clinical Oncology Jobs in the NHS without CESR
Overseas doctors do not require CESR to work in the UK.
There are also roles for more senior oncologists such as a specialty doctor (SAS), specialist grade or acting consultant, where you will likely receive better pay and responsibilities that are more appropriate to your level of experience. While working in these positions, you can also collect evidence of your competences, particularly those specific to the UK clinical oncology curriculum.
Across the UK there are several NHS Trusts with well-established CESR programmes of support for oncology 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, depending on the country in which you completed your training.
#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 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 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.jrcptb.org.uk/certificate-eligibility-specialist-registration
https://www.gmc-uk.org/-/media/documents/sat---ssg---clinical-oncology---dc3556_pdf-48456770.pdf
https://www.rcr.ac.uk/sites/default/files/clinical_oncology_curriculum_2021.pdf
Getting started
Many senior IMG oncologists looking to develop their careers through Specialist Registration with the GMC may be eligible via the CESR route, and attaining CESR can be a long but very rewarding process. Look at our introduction to CESR for clinical oncologists 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.
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 leading NHS cancer center in Manchester is looking for a Consultant Clinical Oncologist specializing in Breast Oncology with an interest in advanced radiotherapy treatments in particular. Candidates can work as either a clinical or radiation oncologist. The Clinical Oncology Breast Disease Group comprises a team of 10 consultants, supported by a multidisciplinary team of nurse clinicians, clinical fellows, specialist trainees, pharmacists, and research nurses. This role is open to both international and UK-based doctors, though those with GMC Specialist Registration or FRCR qualifications 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
Whilst specialist registration is not required, it is a preferred status for those interested in staying longer term given the opportunity to turn the post into a substantive role. Whatever the qualifications or registration type, candidates should have significant experience in the provision of radiotherapy for breast oncology patients. The salary will range from £105k to £139k per annum, dependent on experience.
CORE DUTIES OF THIS ROLE
- Deliver comprehensive clinical services for Breast Oncology patients, including radiotherapy and systemic therapies.
- Participate actively in multidisciplinary team meetings, including remote attendance of the North Manchester General Hospital MDT.
- Contribute to the team’s robust research portfolio, including advanced radiotherapy and systemic therapy trials.
- Participate in the department’s on-call rota, with a 1:20 frequency, covering patient consultations and reviews.
LIFE IN MANCHESTER
Manchester, a thriving city in the North West of England, offers a mix of urban vibrancy and nearby rural tranquility. Popular areas include the city center for urban living and the nearby Cheshire countryside for more relaxed, family-oriented lifestyles. The region boasts excellent schools, extensive transport links including Manchester International Airport, and a wealth of cultural, sporting, and leisure activities. Manchester\'s industrial heritage has shaped the city into a hub of innovation and culture, renowned globally for its contributions to music, sports, and science.
Anyone requiring portfolio support (formally known as CESR) can have their required support discussed on a case by case basis.
JOB REQUIREMENTS AND DETAILS
Full GMC registration and a license to practice with experience in Radiotherapy and chemotherapy are required for this role, and anyone with an interest in Gynaecology and Upper GI Oncology should apply. The salary will be between £88,364 and £119,133 dependent on experience or grade.
CORE DUTIES OF THIS ROLE
- Provide a comprehensive Oncology service and expertise in the management of site specialist cancer services.
- Collaborate with the multidisciplinary teams to develop and support Oncology services.
- Supervise and manage junior medical staff, including supporting the service during colleagues\' leave.
- Undertake teaching, clinical audit, and research, contributing to local and national postgraduate education.
LIFE IN THE NORTH WEST
The hospital is based in the North West of England, with the closest urban areas offering a range of living options from city life to more rural surroundings.
The region boasts excellent schools and transport links, with trains connecting to major UK cities, and plenty of leisure activities for adults and families, including access to outdoor activities and historic landmarks.
The North West has significant historical importance and features stunning landscapes, making it a desirable location to live and work.
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
We are currently looking for an experienced Clinical Oncologist, who works with both chemotherapy and radiotherapy treatments for a large acute hospital in the Midlands, England.
You\'d be joining a team of 8 clinical and 2 medical oncology consultants at the modern Oncology Centre (opened in mid 2010\'s), to help support and develop site-specific services in outpatient and chemotherapy as part of the development of the centre.
There are 3 Elekta LINACS with VMAT and IGRT, using Mosaiq and Raystation for RT planning on site, along with 35 chemo day chairs used across 3 hospitals under this NHS trust.
JOB REQUIREMENTS:
- FRCR Clinical Oncology or equivalent
- Excellent english language skills
- Extensive experience as a consultant oncologist (UK or overseas experience)
LENGTH OF CONTRACT:
12 - 24 months fixed term (subject to be renewed)
Benefits:
- Attractive salary and relocation package
- Training and development opportunities
- CESR support for those eligible
- Tier 2 Health and Care Visa (sponsorship for the whole family)
- Guidance regarding the CV and full interview preparation
- Assistance regarding the GMC registration, visa, accommodation and transportation by an experienced onboarding specialist
- Complete IMG Relocation service from start to finish of process
GRADE:
Locum Consultant
Specialty & Special Interests:
Clinical Oncology with primary interest in Gynaecological and Upper GI cancers
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