GMC CESR & CEGPR Appeals, Reviews, Applications Representation
CESR and CEGPR Appeals Representation and Legal Advice
If you are a doctor who seeks to appeal a decision of the GMC in relation to an application to their specialist or other registers, we can advise and represent you.
If you require assistance in relation to a review, appeal or application for a Certificate of Eligibility for Specialist Registration (CESR) or Certificate of Eligibility for General Practice Registration (CEGPR), we can assist you.
The GMC’s Approach to CESR Applications
Under the CESR certificate of completion of training (CCT) equivalence route, the GMC Registrar must grant a doctor admission to the specialist register where they satisfy the curriculum requirements of the specialty applied for, in the absence of having a CCT.
The GMC requires high standards and will not grant an applicant doctor specialist registration unless they have satisfied the relevant criteria have been met. The GMC generally looks at the past six years of evidence, so that it is current, and not stale.
The GMC will take into account documentation such as log books, testimonials, structured reports, tests of knowledge, consolidation materials, and other structured evidence of competence. The GMC will additionally look for a depth and breadth of skills and specialist knowledge. This is to ensure patient safety within the doctor’s chosen specialism. An entry on the specialist register or a GP entry conveys an elevated knowledge and skill, which others will in turn rely on. Therefore, the granting by institutions of ad eundem awards will usually not qualify to be counted as evidence of competence, as there has been little formal assessment of specialist knowledge.
Where a doctor has not met the requirements of the curriculum, a doctor must demonstrate through other reliable, strong sources of evidence that they meet the relevant requirements of specialist knowledge.
A doctor is expected to provide detailed mappings of the depth and breath of their knowledge and experience against a series of UK curriculum documents, in order to show that they have satisfied the requirements. Quality sources of evidence are needed.
Where a doctor can demonstrate fulfilment of the curriculum requirements, the GMC may grant specialist/GP registration. However, where it is more difficult or not possible to map a doctor’s experience against the UK curriculum, the doctor will more likely see push back from the GMC.
The GMC assessors will generally set out their views as to why a doctor has not satisfied them on the evidence provided, so enabling a doctor to provide further evidence over time, or withdraw their application, or bring an appeal. In some instances, the GMC will make recommendations about how a doctor might choose to improve their presentation of the evidence they have submitted.
A doctor needs to provide ample qualitative evidence of the scope and format of exams and assessments, if they are to satisfy the curriculum criteria. Current certification is usually required, rather than expired certificates, even if the courses were taken in the past six years.
Applying to the GMC
The GMC application process is complex, and it is important that an applicant does not omit to complete all sections of the form. The applicant doctor also needs to provide reliable evidence of completing each step. A doctor might be too specialised to be able to satisfy the wider criteria for inclusion in the specialist register.
By way of 34D (2) (c) of the Postgraduate Medical Education and Training Order of Council 2010 (“the Order”), Article 7 provides that persons are eligible to be registered in the Specialist Register if they are “eligible specialists as specified in article 8:-
Article 8
“(1) Persons are eligible specialists for the purposes of article 7(1)(a) if they are exempt persons and hold a recognised specialist qualification granted outside the United Kingdom as specified in article 10.
(2) Subject to paragraph (4), a person (“S”) is an eligible specialist for the purposes of article 7(1)(a) if S does not fall within paragraph (1) but has—
(a) undertaken specialist training; or
(b) been awarded specialist qualifications,
in a recognised specialty and satisfies the Registrar that that specialist training is, or those qualifications are, or both when considered together are, equivalent to a CCT in the specialty in question.
(3) …
(4) …
(5) If S… —
(a) …
(b) has acquired specialist medical experience or knowledge, wherever obtained, the Registrar shall take account of … that experience or knowledge, when determining the adequacy of the training or qualifications under paragraph (2)….”
Appeals to RAP
Appeals from GMC refusals to grant specialist register inclusion are heard by the GMC Registration Appeal Panel (RAP) in the first instance. A doctor is permitted to question the GMC’s witnesses who made the evaluations of their evidence.
See the GMC’s document: Appealable decisions relating to applications for entry onto the Specialist Register or GP Register via the Portfolio pathway, CCT or Recognised Specialist Qualifications pathway: Guidance for Appellants
Costs: Note that a doctor can be ordered to pay the GMC’s costs in exceptional circumstances. The same for the GMC. This can occur where a party’s conduct has been vexatious, abusive or disruptive, frivolous, or otherwise unreasonable manner, in bringing or during the appeal process. A costs claim must be served on the other party and the tribunal at least 24 hours prior to the appeal hearing.
Fees: The GMC charges fees for a doctor to lodge a RAP appeal.
Appeals to the Higher Courts
Appeals from GMC Registration Appeal Panel (RAP) are to the county court (with a time-limit to file an appeal of 28 days), and from there to the Court of Appeal (with permission)
An appeal to the county court from the GMC Registration Appeal Panel (RAP) is not limited to an appeal on a point of law (per para 11-12 of Nakhla, below) by way of a review instead of a rehearing, with CPR Part 52.11 (1) applying. It will therefore allow an appeal under CPR Part 53.11 (3) where the decision under appeal was (a) wrong or (b) unjust because of a serious or other procedural irregularity. A decision of a RAP should not be overturned lightly, as there will be a need to give regard to the specialist knowledge of the RAP panellists.
CESR/GEGPR GMC Rules and Legislation
Guidance for Responsible Officers
Appeals from RAP Refusals
General Medical Council v Nakhla [2014] EWCA Civ 1522 – appeal allowed at Court of Appeal. The opinion of the court included the following:
“6. ….if an applicant satisfies the criteria in article 8 of the Order, the Registrar must include his name in the Register.”
…
“41. …the ultimate objective of the [RAP] enquiry was to determine whether an applicant’s qualifications or training or both were equivalent to a CCT…””
…
“54. The word “equivalent” in this context does not, in my judgment, mean “identical”. What it conveys is that the applicant’s qualifications or training, or both, coupled with his medical knowledge and experience, are equal in value to the knowledge and skills that would have been recognised by the award of a CCT. Whether one knowledge and skill set has equal value to another is in itself a value judgment. Thus I do not consider that the RAP is required to reject an application merely because an applicant has not demonstrated that he has done and can still do everything that he would have been required to do in order to obtain a CCT. To that extent I accept Mr Nakhla’s argument that what matters is the outcome, rather than how the outcome was achieved. The value judgment that the RAP must make would also accommodate the case of an experienced specialist who has left more general practice behind him. Otherwise one would be left with the paradoxical situation that the more experienced a practitioner was, in a discipline in which more experienced practitioners concentrate on sub-specialities, the less chance he had of successfully applying for inclusion on the Specialist Register. That said, it is essentially a question of medical judgment whether two different skill sets are equivalent; and in forming that judgment the Registrar (and the RAP) are entitled to place weight on the requirement of the curriculum that mastery of all 14 key procedures must be demonstrated.
…
“74. I do, however, have a concern that they [the RAP] may have adopted too mechanistic an approach to testing the “equivalence” of Mr Nakhla’s knowledge and skills when measured against the requirements of the CCT curriculum. Moreover, their apparent requirement that Mr Nakhla should produce contemporaneous evidence of assessment of work done in Egypt before May 2006 (which is practically impossible at this remove) displays a rigidity of approach which, if regarded as a fatal defect in his application, would come close to failing to resolve the paradox, mentioned in paragraph [54] above, that the more experienced (and indeed distinguished) an applicant from abroad is, the more difficult will it be for him to obtain a CESR.”
Per Lord Justice Lewison (with the other two appeal judges being in agreement)
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Sanctions for Alleged Falsified Evidence Submitted in CESR & CEGPR Applications
Igwilo v the General Medical Council. [2017] EWHC 419 (Admin) The doctor appealed an erasure order of a MPT, relating to falsified evidence submitted by way of a CESR application. The erasure order was upheld and the appeal was dismissed. One aggravating feature was noted, as follows (para 31, last bullet point):
“Dr Igwilo’s misconduct had the potential to cause harm to patients, in that, had his dishonesty not been recognised it could have resulted in his being granted a Certificate of Eligibility for Specialist Registration, which could have enabled him to obtain a substantive consultant position which he was not qualified or entitled to undertake.”
The dishonesty was considered to be significant. The court quoted another judge’s remarks that summarised the degree of dishonesty displayed by the doctor – taken from an earlier case that concerned the same doctor (see para 28)
“He falsified a large number of documents: 24 documents described as reports in respect of different patients, 5 documents described as reports for Courts or Tribunals in respect of different patients, 7 sets of documents described as section 48 paperwork for different patients, 1 set of documents described as section 37 paperwork, 4 referral letters, 2 letters to patients’ general medical practitioners and correspondence confirming appointments and placements and other correspondence. The scale of the falsification indicated it was an elaborate deception which must have taken some considerable time to plan and implement. His dishonesty affected his professional colleagues, as he represented their work as his own, or claimed that they had approved of his work when they had not done so.”
The moral of the story is to not submit falsified documents within a CESR application.
(January 2017)
Contact is on 0800 10 88 739 in struct confidence for a no obligation discussion about our CESR or CEGPR application, review and appeal representation services.