Regulating doctors, ensuring good medical practice

Frequently asked questions - specialty equivalence

This page provides common questions and answers for doctors applying for entry onto the CESR or entry onto the GP Register with a CEGPR through the specialty equivalence route.

For detailed information about how to apply please see our applications section. You can find out about fees in our fees section.

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Click on a question in the list below to see the answer.

  1. 1. Are CESR and CEGPR equivalent to being awarded a Certificate of Completion of Training (CCT)?
  2. 2. What are the success rates for applications through the specialty equivalence route?
  3. 3. Do I need to hold full registration to apply for entry onto the Specialist Register or GP Register?
  4. 4. Can I apply for a CESR or a CEGPR if I am currently on a UK training course?
  5. 5. How do I know whether my specialty is the same as one of the UK CCT specialties?
  6. 6. Can I apply for a CESR in a non- CCT specialty if all my training or qualifications were obtained in the UK?
  7. 7. What if I have academic or research experience. Can I apply for a CESR?
  8. 8. Do I have to pass College exams to apply?
  9. 9. How long does an application through the specialty equivalence route take?
  10. 10. Do I need to supply every piece of documentation listed in the specialty specific guidance on evidence?
  11. 11. Which curriculum will my application be assessed against?
  12. 12. Who makes the decisions on applications?
  13. 13. Do you ever overrule Royal College or Faculty recommendations?
  14. 14. Do the certification panels which are used to review specialty equivalence have relevant specialty expertise?
  15. 15. What happens if my application is refused?
  16. 16. How do I apply?
  17. 17. How long will it take me to prepare my application before I submit it?
  18. 18. Is there any way I can speed up my application?
  19. 19. How much documentation should I submit?
  20. 20. How many references do I need for a CESR or a CEGPR application?
  21. 21. Is a clinical director equivalent to a medical director as a referee?
  22. 22. What if I have had a dispute or a disagreement with a referee?
  23. 23. When is an application considered complete?

1. Are CESR and CEGPR equivalent to being awarded a Certificate of Completion of Training (CCT)?

The important issue is entry onto the Specialist Register or GP Register. We will not award a CESR or a CEGPR without entering the applicant onto the relevant register at the same time. Entry onto the Specialist Register means you are able to take up a substantive, fixed term or honorary consultant post in the UK health services. Entry onto the GP Register means you are able to take up a GP post in the NHS.

Holding a CCT, a CESR or a CEGPR represents just some of the several different ways in which doctors have gained entry onto the Specialist Register or GP Register. There are many doctors on the Specialist Register or GP Register who do not hold a CCT or the previous end of training certificate - Certificate of Completion of Specialist Training (CCST).

However, unlike CCT, CESR and CEGPR are not awarded under Annex V (point 5.1.2) of Directive 2005/36/EC for the UK. A CCT confirms that satisfactory completion of specialist training which satisfies the requirements of Article 25 of the Directive or Article 28 where the specialty is General Practice. CCT are only awarded to doctors who complete a fully approved specialty training programme in the UK.

Please note that only 39 of the 61 CCT specialties are listed in Annex V. This means that if a doctor holds a CCT in one of the specialties not listed then they do not have mutual recognition rights in other EU countries.

2. What are the success rates for applications through the specialty equivalence route?

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 an application for a CESR or a CEGPR can be a daunting prospect and you will look to acquire as much information as possible before committing to what is often a time consuming and complex process. However, if you are seeking to ascertain the likelihood of success for a particular application, you should interpret these numbers with caution.

3. Do I need to hold full registration to apply for entry onto the Specialist Register or GP Register?

You can only be granted entry onto the Specialist Register or GP Register if you hold full registration with a licence to practise. If you do not hold full registration with a licence to practise, depending on your circumstances, you will be required to apply for full registration with a licence to practise either before your application for entry onto the Specialist Register or GP Register, or at the same time.

You can find guidance on how to apply in our applications section.

4. Can I apply for a CESR or a CEGPR if I am currently on a UK training course?

Yes you can. Applying for a CESR or a CEGPR is a completely different process to applying for a CCT, but enrolment on a training course does not mean you cannot make an application for a CESR or a CEGPR.

If you have been appointed to a Specialty Training programme after undertaking some training in posts that were not approved for the specialty in which you will complete your training, you may be eligible to apply for a CESR or a CEGPR through the combined programme.

Read more about the combined programme.

5. How do I know whether my specialty is the same as one of the UK CCT specialties?

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.

Please refer to the content (requirements) of the relevant curricula. It may be that your specialty has a slightly different name to those listed here, but it is the content of the curricula, rather than the actual specialty name that is relevant when applying. If the curriculum requirements/content matches those of your specialty, then that will be the specialty to apply under.

6. Can I apply for a CESR in a non- CCT specialty if all my training or qualifications were obtained in the UK?

No. Applying for CESR in a non-CCT specialty is restricted to doctors with specialist training or specialist qualifications obtained outside the UK.

7. What if I have academic or research experience. Can I apply for a CESR?

Yes. A CESR in academic or research medicine may be awarded to a small number of doctors who have not followed conventional specialist training, but have focused on a specific area of narrow research and have made a significant contribution to their academic field.

Read guidance on how to apply for a CESR in academic or research medicine.

8. Do I have to pass College exams to apply?

No. We will not insist that you have passed a particular College or Faculty examination but where a qualification is a compulsory requirement of the CCT curriculum, it is important that you submit alternative evidence suggested in the specialty specific guidance for your specialty to demonstrate the required level of knowledge.

Read guidance on evidence you need to submit.

9. How long does an application through the specialty equivalence route take?

As a general guideline it can take between six and nine months from when you submit your application to the receipt of your decision.

The evidence requirements for this type of application are extensive and it is not uncommon for it to take an applicant between three and six months to prepare their application, gathering and presenting their evidence bundle.

This should be more straightforward if the majority of your training has been through a Specialist or GP training programme.

For more information about the process, please find the right guidance for you in our applications section.

10. Do I need to supply every piece of documentation listed in the specialty specific guidance on evidence?

The specialty specific guidance documents are developed in conjunction with the Royal Colleges and Faculties, who carry out most of the evaluations, however they are not exhaustive and you may have alternative evidence. We recognise that you may not have all the evidence listed and you may wish to delay submitting an application until you are able to gather it.

The evidence you submit must cover the knowledge, skills and qualifications, to demonstrate the required competencies in all areas of the relevant curriculum, if evidence is missing from one area of the curriculum for example, then your application may fail.

11. Which curriculum will my application be assessed against?

Applications for entry onto the Specialist Register with a CESR or entry onto the GP Register with a CEGPR through the specialty equivalence route will be assessed against the curriculum current at the time of the application. If you are not awarded entry onto the Specialist Register or GP Register at the first attempt and you submit a review it will be considered against the curriculum in place at the time of your original application, whereas if you submit a reapplication it will be considered against the curriculum in place at the time of your reapplication.

For applications for a CESR or a CEGPR through the combined programme, we will automatically assess your application against the curriculum in place at the time of your appointment to a Specialty Training programme. If we approve a new programme and you choose to transfer to it then you will be assessed against the curriculum for the new programme (it is your responsibility to provide us with evidence of this transfer from your Deanery).

12. Who makes the decisions on applications?

We make the decisions on all applications. This decision is based on the evidence submitted, referees structured reports, the evaluation from the relevant Royal College or Faculty and any other information we have requested to reach our decision.

13. Do you ever overrule Royal College or Faculty recommendations?

In the vast majority of cases we endorse the recommendations of the Royal Colleges and Faculties, but in a tiny number of cases, when they have been unable to support their opinions with evidence, we may reject their recommendations. When this happens, we ask the Royal College or Faculty to provide evidence in support of their views. If they are unable to provide us with evidence but still retain their opinions, then we may go to the hospital where you are working and check in further detail, with the medical director or relevant clinical director responsible for care at that hospital in order to get their view on the standard of your work. Or we may seek further input from our associates.

We will look at all the evidence available at a specially convened panel. We would reject a recommendation from a Royal College or Faculty only after very careful investigation.

14. Do the certification panels which are used to review specialty equivalence have relevant specialty expertise?

Where we have concerns about an application or an evaluation from a Royal College or Faculty or where we need to seek clarification on an evaluation or for quality assurance purposes a case may be considered by a Certification Panel. This happens particularly where the application or evaluation does not appear to comply with our requirements. Certification Panels are made up of specialists on the Specialist or GP Registers and lay members. The specialists may be in the same specialty as the application, but must not be a College assessor for such cases. If there is no specialist on the panel in the specialty of the application, the panel will call on designated expert advice in that specialty, where needed.

15. What happens if my application is refused?

We will let you know why your application has been refused. We will also tell you what top-up training you need to undertake, its duration and the fields it needs to cover. You can read about what to do next in our unsuccessful applicants section.

16. How do I apply?

Please read the applications guidance thoroughly. If you are not sure which route you are eligible for you should answer the questions in our applications section to find the right guidance for you.

If you know what you are eligible for you can skip the questions and go straight to the guidance here:

17. How long will it take me to prepare my application before I submit it?

It is your responsibility to ensure that you gather the documentary evidence in support of your application before you submit it. The more time you spend doing this, the more likely you are to get it right first time.

It is very important that you do not submit your application prematurely. The biggest single reason why applications fail is because they are incomplete; perhaps because the applicant has not submitted sufficient or appropriate evidence to demonstrate that they meet the criteria. It is much quicker (and cheaper) to take the time to gather all your evidence before you submit your application than it is to submit an incomplete application and be unsuccessful. It is not uncommon for an applicant to take between three and six months to prepare their application.

18. Is there any way I can speed up my application?

Your specialist applications adviser will help you through the application process. You should read the guidance on how to apply, the curriculum for your specialty (or nearest specialty) and the specialty specific guidance on evidence. You are also advised to ensure that your referees are aware of the application process and what is required of them and the importance of them responding promptly to our request.

After you have submitted your application, it is likely that we will need to ask you for further information and evidence. Please let us have this as quickly as you can, so that we can take your application forward promptly.

We also ask you not to contact us unnecessarily, since doing so may divert our staff's time away from the important business of dealing with your application. In return, we undertake to let you know when particular milestones in the application process have been passed - for example, we will tell you if your application has been referred to a Royal College for assessment.

If you do need to get in touch, please communicate directly with your assigned specialist applications adviser. They will be best placed to answer your questions.

19. How much documentation should I submit?

It will help us to deal with your application more quickly if you make sure that you send us only evidence that is directly relevant.

Our guidance on compiling your evidence will help you to decide what is relevant and what is not. We recommend that you read it carefully.

Evidence that is more than five years old  will be given less weight than more recent evidence, so you may not need to include it. As a general guide, we would usually expect to see between 800 and 1000 pages of evidence

20. How many references do I need for a CESR or a CEGPR application?

You will need to provide the names and contact details of six referees from whom we will obtain references in the form of structured reports. We require a minimum of five structured reports before we can proceed with your application.

There is more information about referees, including advice on who to nominate, in our guidance on selecting referees.

21. Is a clinical director equivalent to a medical director as a referee?

No. A medical director has access to information such as disciplinary procedures, regardless of whether you have had personal contact with them. You may instead choose to nominate your clinical director as your first referee.

We recommend that you inform them and/or arrange to meet with them before you submit your application.

22. What if I have had a dispute or a disagreement with a referee?

It is your choice who to nominate as your referees (apart from the current Medical or Clinical Director which is a requirement).

23. When is an application considered complete?

It is deemed complete when we have received:

  • All the relevant supporting documentation and evidence.
  • The five structured reports from your nominated referees.

Once these have been received we will tell you. We have three months to reach a decision on your application after this date.

When you have read this section