The Savvy IMG

How to become a UK specialist without entering a UK training programme – the CESR pathway

In this post we discuss the alternative route to becoming a Specialist in the UK (GP or Consultant) through the CESR pathway (AKA Article 14). This is suitable for those who have already been practising overseas for many years, and for those who are unable to secure a UK training post for any reason.

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Certificate of eligibility for specialist registration aka Article 14 is an alternative pathway to become a UK specialist either as a GP or Consultant

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UPDATED: March 27, 2020

Before you read this make sure you understand how specialty training (residency) works in the UK.

I’ve met several doctors that have taken the alternative route and I want to shed some light on it for you too.

So in this article we discuss the following:

So how does the alternative route work?

After completing training, specialists join a separate register with the GMC. GPs join the GP Register while Consultants join the Specialist Register. But completing a GMC-approved training programme is only one way to join the register.

There are is a pathway to become a UK GP or UK Consultant for those who haven’t entered a UK training programme at all.

This illustration should make it clear:

Pathways to become a UK recognised specialist through the CCT CESR-CP and CESR routes 2 CCT – Certificate of completion of training / CESR-CP – Certificate of Eligibility for Specialist Registration Combined Programme / CESR – Certificate of Eligibility for Specialist Registration

This article is about CESR.

Now, I wanted to shed light on the fact that it’s possible but let me also say that the alternative route is not ideal. In fact, I would argue that it should not be your first choice. It’s a complex process that can potentially take longer than the traditional training pathway, but not always.

Also, be aware that although CESR is considered equivalent to CCT in the UK, CESR is not considered equivalent to CCT in some countries. So if you plan to work as a Consultant overseas after working in the UK, check with the relevant medical authorities first whether they accept CESR Consultants.

What does the alternative route involve?

You’ll need to compile a whole portfolio of evidence to prove you have achieved the equivalent skills and experience of a doctor who has completed a full GMC-approved training programme.

So if a UK trainee needs to perform 5 supervised and 5 unsupervised chest drains for their log, then you should have the same. If a trainee has to attend a certain course, you should attend it too or attend an accepted equivalent course. If a trainee needs pass a particular exam, you’ll need to pass it or an accepted equivalent as well.

You can collect this evidence prospectively through non-training jobs, or retrospectively from your work overseas. Prospective evidence is generally preferred.

When you have collected your evidence you then submit it to the GMC for approval. They’ll review your evidence together with input from the relevant Royal College and decide whether your training is equivalent to a UK trained Consultant. Acceptance rates for CESR are published annually here.

More information about CESR:

Should I pursue the alternative route?

It depends on your circumstances. Here are some situations where you might want to consider the CESR pathway.

1. You have already completed specialty training back home

If you have already completed specialty training then you’re unlikely to want to repeat it. Even if you are willing, you may be overqualified to apply to a first-year post.

In this case, you can apply for more senior roles such as a senior clinical fellow, registrar, specialty doctor or a locum Consultant (locum Consultants are not required to be on the specialist register). 

This way you will have better pay and the roles and responsibilities are more appropriate to your level of experience. 

While working in these jobs you can collect evidence of your experience to put in your CESR portfolio.

2. You haven’t completed training but you have too much experience in your specialty 

As mentioned above, some specialties will not accept you for a first year post if you already have too much prior experience, even if you have not completed a residency programme. This includes any experience abroad (whether training or not) and any non-training jobs in the UK. This means you are not eligible for the CCT route.

But of course you have options. You can either apply in the middle of a training programme, usually at ST3, to follow the CESR-CP route, or continue on the CESR route. (You can read the steps for the CESR-CP pathway here.)

You can check the limits by reviewing the person specifications. It will be under the “Career Progression” section in bold light blue text. 

We’ve also compiled a list of the experience limits for all specialties which you can download here.

3. You have been repeatedly unsuccessful in your specialty application

If you are repeatedly unsuccessful in applying to UK specialty training, then there might come a time when you feel that it would be better to forget about the training programme and make your own way through CESR/CEGPR. It’s a tough road but it can be done.


  • The alternative route presents an opportunity to become a Specialist in the UK for doctors without entering a GMC-approved UK training.
  • It is not the ideal route, but sometimes your circumstances will require you to take this path. This can be because:
    • You have completed training overseas, or
    • You are overqualified to apply for training, or
    • You’ve been repeatedly unsuccessful in your application to UK specialty training.
  • It is difficult, there’s no denying it, but you will not be alone. Many IMGs have gone down this path successfully so don’t despair if you cannot enter a training programme.
  • The GMC provide a lot of information about this route and a patient, determined and well-organised doctor can succeed.

Read more about the traditional training pathway through a GMC-approved training programme here.

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Looking for a step-by-step guide?

Subscribe to the Savvy IMG and grab your FREE 2-year roadmap to UK residency as an IMG.


Looking for a step-by-step guide?

Subscribe to the Savvy IMG and grab your FREE 2-year roadmap to UK residency as an IMG.


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Meet the Team

Hi, we’re Drs Nick & Kimberly Tan, the two IMGs behind The Savvy IMG. We write comprehensive guides, create courses, and provide one-to-one guidance to help other overseas qualified doctors on their journey to the UK.
We have scoured the official guidance to put these posts together, but we can make mistakes! If you spot anything that is incorrect, please get in touch and we’ll put it right.
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