Specialist Registration - CCT vs CESR vs CESR-CP
- November 22, 2021
Here we take a closer look at the routes available to overseas consultants & experienced doctors who wish to join the GMC’s Specialist Register.
IMGs from any country in the world can apply for Specialist Registration, provided certain eligibility criteria are met, though there are different routes available based on a doctor’s qualifications and training.
To shed some light on the routes to Specialist Registration, we've put together a short article to explain further, including the following topics:
- What is Specialist Registration?
- What are the different types of Specialist Registration?
- Am I eligible?
- How do I apply for Specialist Registration and what evidence will I need?
- What are the benefits of Specialist Registration?
- Are other senior NHS posts available without Specialist Registration?
- How much does Specialist Registration cost?
- #IMG Tips
Skip ahead to the relevant section if you know what you’re looking for.
Specialist Registration
All doctors who wish to work as permanent consultants in the UK must show evidence of skills, knowledge and experience in order to apply for Specialist Registration. This registration in any specialty means you can be appointed to a substantive consultant post within the NHS.
Specialist Registration is additional to full registration with the GMC.
The 3 Types of Specialist Registration
There are three types of certificates issued by the GMC, and the type of certificate you will receive at the end of your training defines which training route you are on.
The Certificate of Completion of Training (CCT)
The CCT is the route to specialist registration for doctors who have completed a GMC-approved, specialty training programme through the relevant Royal College.
To be eligible for CCT, an applicant’s entire training (including any core years) must have taken place within UK-approved training posts. Please see our blog on career pathways for a UK doctor in training.
The Certificate of Eligibility for Specialist Registration - Combined Programme (CESR (CP))
CESR(CP) is a simplified route 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.
Doctors on the CESR(CP) route count a combination of approved training and previous experience in non-approved posts (overseas) towards their training time.
The Certificate of Eligibility for Specialist Registration (CESR)
CESR is the route to specialist registration for doctors who have not completed a GMC-approved specialty training programme – doctors who have trained outside of the UK, Switzerland, and the EEA.
These doctors apply directly to the GMC to demonstrate that their specialist training, qualifications, skills, knowledge and experience are equivalent to the requirements for CCT in the UK.
Doctors who have completed their specialist training in the EEA or Switzerland are eligible for direct entry onto the Specialist Register through their Relevant European Qualification (REQ).
For an in-depth guide to CESR, take a look at our blog for overseas doctors here.
Eligibility
Eligibility for Specialist Registration depends on your nationality, qualification and experience.
To meet the minimum eligibility requirements to apply you must have either:
A specialist qualification in the specialty you’re applying in
OR
At least six months continuous specialist training in the specialty you’re applying in
You’ll need to provide evidence of how you’re eligible as part of your application. This could be a copy of your qualification or evidence of your employment.
In your application you must show that you meet the requirements of the CCT curriculum in your specialty.
The CESR certificate is awarded only on the written evidence provided by the applicant. It is not granted on the basis of references or experience.
Applications and Evidence for Specialist Registration
CCT and CESR-CP
Once you have been issued with your Outcome 6 has been issued, you must complete and return the relevant CCT/ CESR(CP) notification to your Royal College along with the following documents:
- Copies of any ARCPs that are not on your ePortfolio
- ARCPS/evidence of successful progression for any LAT/FTTA/SHO posts counting towards your training (this applies to doctors who were appointed above ST1 only)
You will also need to complete an online GMC form. The link to this form will be emailed to you by the GMC and you should contact your Royal College if you do not receive it.
The GMC has created a guide for each CCT specialty with the relevant royal college or faculty. You can see this here.
CESR
You will need to apply to the GMC, who will then send your application to the Royal College for evaluation. The application process for CESR can be lengthy and potentially stressful, so it is important that you read the GMC’s general guidance and specialty-specific guidance before starting to put together an application.
You will need to provide a portfolio of evidence demonstrating that your specialist training or qualifications are equivalent to the award of a CCT in your specialism in the UK. This information is available for each specialty and Royal College on the GMC website here.
If you apply for an NHS post which provides CESR support, your hospital should assist you in this process.
Once the GMC has sent you a letter informing you that your application is complete and has been sent to your Royal College for assessment, the College is not permitted to discuss your case with you until the GMC has sent you a letter informing you of the decision.
Benefits of Specialist Registration
Specialist registration allows doctors to take up permanent or substantive consultant positions. Without CCT, CESR or CESR-CP, a doctor may only take a Trust locum or fixed-term consultant posts.
Fixed-term and locum posts offer of course offer less stability than permanent consultant posts and require extension.
It is a legal requirement before taking a substantive, honorary or permanent NHS consultant post in the UK that doctors have their names entered on the GMC's Specialist Register.
Senior Positions in the NHS
It is important to note that you can apply for more senior roles such as a specialty doctor (SAS), specialist grade or a locum consultant (locum consultants are not required to be on the Specialist Register).
This way, you will have better pay and roles and responsibilities that are more appropriate to your level of experience compared to a trainee. While working in these jobs you can collect evidence of your competences.
These positions also facilitate a faster route to the UK than the CESR route, which can take a substantial amount of time.
Cost
All doctors applying for Specialist Registration must pay a fee. The fees for 2021 are as follows:
#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.
- 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 curriculum, not just your sub-specialty.
- Remember to refer to the relevant CCT Curriculum and Specialty Specific Guidance for the evidence requirements in your specialty.
- Ask an IMG Connect recruitment specialist about NHS posts with CESR support, these are not always advertised by a Trust, but we can help you to find a role which aligns well with your career goals in the NHS.
Most IMGs likely haven’t completed a UK-approved training programme, but you could be eligible for Specialist Registration with the GMC via the CESR or CESR-CP route. Take a look at our in-depth CESR overview 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 fantastic opportunity awaits Histopathologists seeking a fixed-term position. This Pathology Services provides support for CESR accreditation and facilitates entry into specialty training within the NHS. The department is both high-performing and supportive, particularly welcoming overseas doctors new to the NHS or UK-based doctors seeking career advancement. They deliver pathology services to their acute hospitals and local GPs, with some laboratories offering specialized services to the wider NHS and engaging in research studies. Serving 1.76 million patients and conducting 60 million tests, the partnership has resulted in 27,000 additional community phlebotomy appointments, improved turnaround times, and streamlined workflows.
The Pathology Service thrive on a dedicated workforce leveraging cutting-edge technologies, delivering exceptional clinical services centered on patient care.
What is the Pathology Service like?
The Pathology Services comprises four pathology laboratories. These laboratories are responsible for providing pathology services to both acute hospitals and local general practitioners. Additionally, certain laboratories within the network offer specialized services to the broader NHS and engage in research studies and trials. As part of a significant initiative within the NHS, pathology services in England are undergoing reorganization, transitioning into larger local network models. This restructuring has led to the establishment of 29 pathology units nationwide.
This development positions the pathology service as an exceptionally appealing workplace, situated at the forefront of NHS innovation and digitalization in pathology. Despite these advancements, this pathology service remains committed to delivering the latest tests and services, incorporating cutting-edge clinical science into modern patient care. Currently, they manage approximately 120,000 cases with a team of 36 consultants (augmented by some outsourcing), with the capacity to expand its consultant team to 40 full-time positions.
What is the department & team like?
The Pathology Service was established following the Lord Carter review of Pathology services in England, aiming to reduce overtesting, enhance resilience, and lower costs. amalgamates staff, services, and IT platforms from four trusts to enhance pathology quality in the Black Country, serving 1.4 million individuals and conducting 60 million tests annually. It underwent a comprehensive IT system overhaul to facilitate integrated services, embrace new technologies, and expedite laboratory results.
The pathology service operates three laboratories offering nationally accredited consultant-led pathology services. With state-of-the-art facilities and IT systems, they garnered commendation from Lord Carter for its efficiency and innovation in pathology. Notably, innovations showcased during Lord Carter\'s visit in 2021 included pre-barcoded tubes for sample tracking and digital automation in microbiology labs.
Lord Carter praised the service as a model of service integration and technological advancement, emphasizing the importance of technology, including artificial intelligence, in expediting diagnostics. He commended the leadership and dedication of the staff, highlighting their achievements and commitment to patient care. The evidence is there to be seen, as latest figures show they scored 92 per cent compliance on a dashboard provided by NHS Improvement, ranking it one of the best performing services in the country
Career Development & Opportunities Available
Career development opportunities are aplenty. The Centre is one of the highest performing centres in the UK, with excellent CQC scores, a fantastic leadership team, and highly advanced specialist reporting functions. All of this provides an excellent platform for anyone to excel and develop, whether it\'s a step towards specialisation in one anatomical area, or whether it\'s advancing yourself in the world of digital pathology, the right individual can really flourish here.
Digital Pathology and AI is a massive part of what the Group are doing, and part of what makes this opportunity so exciting. Working from home, working abroad, or taking on additional workload out of hours - digital pathology is taking off. They are the most advanced Digital Pathology Service in the UK, and this provides everyone with huge opportunity to grow and develop in a really exciting global field of pathology.
Life in the West Midlands
Based is a modern industrial city situated on the midlands. It is compact, with no boundary more than four miles from the centre and is approximately a 30-minute drive to Birmingham (15 miles), 1 hour 20 minutes to Manchester (60 miles). The city is an urban, multi-ethnic city with a population of around 250,000. The wider hospital catchment area has a population of in excess of 350,000. With more than 600 shops, bars, café and restaurants, the city is not only a great place to work but also somewhere to relax and enjoy. The city centre is just a 10-minute bus ride from the Hospital.
The nearby countryside of Staffordshire and Shropshire is delightful. To the north is Cannock Chase and to the west the Shropshire borders with attractions of Bridgnorth, the Clee Hills, the Long Mynd, Wenlock Edge, and the Severn Valley. South of Wolverhampton, the City of Worcester is easily accessible, and to the west north-Wales can be reached in just over an hour. The area has a large network of canals, the majority renovated, offering adjacent housing and popular for narrow boat holidays.
Am I eligible for this role?
To be eligible for this vacancy you will need the following:
EEA candidates:
- Recognised European Medical Degree
- Specialist Qualification in Histopathology
- IELTS or OET
Non-EEA candidates:
- FRCPath
- IELTS or OET
UK-based candidates:
- Within six months of CCT or CCT Holder
This is a great opportunity for any experienced histopathologist interested in specialisation, and with interest in digital pathology.
An excellent opportunity to join the dynamic team at an esteemed organization recognized for its excellence by the CQC. This is an opportune moment to become part of the Acute Medicine and Medicine Specialties Teams. With a strong history of achievements, they are committed to delivering exceptional patient-centered care. They are seeking dynamic and motivated specialists histopathologists to become part of their welcoming and enthusiastic gastroenterology team. This presents a chance to join a dedicated histopathology team committed to delivering the highest quality comprehensive service.
This is a great opportunity for overseas consultants or specialists who want to establish themselves in the NHS, and grow their consultant career. 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 stands as one of the nation\'s largest integrated healthcare organizations, delivering both hospital and community services to a populace exceeding 650,000 individuals. Renowned for their ambition and innovation, they boast a skilled workforce comprising over 7,000 dedicated colleagues. Operating across two acute sites for hospital services and encompassing centers and community hospitals in six towns for planned care, they extend their services even to patients\' residences.
Recognized as a high-performing entity with a history of accomplishments, the Trust has functioned as an integrated acute and community services provider since 2011 and achieved foundation trust status in 2007. Guided by their strategic framework \"Our Patients Matter,\" they articulate their short- and long-term objectives and delineate the path to their realization. This framework underscores their commitment to providing the safest, most compassionate, and seamlessly coordinated care to the communities they serve.
Within this NHS Foundation Trust, medical professionals are presented with a plethora of career prospects and exposure to diverse care settings rarely encountered elsewhere. Additionally, they have the opportunity to reside and practice in some of the most culturally rich and picturesque locations across the country!
What is the Department & Team like?
The Histopathology department is dedicated to delivering precise diagnostic services crucial for patient care. Led by a team of experienced consultants and supported by junior doctors and skilled laboratory personnel, the department handles a wide array of cases across various medical disciplines. This includes examining tissue specimens for cancer diagnosis, assessing surgical margins, and identifying infectious diseases.
Equipped with advanced technology and instrumentation such as microscopes, tissue processing equipment, and digital imaging systems, the department ensures accurate diagnosis. The team collaborates closely with other departments like surgery, oncology, and radiology to ensure seamless patient care.
The department processes a significant volume of histopathology and cytology cases, providing essential information to clinicians for treatment planning and patient management. Committed to excellence and precision, the Histopathology team plays a pivotal role in delivering top-notch healthcare to the community.
What is life like in the area?
The North East of the UK offers a diverse mix of rural and urban settings, providing doctors with a range of living options. Residents can explore stunning coastal areas like Northumberland\'s beaches or venture inland to scenic national parks such as the North Pennines. The region is home to respected schools and universities, including Newcastle University. Transportation links are robust, with efficient road and rail networks connecting residents to major cities like Newcastle, Durham, and Sunderland, as well as international airports. Housing options range from quaint cottages in picturesque villages to modern apartments in vibrant city centers, catering to various lifestyles.
ARE YOU ELIGIBLE FOR THIS ROLE?
EEA Candidates:
- Experience of working in Histopathology
- Specialist Qualification in Histopathology
Non-EEA Candidates:
- FRCPath
- Experience of working in Histopathology
UK based applicants
- Experience of working in Histopathology
An exciting opportunity for a Consultant Breast Radiologist with expertise in breast and general radiology to work for a health board that aims to provide the best services to their patients. Ideal for overseas consultants looking to establish themselves in the NHS. The health board serves a population of 384,000 in several towns. They aim to improve healthcare by collaborating with local government and the third sector.
You will be a part of the Breast Radiology Department, which is a vital part of the healthcare service in the area, providing comprehensive diagnostic and interventional breast radiology services. Their team includes experienced consultants and junior doctors, ensuring high-quality care. The facility is well-equipped, and the successful candidate will lead and enhance the department\'s services. You will have a lot of growth opportunities as the Health Board is involved in education and research, with strong links to other universities. They aim to engage emerging clinicians in addressing Prudent Health Cares. Their Clinical Research Facility and initiatives in BioBanking and telemonitoring demonstrate their commitment to research and advancement.
It is situated in a town that offers a tranquil lifestyle with access to scenic coastal areas. It is a blend of rural and urban living. The region features quality schools and links to the University of Wales Trinity Saint David. Transportation connections are strong, and housing options are diverse, catering to different preferences. It\'s a balanced location for professionals and families.
ARE YOU ELIGIBLE FOR THIS ROLE?
EEA Candidates:
- Experience of working in Radiology
- Board Certified Specialist in Radiology
Non-EEA Candidates:
- Experience of working in Radiology
- FRCR
UK based applicants
- Experience of working in Radiology
- Within 6 - 12 months of completing CCT
An excellentHealth Board is actively seeking a Consultant Interventional Radiologist to join their innovative team. The role involves enhancing radiological services across the Health Board, reflecting their commitment to exceptional patient care. This opportunity is well-suited for overseas Consultants looking to establish themselves in the NHS or experienced IMGs seeking to complete CESR requirements.
The Health Board caters to 384,000 residents across several towns, delivering a wide spectrum of healthcare services. Their dedication to patient well-being includes a focus on continuous improvement, achieved through collaboration with local government and the third sector. The Health Board actively promotes education and research, fostering multi-profession teaching and supporting the development of up-and-coming clinicians. Their Clinical Research Facility and initiatives like BioBanking and telemonitoring reflect their commitment to advancing healthcare.
The Interventional Radiology Department is well-equipped and managed by experienced consultants and junior doctors. They provide comprehensive care, specializing in minimally invasive treatments for various conditions. Their advanced imaging technology ensures accurate diagnoses, and they handle a significant caseload of interventional radiology cases.
The hospital sits within a town that offers a balanced lifestyle with both urban conveniences and access to scenic rural areas. The region is known for its beautiful landscapes, high-quality schools, and strong transportation links to major cities and airports. Housing options are diverse, accommodating various preferences. This opportunity presents a holistic and enriching professional and personal life for healthcare professionals.
ARE YOU ELIGIBLE FOR THIS ROLE?
EEA Candidates:
- Experience of working in Radiology
- Board Certified Specialist in Radiology
Non-EEA Candidates:
- Experience of working in Radiology
- FRCR
UK based applicants
- Experience of working in Radiology
- Within 6 - 12 months of completing CCT
This is a good opportunity for any FRCPath or European-qualified histopathologists to join a friendly, high calibre department in the North East of England. The department are looking for experienced but hungry histopathologists to join them for a long-term post, and the trust will support candidates working on the Portfolio Pathway in Histopathology (formerly known as CESR). The trust will consider both UK and overseas applicants.
What is the NHS Foundation Trust like?
The NHS Foundation Trust serves as a district general hospital, providing essential healthcare services to the local population. Under its management, various healthcare facilities in the region. Consistent positive evaluations from the Care Quality Commission (CQC) underscore its commitment to delivering high-quality patient care, safety, and efficiency. The catchment area of this trust encompasses the north east, ensuring residents have access to comprehensive healthcare close to home. Through its services, the trust plays a vital role in promoting community health and well-being, contributing to a stronger, healthier population.
What is the department & team like?
The department have been centralized at a state-of-the-art Pathology Centre located at the NHS Foundation Trust\'s main hospital. These services cater to the local population in the North East. The consolidation of Cellular Pathology Services, completed in 2014, marks an innovative reorganization in pathology services. Satellite hot lab facilities are available at the NHS Foundation Trust\'s other sites. The NHS Foundation Trust leads this service, and the appointed individual will be contracted.
Pathologists are equipped with high-quality IT infrastructure to facilitate remote attendance at Multidisciplinary Team Meetings (MDTs). In cases where physical presence is required, a departmental electric car or a hopper service is available for transportation. Digital pathology implementation is underway progressively for pathologists interested in participation.
Career Development & Further Opportunities Available
The department will in time be moving towards a specialist reporting model and there will be opportunity to carve out your lead role in either the GI, head & neck, and urology sub-specialties.Life in North East
The North East of England offers a diverse mix of rural landscapes and urban centers, providing doctors with a range of living options. Residents can explore historic sites like Hadrian\'s Wall or enjoy scenic walks along the Northumberland coast. The area boasts reputable schools and universities such as Durham University. Transportation links are efficient, connecting the region to major cities like Newcastle and Sunderland, as well as airports for convenient travel. Housing options vary from picturesque villages to modern city apartments, accommodating different preferences and lifestyles.
AM I ELIGIBLE FOR THIS ROLE?
Non-EEA candidates:
- FRCPath
- Experience in Histopathology
EEA candidates:
- Specialist certification in Histopathology
- Experience in Histopathology
UK candidates:
- CCT, CESR or within 6-12 months of specialist registration
- Experience in Histopathology