Video Guide to CESR and Portfolio Pathway16 September, 2023
To practice as a substantive Consultant in the UK, international medical graduates must be specialist registered with the GMC (General Medical Counc...
To practice as a substantive Consultant in the UK, international medical graduates must be specialist registered with the GMC (General Medical Council). It's a lengthy process in which you'll need to partake in in-depth training and career development, either through the UK system via CCT or by having your overseas experience recognised using CESR / Portfolio Pathway.
CCT (Certificate of Completion of Training) and the CESR (Certificate of Eligibility for Specialist Registration) / Portfolio Pathway both allow trainee doctors to get onto the specialist register. They both hold the same recognition, but the journey to getting them is slightly different. CCT is the route that UK doctors take and CESR is the route used to have overseas experienced acknowledged at the same level. CESR-CP sits somewhere in the middle allowing a combination of UK and overseas experience.
As of November 2023 the GMC is changing the evidence required from doctors wishing to join the Specialist or GP registers. The objective is to allow candidates to be able to use a wider range of evidence to demonstrate their knowledge skills and experience.
Use the following timings to skip ahead to the chapter you need:
- 00:00 - Introduction
- 00:47 - What is Specialist Registration
- 02:17 - How to Get CESR / Portfolio Pathway
- 04:20 - How to Get CCT
- 06:15 - How to Get CESR-CP
- 08:05 - How to Make your CESR Application
- 12:35 - Summary and CESR Support
Get in Touch
If you're an IMG or UK based doctors looking to complete CCT or CESR then contact the expert team at BDI Resourcing for guidance. Over 100 NHS Trusts have utilised BDI Resourcing to reach, recruit and relocate more than 1,500 UK and international Doctors.
The following is a full transcript from the video:
00:07 We're going to talk today about CESR, which
00:09 is soon to be called the Portfolio Pathway.
00:12 This is a really exciting topic for
00:14 IMGs because it's one of the most
00:16 well trodden paths to specialist registration.
00:19 We do work with lots of trusts who provide
00:22 assistance and guidance for CESR, so if you are
00:26 along that path to becoming a consultant for the
00:30 NHS, then do email, your CV across to
00:33 us via firstname.lastname@example.org and we'd be happy to give
00:37 you any guidance and support that we can.
00:40 And as always, hit the subscribe button and you'll
00:43 get all the latest updates from BDI Resourcing.
00:50 So we're going to go back to the start
00:51 with this and explain what the specialist register is.
00:54 That might seem a bit basic, but if
00:56 you're coming from overseas, it's important to recognise
00:59 all these things from first principles.
01:01 So the GMC register, the General Medical Council, is the
01:05 register for all doctors that work in the NHS.
01:09 Now, if you're below a consultant level,
01:11 you'll just be on the general register.
01:13 However, once you become a consultant,
01:16 you're able to practise independently and
01:18 take up a substantive consultant post.
What is the Specialist Register?
01:20 So the specialist register is the register of all
01:24 of the doctors who have completed CCT or CESR
01:28 and therefore are recognised as specialists in their field.
01:31 So that was introduced in 1997 and there's
01:35 a whole area of different fields that you
01:38 can have a CCT or a CESR in.
01:40 So you may be a CCT qualified doctor in acute
01:43 medicine or respiratory medicine, or whatever it might be.
01:47 And that's your route to getting specialist registration
01:51 so important, because it means you get recognised
01:54 as being able to practise independently.
01:55 You can take up a substantive post in the NHS.
01:58 And I know for a lot of international doctors,
02:00 it's really important because it's something you can actually
02:02 take back to your home healthcare system, to
02:06 allow you to earn a consultancy post overseas.
02:10 And, of course, that means that you can
02:11 earn much more money and it comes with
02:14 all the rewards that come with that.
02:24 or haven't completely trained within the UK system, so
02:27 they've not come through one of the GMC's recognised
02:29 training programmes and therefore earned their CCT.
How to Get CESR / Portfolio Pathway
02:33 So CESR provides a certificate
02:35 of equivalent specialist registration.
02:38 Now, what's happened recently is that the GMC
02:41 have decided to change the way that doctors
02:43 are able to provide the evidence needed for CESR.
02:47 So I've got a couple of the
02:49 quotes and statements here from the GMC.
02:51 I think they're really important that we digest them.
02:54 The first says the prescriptive and inflexible nature
02:57 of the legislation means that applications for specialist
03:00 and GP registration are overly bureaucratic, complex to
03:04 navigate and burdensome to satisfy.
03:06 I think that's really important first point here, because what the
03:09 GMC is saying is, up until now, if you trained or
03:13 did half of your training overseas, you would have had to
03:16 evidence that you had done the exact same criteria and met
03:20 the exact same evidence as someone who had done all of
03:24 their training within the UK system.
03:26 Which is actually a big ask because of
03:28 course, not every healthcare system and not every
03:30 training system is identical to the NHS.
03:33 So they've recognised first of all that
03:36 it's a burdensome process for international doctors
03:39 and they want to simplify it.
03:40 So that's really good starting point.
03:42 The second quote, this change does not represent a
03:45 lower standard or lowered expectations of the applicants.
03:49 Instead it will introduce consistent, minimum safe standards
03:52 across all pathways to specialist and GP registration,
03:57 both now and in the future.
03:59 So I think the second key point to take from
04:02 that is that the GMC are not lowering the
04:04 standards, they're just changing the ways that you can
04:07 provide evidence that you meet the criteria of someone
04:10 who should be on the specialist register.
04:12 So easier to provide evidence, but
04:15 not of any lower standards.
How to Get CCT
04:22 CCT is the route that UK
04:25 trained doctors will go through.
04:27 So if you train in the UK system, you leave
04:29 medical school, you do foundation years one and two, then
04:32 you either go into core training one and two, or
04:35 specialist training and you do a run through programme.
04:38 So at that point, you're basically working your way through
04:43 a specialist field, either as a run through in something
04:46 like histo or radiology, or as a combined section in
04:50 something like surgery or medicine, where you do a couple
04:52 of years of core training and then in one individual
04:55 specialist field from that point onwards.
04:58 So minimum three or four years all done
05:01 through the Royal Colleges, and they have to
05:03 be on a recognised GMC programme.
05:06 So if you are, let's say, a doctor who's just coming
05:11 up to registrar level, then you can probably get away with
05:14 joining the GMC, finding a service job in the NHS.
05:17 And then once you're here applying to specialist
05:20 training at ST3 level, for example, and
05:23 you could work your way through and become
05:25 a consultant on the specialist register with CCT.
05:29 CESR allows for doctors who are at a more senior level
05:32 who've perhaps completed some or all of their training overseas and
05:36 want to have some of that recognised, rather than stepping all
05:39 the way back to, say ST3, which may be a
05:43 bit of a step backwards in their career.
05:45 So for a UK trained doctor, they'll spend
05:48 those three or four years of training gathering
05:54 things like their logbook, cumulative data sheet, educational
05:58 Supervisor reports, all of which are signed off
06:00 by the programme director.
06:02 They then complete a CCT application form which
06:05 goes off to the Royal Colleges and the
06:08 GMC, and eventually they get their CCT recognition
06:11 and they're on the specialist register.
How to Get CESR-CP
06:19 The third route is CESR combined programme,
06:22 CESR-CP, as it's commonly known.
06:25 And the good thing with CESR-CP is
06:28 that actually, it allows you to combine the
06:31 experience that you've gathered overseas and the training
06:33 you've done overseas, along with any UK experience
06:37 and UK training that you've done as well.
06:39 So for doctors who maybe join a training system,
06:42 partway through ST4 level perhaps, or for those
06:45 that have done a lot of their training overseas
06:47 but are missing certain criteria from the curriculum, they're
06:51 able to fill in the gaps with UK experience
06:54 using the combined programme.
06:55 This is a really common pathway for international
06:58 doctors because getting all of your experience and
07:01 evidence to match up exactly to a UK
07:04 trainee is very, very difficult.
07:06 We'll see where this leaves us
07:08 with portfolio pathway because, of course,
07:10 that might make things slightly easier.
07:12 We're not sure whether CESR and CESR-CP are going
07:15 to be combined into one on the portfolio pathway.
07:18 That remains to be seen.
07:20 However, at the moment, it's a very useful route because
07:23 it allows you to take all the experience you've got
07:25 and then, let's say you need to do six months
07:28 in a specialist area that you hadn't done overseas.
07:31 So if you were a Gastro trainee who
07:33 had never done any Hepatology work, hepatology is
07:36 part of the curriculum in the UK.
07:38 So you'd need to do six months working in
07:40 Hepatology to gather your evidence so you could take
07:43 all of your Gastro experience from overseas and then
07:46 combine it with those six months that you maybe
07:47 do in a service role in the UK.
07:51 Get the sign offs that you need from that UK
07:53 experience in Hepatology, combine the two together and then apply
07:56 to the Royal College and apply to the GMC for
07:58 your CESR-CP route to specialist registration.
How to Make your CESR Application
08:07 When it comes to making your application, the
08:10 first thing you need to think about is,
08:12 have you got all of the evidence required?
08:14 And actually, the best piece of advice that
08:17 we can give to an international doctor thinking
08:19 about going down one of the CESR routes,
08:21 whether it's CESR or CESR-CP, is to
08:24 start thinking about gathering that evidence early.
08:26 So don't wait until you're in the UK or to
08:29 the point where you're thinking about making a GMC application
08:31 to start gathering and evidence, because by that point, you're
08:34 going to have to get things retrospectively and that's going
08:36 to be much, much harder work.
08:39 An average CESR application, full CESR application, is usually
08:43 800-1000 pages and 100-150 documents.
08:48 So you're talking about a lot of documentation.
08:51 Now, if you compile that as you go
08:53 along, it's going to be much more manageable
08:55 when the final submission comes around.
08:57 A couple of things to note on there.
08:59 The GMC won't anonymize evidence for you,
09:02 so you need to anonymize everything.
09:04 You need to make sure that any identifiable patient
09:07 information is redacted from any evidence you provide.
09:10 So that could be a big task in hand and
09:14 obviously something you need to do with care and attention.
09:16 So, again, doing it as you go along will be
09:18 much easier than having to retrospectively go back over potentially
09:22 years worth of training to try and do that.
09:25 Translations as well.
09:26 Everything's going to need translating into English, so it's good
09:29 to get yourself a good translator early on, or at
09:33 least know that you've got someone lined up so that
09:35 when it all gets translated at the end, you can
09:38 have that readily available to submit to the GMC.
09:42 Think about where you're going to
09:43 get the evidence from as well.
09:45 So different healthcare systems obviously use
09:47 different It systems, different patient record
09:49 systems, all that kind of thing.
09:51 So you need to be thinking about, does your
09:53 system correlate with the UK and what can you
09:57 do to make sure that evidence is best presented?
10:00 Because if it's unrecognisable to the
10:02 GMC, unfortunately, it's going to mean
10:04 that your application is rejected.
10:07 You need to think about your
10:08 references early on as well.
10:10 So you have to have four
10:12 references for a CESR application.
10:14 One of them, your primary reference, has
10:16 got to be from a medical director.
10:18 So really important that you suss those out early on,
10:21 perhaps let them know what you're going through at the
10:23 moment and obviously present it to them that you need
10:26 your references to paint you in a certain light.
10:29 They need to say about all the
10:30 different things that you've done, make sure
10:32 they're detailed and good references.
10:34 Again, if you wait until the end of your training
10:36 to ask for those references, it might be that the
10:38 medical director has moved on, they've taken another role, or
10:41 they've retired, or whatever it might be.
10:42 So make sure you're keeping in good communication
10:45 about what you're planning to do and obviously
10:48 let them know that you're intending to put
10:49 them down as you reference.
10:51 Now, once you get to the stage
10:53 where you're beginning your actual application, it's
10:56 all done on the GMC's website.
10:58 They send it off to the Royal College for you.
11:00 So you pay a fee.
11:01 It's £1781 as of 2023 April.
11:06 Now, who knows, that might change
11:08 with portfolio pathway coming in.
11:10 So worth keeping an eye on that.
11:12 That comes in at the end of November,
11:13 so we'll wait and see what happens.
11:15 At that point, the GMC send your application
11:18 off to the Royal College and they make
11:20 an assessment against the criteria and the curriculum
11:23 set out in the training programmes.
11:25 If that comes back successful, then good
11:28 news, you can join the specialist register.
11:31 However, if it doesn't, you've got a couple of options.
11:34 You can ask for feedback and you can think about what
11:38 it was that was missing, or you can make an appeal.
11:40 Usually people would go down the route of asking
11:43 for feedback and trying to find out what other
11:46 evidence they missed, because most of the time, a
11:49 rejected application only comes because something was missing.
11:53 So you can fill in those gaps.
11:56 It might be that you missed some references you
11:59 forgot to anonymize all the evidence didn't have authenticated
12:02 or validated evidence, it wasn't translated properly.
12:06 Or it might be just missing a gap,
12:08 something that you need to fill in and
12:09 gather some more experience and training in.
12:12 You can get that feedback from the GMC and
12:14 you can make a new application, or you can
12:16 make a resubmission with those bits filled in.
12:21 So that might be your best bet.
12:23 Don't be surprised if the initial feedback is not that
12:25 it was successful and that you've got some more work
12:28 to do, because it is a very cumbersome and all
12:30 encompassing application that you're looking to make.
Summary and CESR Support
12:38 The onus of CESR is very much on the applicant to
12:41 make the submissions to the GMC and the Royal Colleges.
12:45 Now, that's something that's really important to note, because
12:48 you need to make sure that if you're going
12:50 through the CESR-CP route and you're looking to
12:53 fill in any of the gaps, you've got the
12:55 support of a good mentor who can help you.
12:57 Now, we work with some of the best providers in
13:01 the NHS, some of the best trusts, some of the
13:03 only trusts actually have dedicated CESR-CP leads and education
13:08 departments that are equipped to assist with CESR applications, to
13:12 make sure that you can fill in any gaps and
13:14 to help you identify where those gaps might be.
13:17 So if you're interested in pursuing a career in
13:19 the NHS and joining the specialist register through CESR
13:22 or CESR-CP, please do get in touch.
13:25 Obviously, you're going to need to be a
13:27 fairly senior level doctor to do that.
13:29 So if you're a specialist or a speciality doctor,
13:31 or indeed a consultant in your home country, then
13:34 this is going to be the route for you.
13:36 As I say, email CVs to email@example.com
13:40 As always, we'll put the contact details
13:42 up at the end of the video.
13:43 Thanks so much for watching.