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About the combined programme (CP)

What is the combined programme?

The GMC approves specialist training programmes in 65 specialties. Trainees who achieve all programme competencies in approved posts can apply for entry onto the specialist or GP register via a Certificate of Completion of Training (CCT).

However, some trainees who decide to join an approved specialist training programme have previously trained in other, non-approved posts. Your LETB/deanery and college/faculty may decide that this has already given you some of the CCT curriculum competencies. If so, you can enter training at a later starting point, complete the rest of the programme and gain the remaining competencies.

This is known as the ‘combined programme’, at the end of it you can apply for entry onto the Specialist Register via a CESR (CP), or to the GP Register via a CEGPR (CP).

Within the UK, there’s no difference in the recognition of a CESR/CEGPR and a CCT. Both certificates allow specialist or GP registration on exactly the same terms. And specialist registration in any specialty means you can be appointed to a substantive consultant post in the UK health services; while GP registration means you can apply for inclusion in a performers list to work as a UK health service GP.

If you want to work elsewhere in Europe, it’s more complicated. Under European law, a CCT is recognised automatically in EEA member states and Switzerland if (and only if) these two conditions are met:

  • the doctor concerned is an EEA or Swiss national, or benefits for these purposes from an enforceable Community right under the Citizenship Directive
  • the specialty is listed in Table 5.1.3 or 5.1.4 of Annex V of  The Directive on Recognition of Professional Qualifications (the Directive) for both the UK and the country you’re moving to (some UK specialties aren’t listed in the Directive; and, of those that are, not all of them have a corresponding listing in every other member state).

CESRs and CEGPRs (and CCTs that don’t meet the second of those two conditions) aren’t recognised in the same way. Instead, the holder must apply for recognition under what the Directive calls ‘the general system for the recognition of evidence of training’. And this is likely to involve a process of assessment.

If you think you might want to work in Europe, you should therefore check the requirements in the country you are thinking of moving to.

Approved training

Different organisations have had responsibility for approving training at various points. Approved training must have been approved by one of the organisations below:

Organisation Period
The relevant medical Royal College or Faculty Before September 2005 (for specialists)
The Joint Committee on Postgraduate Training for General Practice (JCPTGP) Before September 2005 (for GPs)
Postgraduate Medical Education and Training Board (PMETB).

However, some training posts completed before 31 December 2006 were approved retrospectively by the relevant Royal College or Faculty. This approval will have been granted before 31 July 2007 and the doctor will have written confirmation from the Royal College or Faculty confirming this.

Between September 2005 and March 2010
The GMC From April 2010

Training must be also be approved specifically for the relevant curriculum. This means that if you were appointed to a training programme at a higher level as a result of competencies gained in another specialty training programme, you will need to apply via the CESR (CP) application type. The only exception would be if your previous training posts were also prospectively approved for your new programme. In this case, you would be on the CCT route.

How will I be enrolled onto a combined programme?

  • A postgraduate deanery will appoint you to a Specialty Training Programme and award you a National Training Number (NTN).
  • You must then enrol with the relevant Royal College or Faculty.
  • The Royal College or Faculty, in consultation with your deanery, will confirm your entry level to specialist training. This needs to be done no later than your first Annual Review of Competence Progression (ARCP).
  • You can be appointed at any level, as long as you undergo two ARCPs (including the final ARCP) within programme. GP trainees need to undergo at least their final ARCP within the programme.
  • The deanery will then make an application to the GMC to ask us to approve your enrolment. The GMC will write to you, your deanery and your college, confirming that you are following the combined programme.

Important information about previous training

It is important to note that previous training can only be taken into account at or before your first ARCP. After the first ARCP, recognition of previous training and enrolment on a combined programme cannot be used to bring your completion of training date forward.

Completing the combined programme

If you are due to complete specialist or GP training through the combined programme, please read our guidance on how to apply for a CESR or CEGPR through the combined programme.

You must submit your application within 12 months of completing training. After this point, you will need to submit a full CESR application. For more information, please see our guidance about applying for a CESR.

If you do not achieve all the curriculum competencies within the combined programme, your College will not be able to recommend you. This includes passing any required assessments systems, such as exams. If you are in this position and feel that you can show that your knowledge, skills and experience are equivalent to the CCT curriculum you can apply for specialist registration via a CESR. For more information, please see our guidance about applying for a CESR.

Apply online

If you are sure this is the right route to specialist or GP registration for you, you can apply online now.