From the 30th of November 2023, the UK’s General Medical Council will introduce significant changes to the application process for Specialist Registration, namely CESR (Certificate of Eligibility for Specialist Registration) and CEGPR (Certificate of Eligibility for GP Registration). These changes focus on the evidence required in creating an application for Specialist Registration.
What are the new changes to the CESR and CEGPR process?
Doctors who are applying for Specialist or GP Registration will now need to demonstrate that their knowledge, skills, and experience align with the high-level learning outcomes of the GMC-approved UK curriculum in the relevant specialty. These generic professional capabilities will be incorporated into specialty curricula and will therefore be equally demonstrated by UK trainees at the end of their approved training.
Why are these changes being made?
The current system for CESR and CEGPR applications requires the mapping of evidence to the detailed CCT (Certificate of Completion of Training) curriculum in a specific specialty. The goal of this change is to ensure that doctors have a comprehensive understanding of the core competencies needed to practice effectively in their chosen specialty, whilst allowing the GMC the flexibility to accept a wider range of evidence.
This change is significant because it shifts the focus from a narrow and specific curriculum to a broader and more comprehensive approach. By aligning with the high-level learning outcomes, doctors will be better equipped to provide quality care and meet the evolving needs of patients.
What will the new system be called?
The GMC has confirmed that both the CESR and CEGPR will be known as ‘Portfolio Pathway’ from 30th November 2023. This will be a more appropriate name which aligns with the evidence of knowledge, skills and experience required for practising as an eligible Specialist or GP in the UK.
Sources
https://www.gmc-uk.org/registration-and-licensing/join-the-register/registration-applications/cesr-cegpr-application-process/changes-we-are-making-to-cesr-and-cegpr-applications
https://www.gmc-uk.org/registration-and-licensing/join-the-register/applying-for-specialist-or-gp-registration/changes-to-how-doctors-demonstrate-the-standard-required-for-specialist-and-gp-registration/what-is-changing
Connect with us
Get in touch with us to find out more about achieving CESR or CEGPR as an IMG and join our upcoming CESR workshop and webinars on the GMC registration process and working in the UK as a doctor.
Many junior doctors applying for Specialty Training in the UK will need to take the MSRA or Multi-Specialty Recruitment Assessment.
The MSRA plays an important role in the shortlisting and assessment process for entry into postgraduate training in several specialties for ST1 and CT1 level jobs, by assessing essential competencies.
In this blog, we will be taking a closer look at the assessment, focusing on some key questions summarised below:
Who needs to sit the MSRA?
How is the assessment formatted?
What is the structure of the MSRA?
Where can I take the MSRA and how much does the assessment cost?
How can I prepare for the assessment?
#IMG Tips
Skip ahead to the relevant section if you know what you’re looking for.
MSRA Specialties
At present, the MSRA is being used within the following specialties:
ACCS-Emergency Medicine
Anaesthetics
Child and Adolescent Psychiatry
Clinical Radiology
Community Sexual & Reproductive Healthcare
Core Psychiatry Training
Core Surgical Training
General Practice
Neurosurgery
Nuclear Medicine
Obstetrics and Gynaecology
Ophthalmology
Not every specialty uses the MSRA in the same way, however on the whole, candidates’ scores from the MSRA are used as part of CT and ST recruitment to shortlist for interviews and selection centres, as well as making up part of your overall ranking (with the rest coming from interviews selection centres).
For example in 2023, GP, CAMHS, and Core Psychiatry Training will not have any interviews or selection centres and 100% of your rank will be determined by your MSRA scores. Core Surgical Training will also be using the MSRA in shortlisting for the first time this year.
MSRA Format
The MSRA is a single computer-based exam comprising two papers: Professional Dilemmas (PD) and Clinical Problem Solving (CPS). As an exam used across many specialties for entry into Specialty Training, the MSRA assesses a foundation level of competence.
There is an optional five-minute break between the two papers. If candidates choose to take a longer break, the extra time will be subtracted from the time available to complete the CPS paper.
A combination of question types is used within the assessment, primarily extended matching questions (EMQ) and single best answer (SBA) questions, however the assessment may also include multiple best answer (MBA) questions: up to 3 correct answers, picture questions: may include skin lesions, blood reports, ECGs etc., and algorithm questions – drag boxes to the right part of the algorithm or select the correct answer from a list.
Structure of the MSRA
The MSRA last 170 minutes and is divided into two sections: Professional Dilemmas (PD) and Clinical Problem Solving (CPS).
Professional Dilemmas (PD)
The Professional Dilemmas (PD) paper is a Situational Judgement Test (SJT) which measures how a candidate’s judgement regarding challenging professional dilemmas they may face.
The PD paper is not a test of knowledge of problem-solving ability or knowledge specific to specialty training within any specialty, but aims to assess professional attributes which are considered important for successful progression through training and performance in one’s clinical role.
Time: 95 minutes
Number of questions: 50
Context: the PD component is set within the context of Foundation Training with the candidate assuming the role of an F2 doctor. There is also a mixture of settings such as a hospital (across a variety of wards or placements), general practice and out-of-hours clinics.
Core competencies: professional integrity, coping with pressure, empathy and sensitivity (you can find more information on the behavioural indicators linked to these competencies here).
Clinical Problem Solving (CPS)
The Clinical Problem Solving (CPS) paper assesses a candidate’s ability to apply clinical knowledge and make clinical decisions in everyday practice.
Again, the CPS scenarios are based on Foundation level clinical practice. They test a candidate’s ability to synthesise and apply medical knowledge (not just knowledge recall).
Questions may relate to the investigation, diagnosis or management of common and important diseases as well as rare presentations.
Time: 75 minutes
Number of questions: 86
Context: the CPS covers 12 clinical topic areas relevant to general medicine. Each test paper includes a balance of scenarios which cover all 12 topics, including:
Cardiovascular
Dermatology / ENT / Eyes
Endocrinology / Metabolic
Gastroenterology / Nutrition
Infectious disease / Haematology / Immunology / Allergies / Genetics
Musculoskeletal
Paediatrics
Pharmacology and therapeutics
Psychiatry / Neurology
Renal / Urology
Reproductive
Respiratory
Core competencies: investigation, diagnosis, emergency, prescribing, management (you can find more information on these domains here).
Exam Centres for the MSRA
The MSRA is held remotely and is delivered in partnership with Work Psychology Group and Pearson VUE. Candidates will need to register for an account with Pearson VUE and once invited, they can book an assessment at a centre, date and time of your choosing (subject to availability).
The MSRA is delivered globally on several consecutive days in many Pearson VUE Computer Testing Centres. You can find your nearest Pearson VUE assessment centre by visiting the Pearson VUE website.
The exam itself is free to sit, but depending on the centre you choose, there may be additional travel and accommodation costs. It’s therefore advisable to book your seat as soon as possible for the best chance of securing a nearby centre.
Preparation for the MSRA
On the whole, your previous (and current) experience working as a junior doctor will have prepared you for most of the questions and scenarios within the MSRA, although to different extents, depending on where you have gained your experience.
However, as your MSRA scores are often added to the interview score to determine overall rank, or even to exempt you from interview, it may be advantageous to attempt to score as highly as possible.
Blueprint: First and foremost, you should use the MSRA blueprint to better understand the target domains.
Sample questions: Sample questions for both papers are available on the Health Education England Medical Education Hub. You can access these here.
Commercial resources: Exam revision courses, books and online question banks are available, although these are not officially endorsed, and you can find some of the most popular providers below:
Medibuddy
Passtest
eMedica
Passmedicine
4,000 Question bank and mock tests
1,950 Question bank and mock tests
2,200 Question bank and mock tests
2,500 Question bank and mock tests
£30 - £50
£35 - £55
£49 - £119
£25 - £30
#IMG Tips
Start early – Once you have decided to sit the test, plan well in advance to give yourself enough time to prepare and score as highly as possible.
Take a test tutorial – You can take a practice test to familiarise yourself with the controls and screen layouts in advance – see Pearson VUE or Oriel for details.
Negative marking - One mark is given for each correct answer and negative marking is not used within the assessment, so try to answer all questions, even when unsure.
Read carefully - Read the instructions and questions carefully – you may often be looking for the most suitable answer, rather than the only correct one.
Sources
https://medical.hee.nhs.uk/medical-training-recruitment/medical-specialty-training/general-practice-gp/how-to-apply-for-gp-specialty-training/what_x0027_s-in-the-msra/structure-of-the-msra
https://medical.hee.nhs.uk/medical-training-recruitment/medical-specialty-training/general-practice-gp/how-to-apply-for-gp-specialty-training/taking-the-msra
https://www.bmj.com/careers/article/a-guide-to-the-multi-specialty-recruitment-assessment-msra-
https://heeoe.hee.nhs.uk/sites/default/files/msra_test_blueprint_information_nov_2019.pdf
The MSRA is a key examination for many IMGs developing their careers by entering Specialty Training. UK training programmes are very competitive and particularly for overseas doctors unfamiliar with the NHS system, taking the time for extensive preparation for the MSRA can greatly impact your chances of being successful in joining a training programme.
Read more useful articles on exams, NHS jobs and salaries in our IMG Resources library.
For regular news and updates, follow IMG Connect on social media using the links below:
Getting to grips with the different titles given to doctors in the UK can be difficult, not least because they may differ from those used in other countries and there may be several titles to describe a certain role.
It is important for overseas doctors to have a working knowledge of the different doctor titles in the UK in order to understand how their experience may translate to the UK in terms of seniority of roles as well as the pay they may be entitled to.
In this blog we will be breaking down all the different names given to UK doctors (both in and out of training), clarifying the meaning of these terms to paint a clearer picture of designations in the NHS.
We will cover these titles within the following groups:
Doctors in Training
Doctors in non-Training Jobs
Broad Terms for UK Doctors
Doctors in Training
Doctors in GMC-approved training programmes have designations according to the period and specific year of their training – generally the abbreviation of the training, followed by a number.
Foundation Training
Other Titles / Designations: F1, F2, FY1, FY2, F3+, SHO, Junior Doctor, Trainee
These are doctors in a Foundation Programme, having graduated from medical school. In the UK, this is a 2-year programme equivalent to an internship.
During Year 1 of Foundation Training, doctors are referred to as F1/ FY1 and during Year 2, they are F2/ FY2.
Although Foundation Training lasts two years, doctors who may be unsure of which specialty to pursue may work in non-training jobs before applying to a training post. The naming structure for these roles is the same, depending on the years in their role.
Core Training
Other Titles / Designations: CT1, CT2, CT3, ST1, ST2, ST3, SHO, Junior Doctor, Trainee
These are doctors in Core Training who are at the initial stage of an ‘uncoupled’ training programme. An uncoupled training programme is one in which there is a break in training where doctors are required to apply to higher specialty training upon completion of core training. Core training usually lasts from two to three years.
For ‘run-through’ training programmes, doctors at ST1 would have come from Foundation Training and have automatic entry into higher specialty training through their initial application to ST1.
Specialty Training
Other Titles / Designations: ST3+, StR, SHO, Junior Doctor, Trainee
Higher specialty training generally begins at ST3/ ST4 and can go up to ST9 depending on the specialty.
The curriculum for each specialty will provide the typical training period, however this is indicative (doctors may take longer than this to complete their specialty training for any number of reasons).
SHO
The term SHO stands for Senior House Officer, less commonly known as a House Officer. This is an older term for a very junior doctor, typically equivalent to an F1/ F2, although the term can be used to describe doctors up to CT2 (up to higher specialty training).
Trainee
The term trainee can refer to any doctor in a training programme (generally from CT1 to ST9). These doctors may be referred to as residents in other countries. This can but does not generally include doctors in Foundation Training.
Doctors in non-Training Jobs
Doctors in non-training positions are often given titles which align with their training counterparts, so it’s easier to understand at what level they are practising, but there are no hard and fast rules.
SHO
Other Titles / Designations: Junior Clinical Fellow, Junior Doctor, Middle Grade
As with doctors in training, a non-training SHO would typically be equivalent to an F1/ F2, but it may be more common for a doctor not in training to have this title since an equivalent doctor in training would most likely be referred to as an F1/ F2.
Senior Clinical Fellow
Other Titles / Designations: Junior Doctor
This is a slightly confusing term which is usually for doctors at ST3+ level and generally have not completed a UK training programme. The role of these doctors often includes a combination of research and specialist clinical work.
SAS Doctor
Other Titles / Designations: Senior Doctor, Specialist
SAS stands for Staff grade, Associate Specialist, and Specialty Doctor. These doctors will have at least four years of full-time postgraduate training, two of which have been in their relevant specialty.
They are experienced and senior doctors in fixed term or permanent posts (outside a UK training programme) and can work across primary, community and inpatient care.
Many SAS doctors have made a positive choice to step into a SAS position from a traditional consultant training pathway. This could be for reasons such as geographical stability or wanting to familiarise themselves with the NHS system before working up to a consultant position.
Broader Terms
There are also several terms which may more broadly be used to describe a doctor's level.
Junior Doctor
This term can be used to describe anyone from F1 up to ST9These are qualified doctors in clinical training.
Registrar
Other Titles / Designations: SpR, Junior Doctor, Middle Grade
This is another slightly older term. Registrar or SpR (Specialty Registrars) refers to the main training grade where doctors are undertaking higher specialty training (this is the earliest you can specialise).
It can refer to both trainees and non-trainees and is generally equivalent to ST3 and above (doctors who have completed their foundation training but are still in training in a specialty area of medicine). This term is therefore commonly used to describe more senior trainees and generally aligns with its use overseas.
Senior Doctor
Other Titles / Designations: Specialist Grade, Specialty Doctor, Associate Specialist, GP, Consultant
As ‘junior doctor’ and ‘senior doctor’ are indicative of whether or not a doctor is in training, senior doctors are those able to practise independently – those working as a consultant, SAS doctor or GP.
Consultant
Other Titles / Designations: Senior Doctor
Consultants are senior doctors that have completed full medical training in a specialised area of medicine. They usually work in hospitals or community settings. They have clinical responsibilities and administrative responsibilities in managing SAS and junior doctors.
There are two types of consultants:
Substantive - These are consultant who have been appointed to the Specialist Register for their area of medicine by the GMC. These doctors will either have completed a GMC-approved training programme (CCT) or completed an application for CESR or CESR-CP. You can learn more about Specialist Registration for overseas doctors here.
Locum - These are consultants who are appointed into an equivalent consultant post but are not required to be on the Specialist Register. Locum consultants are unable to take up a permanent position (only fixed term). A locum consultant’s work tends to be more clinical, however there may also be teaching and management responsibilities involved. It is also important to distinguish between two types of locums here: Trust Locums and Agency Locums. As the name suggests, agency locums work with a private agency and will generally receive an hourly wage. Trust locums on the other hand are appointed by the NHS Trust themselves and will be on a fixed-term contract which can be renewed.
GP
GP stands for General Practitioner, and these are doctors who are responsible for the primary care of patients, covering illnesses and ailments across many specialist areas.
GPs are fully trained and are allowed to practice independently without supervision and all qualified GPs are listed on the GMC’s GP Register.
Unlike is often the case in overseas healthcare systems, general practitioners are not synonymous with doctors specialising in general medicine, so a general practitioner overseas may not necessarily have the same title in the UK.
Locum Doctor
These are doctors who are covering a role within a healthcare setting.
All doctors (aside from F1 doctors) can work as locums. Like all practising physicians, locum doctors are fully registered with, and regulated by, the GMC.
Sources
https://www.bma.org.uk/advice-and-support/international-doctors/life-and-work-in-the-uk/toolkit-for-doctors-new-to-the-uk/doctors-titles-explained
Hopefully, this article goes some way to demystify these terms and titles for international doctors interested in working in the UK. For more information including working in the NHS, doctors' benefits and salaries and how to register with the GMC, take a look through our IMG Resources library.
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
.pdf
.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/registration-and-licensing/join-the-register/registration-applications/specialist-application-guides/specialist-registration-cesr-or-cegpr
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.
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 medical 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 MRCP for CESR?
What is the CESR equivalence process?
What evidence is required for a CESR in medical 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?
#IMG Tips
How do I get started?
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 medical 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 medical experience or knowledge as a medical 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.
MRCP for Specialist Registration
Whilst it is always beneficial to complete MRCP (UK), particularly for doctors who have trained outside the UK or the EEA, 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 Medical Oncology curriculum is the MRCP (UK) exams, so passing these exams confirms the attainment of the competencies of the core curriculum.
MRCP (UK) is only a requirement for doctors looking to attain Specialist Registration via the CCT or CESR-CP route.
The structure of medical oncology training in the UK is an indicative two years in Core Medical Training or Acute Care Common Stem (ACCS), followed by an indicative four years of training in Medical Oncology. Therefore, applicants need to demonstrate the appropriate level of acute medicine expertise as well as competencies in medical oncology.
You can read more about the evidence required in the specialty specific guidance here.
CESR Equivalence Process
Equivalence refers to the process of assessing an overseas applicant’s training and experience against the current medical 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 Physicians 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 Medical 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 Medical 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 & 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 medical 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
.pdf
.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 medical oncology 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 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.
#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 Medical Oncology curriculum, not just your sub-specialty.
Remember to refer to the most up-to-date Medical 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 MRCP aspirants and dedicated oncology recruiters.
In this group you will find tailored resources for oncology IMGs, including access to our MRCP crash courses, 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/registration-and-licensing/join-the-register/registration-applications/specialist-application-guides/specialist-registration-cesr-or-cegpr
https://www.gmc-uk.org/-/media/documents/sat---ssg---medical-oncology---dc2310_pdf-48455474.pdf
Getting started
Attaining Specialist Registration through the CESR pathway can be a long but very rewarding process. Look at our introduction to CESR for medical 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:
For international doctors looking to work in the UK, it is important to understand the salary you will be offered with your NHS job and how this can be different depending on the country you are working in within the UK.
The NHS follow pay guidelines that are used to fairly and uniformly determine consultant pay, however these do differ across countries in the UK.
What is an SAS doctor?
SAS stands for Staff grade, Associate Specialist, and Specialty Doctor. They will have at least four years of full-time postgraduate training, two of which have been in their relevant specialty.
They are experienced and senior doctors in fixed term or permanent posts (outside a training pathway).
Many SAS doctors have made a positive choice to step into a SAS position from a traditional consultant training pathway. This could be for reasons such as geographical stability or wanting to familiarise themselves with the NHS system before working up to a consultant position.
SAS doctors maintain their skills through the CPD system and there are routes, through gaining CESR (Specialist Registration) or applying for a training post, for SAS doctors to become consultants if they wish to.
Basic Pay
Specialist Grades and Specialty Doctors in England and the other home countries have their own contracts in place for senior doctors. These contracts are based on a full-time work commitment of 10 programmed activities (PAs) per week, each having a time-tabled value of four hours.
The basic pay thresholds in the UK are shown below:
England
Scotland
Wales
Northern Ireland
England
SAS doctors currently earn a basic rate of between £52,530 and £82,400 as Specialty Doctors and from £83,945 to £95,275 as Specialist Grade doctors in England.
Specialty Doctor
Years of experience
Basic Salary
0 (min)
£52,530
1
2
3
£60,519
4
5
6
£67,465
7
8
9
£74,675
10
11
12
£82,400
13
14
15
16
17
Associate Specialist / Specialist Grade
Years of experience
Basic Salary
0 (min)
£83,945
1
2
3
£87,000
4
5
6
£95,275
The most recent full pay circular for England can be found here.
Scotland
SAS doctors currently earn a basic rate of between £45,193 and £84,272 as Specialty Doctors and from £63,361 to £103,074 as Associate Specialists in Scotland.
Specialty Doctor
Years of experience
Basic Salary
0 (min)
£45,193
1
£49,057
2
£54,080
3
£56,772
4
£60,651
Threshold 1
5
£64,516
6
7
£68,466
8
9
£72,418
10
Threshold 2
11
£76,370
12
13
14
£80,321
15
16
17
£84,272
Associate Specialist
Years of experience
Basic Salary
0 (min)
£63,361
1
£68,454
2
£73,546
3
£80,271
4
£86,099
Threshold 1
5
£88,517
6
7
£91,673
8
9
£93,880
10
Threshold 2
11
£96,945
12
13
14
£100,008
15
16
17
£103,074
The most recent full pay circular for Scotland can be found here.
Wales
SAS doctors currently earn a basic rate of between £51,765 and £81,200 as Specialty Doctors and from £82,722 to £93,887 as Specialists in Wales.
Specialty Doctor
Years of experience
Basic Salary
1
£51,765
2
3
4
£59,637
5
6
7
£66,482
8
9
10
£73,587
11
12
13
£81,200
14
15
16
17
18
Specialist
Years of experience
Basic Salary
1
£82,722
2
3
4
£88,305
5
6
7
£93,887
The most recent full pay circular for Wales can be found here.
Northern Ireland
SAS doctors currently earn a basic rate of between £51,000 and £80,000 as Specialty Doctors and from £81,500 to £92,500 as Associate Specialists in Northern Ireland.
Specialty Doctor
Years of experience
Basic Salary
Pay Point
0
£51,000
1
1
2
3
£58,756
2
4
5
6
£65,500
3
7
8
9
£72,500
4
10
11
12
£80,000
5 - top
13
14
15
16
17
Specialty Doctor
Years of experience
Basic Salary
Pay Point
1
£81,500
1
2
3
4
£87,000
2
5
6
7
£92,500
3 (top)
The most recent full pay circular for Northern Ireland can be found here.
Job Planning and Programmed Activities
As part of your contract, your job plan will be created in partnership with your new NHS employer. This is an annual agreement that sets out your duties, responsibilities and objectives for the length of your contract.
There are four basic categories of contractual work which will be included in your job plan: direct clinical care (DCC), supporting professional activities (SPAs), additional responsibilities and external duties.
There are ways that consultants will be able to earn more than the basic rates above and these can include additional rotas and PAs. This will also be discussed in the creation of your job plan.
Sources
https://www.nhsemployers.org/system/files/2023-02/Pay%20and%20Conditions%20Circular%20%28MD%29%202-2023.pdf
https://www.sehd.scot.nhs.uk/pcs/PCS2022(DD)01.pdf
https://www.nhs.wales/files/pc-resources/042023-md-circular/
https://www.health-ni.gov.uk/sites/default/files/publications/health/doh-hsc-tc8-03-2022.PDF
Getting started
NHS Trusts can interpret the NHS consultant pay scales above and an international doctor’s experience in different ways, so use this blog as a guideline for understanding what you may be eligible for when coming to work in the NHS.
Your IMG Consultant is happy to assist with any negotiations related to your job plan to ensure your experience is taken into account.
For more information on NHS doctor benefits and pay arrangements in the UK, take a look at our IMG Resources library.
Doctors from any country can apply for Specialist Registration in the UK, provided they meet certain eligibility criteria, though there are different routes available based on the doctor’s training and qualifications.
In this blog we’ll be exploring Specialist Registration in medical oncology for overseas medical 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 is best for me as an overseas oncologist?
Do I have to complete CESR before I can work in the UK?
Do I need MRCP (UK) for Specialist Registration?
What is the CESR equivalence process?
What evidence do I need to submit for a CESR in medical 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
Holding Specialist Registration in any CCT specialty means that you can be appointed to a substantive (or permanent) consultant position in the NHS. All medical 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 oncologists, attaining specialist registration will mean you are qualified to practice independently as a medical oncology consultant in the NHS.
Specialist Registration is additional to full registration with the GMC and is therefore not required to practice as a medical 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 Oncologists who have complete 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.
CESR for Overseas Oncologists
For overseas doctors who have completed their full training outside 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.
You can read a detailed breakdown of Specialist Registration in the UK in our IMG Resources library.
Medical Oncology Positions in the NHS without CESR
It is important to note that you can apply for senior oncology roles in the NHS, such as a specialty doctor (SAS), specialist grade or a locum consultant without being on the Specialist Register.
Similarly, CESR is not required by overseas doctors before moving to the UK to work in the NHS.
In these senior NHS roles, you will have better pay and responsibilities that are more appropriate to your level of experience compared to a trainee. Within these positions, you can collect evidence of your competences, particularly those specific to the UK medical 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.
MRCP (UK) for Specialist Registration
Whilst it is always beneficial to complete MRCP (UK), particularly for doctors who have trained outside of 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 Medical Oncology curriculum are the MRCP (UK) exams, so passing these exams confirms the attainment of the competencies of the core curriculum.
MRCP (UK) is only a requirement for doctors looking to attain Specialist Registration via the CCT route.
The structure of the programme is an indicative two years in Core Medical Training or Acute Care Common Stem (ACCS), followed by an indicative four years of training in Medical Oncology. Therefore, applicants need to demonstrate the appropriate level of acute medicine expertise as well as competencies in medical oncology.
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 medical 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
skills and knowledge
The Royal College of Physicians 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 Medical 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 Medical 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 medical 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.
CESR Application Cost
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 Medical 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 medical oncology 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 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 Medical Oncology curriculum, not just your sub-specialty.
Remember to refer to the most up-to-date Medical 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 MRCP aspirants and dedicated oncology recruiters.
In this group you will find tailored resources for oncology IMGs, including access to our MRCP crash courses, 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/registration-and-licensing/join-the-register/registration-applications/specialist-application-guides/specialist-registration-cesr-or-cegpr
https://www.gmc-uk.org/-/media/documents/sat---ssg---medical-oncology---dc2310_pdf-48455474.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 medical 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:
As an overseas doctor looking to work in the UK, it is essential to understand the salary that comes along with your NHS job and how this can be different from one country in the UK to another.
Whilst the NHS has guides that are used to fairly and uniformly determine consultant pay, these do differ across the UK.
Basic Pay
Consultants in England and the other home countries each have their own consultant contracts in place. These are based on a full-time work commitment of 10 programmed activities (PAs) per week, each having a time-tabled value of four hours.
The basic pay thresholds in England and their equivalents in the rest of the home countries are shown below:
England
Scotland
Wales
Northern Ireland
England
Consultants currently earn a basic rate of between £93,666 and £126,281 in England.
Threshold
Years completed as a consultant
Basic Salary
1
0
£93,666
2
1
£96,599
3
2
£99,532
4
3
£102,465
5
4
£105,390
5
6
7
8
6
9
£112,356
10
11
12
13
7
14
£119,323
15
16
17
18
8
19+
£126,281
The most recent full pay circular for England can be found here.
The National Clinical Impact Award (NCIA) scheme aims to reward consultants who contribute most to the delivery of safe and high-quality care and the improvement of NHS services. You can apply for a new award after you have completed a full year in an eligible role.
Scotland
Consultants currently earn a basic rate of between £96,963 and £128,841 in Scotland.
Threshold
Years completed as a consultant
Basic Salary
1
1 (starting salary)
£96,963
2
2
£99,011
3
3
£101,957
4
4
£104,906
5
5
£107,846
6
7
8
9
6
10
£114,846
11
12
13
14
7
15
£121,846
16
17
18
19
8
20+
£128,841
The most recent full pay circular for Scotland can be found here.
All consultants who have reached point five of the pay scale are eligible for consideration for discretionary points, except for distinction award holders. Consultants granted discretionary points are not normally considered again for two years, although this may vary.
Wales
Consultants currently earn a basic rate of between £87,354 and £113,408 in Wales.
Threshold
Years completed as a consultant
Basic Salary
1
0 (starting salary)
£87,354
2
1
£90,137
3
2
£94,789
4
3
£100,191
5
4
£106,363
6
5
£109,882
7
6
£113,408
The most recent full pay circular for Wales can be found here.
Please note that the pay scale above is for substantive or permanent doctors in Wales.
For locum consultants, there is a fixed pay point of £100,381 which will apply regardless of years of consultant experience.
Commitment awards are available to all consultants after three years’ service at the top of the consultant pay scale, who demonstrate their commitment through satisfactory job plan reviews. They are then eligible at three-yearly intervals, until they have achieved eight award levels.
Northern Ireland
Consultants currently earn a basic rate of between £88,799 and £119,723 in Northern Ireland.
Threshold
Years completed as a consultant
Basic Salary
1
1 (starting salary)
£88,799
2
2
£91,581
3
3
£94,362
4
4
£97,141
5
5
£99,913
6
7
8
9
6
10
£106,520
11
12
13
14
7
15
£113,124
8
16+
£119,723
The most recent full pay circular for Northern Ireland can be found here.
Job Planning and Programmed Activities
As part of your contract, your job plan will be created in partnership with your new NHS employer. This is an annual agreement that sets out your duties, responsibilities and objectives for the length of your contract.
There are four basic categories of contractual work which will be included in your job plan: direct clinical care (DCC), supporting professional activities (SPAs), additional responsibilities and external duties.
There are ways that consultants will be able to earn more than the basic rates above and these can include additional rotas and PAs. This will also be discussed in the creation of your job plan.
Getting started
NHS Trusts can interpret the NHS consultant pay scales above and an international doctor’s experience in different ways, so use this blog as a guideline for understanding what you may be eligible for when coming to work in the NHS.
Your IMG Consultant is happy to assist with any negotiations related to your job plan to ensure your experience is taken into account.
For more information on NHS doctor benefits and pay arrangements in the UK, take a look at our IMG Resources library.
Sources
https://www.nhsemployers.org/sites/default/files/2021-08/Pay-and-Conditions-Circular-MD-3-2021.pdf
https://www.sehd.scot.nhs.uk/pcs/PCS2022(DD)01.pdf
https://www.nhs.wales/files/pc-resources/042023-md-circular/
https://www.health-ni.gov.uk/sites/default/files/publications/health/doh-tc8-2-2020.pdf
As there is no hard and fast rule for what position you will have after gaining a UK qualification, it is important for IMGs to understand the posts that are available to you after completing FRCR (Oncology).
FRCR (Oncology) is a highly beneficial qualification to achieve, but it does not guarantee you a consultant position in the NHS.
This can be a confusing area for overseas clinical and radiation oncologists, but this blog aims to de-mystify the subject. This article will explain the following topics:
What is FRCR (Oncology) and how does it fit into the UK training programme?
What grade will IMGs, new to the NHS, be offered with FRCR (Oncology)?
Can I take a permanent consultant post if I have FRCR (Oncology)?
CESR opportunities for clinical oncologists in the NHS
Skip ahead to the relevant section if you know what you’re looking for.
FRCR (Oncology) within the UK Oncology Training Programme
Fellowship of the Royal College of Radiologists (Oncology) or FRCR (Oncology) is the postgraduate qualification awarded by the Royal College of Radiologists, the body responsible for the specialties of clinical oncology and clinical radiology throughout the UK.
FRCR (Oncology) is a three-part exam which is a necessary part of the training programme of clinical oncologists in the UK.
For trainees who have chosen to pursue clinical oncology, FRCR (Oncology) Part 1 or CO1 must be passed by the end of ST4.
Clinical oncology trainees will then sit Final FRCR (Oncology), also known as Part 2A and 2B or CO2A and CO2B, usually from ST6 to ST7.
These final exams are important in that they assess a trainee’s knowledge and skills related to the investigation of malignant disease and the care and management of patients with cancer.
Any UK-trained clinical oncologist applying for a CCT in order to work as a substantive consultant must have completed full FRCR (Oncology).
As shown above, UK trainees will also have completed MRCP (UK), although this is not required for overseas clinical oncologists.
Positions for Doctors new to the NHS with FRCR (Oncology)
As an IMG with full FRCR (Oncology), you will be eligible for consultant grade positions in the UK.
You are not guaranteed a consultant position, particularly if you do not have previous consultant position in your home country, but you will certainly be able to attain more senior positions in the NHS, such as a specialty doctor (SAS) or specialist grade.
Consultant positions are the most senior in the UK, and thus the highest paid position for doctors within the NHS pay system.
For further information on how NHS pay scales work for consultants, please see our detailed article here.
Of course, this is assuming that you have also completed the other necessary components to make you eligible for GMC registration.
Alongside your postgraduate qualification, you will need to have passed an English Language Test (either IELTS or OET).
Additionally, you must obtain a Certificate of Good Standing, and submit this to the GMC. Upon the receipt of these three components, you will receive full GMC registration.
Permanent Consultant Posts with FRCR (Oncology)
To take up a permanent consultant position in the NHS, you would need to have Specialist Registration. Specialist Registration (more specifically CESR for most overseas doctors) allows you to take up permanent or substantive consultant roles in the NHS.
The type of consultant position you would be eligible for with FRCR (Oncology) is a locum consultant post.
Firstly, we should clarify the meaning of the term ‘locum consultant’ in the UK. The NHS has two types of locums - Trust locums and Agency locums.
If you are an IMG with full registration, but you are not on the Specialist Register, you are only able to take on consultant positions as a trust locum, but no permanent positions.
Trust locums are hired on a fixed-term contract and are able to better acclimatize themselves to the NHS system, whilst receiving the support and guidance to work towards consultant positions and CESR.
Please note, you can only work as an agency locum if you have a British passport.
CESR Opportunities in the NHS
CESR or the Certificate of Eligibility for Specialist Registration is a route of entry to the Specialist Register for those doctors who have not followed a GMC-approved training programme.
You can read more about CESR in Clinical Oncology through our IMG Resources library here.
IMG Connect are able to help you to secure senior roles such as specialty doctor (SAS), specialist grade or locum consultant in Trusts that offer CESR support.
In these roles, you will have better pay and responsibilities that are more appropriate to your level of experience compared to a trainee. These Trusts have a lot of experience in supporting overseas doctors to progress their careers through CESR.
You can collect evidence of your competences, particularly those specific to the UK Clinical Oncology curriculum and those you may not be able to achieve outside the UK.
These positions also facilitate a faster route to the UK than applying directly through 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.
Getting started
We hope this blog has been helpful in clarifying your questions about securing senior posts in the NHS with FRCR (Oncology). If you have any further questions regarding the postgraduate exams, CESR or Oncology in the NHS - feel free to contact us directly.
Join the IMG Oncologists Facebook group for access to a community of like-minded clinical and radiation oncologists and dedicated oncology recruiters.
In this group you will find tailored support for oncology IMGs, including access to our NHS and CESR webinars, completely free to all doctors.
You can access our IMG Oncologists community here.
Follow us on social media through the links below for regular news and updates on the Royal College, relocating to the UK and working in the NHS.
NHS Hospitals across the UK are offering specialty doctor job plans in Psychiatry with the opportunity for programmed CESR support, giving psychiatrists the chance to quickly work towards Specialist Registration.
For experienced IMGs, this is a new and relatively quick route to your first consultant post in Psychiatry.
By taking up a service level job as an SAS Doctor with CESR support as part of the job plan, many overseas psychiatrists are securing a great start to their career in the NHS that is suited to their senior level experience, whilst taking the time to acclimatize to the NHS and their Trust.
CESR Programmes for Specialty Doctors
By taking such posts in the NHS, you can join diverse, dynamic and inspiring groups of specialty doctors and acting consultants all on the way to achieving Specialist Registration as part of a tailored programme. You can read more about CESR for psychiatrists here.
In offering such job opportunities, Trusts will provide a supportive environment with protected time to fulfill all the requirements of the CESR application in Psychiatry and its sub-specialties, gaining career-enhancing experiences as you do.
Acting up, dedicated peer groups, coaching & mentoring, scheduled learning and study time are some of the benefits that you could receive in one of these roles.
In such roles you will typically receive hands on support from consultant colleagues and exposure to a wide range of experience to specifically aid competency achievement for your CESR application in relation to the Specialty Specific Guidance (SSG) for your sub-specialty.
In some specialty doctor jobs with CESR programme you will rotate through various departments, dependent on your required experience.
Some Mental Health Trusts will also provide the following as part of their CESR programme:
A number of Supported Professional Activity (SPAs) sessions per week
Tailored experience to your CESR portfolio
Regular clinical supervision
A CESR mentor
Involvement in academic programmes and medical student teaching
Support in gaining research competencies
SAS Tutor support
CESR / SAS support forums and meetings
Finding SAS Roles with CESR Support
If you are an overseas doctor looking for a Specialty Doctor job with the chance to work towards your Certificate of Eligibility for Specialist Registration (CESR) in Psychiatry, speak to the IMG Connect team to discuss if this is a suitable route for you.
We have opportunities across the UK for international psychiatrists to take advantage of the CESR programme.
You can also send your CV to info@imgconnect.co.uk or register here. It takes less than 30 seconds to register!
IMG Jobs
Search and find live Psychiatry jobs in the NHS with CESR support
IMG Resources Library
Browse our library for more useful articles on NHS jobs in psychiatry, salaries for doctors in the UK and postgraduate qualifications for psychiatrists and much more!
Connect with us
Don’t hesitate to get in touch using the buttons above (and below) and chat with an IMG Consultant to discuss your options for NHS roles with CESR support and start your journey towards Specialist Registration with IMG Connect.
For access to a community of like-minded psychiatry IMGs and dedicated psychiatry recruiters, join the IMG Psychiatrists Facebook group.
To receive the latest news and updates on all things psychiatry, including the Royal College, GMC registration and the NHS, follow us on social media and join the conversation.
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.
CESR for Overseas Oncologists
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:
training and/or competence
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.
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/registration-and-licensing/join-the-register/registration-applications/specialist-application-guides/specialist-registration-cesr-or-cegpr
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:
For overseas doctors, there are several routes you can use to apply for GMC registration in the UK. The route that is right for you, depends on your qualification and experience.
GMC registration is essential for doctors practicing in the NHS, therefore it is important for overseas doctors to determine the most suitable route before securing a role.
This article will help you to identify the appropriate GMC application route for you as an IMG and will give you guidance on the steps you need to take, covering key areas including the following:
What is the GMC?
What do I need for GMC registration?
Routes to GMC registration:
PLAB
Accepted Postgraduate Qualifications / Licensing Exams
Relevant European Qualifications
Sponsorship & MTI
Specialist Registration – CESR, CESR-CP & CEGPR
#IMG Tips
How do I get started?
Please skip ahead to the relevant section if you know what you’re looking for.
The General Medical Council
The GMC is the body in the UK which is responsible for licensing and revalidating every doctor. Therefore, for every doctor practicing in the UK, GMC registration is essential – you cannot practice in the UK without full GMC registration with a license to practise.
The primary responsibility of the General Medical Council is to ‘protect, promote and maintain the health and safety of the public’ in addition to improving medical education and practice across the UK.
Requirements for GMC Registration
Registering with the GMC is a multi-stage process, including key timings, actions and documents. For full GMC registration, international doctors must provide evidence of:
1. (EEA doctors) Sufficient skill and knowledge – as an EEA physician, this would be your recognised EEA qualification.
OR
1. (non-EEA doctors) Sufficient skill and knowledge – as a non-EEA physician, this would either be PLAB, your Royal College postgraduate qualification (e.g. MRCP) or a GMC-approved qualification.
AND
2. English language capabilities - either your IELTS, OET or an approved reference from your current employer (if you have been working in an English-speaking country for the last two years).
AND
3. Certificate of good standing – the certificate from your medical regulatory authority which demonstrates good standing.
There are several steps involved in the registration process, but these are the three main components required in order to be eligible.
To understand the registration process more fully, read our blog on GMC registration for overseas doctors here.
PLAB
The PLAB exam is a two-part licensing exam that assesses a doctor’s ability to work safely as an SHO in the UK. As such, it does not demonstrate ability in any particular medical specialty.
For this reason, PLAB tends to be a route for junior doctors who have not already chosen their field of specialisation in medicine. That said, for some senior doctors PLAB can be an attractive option, offering a quicker route to the UK, whilst still securing competitive salaries.
If taking this option, doctors can then take up training or a more senior post once they have established themselves in the NHS. Take a look at our comprehensive guides on PLAB for more information.
Is PLAB suitable for me?
The PLAB route may be suitable for you if:
You have not completed an internship, or your internship does not meet the acceptable pattern OR;
You have completed an acceptable pattern of internship, but have no other clinical postgraduate experience OR;
You are currently in or have completed postgraduate training (residency), and you want a faster route to full GMC registration.
Acceptable Postgraduate Qualifications or Licensing Exams
The GMC has produced a list of postgraduate qualifications which are accepted as sufficient evidence of the necessary knowledge, skills and experience required for full registration.
If these postgraduate qualifications are more than 3 years old when your application is made, you will have to provide further evidence of your recent medical experience.
UK Postgraduate Qualifications
Attaining a Royal College qualification is a preferred path for doctors who have already chosen their field of specialism i.e., pathology.
For senior doctors taking this route, they will gain access to more senior, well-paid jobs in the specialism of their choice.
For example, the Royal College of Physicians is the professional body that regulates all medicine specialties in the UK, and Membership of the Royal College of Physicians (MRCP UK) is the qualification attainable by examination. For overseas doctors, attaining full MRCP (UK) will satisfy the knowledge & skill criteria for GMC registration and facilitate application for more senior medicine roles in the UK.
Take a look at our complete guides on the Royal Colleges in the UK through our IMG Resources library to understand more.
The full list of UK postgraduate qualifications can be found here.
Overseas Postgraduate Qualifications
There are also some overseas qualifications that meet the same standards as UK postgraduate qualifications, although they are not necessarily the same in every aspect.
You can find the full list of UK and overseas qualifications here.
Licensing Exams
Doctors who have passed an acceptable overseas registration exam can apply for full GMC registration.
You are eligible for to apply via this route if you:
graduated from a medical school outside the UK or Switzerland
and you:
hold an acceptable primary medical qualification
have completed an internship
have passed one of the following overseas registration exams:
United States Medical Licensing Exam (USMLE): Step 1, Step 2 clinical knowledge and Step 2 clinical skills; For Step 2 clinical skills, your pass must be between 16 April 2004 and 13 March 2020.
Medical Council of Canada Qualification Examination 2 (taken in English) on or before 27 October 2020
The Australian Medical Council Clinical Examination on or before 5 March 2020
have passed each part of the exam including the knowledge tests and clinical skills components in four attempts or less. If you sat any part of the exam more than four times before passing, you will not be eligible for this application.
Is the postgraduate/ licensing exam route suitable for me?
The postgraduate route to GMC registration is a popular one and facilitates the attainment of more senior roles in the NHS than for example PLAB (when combined with the relevant experience).
If you have already completed an acceptable postgraduate qualification in your home country, this is the most suitable pathway for you, as you will not have to sit additional exams.
The same goes for acceptable licensing exams, which also exempts overseas physicians from PLAB.
If you have not passed an acceptable overseas postgraduate qualification or licensing exam, you would have to complete the relevant UK postgraduate qualification.
Relevant European Qualification
If you hold a medical qualification awarded in the EEA or Switzerland, it may be classed as a Relevant European Qualification (REQ). You can find out whether your qualification is classed as a REQ by selecting your country through this link. Each country’s page covers the qualifications you would need to send to the GMC to support your application for entry onto the Medical Register, GP and Specialist Registers, and where appropriate, provisional registration with a licence to practice.
Is the REQ route suitable for me?
The Relevant European Qualification route to GMC registration is suitable for you if you hold a specialist certification that is recognised by the GMC. You can verify this through your country’s GMC page here.
Sponsorship & MTI
Some institutions can provide sponsorship for GMC registration. Doctors who receive sponsorship are therefore exempted from PLAB or the need to have an acceptable postgraduate qualification or licensing exam.
MTI
The Medical Training Initiative (MTI) is a training programme that provides junior doctors from all over the world the opportunity to gain clinical training and development in the UK for a maximum of 24 months.
Although doctors practicing in the UK must be registered with the GMC, for MTI candidates, registration is typically supported by the Royal College, some NHS Trusts also have the right to register MTI doctors.
You can read more about the MTI scheme here.
Sponsorship
There are several types of sponsorship available to overseas doctors, such as sponsorship offered by NHS Trusts through International Fellowships or sponsorships for specific posts.
If you apply for GMC registration through sponsorship, you’ll have to satisfy the sponsor that you possess the knowledge, skills and experience required for practising as a fully registered medical practitioner in the UK.
Each sponsor may have their own scheme which has been pre-approved by the GMC, and since each scheme differs from the next, we advise that you check the sponsor’s official website and contact them for more information.
A key aspect of all sponsors' criteria is that a doctor applying for GMC sponsorship must have been engaged in medical practice for three out of the last five years including the most recent 12 months. It is important to meet these minimum criteria for the best chance of providing sufficient evidence to support your application.
The complete list of GMC-approved sponsors, including NHS Trusts and Royal Colleges, can be found here.
Is the sponsorship route suitable for me?
MTI is best suited to junior doctors and those who wish to return to their home country after the training period, whereas the criteria for other types of sponsorship can be more varied.
Specialist Registration
The Specialist Register is a register of doctors who can take up substantive consultant (permanent) posts in the UK. All doctors who wish to work as substantive consultant in the UK must show evidence of skills, knowledge, and experience in order to apply for Specialist Registration.
Specialist Registration is additional to full registration with the GMC. You can read more about the types of GMC registration here.
Doctors eligible for Specialist Registration 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 may be eligible for direct entry onto the Specialist Register through their Relevant European Qualification (REQ) and are awarded a CCT after a successful application.
CESR is the route to Specialist Registration for doctors who have not completed a GMC-approved specialty training programme i.e. doctors who have trained outside of the UK, Switzerland, and EEA countries. This is often the preferred route of IMGs.
For an in-depth guide to CESR, look at our blog for overseas doctors here.
Is Specialist Registration suitable for me?
Specialist Registration may be suitable for you if you (at minimum):
1. Hold a specialist qualification in the specialty you’re applying in
OR
2. Have at least six months of continuous specialist training in the specialty you’re applying in
You will have to provide evidence of your eligibility as part of your application, as well as evidence that you meet the requirements of the CCT curriculum in your specialty.
The indicative period of training to be awarded a CCT ranges from 5 years to 9 years in the UK (depending on the specialty), so if you have less training than this, it is unlikely that you will have the full evidence required for a successful application for Specialist Registration.
#IMG Tips
In short, there are routes that depend on qualifications or exams from countries you’ve trained in: licensing exams, acceptable postgraduate qualifications, or REQs; or if you do not hold any of these: MTI, UK postgraduate exams or PLAB.
Use the GMC route finder to double-check you are pursuing a route to registration that you are eligible for.
If your route requires additional exams, begin your preparation for these well in advance and always start with the syllabus or curriculum for your exam!
Read through the GMC’s page on required documents – the necessary documents can change, as the GMC adapts to changes in healthcare and current issues such as the COVID-19 pandemic.
If you’ll be completing exams to register with the GMC, complete these or begin the process before you focus on English language testing – your IELTS or OET only have a 2-year validity period!
Getting started
So, there you have it, the main routes to GMC registration for IMGs. Once you have determined your route to GMC registration, it’s time to either begin gathering the required documents for your application or begin your preparation for any exams you’ll need to sit.
Have you already registered with the GMC, or looking to get started? Get in touch with us here to discuss finding an NHS post.
If you have any other questions, please feel free to get in touch with our team.
For advice, guidance and news and updates for IMGs, join the conversation through the links below.