Portfolio Pathway

The Portfolio Pathway (formerly CESR: Certificate of Eligibility for Specialist Registration) is for doctors who wish to join the General Medical Council (GMC) Specialist Register and whose specialist training, qualifications or experience was partly or completely acquired outside of an approved CCT (Certificate of Completion of Training) programme.

It is equivalent to a CCT and certifies that the recipient has the same knowledge, skills and experience as a doctor who has completed training in the CCT curriculum.
Last modified
29 April 2024

Portfolio Pathway: changes to CESR evaluation process

On 30 November 2023, the GMC introduced new methods for evaluating evidence for equivalent Specialist Registration. The process, named Portfolio Pathway, does not differ from the previous CESR process in terms of the types of evidence needed or how it should be submitted.

If you started preparing for CESR, see how the new evaluation method may affect your application

Who can apply for the Portfolio Pathway?

Paediatrics

If you have training, qualifications and experience in paediatrics but have gained these partly or completely outside of an approved CCT training programme (for example, you have trained outside the UK or EEA, moved abroad or taken a career break), you may apply for Specialist Registration in a CCT specialty, listing your specialty as paediatrics.

You will need to demonstrate that you have the knowledge, skills and experience (KSE) defined in the GMC Specialty specific guidance. The KSE are keyed to Higher Level Learning Outcomes; these outcomes are the same as those specified in the CCT curriculum (RCPCH Progress+), including clinical capabilities and generic abilities expected of all consultants.

Paediatric sub-specialties 

Specialist Registration in a sub-specialty is only possible if you have undertaken training outside the UK towards a qualification in a sub-specialty of paediatrics, through Portfolio Pathway in a non-CCT specialty. You would be listed on the Specialist Register in your chosen sub-specialty only, without the specialty of paediatrics.

The non-CCT specialty may be in any field consistent with practice as a consultant in the NHS, but will usually correlate to a sub-specialty of paediatrics. Please consult the list of GMC-approved sub-specialties in paediatrics as a guide to what may be certified by this route.

Researchers and academics

If you have not followed conventional specialist training and work outside of clinical practice, but have focused on a specific area of research and made a significant contribution to your academic field, you may apply through Portfolio Pathway for registration in academic and research medicine. 

You will need to demonstrate your contribution to your academic field and that you have achieved knowledge and skills consistent with that of a consultant in the NHS.

Before you apply

All intending applicants are advised first to contact both the RCPCH Certification team and the GMC to discuss the most appropriate route for certification.

Applicants will need to consult the following pages below:

  • GMC Specialty specific guidance on evidence to be submitted with your application. Use the document listed under ‘Royal College of Paediatrics and Child Health’. This applies particularly to applicants in paediatrics, but  non-CCT applicants should also consult it for examples of evidence.
  • GMC Approved postgraduate curricula in paediatrics and sub-specialties show the full range of specialist learning outcomes expected of a doctor attaining either a CCT in paediatrics or a paediatric sub-specialty, which can give further background on the Higher Level Learning Outcomes needed for Portfolio Pathway.

How to apply

Apply online on the GMC website. You will need to supplement your application with supporting evidence and structured reports from four nominated referees.

The application process includes a guide - please read this carefully. Applications are often unsuccessful because applicants do not submit sufficient, recent evidence (ie within the past five years) to cover the full breadth of the required KSE.

Evidence overview

For different routes:

  • Portfolio Pathway in a CCT specialty - Ensure you can provide primary evidence of your Knowledge, Skills and Experience in all required aspects of clinical care in paediatrics, in accordance with the Higher Level Learning Outcomes. If you have not covered all of these, it is advisable to postpone an application until you have been able to gain evidence for them.
  • Portfolio Pathway in a non-CCT specialty - Submit primary evidence that particularly addresses the specialist learning outcomes expected within your sub-specialty syllabus. Such applications may not require evidence to the same standard for all other KSE outside of their sub-specialty. Nevertheless, you should address all Higher Level Learning Outcomes required in the application, to the standard defined in the syllabus of your chosen sub-specialty.
  • Portfolio Pathway in academic and research medicine - Submit primary evidence that particularly addresses the capabilities expected within your area of research. Nevertheless, you should address all Higher Level Learning Outcomes required in the application, to a standard appropriate to your research. Applicants are expected to submit evidence of additional experience related to research and academia.

All applicants are expected to submit the following evidence:

  • Resuscitation - Current certification in advanced paediatric and neonatal life support skills. (Academic applicants may not require this level of certification.)
  • Child protection - Current certification of level three child protection training, with primary evidence of experience, eg child protection reports, witness statements, case-based discussions. (Non-CCT and academic applicants may not require evidence of practical experience.)
  • Quality Improvement - Audit reports written by the applicant, and other evidence of service improvement, risk management projects or other quality or clinical governance activity.
  • Teaching and supervision - Teaching presentations, with feedback from attendees. Evidence of attendance at a ‘training the trainers’ course and/or the training or supervision of more junior colleagues. Assessments or feedback for students or colleagues, such as workplace-based assessments, multisource feedback, reference letters or other constructive advice.
  • Management - Examples of rota management, meeting or event management, budget management, leading ward rounds, leading audits and service improvement projects, leading on educational or research related activities.
  • Structured reports - Applicants are asked to nominate four referees, who the GMC will contact to provide structured reports in support of your application. One will be your current Clinical Director or Lead. It is strongly recommended that your other nominated referees should be aware of the current expected Learning Outcomes and able to provide detailed support for your capabilities across all or most areas.

Application outcomes

All Portfolio Pathway applications are decided on by the GMC, based upon recommendations by the College. Once the College receives an application from the GMC for evaluation, it can take two to three months for the GMC to determine the final outcome. 

Please note that the GMC and RCPCH are experiencing delays in processing applications, so it may take several months for an application to reach the RCPCH and further unexpected delays may occur. The RCPCH will endeavour to keep the GMC briefed on expected return dates for applications.

Unsuccessful applicants

Should your application be unsuccessful, you have 12 months to submit a review application. The College’s evaluation will specify what further evidence would be required for a successful review. Reviews are evaluated only on the points not previously approved.

If there is insufficient evidence of recent clinical experience, the College will typically recommend the applicant take a six month placement in a given field, such as community paediatrics or neonatal medicine, before submitting a review. Applications are evaluated on evidence of knowledge, skills and experience, so this period of time is indicative only as sufficient time to obtain enough new evidence. In some circumstances, usually involving acute paediatrics, a 12-month placement may be recommended. It is not the College’s responsibility to provide additional training for Portfolio Pathway applicants.

Myth busting

There is no need for any specific time in any specific specialty area.

There are many myths around the Portfolio Pathway and CESR process and what is needed for a successful application. One of the most prevalent myths is about time in a post. To help clarify, there is no need for any specific time in any specific specialty area (eg neonatal medicine or community child health) - and there hasn't been since 2007. In an approved training programme, rotations are usually for six months (WTE) training, so it was incorrectly assumed that this would also be a requirement for CESR. 

Once you are on the Specialist Register, you are eligible to apply for consultant posts in any specialty or sub-specialty, regardless of what specialty is listed on the Register. Employers will review your employment history to see if you are suitable for the job. If you have registration in paediatrics, you do not need to apply for sub-specialty registration. If you are registered in a sub-specialty only, you may still apply for general paediatrics roles.

Frequently asked questions

These questions have been collected by the Soft Landings team based on their interactions with international doctors enquiring about the Portfolio Pathway in paediatrics.

What are the minimum number of work based assessments, eg CBDs and Mini-CEXs that are considered sufficient for an application?

There is no minimum number for workplace-based assessments. The intention is to demonstrate quality over quantity, which is the guidance to doctors in training. Our assessment table is purely an indicative absolute minimum for meeting grade level requirements in training and you can see our guidance on how to use assessments to best effect. Any assessments or development logs used as Portfolio Pathway evidence should be relevant to the Knowledge, Skills and Experience set out in the GMC Specialty Specific Guidance (SSG).

How much evidence is required as a minimum for each Learning Outcome?

As with the above, there is no minimum. One hundred and fifty poor, unclear pieces of evidence is worse than 20 clear, well structured and reflective pieces of evidence. It is not a tick box exercise. Our guidance (SSG) shows the indicative spread of evidence across the eleven Higher Level Learning Outcomes, but this is not a template for guaranteeing success unless quality and relevance is considered.

What is the best way to collect evidence like reflections and work-based assessments without an ePortfolio?

If working in the UK, all doctors must meet the requirements of revalidation. This means employers will offer ways of recording continuous professional development (CPD) activity, which can be used to demonstrate reflections and clinical activity through a CPD diary or similar.

RCPCH does also offer an online CPD Diary inclusive with membership or payable without membership. If working outside the UK, we recommend using guidance documents and resources available on the RCPCH and GMC websites to structure and order your evidence.

Is there a minimum number of years of NHS experience needed before a Portfolio Pathway application or is the assessment of equivalence just based on evidence of competencies?

There is no minimum tenure of NHS working experience needed. As long as you meet the GMC's eligibility for applying to Portfolio Pathway, your work experience is only relevant for demonstrating your Knowledge, Skills and Experience. Your application is judgement-based on your evidence and how you meet the RCPCH requirements, to the standard of a day-one consultant. Evidence from within the past five years in practice and/or training will be given precedence when evaluated, as indicated in the Specialty Specific Guidance. Older evidence should be supplemented by more recent evidence showing that KSE has since been maintained.

Is neonatal level 3 required or is DGH level 2 adequate?

There are no experiential-based requirements to meet the application level. The focus is on how your experience (from wherever it comes) meets the standard of a day-one consultant.

If applying for Portfolio Pathway in neonatal medicine [i.e. in a non-CCT specialty], is DGH level 3 experience adequate or do you need tertiary experience? Similarly, is neonatal experience adequate for a neonatal application or do you need a certificate in neonatology training?

You do not need a certificate in neonatal training. While tertiary experience would be supportive, it is not mandatory. It is only because tertiary neonates experience might give you the strongest opportunities to demonstrate the required standards for Portfolio Pathway.

For community experience, do you need a community placement or are child protection courses sufficient? How do you show evidence of community competencies without having a community placement/ rotation?

For the purposes of the curriculum, and therefore of Portfolio Pathway, there are no specific community competencies. Your application is evaluated against your Knowledge, Skills and Experience (KSE) under Higher Level Learning Outcomes. The SSG outlines the indicative evidence along with the KSE. If applying in non-CCT in Community Child Health (as an example), it would be difficult to demonstrate the depth of standards for a day-one consultant without having had experience in community placements - however, this is still not mandatory, and it is the required standard that needs to be demonstrated rather than where you have worked.

Do you have to be working full time before submitting your application?

No. That would contravene many aspects of the GMC and RCPCH commitment to Equality, Diversity and Inclusion to insist on this. It will not be a consideration in any Portfolio Pathway evaluation.

With the new training modules starting, will the Portfolio Pathway tick boxes change?

The SSG is the "tick box" and applicants have to meet its defined KSE requirements, as demonstrated through their evidence.

Can you give any guidance on how to group evidence? (previous examples of candidates being asked for 150 entries)

The GMC will give you a structure for organising your evidence, and this is described further in the SSG. Evidence for your KSE is grouped under eleven Higher Level Learning Outcomes (HLLOs).

A process that has worked for some applicants is to group items first by topic, eg, assessments, appraisals, CPD activity, reflections, referral letters, audits, etc. and then align them to the most relevant HLLO. When submitting the evidence, the same piece of evidence will be considered across all HLLOs as it will typically address more than one aspect of care (e.g. clinical correspondence relates to knowledge, reflective practice, communication and coordination of care management). The SSG will guide you on where to place your evidence for ease of evaluation.

Contact

Prospective applicants are advised to contact the Training Services team (in Training & Quality) at RCPCH to discuss the most appropriate route to obtaining certification, at equivalence@rcpch.ac.uk or on 020 7092 6000.