Video Guide to CESR and Portfolio Pathway

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 

Useful Links: 

CESR is becoming Portfolio Pathway 

How to get CESR for Specialist Registration 

How to get CESR CP for Specialist Registration 

What are CCT and CESR for IMGs  

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 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

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.