CESR Guidelines for SEM Doctors


Certificate of Eligibility for Specialist Registration (CESR) Article 14 (4) General and Specialist Medical Practice (Education, Training and Qualifications) Order 2003

Guidance for FSEM Members and Fellows regarding an A14 application

Dr Simon Kemp Council Member FSEM

Certificate of Eligibility for Specialist Registration (CESR) Article 14 (4) General and Specialist Medical Practice (Education, Training and Qualifications) Order 2003

  • Entry to the GMC’s specialist register in SEM (a legal requirement for employment as a consultant within the NHS) is either by:

– completing higher specialist training and gaining a Certificate of completion of training (CCT) or by – Applying via article 14(4) (A14) with evidence of relevant training and experience

  • On 1 April 2010 PMETB merged with the GMC and the GMC is now responsible for the regulation of all stages of medical education and training and is ultimately responsible for the A14 process. Certificate of Eligibility for Specialist Registration (CESR) Article 14 (4) General and Specialist Medical Practice (Education, Training and Qualifications) Order 2003
  • The key task for applicants is to show that they have equivalent competencies to SEM trainees who have completed the SEM training scheme (ST1-6)
  • Please note that equivalence is judged against the entire training programme (ST1 – 6) and not just the SEM specific curriculum. In other words applicants have to have at least two years basic medical training (at SHO level or equivalent) in either general medicine, general practice or acute care specialties. A14 – Key organisations
  • GMC – overall responsibility for the article 14 process and ultimately makes the decision as to whether an applicant should be included on the specialist register or not – http://www.gmc-uk.org
  • JRCPTB – co-ordinates the processing of an A14 application and, taking into account the assessment of the Faculty assessors, makes a recommendation to the GMC on the suitability of applicants http://www.jrcptb.org.uk

A14 – Information resources

The GMC provide extensive guidance regarding the A14 process on their website and identify links to key resources and generic and specialty specific guidance.

Specialty Specific Guidelines, give more detailed advice on the type of documentary evidence required to support an application.

A14 Application – key elements

With such detailed and apparently specific guidance it can be difficult to know what you actually have to produce.

Your completed application is likely to fill between 1 and 2 foolscap box files and will comprise the following three discrete (but linked) elements

A completed application form (CN2)

A full and current Curriculum vitae

Evidence submitted in support of your application

Supporting both your CN2 and providing evidence that you can demonstrate the curriculum competencies

A14 – Demonstrating competencies – the challenge for applicants.

  • Having downloaded the application form and read the guidance it is difficult to know where and how to start and what level of detail is required.
  • A key element of your application is to demonstrate clearly to the assessor that you have the competencies defined in the speciality training curriculum.
  • An approach used by a number of successful candidates is to address this early in the application process and make this a discrete part of their submission. You may wish to copy the current speciality curriculum (downloadable from the JRCPTB website) onto an Excel spreadsheet (one module per sheet) and then to cross reference the knowledge, skills and experience competencies to the appropriate section(s) of your CV where you best demonstrated the competency

A14 – Demonstrating competencies – the challenge for applicants

  • Advantages of this approach include – identifying where there are deficiencies in your experience and looking to address these whilst you are preparing your application – The ability to easily cut and paste all the curriculum competencies that were demonstrated in each post into the relevant sections of your CV. When you are looking for the relevant supervisor to sign off the competencies demonstrated in a particular post – you can then cut and paste the competencies into a draft letter for them to print off, sign and return – Submitting the master competency spreadsheet as effectively the index to the competency evidence section of your application will help guide the assessor through your application

A14 – CN2 – the need for a project plan

  • You also need to create a way for you to define and prioritise all the sub-tasks that you need to complete, monitor your progress in achieving these and collecting the evidence needed for your application • An approach used by a number of successful candidates is to copy the application form (CN2 downloadable from the GMC website) onto an Excel spreadsheet and create a list of sub-tasks for each section of the form – This then forms an updateable master project plan and completed tasks progress from red (not started), through amber (in progress) to green (completed)
  • The current guidance on the GMC website is comprehensive and the application form (CN2) is now in fillable PDF format.
  • The application form gives clear guidance as to the types of evidence needed under the four domains and the percentage that each domain should contribute to your application

A14 – CN2 – key supporting evidence

  • Sections 1,2,3,4,5 and 6 are self explanatory
  • Section 7 contains the documentary evidence supporting your application and suggested proportions for the four domains. The focus should be on the last five years and the majority of the evidence will have formed part of your annual appraisals.
  • The standards for these elements are in line with the standards expected as part of the FSEM appraisal

Evidence will typically include certified copies of all qualifications, evidence of training completed – employment records, job descriptions and plans, log books, assessments and appraisals, patient surveys, multi-source feedback, case based discussions etc.

Evidence of CPD, teaching and research / audit.

Evidence of working with colleagues – MSF, management activities, referral letters, testimonials from colleagues etc.

Names of six referees who can supply structured reports in support of your application. A14 – CN2 – The key role of the referee

The GMC website gives explicit guidance on selecting your referee.

The referee is asked to complete a structured report commenting on whether he/she believes that you have full range, depth, breadth of experience and skills required for the award of a CCT in SEM and the evidence showing how you have demonstrated this to him/her.

The referee therefore needs to be familiar with the curriculum (and usually appreciates some guidance from you as to the areas you are are hoping that he/she will comment on) and the standards expected of a specialist.

The referee needs to allow 4 hours to complete the structured report

A14 – Evidence – Verification and confidentiality issues

Significant emphasis is placed on both these areas.

  • The GMC do not accept original documents, only copies. Through authentication and validation they can be satisfied that these copies are genuine.
  • The GMC also need to be assured of patient confidentiality and therefore do not accept documents featuring details of patients or colleagues that have not been anonymised.
  • It is important that you read and comply with the guidance below when compiling your evidence.


You need to be explicit in stressing to those you are asking to validate your documentation exactly what these standards are and the critical importance of meeting them. Preparing your application:

  • Consider sourcing some administrative help – a small investment in creating a detailed project plan that prioritises your tasks and enables you to track where you are is money well spent
  • Keep a note of costs , including the application costs – they are probably Tax deductible
  • Dedicate a space in the house to set out all the work – it shouldn’t be disturbed
  • If you are still overawed by the whole process, complete an FSEM Appraisal application – it will be a good start on a CESR application The submission process:
  1. Your application should be submitted to the GMC
  2. The GMC will determine if your application is complete and meets their administrative standards
  3. Invariably applications are returned to you by the GMC for (hopefully) minor amendments/revisions to satisfy a range of administrative issues.
  4. Once you and the GMC believe that the application is complete, it is forwarded it to the Faculty for evaluation via JRCPTB – this is performed independently by two trained Faculty assessors. The timeframe for Faculty assessment is typically 6 weeks. Faculty assessors are unpaid volunteers!
  5. The Faculty then makes a recommendation to the GMC via JRCPTB – the GMC make the final decision on whether to award a CESR.
  6. If the answer is ‘no’, GMC must supply you with reasons and recommend the period of additional training required and the areas to be covered by this training.

Unsuccessful applicants have the right to appeal. The submission process:

  1. Establish a friendly relationship with your Case Officer
  2. They are on your side
  3. Agree realistic deadlines with them
  4. Keep in touch every two weeks after submission to track your application and make sure it does not become stalled
  5. Keep a diary of your contacts with the GMC
  6. Keep copies of everything
  7. You may want to keep a copy of your application off site as it progresses to be able to back it up in the event of a fire or flood!
  8. When you are successful, thank everyone and enjoy a normal life again…