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last updated:21/09/2016 @ 9:41 am
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Combined Programme (CP) training

Alternative routes to specialty training

There are two possible GMC-recognised routes of entry into occupational medicine specialty training, which begins at ST3 level.  In order to enter with the prospect of achieving specialist registration via the Certificate of Completion of Training route, all the steps outlined in the person specification must be completed, in GMC-approved posts, before OM specialty training begins.

However, there are many possible scenarios where prior training or experience differs from the options mentioned in the person specification, but still provides eligibility for specialty training. Following successful completion of specialty training, these candidates apply for specialist registration via the Combined Programme route (aka CESR CP) and become eligible for Faculty Membership. As specialty training itself is completed in a GMC-approved post, in the same way as a CCT candidate, the CP application process is much more straightforward than that for the full CESR. The certificate achieved via the CP route is of equal value to a CCT certificate in the UK.


While the details may vary, the following are common reasons to be interested in the Combined Programme option:

• Some or all core medicine competencies achieved outside of GMC-approved training programme;
• Training undertaken outside of the UK.
• CT1 and CT2 competencies achieved in a specialty other than surgery, psychiatry, acute medicine, general practice (ST1 to ST3), public health (Phase 1);

For example, this would be the entry route for a doctor previously trained in anaesthetics, but now interested in becoming a consultant in occupational medicine.


Eligibility would be assessed by the National School of Occupational Health, with support from the Faculty, as part of the National Recruitment process. Achievement of competencies would have to be evidenced by completing the Alternative Certificate of Core Competence, published by JRCPTB.

Although the certificate awarded by the GMC at the end of CP training is a Certificate of Equivalence (CESR), a CP candidate’s specialty training is the same as a CCT candidate’s. The GMC also aims to confirm CP eligibility at the start of training, so there should be no added burden for candidates at the end. The GMC specialist register does not display the type of certificate awarded.

However, other EU countries may have their own rules affecting CESR holders, which is important to consider if you are planning to work outside of the UK. The GMC website clarifies the situation:

Within the UK, there’s no difference in the recognition of a CESR/CEGPR 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; while GP registration means you can apply for inclusion in a performers list to work as a UK health service GP.

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 Directive 2005/36/EC 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.
[www.gmc-uk.org]

Health Education England provides further guidance on specialty training.