A guide to the routes of entry on the GMC’s specialist register for trainees starting specialty training at ST3 or above in the North West School of Surgery
Certification Types There are three types of certificates in the UK issued by the General Medical Council (GMC):
The Certificate of Completion of Training (CCT)
The Certificate of Eligibility for Specialist Registration via the Combined Programme (CESR (CP)) The Certificate of Eligibility for Specialist Registration (CESR)
The type of certificate you will receive at the end of training defines which training route you are on.
Within the UK, there’s no difference in the recognition of a CESR 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.
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.1
1 GMC Website: About the combined programme (CP): https://www.gmc-uk.org/doctors/24631.asp
Page 1 of 3 Defining a training programme When deciding on the training route of a trainee doctor, the whole of a trainee’s training programme must be considered. The GMC considers the whole period of training from CT1/ST1 to the completion of training as the training programme. This means that core training is considered a part of the training programme of a particular specialty, even if trainees are regularly appointed at ST3. Joining a training programme at ST3 is therefore considered by the GMC as joining a training programme part way through.
For example, in Plastic Surgery, the training programme is eight years in length, consisting of two years of core training and 6 years of specialist training. Even though CT1 and CT2 were completed as part of a Core Surgical Training, these core years are considered to be part of the Plastic Surgery Training Programme when deciding on the route to entry on the GMC’s specialist register.
Certificate of Completion of Training (CCT)
A CCT confirms that a doctor has completed an approved training programme in the UK and is eligible for entry onto the GP Register or the Specialist Register. To be eligible to apply to the GMC for a CCT, your entire training (including any core years) must have taken place in GMC approved training posts, or in posts undertaken in the EEA/Switzerland and approved by the statutory authority in that country.
Please note that if you completed an “Alternative Certificate of Core Competence”
during recruitment, this does not automatically mean you are eligible to be on the CCT route. The “Alternative Certificate of Core Competence” only confirms that you have the competencies expected of someone who had completed Core Training.
You are on the CCT route if:
You are a UK trainee who achieved the required competences considered towards your appointment to a NTN programme in GMC approved training posts.
Approved posts are ones which have been prospectively approved for training by the GMC. Training undertaken in the EEA/Switzerland can be approved if you provide evidence that the posts were approved by the statutory authority in the country in which you undertook your training.
Certificate of Eligibility for Specialist Registration (Combined Programme)
(CESR (CP)) The CESR (CP) is a simplified application process for doctors appointed to a training programme intended to lead to a CESR for specialist registration. It is awarded by the GMC to those trainees who have not completed a GMC approved training programme in its entirety.
The combined programme CESR/CEGPR is known as the CESR(CP) or CEGPR(CP). This
route applies to trainees who enter a GMC approved training programme (above the first year of the training programme) having undertaken training in non-approved posts prior to entry and then subsequently complete the remaining part of their training in a GMC approved training programme. These trainees follow the same processes for award of their CESR(CP)/CEGPR(CP) as a CCT trainee.2
It may also include those doctors who have not acquired the pre-requisite entry qualifications asked for in the curriculum, but who can offer an alternative qualification that has been judged to be an acceptable equivalent by the appointing HEE local office. 2 The Gold Guide - 7th Edition, 2.34, Page 13: https://www.copmed.org.uk/gold-guide-7th-edition/the-gold-guide- 7th-edition
Page 2 of 3 Trainees who are appointed to a specialty training programme above ST1, but have not gained their core competencies in GMC approved training posts, or in posts undertaken in the EEA/Switzerland and approved by the statutory authority in that country, will be placed on the CESR (CP) route to specialist registration.
You are on the CESR (CP) route if:
You are a UK trainee who achieved some or all of the required competences considered towards your appointment to a NTN programme in non-approved posts.
This only applies to trainees who enter a training programme above ST1.
Therefore you will be placed on to a CESR (CP) route to specialty registration if you gained your core competencies:
outside of the UK,
in the UK but not as part of a GMC approved training programme, or in the EEA/Switzerland but in posts that were not approved by the statutory authority in that country.
Certificate of Eligibility for Specialist Registration (CESR)
This route is for those doctors who leave GMC approved training without completing the full programme (including the required assessments/examinations) and who are not eligible for the CESR(CP) or for those who have never been in a GMC approved training programme. These doctors apply directly to the GMC for an assessment of their training, skills, knowledge and experience against the CCT curriculum. Doctors in training are not usually placed on this training route.
Note regarding National Training Numbers (NTNs)
A trainee may be issued with an NTN ending with the letter “C” (denoting being on the CCT pathway) before it is established that they are on the CESR CP pathway. Once it has been confirmed that a trainee is not on the CCT pathway, the trainee will be issued with a new NTN ending with an “L” (denoting being on the CESR CP pathway).
Further Information and Reading
GMC Website: Specialist and GP certificates
GMC Website: Certificates of Completion of Training (CCT)
GMC Website: The Combined Programme (CP)
GMC Website: Specialty equivalence (CESR and CEGPR)
