The Combined Programme (formerly CESR CP) for Specialist Registration

The specialist register is a step up from the GMC register. All UK doctors might hold a GMC licence, but the specialist register is for expert doctors who want to work as consultants in any capacity, including in a fixed, permanent role.

The most traditional route to getting on the NHS specialist register is through a CCT. However, that’s not always viable for international medical graduates – particularly IMGs who have done some of their training in a non-GMC-approved programme. In this case, they have two options: the Portfolio Pathway or the combined programme. This article will cover the combined programme, including what it is and the steps you need to take to get it.

The Combined Programme: An Overview 

The combined programme is for doctors who completed part of their specialist training overseas and then joined a GMC-approved training programme in the UK above the first year. It used to lead to a separate certificate called CESR CP, but the GMC now awards a full Certificate of Completion of Training (CCT) at the end of a combined programme instead. Doctors previously issued a CESR CP can email cct@gmc-uk.org to request a retrospective CCT free of charge - though this requires that you trained in approved UK posts for the minimum time required in your specialty; if you fall short you may be offered a prospective (current-dated) CCT instead. You will have access to the specialist register at the end of the training. It is considered equal to having a CCT in the eyes of the GMC and NHS.

The combined programme sits in the middle of the Portfolio Pathway and a CCT. The Portfolio Pathway involves doing all of your medical training overseas, whereas a CCT involves doing all of it in a GMC-approved programme. The combined programme is a mixture of both of them. It’s perfect for IMGs who have done some specialist medical training in their home country but would like to get on a more straightforward track to joining the NHS specialist register.

As of April 2023, the combined programme cost £1,974 in total. Please note that these costs often go up yearly, so the price may have changed by the time you read this!

How to Complete the Combined Programme 

If you have completed some training overseas and then started a GMC-approved course, you can get started on the combined programme. You can do this as soon as you are in your approved post. In fact, we recommend starting the application process before your training has ended.

During your training, you will need to contact your Royal College or independent faculty to let them know you want to begin the process of joining the combined programme. They will know exactly how it works and what you need to do depending on your speciality. The amount of training you will need depends on your circumstances. However, expect to spend a minimum of three years in clinical training.

As soon as the Royal College or faculty know that you want to start the application process, they will contact the GMC, who will send you an invitation inviting you to send an application.

How you get assessed will be up to your Royal College or faculty – you will need to follow their instructions. You will also need to collect evidence from your training overseas. For any evidence you get from your international training, you must organise, anonymise, and translate it. You can speak to your Royal College or individual faculty about what evidence you may need from your previous medical training that didn’t take place in the UK.

Keep in mind that you only have twelve months to complete your application from the date you finish your training programme, so it’s important not to put it off!

What Are Your Other Options?

As mentioned, the combined programme sits somewhere in the middle of the CCT and the Portfolio Pathway. However, all of them have the same effect – once acquired, you can get on the specialist register.

If you have not completed any of your training overseas, a CCT would be the better option as it doesn’t involve collecting evidence in the same way. You will need to start a GMC-approved training programme from the beginning and fully complete it before being able to gain access. It will take a minimum of three years. If you choose this route, the application process is much smoother, although your options for where you train won’t be as flexible.

Your other option is to do all your training overseas and gain access to the register through the Portfolio Pathway. However, this route can be a little complicated, as you’ll need to compile all your evidence to prove to the GMC that your training holds up against a CCT.

Who is the Combined Programme for?

The combined programme is for international medical graduates who want to carry on their medical training in the UK intending to get on the specialist register. If you want to work as a consultant in the UK, it’s a great route. It will take a lot of work, training, and a somewhat complicated application process. Still, ultimately, you’ll be able to practice as a consultant in your chosen speciality in a fixed, permanent role. Your position will be highly respected and earn you a high salary.

Of course, with such a long road ahead, you must ensure that it’s what you really want first!

Why is the Combined Programme Necessary?

The combined programme (as well as the CCT and the Portfolio Pathway) is necessary for getting on the specialist register because you need to prove your competency. The NHS and the GMC need to know that all their speciality doctors can provide high-quality care to all patients. It’s about knowing that you have the necessary training and skills behind you to manage in such a senior role.

In Summary 

The combined programme is the route that grants you access to the UK specialist register. The application process involves contacting your Royal College or independent faculty, who will get the ball rolling with the GMC. To prove to the GMC that you are capable, you will need to use a mixture of evidence from your overseas training, as well as proof of completion of your GMC-approved programme in the UK.

Want to know more about how to get on the specialist register? In the next article, we will discuss the Portfolio Pathway in detail, which is a slightly more complicated process for applicants. It’s for those who have completed all their training in a non-GMC-approved programme.

If you’re not sure which route is best for you then please email us and one of our expert team will be happy to provide guidance and support.