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Harder equivalency route to specialist registration

The General Medical Council is currently consulting on possible changes to the routes to entry on the GP Register and Specialist Register. Of interest, research commissioned in preparation for the consultation revealed that 69% of all doctors were not aware of any route to GP or specialist registration other than completion of an approved speciality training programme in the UK and award of a CCT, or Certificate of Completion of Training.

There are in fact three routes to GP or specialist registration: 1. CCT 2. CESR/CEGPR and 3. CESR(CP)/CEGPR(CP).

Why is GP or specialist registration important?

In order for a doctor to take up a substantive, honorary or fixed term consultant appointment in the NHS, it is a legal requirement that they be listed on the Specialist Register of the GMC. Similarly, a doctor practising as a NHS GP must be on the GP Register.

How do I get on the GP or Specialist Registers?

The most well-known route of entry to the registers is via the award of a CCT. CCTs can only be awarded to applicants who have successfully completed an approved course of specialty training in the UK. Places on the specialty training programmes are awarded following annual, open competition and the competition is fierce: in 2011 the average ratio of doctors applying for each training post was 2:1, but in popular specialisms the ratio rose considerably – four applicants for each post in surgery and almost six applicants for each post in cardiology.

The equivalency routes

The less well-known route of entry to the registers is via the award of a CESR/CEGPR or CESR(CP)/CEGPR(CP), meaning:

CESR – Certificate of Eligibility for Specialist Registration

CEGPR – Certificate of Eligibility for GP Registration

CESR(CP) – Certificate of Eligibility for Specialist Registration (Combined Programme)

CEGPR(CP) – Certificate of Eligibility for GP Registration (Combined Programme)

These are often referred to as the ‘equivalency routes’.  In summary, doctors who have training, qualifications and experience gained outside an approved specialty training programme can apply to the GMC for entry to the Specialist Register or GP Register on the basis that their training, qualifications and experience are equivalent to the requirements for the award of a CCT/practise as a consultant in the NHS.

CESR(CP) and CEGPR(CP) is the mechanism to be utilised by doctors who have completed a combined programme – some training within an approved specialty training programme and some without. For example, doctors who have undertaken some years of specialty training abroad and are then appointed to approved specialty training programmes in the UK above ST1 (first year of specialty training) level.

How do I demonstrate equivalence to the GMC?

To apply through the equivalency routes, the doctor submits a portfolio of evidence to the GMC. The GMC then sends the doctor’s application to the relevant Royal College or Faculty for evaluation. A team of experts from the royal college or faculty reviews the evidence and makes a recommendation to the GMC as to whether the doctor meets the required standards. The GMC is not bound by the royal college or faculty’s recommendation, but departs from the recommendation in less than 1% of all cases.  The entire decision-making process is based on documentary evidence rather than, for example, practical assessments or oral hearings.

The application process through the equivalency route is complex and time consuming. Success rates between 2005 and 2011 varied considerably across specialisms, ranging from 0% in thoracic surgery to 100% in endocrinology. The most common reason why applications fail is because they lack sufficient and appropriate evidence, which is perhaps not surprising considering most doctors apply without the benefit of professional assistance.

Consultation on changes

Until 15 June 2012 the GMC is running a consultation regarding a possible new model for the equivalency routes. The new model would comprise four elements:

1. A period of acclimatisation to UK health services – equivalency route candidates would need to already hold full GMC registration and a licence to practise and have practised as a licensed doctor in the UK for at least six months in the previous three years.  Doctors who had not previously practised within the UK would no longer be able to relocate to the UK and immediately work at GP or consultant level, regardless of their experience or status in their home country. An exception would be made for a very small category of doctors known as “eminent overseas doctors”, or doctors of high international standing.

2. Demonstration of specialist knowledge – as with CCT candidates, equivalency route candidates would be required to demonstrate their specialist knowledge by passing a formal test set by the relevant royal college or faculty, for example the FRCS(Urol) exam in the case of Urology candidates.

3. Workplace evaluation of performance in the UK – it would be mandatory for equivalency route candidates to pass assessments carried out by educational supervisors within recognised UK training environments, under the auspices of the local deanery. The supervisor would then make a recommendation to the GMC as to the candidate’s suitability.

4. Documentary evidence of experience – the volume of documentary evidence submitted by candidates would be much reduced and limited to demonstrating aspects of knowledge and experience not separately demonstrated through steps 2. and 3. above.

Changes to the equivalency routes to specialist registration are of significant importance to a large cohort of doctors working in the UK at staff grade, associate specialist and specialty doctor levels. The proposed changes would make it even more difficult for them to ever achieve specialist or GP registration.

However, many may welcome a more robust process in order that, when they do achieve specialist or GP registration via the equivalency route, it will no longer be viewed as a back door to the specialty register by some detractors. The GMC’s consultation remains open until 15 June 2012 if you want to have your say.

Andrea James is head of healthcare regulatory at George Davies Solicitors LLP, a former in-house Solicitor to the GMC and specialises in advising doctors, including in relation to applications for specialist and GP registration. Click here for further details.

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One Response to “Harder equivalency route to specialist registration”

  1. Laura says:

    For those speaking a foreign language spoken in the EU, there is yet another route to the specialist register: Obtain the specialisation in an EU country! Become a speciaist without having to deal with any Royal College and earn a legal right to have it recognised thanks to EU legislation.

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