Registration & Pathways
The UK Portfolio Pathway | Working as a Specialist Doctor
Dec
Many doctors who aim to practise clinically in the UK feel hesitant about having to restart their careers as trainees.
For IMGs who have already spent many years working as fully qualified specialists abroad, the prospect of returning to several years of postgraduate training can feel unnecessarily time-consuming.
Traditionally, doctors in this position utilised the CESR (Certificate of Eligibility for Specialist Registration) route. However, as of November 2023, this system has been replaced by a new framework called the Portfolio Pathway.
This article summarises what is currently known about the UK’s Portfolio Pathway and how it impacts IMG specialists seeking specialist registration.
The Portfolio Pathway
Overview of the New System
Under the new system—just as with the former CESR route—IMGs can obtain specialist registration with the General Medical Council (GMC) without completing a formal UK training programme.
The focus of this pathway is on outcomes rather than process. Applicants must demonstrate that they can fulfill the same level of responsibility as UK-trained consultants and possess the advanced knowledge and competencies required within their specialty.
As before, applicants must submit documentary evidence demonstrating their experience as specialists. However, the GMC now provides much clearer guidance on the types of evidence required across defined professional domains known as Capabilities in Practice (CiPs).
Unlike CESR, applicants are no longer required to prove that they followed training protocols equivalent to the UK training curriculum step by step.
The Portfolio Pathway was jointly developed by the GMC and UK Royal Colleges to provide overseas doctors with a clearer, more structured route toward specialist registration.
The GMC explains the pathway as follows:
Doctors applying via the portfolio pathway for specialist or GP registration must demonstrate they have the knowledge, skills and experience necessary to practise as a specialist or GP in the UK. This pathway was previously called CESR (or CEGPR). Changes in legislation have allowed the GMC greater flexibility to accept a wider range of evidence when assessing applications for specialist or GP registration.
Portfolio pathway application (formerly CESR)
This legislative update was introduced to address workforce shortages within medical specialties and has expanded access by offering greater flexibility in evidentiary requirements. In short, more IMGs now have viable pathways toward UK consultant-level practice.
Comparison with the Former CESR Route
Understanding the difference between the two systems is essential.
Under CESR, applicants were required to prove that they had completed training equivalent in scope and structure to the UK specialty training curriculum.
Applicants effectively needed to demonstrate that they had undergone training at the same level as doctors who completed a full NHS pathway toward a CCT (Certificate of Completion of Training).
The core principle of CESR was:
Demonstrating possession of equivalent skills, knowledge, and experience to a UK-trained consultant.
CESR applicants had to document evidence covering every module within the UK training curriculum, including:
- 360-degree multi-source feedback assessments
- Professional development planning documentation
- Detailed clinical case logs
- Approximately five years of patient records (often amounting to thousands of pages)
Even highly accomplished specialists were required to navigate this extensive documentation process, often accompanied by vague or inconsistent official guidance, making submission extremely burdensome.
By contrast, the Portfolio Pathway simplifies and clarifies this process, shifting the emphasis toward practical competency outcomes rather than rigid curricular alignment.
It should also be noted that the CESR-CP route—a hybrid pathway combining CESR-style evidence with at least three years of UK training—remains a valid option for some applicants.
How to Apply
Let’s review the key steps in the Portfolio Pathway application process.
Step 1: Contact the GMC
Applicants are strongly advised to begin by contacting the GMC Specialist Applications Team. They can provide personalised instructions based on your circumstances, ensuring greater clarity and fewer procedural delays.
A useful rule of thumb is:
“If in doubt, ask the GMC.”
Step 2: Submit Your Application
Applications are submitted directly via the GMC website. Once initiated, applicants have 24 months to collect and submit all required documentation.
Following submission, the GMC forwards the application to the appropriate medical Royal College or specialty faculty for evaluation.
Step 3: Advisor Assignment and Evidence Submission
After passing the initial threshold review, applicants are assigned an application advisor.
The advisor reviews submitted documentation and provides feedback. Based on this guidance, applicants revise or supplement their evidence before final submission.
This stage is time-intensive and may involve:
- Translation and verification of documents
- Collecting supporting testimonials and references
- Organising large volumes of clinical documentation
Step 4: Final Assessment and Decision
Once all evidence has been submitted and verified, the relevant Royal College conducts the final assessment.
After endorsement, the GMC issues the official registration decision.
While the application process remains demanding, it is widely regarded as far more structured and transparent than the former CESR system.
Required Competency Evidence – CiPs
Applicants must meet five core Capabilities in Practice (CiPs), which apply across specialties.
CiP 1: Outpatient Management
Applicants must demonstrate competence in clinical outpatient practice, including:
- Effective patient communication
- Appropriate referral coordination
- Time and service management
CiP 2: Emergency Care Management
Evidence must show the ability to manage acute and emergency patients within the department, including:
- Comprehensive patient assessment
- Resuscitation interventions
- Development of safe treatment plans
CiP 3: Ward Rounds and Inpatient Care
Applicants must demonstrate proficiency in inpatient care management, including:
- Identifying critically ill patients
- Multidisciplinary team leadership
- Managing complications
- Clinical reassessment and follow-up
CiP 4: Operating List Management
Applicants must provide evidence of surgical service leadership, including:
- Selecting appropriate surgical cases
- Arranging anesthesia support
- Surgical scheduling coordination
- Performing operative procedures
CiP 5: Multidisciplinary Team Leadership
This domain evaluates performance within complex team-based care environments, including:
- Prioritisation of urgent patients
- Workflow and service management
- Treatment planning
- Effective interdisciplinary communication
Conclusion
The UK Portfolio Pathway represents a major advancement for international medical graduates seeking specialist registration.
For experienced IMGs, the barriers to achieving UK consultant-level registration are now lower and clearer than ever before—though sufficient demonstrable experience remains essential.
For specialists who already possess knowledge and skills equivalent to UK-trained consultants, this pathway provides a meaningful opportunity to practise at their professional level in the UK without restarting years of formal training.
Those with adequate preparation time and long-term UK career ambitions may find that pursuing this pathway is well worth the effort.
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