NHS Shortage Specialties for Internationally-Qualified Doctors
Eight more high-demand NHS specialties, each with the cited Royal College workforce data, the GMC specialist-registration route, and a deeper explainer of the CESR → Portfolio Pathway change — organised around the honest fact that basic pay is set by grade, not by specialty.
As of July 2026, any doctor who wants to practise a specialty in the UK must hold registration with a licence to practise from the General Medical Council (GMC), and — for a substantive consultant post — be on the GMC Specialist Register. The two routes onto that register are a UK training programme (CCT) or the Portfolio Pathway — the route the GMC introduced in late 2023 to replace CESR — for doctors whose experience was gained outside a UK programme. This guide deepens our original specialty guide with eight further NHS specialties that have documented workforce shortfalls.
Choose a specialty
Each guide cites the relevant Royal College or Faculty workforce data, the GMC specialist-registration route, and how pay works for that specialty.
Clinical Oncology
~17%
A plain-English guide to a UK clinical-oncology career for internationally-qualified doctors — why demand tracks cancer waiting times, the GMC specialist-registration route, and how NHS pay works.
Read the Clinical oncology guide →Ophthalmology
Highest-volume outpatient specialty
A clear guide to a UK ophthalmology career for internationally-qualified doctors — the demand from the NHS’s busiest outpatient specialty, the GMC specialist-registration route, and how NHS pay works.
Read the Ophthalmology guide →Cardiology
~Half of consultant physician posts unfilled
A guide to a UK cardiology career for internationally-qualified doctors — the workforce demand, the GMC specialist-registration route, and how NHS pay and on-call work.
Read the Cardiology guide →Respiratory Medicine
~Half of consultant physician posts unfilled
A guide to a UK respiratory-medicine career for internationally-qualified doctors — the acute-care demand, the GMC specialist-registration route, and how NHS pay works.
Read the Respiratory medicine guide →Gastroenterology
Endoscopy demand > capacity
A guide to a UK gastroenterology career for internationally-qualified doctors — the endoscopy-driven demand, the GMC specialist-registration route, and how NHS pay works.
Read the Gastroenterology guide →Obstetrics and Gynaecology
Consultant & training gaps
A guide to a UK obstetrics-and-gynaecology career for internationally-qualified doctors — the maternity-service demand, the GMC specialist-registration route, and how NHS pay and on-call work.
Read the Obstetrics & gynaecology guide →Stroke Medicine
Consultant shortfall
A guide to a UK stroke-medicine career for internationally-qualified doctors — the hyperacute-service demand, the GMC specialist-registration route, and how NHS pay works.
Read the Stroke medicine guide →Dermatology
Unfilled consultant posts
A guide to a UK dermatology career for internationally-qualified doctors — the demand from a small, hard-to-fill specialty, the GMC specialist-registration route, and how NHS pay works.
Read the Dermatology guide →CESR is now the Portfolio Pathway — the route explained
If you trained outside a UK programme, this is the route you will use to join the GMC Specialist Register. Here is what changed in late 2023, and what the evidence application actually involves.
For an internationally-qualified doctor, the phrase you will still see most often online is “CESR” — the Certificate of Eligibility for Specialist Registration (and CEGPR, its general-practice equivalent). CESR was the route by which a doctor who had not completed a UK training programme could still join the GMC Specialist Register or GP Register, by demonstrating that their training and experience were equivalent to a UK-trained specialist.
In late 2023 the General Medical Council replaced CESR and CEGPR with a single, renamed route: the Portfolio Pathway. The underlying principle is unchanged — you evidence equivalence to a UK Certificate of Completion of Training (CCT) — but the evidence framework was clarified and the application updated. Because the change is recent, most search results, forums and even some employer job adverts still say “CESR”; when they do, they are describing what is now the Portfolio Pathway.
The Portfolio Pathway is not an exam. It is a structured evidence application, assessed by the GMC with specialist advice from the relevant Royal College or Faculty against the UK curriculum for your specialty. There is no fixed processing time — each application is assessed individually — and a GMC fee applies. Being entered on the register is a licensing step, not a job offer.
From CESR to the Portfolio Pathway
Before late 2023
The route was called CESR (specialist register) or CEGPR (GP register). Doctors without a UK CCT applied by submitting evidence of equivalence to the relevant Royal College curriculum.
Late 2023 (changes took effect from 30 November 2023)
The GMC replaced CESR/CEGPR with the Portfolio Pathway — same equivalence principle, revised and clearer evidence requirements, and an updated application and fee. Existing CESR applications transitioned across.
Now
You apply through the Portfolio Pathway. The CCT route (completing a UK training programme) is unchanged and remains the alternative way onto the Specialist or GP Register.
What evidence the Portfolio Pathway looks for
The GMC assesses your application, with specialist advice from the relevant Royal College or Faculty, against the UK curriculum for your specialty. Evidence typically spans:
- Primary medical qualification and postgraduate qualifications, verified by the GMC
- A full, dated employment and appointment history with job descriptions
- Clinical experience evidenced by logbooks, caseloads and outcome data where relevant
- Workplace-based assessments, annual appraisals and multi-source (360°) feedback
- Teaching, training and supervision of others
- Audit, quality improvement and clinical governance activity
- Research, publications and presentations, where you have them
- Continuing professional development (CPD) records and reflective practice
- Structured references and testimonials from senior colleagues
Important to understand
- There is no guaranteed timescale — the Portfolio Pathway is assessed on the strength and completeness of your evidence, not on a fixed calendar.
- A GMC application fee applies, and the amount is set by the GMC — confirm the current fee at gmc-uk.org.
- The Royal College or Faculty for your specialty advises the GMC against its UK curriculum, so the evidence you gather is specialty-specific.
- Joining the Specialist or GP Register makes you eligible for a substantive consultant or GP post. It is not itself a job, a visa, or a placement — you apply for posts separately and on your own account.
How NHS doctor pay actually works
NHS basic pay is set by grade, not by specialty — so a consultant oncologist, ophthalmologist and cardiologist share the same basic pay scale. Figures below are for England, 2024/25. Indicative — pay is set annually and differs in Scotland, Wales and Northern Ireland.
| Grade | Typical role | Basic pay (England) | Notes |
|---|---|---|---|
| Foundation Year 1 (FY1) | Newly-qualified resident (formerly "junior") doctor, first year | £36,616 | The starting basic salary for a first-year foundation doctor in England. Additional pay applies for out-of-hours and on-call work. |
| Specialty registrar (StR) | Doctor in higher specialty training | £55,329 – £70,425 | Basic pay across the specialty-training nodal points (2016 contract, England). On-call and out-of-hours supplements are added on top. |
| Specialty doctor (SAS) | Non-training career-grade doctor | £59,175 – £95,400 | The 2021 specialty-doctor contract range. A common substantive route for internationally-qualified doctors before or instead of the specialist register. |
| Consultant | Senior doctor on the GMC Specialist Register | £105,504 – £139,882 | The England consultant pay scale — the same range for every hospital specialty, because basic pay is grade-based, not specialty-based. Requires specialist registration. |
Source: NHS Employers / BMA medical pay scales (England). Indicative snapshot for the 2024/25 pay year — confirm current figures with NHS Employers (nhsemployers.org) and the BMA (bma.org.uk).
What this guide is — and is not
This is
- Free, general educational information about UK specialist registration.
- Organised for doctors who are independently exploring their options.
- A pointer to the official sources — the GMC (gmc-uk.org), the Royal Colleges and gov.uk — for the current, authoritative detail.
This is not
- A recruitment service. GeraClinic does not place doctors into NHS jobs and is not a recruitment agency.
- Active recruitment from countries on the WHO Health Workforce Support and Safeguards List (2023) — we provide information only.
- Legal or immigration advice, or a guarantee of registration, a job or a visa.
Individuals may always apply directly, of their own accord, to the GMC and to any advertised vacancy. For your country-of-training route (PLAB, English evidence, visa), see the UK Doctor Pathway guide, which covers permitted source corridors only.
Frequently asked questions
What is the Portfolio Pathway, and how does it relate to CESR?+
The Portfolio Pathway is the route the General Medical Council (GMC) introduced in late 2023 to replace CESR (the Certificate of Eligibility for Specialist Registration) and CEGPR (its GP equivalent). The change took effect from 30 November 2023. It keeps the same principle — you evidence equivalence to a UK-trained specialist (CCT) — but with a clarified evidence framework. Most search results and job adverts still say “CESR”; they are describing what is now the Portfolio Pathway.
Does NHS doctor pay differ by specialty?+
No. Basic NHS pay for a doctor is set by grade — foundation doctor, specialty registrar, specialty doctor (SAS), specialist grade, and consultant — and is the same across hospital specialties. What varies by specialty is training-post competition, international-recruitment demand, on-call intensity (which can attract extra contractual pay), and private or locum earning potential.
Which specialties have the highest demand for international doctors?+
Specialties with the largest documented UK workforce shortfalls most rely on internationally-qualified doctors. This guide adds clinical oncology, ophthalmology, cardiology, respiratory medicine, gastroenterology, obstetrics & gynaecology, stroke medicine and dermatology to the original set (psychiatry, emergency medicine, radiology, anaesthetics, general practice, histopathology and geriatric medicine). Each page cites the relevant Royal College or Faculty workforce data.
Is GeraClinic recruiting doctors for the NHS?+
No. GeraClinic is a telemedicine platform operated by Gera Systems Ltd, not a recruitment agency. These pages are free educational information for doctors who independently want to understand the UK specialist-registration pathway. Gera does not place doctors into NHS jobs and does not actively recruit from countries on the WHO Health Workforce Support and Safeguards List (2023).
Related guides
UK Doctor Specialties (original guide)
The first specialty cluster — psychiatry, emergency medicine, radiology, anaesthetics, general practice, histopathology and geriatric medicine.
UK Doctor Pathway — by where you qualified
Choose your GMC registration route by the country where you trained — PLAB, English evidence, and the visa overview, corridor by corridor.
NHS Pay Scales
See the full NHS medical and Agenda for Change pay scales, with sources, across grades and nations.
Important — please read
This is general information to help internationally-qualified doctors understand how UK specialist registration works for this specialty. It is not recruitment, immigration or legal advice. Gera is not a recruitment agency: we do not place doctors into NHS jobs, do not match candidates to specific vacancies, and do not actively recruit from countries on the WHO Health Workforce Support and Safeguards List (2023). You apply on your own account, directly to the GMC and to any employer. Registration routes, workforce figures, fees and pay scales change — always confirm the current position with the General Medical Council (gmc-uk.org), the relevant Royal College or Faculty, UK Visas and Immigration (gov.uk) and NHS Employers (nhsemployers.org).
Keep practising while you plan your move
GeraClinic is a remote telemedicine platform for licensed doctors. Wherever you are registered today, you can see patients online, set your own hours and fees, and keep earning while you work through your UK specialist registration. It is free to apply.