1. Applying for Specialist Registration through the CESR route

2. What is a CESR/CEGPR
Entry onto the Specialist Register with a Certificate of Eligibility for Specialist Registration (CESR)
Entry onto the GP Register with a Certificate of Eligibility for GP Registration (CEGPR)
It is a route for doctors who have not followed a full UK training programme
If an applicant does not already hold full registration, they must apply for this at the same time
So, what is a CESR/CEGPR?
A CESR is a Certificate of Eligibility for Specialist Registration and it’s for any doctor who want to practice as a substantive, honorary or fixed term consultant in the UK health services and have not completed a GMC approved training programme.
It’s important to say at this point that if an applicant does not already hold registration, then they will need to apply for a CESR with full registration. The full registration element will be processed alongside your CESR application and your Certification Adviser will advise you on that process. 2

3. Eligibility in a CCT specialty
To be eligible to apply for a CESR in a CCT you must have:
6 months continuous training in the speciality in which you are applying, undertaken anywhere in the world OR
A Specialist Medical Qualification in the speciality in which you are applying, obtained anywhere in the world.
The most important thing to do before you apply is to make sure you are eligible!
Deciding whether your specialty is equivalent to a UK CCT specialty is important because it determines your application type and the minimum eligibility requirements that you must meet.
To do this you will need to refer to the content or the requirements of the relevant curricula. It may be that your specialty has a slightly different name to those listed, but it is the content of the curricula, rather than the actual specialty name that is relevant when applying. If the curriculum requirements or content matches those of your specialty, then that will be the specialty to apply under.
You can find a list of the 64 specialties we currently recognise on our website.
If you are applying in a CCT specialty you must have:
6 continuous months specialist training in that speciality Or
a specialist qualification in that specialty
And you must demonstrate that this, together with your experience, is equivalent to the requirements for the award of a CCT in that specialty in the UK. 3

4. Eligibility in a non-CCT specialty
To be eligible to apply for a CESR in a non-CCT specialty you must have:
A Specialist Medical Qualification obtained from outside the UK in any non-CCT specialty OR
At least 6 months continuous specialty training undertaken outside the UK in any non-CCT specialty
To be eligible to apply for a CESR in a non-CCT specialty an applicant must have:
A specialist medical qualification from outside the UK Or
At least 6 months continuous specialty training undertaken outside of the UK in any non-CCT specialty.
You must demonstrate that this, together with your experience shows that you have the knowledge and skills consistent with practice of a consultant in the NHS. 4

5. How to apply and cost
All applications can be made on line via GMC Online.
Inactive applications (6 months) will be withdrawn
Fees:
A CESR application is £1,500
A CESR application with registration is £1,890
All applications are made on line via your GMC Online account. If you don’t already have a GMC Online account, it is very quick and easy to set up. (How?) website or contact centre.
Once you start your application, you will need to complete and submit it to us within 6 months. If you don’t, then your application will be automatically withdrawn and you will need to start again. So applicants should read the guidance and make sure they are ready to apply before starting the application.
A CESR application currently costs £1,500 and a CESR with full registration is £1,890. 5

6. Preparing for submission
Get your evidence ready first
Validation and authentication are key
It can take 3-6 months to get your evidence ready
Your evidence should demonstrate your skills and knowledge are equivalent to the curriculum you are applying in
As I have just mentioned, the key to a CESR application is to be sure you are ready to apply, by obtaining as much of your evidence as you can before you start the application process.
Your evidence will need to be correctly validated and authenticated – which I will explain in more detail shortly. If you do this before you submit it to us, you will save time and we will be able to process your application quicker. Evidence that isn’t correctly validated or authenticated will NOT be considered when your application is evaluated.
The evidence requirements for this type of application are extensive and it is not unusual for an applicant to take between 3-6 months to prepare their evidence, before submitting an application to us.
A CESR application is an evidence based application, and as such must provide evidence which demonstrates that your knowledge and skills are equivalent to all of the competencies of the curriculum of the specialty in which you are applying. 6

7. Preparing for submission
Documentary evidence based on GMC’s Good Medical Practice Guide:
Domain 1: Knowledge, skills and performance
Domain 2: Safety and quality
Domain 3: Communication, partnership and teamwork
Domain 4: Maintaining trust
Your documentary evidence will be based on the GMC’s Good Medical Practice guide:
Domain 1 is Knowledge, skills and performance - typically around 75% of your evidence bundle
Domain 2 is Safety and quality - typically around 20% of your evidence bundle.
Domains 3 and 4 are Communication, partnership and teamwork AND Maintaining trust –typically around5% combined 7

8. Suggested documentary evidence
Evidence of specialist qualifications or examinations passed
Employment records
Appraisal portfolios
Work-based assessments
360 degree appraisals (where available)
Evidence of participation in teaching, lecturing and management
Evidence from specific cases, etc
The types of evidence you could submit are:
Evidence of specialist qualifications or examinations passed
Employment records
Appraisal portfolios
Work-based assessments
360 degree appraisals (where available)
Evidence of participation in teaching, lecturing and management
Evidence from specific cases, such as Log books, Case Based Discussions, Work Placed Based Assessments – or ANYTHING that shows equivalence. 8

9. Preparing for submission
Read the Specialty Specific Guidance – SSG
If you don’t have the evidence, wait until you can get it
Bundles are typically pages long
No need to duplicate evidence
Make sure your evidence is relevant

10. Evidence - Authentication
Registration or Qualifications obtained outside the UK
Authentication by a Solicitor or the Awarding Body
They stamp and sign a copy – to certify they have seen the original
Also known as a Certified Copy
The most common problem with evidence is that it is not correctly validated or authenticated. This can slow down the process, and in some cases make the difference between a positive and negative outcome.
We only require copies of documents. These copies need to validated or authenticated, so please do not send us originals.
Any evidence which does not meet the requirements of authentication or validation will not be submitted to the college for consideration, so it really is important to get it right.
We have a separate hand out for validation and authentication for you to take away with you.
Registration with another regulatory body or qualifications obtained outside the UK must be authenticated by either the awarding body or a solicitor. This means that the awarding body, or solicitor, upon seeing the original certificate and the copy together, must stamp, sign and date the copy to confirm that it is genuine. This is also known as a certified copy. 10

11. Evidence - Validation
Every piece of evidence that relates to your training and experience
Medical Supervisors who can confirm it is a true and accurate record
Hospital Stamp
Name of person validating
Their job title
Their Signature
Incorrectly validated or authenticated evidence will not be sent to the Royal College
Every piece of evidence that relates to your training and experience must be validated by someone in a medical supervisory position at that hospital, who can confirm that it is a true and accurate record.
Each piece of evidence must have:
The relevant hospital stamp
Name printed in full of the person validating
Their job title
Their signature
Where a document has multiple pages, the first page and consolidation sheets must show the stamp, name, job title and signature.
The practical exercise that we are going to do later on in the workshop will clearly demonstrate this.
Again, incorrectly validated or authenticated evidence will NOT be sent for evaluation, and could be the difference between a grant or a failure. 11

12. Structured Reports You will be asked to provide 6 referees
Less than 5 is very unusual
The Royal College uses them to triangulate your primary evidence
Verify work, training and experience
Details on your personal attributes, skills and competencies
First referee should be your current medical / clinical director
We recommend you provide the names and details of six referees, who we will contact to obtain structured reports from. In our experience, applications where we do not receive structured reports from at least five referees in the same specialty are extremely unlikely to be successful.
It is good practice to speak with your referees to obtain their permission before nominating them. Let them know how much work is involved in filling the reports out – we have sample forms with us today so you can see what they look like.
The Royal College will use the structured reports to triangulate evidence from your application to verify work, training and experience you have undertaken.
The reports will also provide detail on your personal attributes, skills and competencies. Your first referee should be your current medical or clinical director or head of your department.
We ask your referees to complete and return these reports to us within 21 days. We will actively chase them for a further 21 days. If at this point they have not been received your adviser will ask you to make contact with your referee or suggest you nominate someone else. 12

13. What happens once you have applied?
You will be allocated a Specialist Applications Adviser who will contact you
They will undertake an initial assessment based on the information you have provided
Request your structured reports
This will happen within 2 working days of us receiving your application
An application will be allocated to a Certification Adviser, who will contact you to introduce themselves. They will guide you throughout the whole process and will be able to offer you specific advice about your application. They will complete an initial eligibility check based on the information you have provided in your application.
They will also send off for your structured reports from your nominated referees.
This will all happen within the first two working days of us receiving your online application. 13

14. What happens next?
We will expect to receive your evidence bundle within 14 days of receiving your application
We then have 30 days to provide you with a checklist
Checked against the SSG and Curriculum to identify gaps
You then have a further 60 days to submit any further evidence
We will expect to receive your evidence within 14 days of you submitting your application. We won’t be able to process you application until we have this evidence bundle. It is also important to include your evidence of eligibility in your initial bundle. If you don’t, your application is likely to be delayed.
Once we have your bundle we will start assessing the evidence you have provided, and start to produce a checklist. This will help identify any gaps in your evidence. Your Adviser will be able to offer you structured advice and guidance on what other evidence you may wish to submit. In the practical exercise later today we will give you an example of a checklist so you know what to expect.
Any evidence which has not been accepted for validation purposes will be returned to you for you to validate correctly. Your Adviser is able to cross reference evidence, so there is no need to submit a piece of evidence more than once.
When looking at the evidence you have submitted, we will check it against the SSG and curriculum to see that you have provided evidence to be considered in each domain. If there is an area which is lacking in evidence, you may be advised to withdraw your application if you are unable to get this evidence together quickly. 14

15. What happens next? After 60 days your application is deemed closed
It is uploaded to the Royal College for evaluation
We have 3 months to issue a decision
Internal Quality Assurance process prior to decisions being issued
We will close your application no later than 60 days after sending your first checklist. At this point we will not accept any further evidence or Structured Reports.
We will scan all the evidence you have sent us to create one bundle, and upload electronically to the relevant Royal College for evaluation.
The Royal College will source two independent evaluators to assess your application and amalgamate their comments into one evaluation form, and then return to us.
At this point, we are legally obliged to issue you with a decision within 3 months.
I’m sure there are people in this room who would have had a very different experience – 2 years, 3 years – 3 years to find out they are not eligible!!!!
PMETB never issued decisions within 3 months – When GMC took this over in April 2010, less than 20%
Now we issue 95% within the 3 month deadline.
When we receive your evaluation back from the Royal College we undertake an internal review to ensure that the recommendation is correctly evidenced AND where the recommendation is to reject, that appropriate recommendations have been made to assist the applicant in any future application. 15

16. A decision is made - Successful
Specialist Registration (and Full Registration) is automatically granted
A copy of the evaluation is sent to you
Once we are satisfied that all of the evidence you have submitted has been considered and assessed against the correct standards, we will write to you and let you know the outcome of your application.
Where a decision has been made that you are to be granted a CESR, you are automatically placed onto the Specialist Register. A copy of the evaluation is sent to you so you can see the comments the royal college evaluators made about your application. 16

17. A decision is made - Unsuccessful
A letter confirming you have not been successful
A copy of the evaluation
Recommendations which will help in future applications
When a decision has been made that you have not been successful, you will receive a letter outlining your options.
Your evaluation will include robust recommendations which will help you in any review or re-application you may wish to make.
I have spoken to many potential applicants that have expressed that they are perhaps anxious of applying as they don’t want to fail. The point to remember, is that if you are un-successful first time round, you will be given specific recommendations on what training or experience you will need to undertake to get you where you want to be. 17

18. Review
You may wish to review our decision on an unsuccessful application if:
You have additional relevant documentary evidence OR
You have completed the top-up training recommended
You consider there has been a procedural error
You must apply within 12 months of the date on your decision letter
You may apply for a review if:
You have additional relevant documentary evidence that you have not previously submitted that addresses the shortfalls set out in our decision and recommendations Or
You consider that there has been a procedural error or other unfairness in the way in which we have processed your application or made our decision
(For example, you feel that the evidence you submitted met our requirements but we did not take it into account when we made our decision.)
You must submit your review application within 90 days of the date on your decision letter. 18

19. Success Rates Success depends on: Your past experience and training
The evidence you provide
Your willingness to engage
Your referees’ comments
The following statistics are not an indication of your likelihood of success
Success depends on your previous experience, the level and availability of the evidence you are able to provide, your willingness to engage with the process and whether your referees are able to provide the necessary information.
We have produced statistics on successful and unsuccessful CESR and CEGPR applications as we understand that these applications can be a daunting prospect and you will look to get as much information as possible before committing to what is often a time consuming and complex process.
However, if you are seeking to determine the likelihood of success for a particular application, you should interpret these numbers with caution. 19

20. Success rates In Q1 of 2012 we had 135 CESR applications.
59 applications were successful and 76 were un-successful.
This does not mean you have a 44% chance of a successful application. It really is all dependant on your skills and experience and how you demonstrate that through the evidence which you submit! 20

21. ü * ( For more help from the team… Website www.gmc-uk.org Email
Between 15 March 2012 and 15 June 2012 we consulted on the recommendations from our review of the routes to the GP and specialist registers. In September 2012 Council approved a number of recommendations, including the proposals of a new model for evaluating applications for GP and specialist registration under the equivalence routes. The model comprised four elements:
That prospective applicants for the equivalence routes must have practised in the UK as a licensed doctor for at least 12 months in the three years prior to the application
That in principle, tests of specialist knowledge should be a mandatory element of the new model for evaluating equivalence applications.
That there should be a workplace evaluation of performance in practice in the UK.
That there should be documentary evidence of experience.
This new model is however a long term objective for the GMC. Legislative changes will be required; and although we will start our work in preparation of the changes being made, we will not be in a position to implement the new model before We will work with the Academy, Royal Colleges and Faculties and other stakeholders to develop the new model in greater detail.
Phone
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22. The CESR application process