Routes to registration

This page contains information on how the recently announced (7 October) General Medical Council (GMC) policy changes can impact on your certification.

There are four main routes to specialist registration in the UK. These pathways, and the certificates they result in, are outlined below:

Route 1:


Certificate Issued:

Certificate of Completion of Training (CCT)

Eligibility Requirements:


This is for doctors who complete their specialist psychiatric training in GMC-approved training posts. The specific requirements for CCT differ depending on the higher specialty. 



Route 2:

CESR - CP or The Combined Programme

Certificate Issued:

Certificate of Eligibility for Specialist Registration (CESR)*

Eligibility Requirements:


This is for those who have completed part of their training in GMC-approved training posts and some outside of approved training posts, typically either international training that isn’t recognised by the GMC or working as a Specialist or Associate Specialist doctor to obtain competencies. 



Route 3:


Certificate Issued:

Certificate of Eligibility for Specialist Registration (CESR)

Eligibility Requirements:


This is the equivalence process for those who have not completed GMC-approved training where doctors use their current psychiatric practice (the last 5-6 years) to evidence each competency outlined in the relevant specialty curriculum.



Route 4:

Relevant European Qualification - Specialist

Certificate Issued:

No certificate issued

Eligibility Requirements:


For doctors who hold a relevant specialist European Qualification which meets the current GMC criteria for recognition. 


*Due to some of the queries we have received, we think it is important to note that the CESR-CP pathway has always resulted in the issuing of a CESR. The GMC only issue two certificates, CESR and CCT.

GMC policy changes to CCT eligibility

On 18 May 2020, the GMC enacted a policy change with regards to eligibility for CCT after extensive legal consultation and consultation with Medical Royal Colleges and Faculties. The review came as part of the flexibility in training agenda and the intention is to expand the criteria for CCT eligibility without a legislative change. This was phase 1 of the project and was only applicable to specialties named in the EU directive. 

On October 7 2020, the GMC have enacted a further policy change in relation to those specialties that are not named in the directive and as a result do not have a minimum training time requirement for CCT. 

After the first phase of this project, it was noted by us at the Royal College of Psychiatrists that there was some confusion as to what this means for psychiatry, so have set out the following psychiatry specific guidance for eligibility:

NOTE: The UK left the EU on 1st January 2021 and we are no longer bound by the EU directive on the Recognition of Professional Qualifications. The exact impact on training resulting from Brexit has yet to be confirmed to the College. 

The information below was written prior to Brexit and will be updated as soon as have further information.

Requirements for eligibility 

  • Not all psychiatric specialties are named under Annex 5.1.3 of EU Directive on the Recognition of Professional Qualifications (2005/36/EC), only two psychiatric specialties recognised in the UK are named: General psychiatry and Child and Adolescent psychiatry.
  • The legislative minimum training requirements for those specialties are a minimum of four years (WTE).
  • All other psychiatric specialties (Forensic, Old Age, Psychiatry of Learning Disability and Medical Psychotherapy) do not have a legislated minimum training time requirement. 

What this means for current trainees

  • For General Adult and Child and Adolescent trainees currently on the CP training pathway, if you will have completed four years (WTE) of GMC-approved UK training posts by the end of your training, it is likely that your training pathway will be changed to a CCT. 
  • For all other psychiatric specialties, if you enter and successfully complete higher training within a GMC-approved UK training posts, you will be automatically eligible to be issued with a CCT.

Note for dual trainees: as no dual programme in psychiatry is shorter than four years (WTE), you would automatically be eligible to be issued with a CCT in both specialties.

What this means for those previously issued with CESR CP

  • Those previously issued with a CESR at the end of their CESR CP programme may be eligible to have it reviewed and be issued with a CCT.
  • If you have qualified in either Child and Adolescent or General psychiatry, you will need to have been in GMC-approved UK training for a minimum of four years (WTE) and be able to provide evidence of this. 
  • For all other specialties with no minimum training time requirement, you would need to provide evidence of your time in UK training and that you left a GMC-approved UK training programme ready for consultant practice.

The GMC website has information on how to apply for a retrospective granting of a CCT for doctors granted a CESR through the combined programme. 

What this means for MTIs

  • Medical Training Initiative posts are not required to be undertaken in GMC approved UK training posts and MTI doctors and trusts are required not to complete a formal documented ARCP process.
  • This means that MTI posts are not eligible to count towards a CCT.

Advice for SAS doctors

The experience and circumstance of SAS doctors is not universal and the best course of action for specialist registration within psychiatry is very dependent on the specific doctor. We understand that the individual circumstances, of each doctor, are not always compatible with re-entering into training.

To ascertain what your best course of action should be we would advise you to:

  • speak with your local School of Psychiatry for a clear understanding of training and the options within it
  • speak with a CESR mentor in your trust (if you have one)
  • speak with any known colleagues who are undergoing or have undergone the CESR process.

We would also advise you to contact the CESR & Training department at the College who are happy to talk through your circumstances and your options in relation to those circumstances. It is our aim to maintain a lack of bias between all routes to consultancy and to offer clear and concise advice relevant to your specific situation. 

Contacts for clarification

Current trainees or prospective trainees (incl. of MTIs and SAS doctors) should email for clarification around their CCT eligibility or potential eligibility.

Those already on the specialist register should email the GMC at to directly to discuss their eligibility.

Further Clarification

We have created a flowchart below to walk you through your training experience and our expectations surrounding the certificate you will be issued. A version of this CCT eligibility flowchart is also available to download. 

CCT Eligibility Flowchart image