Certificate of Eligibility for Specialist Registration (CESR)
Doctors must have their names entered on the General Medical Council's (GMC's) Specialist Register before taking up substantive, honorary or fixed term NHS consultant posts in the UK.
Until 23:59 on 29 November 2023 doctors who have not completed a UK specialty training programme and have a combination of qualifications and/or training and experience gained anywhere in the world can be evaluated as part of an application for entry to the GMC’s Specialist Register. This route is known as Certificate of Eligibility for Specialist Registration (CESR).
The standard for this route is ‘equivalent to a CCT in the specialty in question’ (The Post-graduate Medical Education and Training Order of Council 2010). This means that you need to demonstrate equivalence to the curriculum current at the time of application. Not only must you demonstrate that you have gained the competencies, but you must also demonstrate that you are currently maintaining those competencies across the depth and breadth of the curriculum. More details below.
From 30 November 2023 the legislation has changed. The new legislation no longer refers to equivalence. Instead, it requires applicants to demonstrate that they have the ‘knowledge, skills and experience (KSE) required for practising as an eligible specialist or GP in the UK’. The GMC are renaming the CESR pathways to the ‘portfolio pathway’ on 30 November.
Portfolio pathway from 30 November 2023
You can find all the information about what KSE is required for practising as an eligible specialist in the UK for your specialty here: Updated Specialty Specific Guidance for applying for entry onto the Specialist Register via the Portfolio pathway
This guidance is comprehensive and sets out exactly what you need to provide to meet the standard. In addition, the GMC have provided advice about the changes and new standard here: GMC advice about the changes and new standard
Information about applications pre 30 November 2023 - the CESR Route
The standard for CESR was equivalence to a CCT - the curriculum. Up until 30 August 2023 you could choose to apply under the 2021 curriculum or the most recent version before that (referred to as older version of the curriculum).
Both versions of the CCT curriculum are on the GMC website and applicants should also refer to the Specialty Specific Guidance. This is the GMC document that sets out how to provide the evidence for application. There are versions for both curricula. If you are applying under the older version of the curriculum, you should also refer to the Certification Guidelines in your specialty. If you are applying under the 2021 curricula this information has been incorporated into the curriculum in section 5.4 Completion of Training in your specialty.
The JCST CESR Guidance for Applicants (see sidebar) gives details and relevant links for those who need information about this. Guidance about applying under the 2021 curriculum is below together with relevant links.
About the 2021 Curricula
The GMC designed its new standards for postgraduate medical curricula Excellence by Design and its framework for Generic Professional Capabilities, published in May 2017, to help postgraduate medical training programmes re-focus trainee assessment away from an exhaustive list of individual competencies, towards fewer broad capabilities required to practice safely as a day-one consultant.
As a result, the 2021 surgical curricula are outcomes-based, meaning that trainees will be assessed against the fundamental capabilities required of consultants in the working week. These include the general skills which all doctors need to have (the GMC’s Generic Professional Capabilities (GPCs) as well as those needed to carry out all the specific day to day tasks undertaken by a consultant surgeon. JCST has called these Capabilities in Practice (CiPs).
There are five CiPs which are shared between all surgical specialties:
CiP 1 Manages an out-patient clinic
CiP 2 Manages the unselected emergency take
CiP 3 Manages ward rounds and the on-going care of in-patients
CiP 4 Manages an operating list
CiP 5 Manages multi-disciplinary working
Some specialties also have specialty specific CiPs. Full details are in the curricula
A new assessment tool has been developed to assess the CiPs and GPCs. This assessment tool is called the Multiple Consultant Report (MCR). The MCR allows assessment of performance relative to the level required of a Day 1 consultant in each CiP and the GPCs. The MCR is an assessment based in the workplace using observations gathered over an extended period of time. For trainees, this is the entire duration of a placement. For CESR applicants we would expect observations to be over a similar time frame. The MCR for CESR would be like the final MCR for a trainee and should be a summative assessment. The MCR should cover a period of at least 6 months prior to making the CESR application. Applicants should bear this in mind when they first begin to gather their evidence for CESR. The MCR for CESR must be prospective.
The MCR for trainees is available via ISCP but for CESR you should use the following version on the JCST website MCR form for CESR. Also available on the JCST website is:
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