What does GMC registration actually mean?
To work as a doctor in the UK you need registration with the General Medical Council (GMC) and a licence to practise. Most international doctors aim for full registration, which lets you work in an unsupervised (though still supported) role. Specialist and GP registration are separate entries on top of full registration. You need one of these to take up a substantive consultant post or to work as a GP.
People often say "route" as if there is one exam. In practice the GMC is asking two separate questions. First, is your basic medical degree acceptable? Second, how will you show that your knowledge and skills are good enough for UK practice? The routes below are different answers to the second question.
Is my medical degree acceptable to the GMC?
Before any route, check your primary medical qualification (PMQ). The GMC publishes criteria for acceptable overseas qualifications. In summary, the awarding institution needs to be listed in the World Directory of Medical Schools, and the listing details must match your degree. The degree must let you register to practise, including doing an internship, in the country that awarded it.
The GMC also looks at the length of the course, the amount of clinical training, supervised placements in at least medicine and surgery, and whether most teaching was in person. Courses delivered largely online are only considered in exceptional circumstances. If you studied at more than one medical school, the rules on transfers apply.
How do I show my English is good enough?
Most international doctors provide an IELTS or OET certificate that meets the GMC's minimum scores. The GMC's application guides say the certificate needs to have been awarded within the last two years. The sponsorship guidance specifies academic IELTS or the medicine version of OET.
There is a narrow exemption for doctors who are nationals of a country where English is the first and native language and who also gained their medical degree in such a country. The GMC also lists other types of evidence in its English language guidance. Minimum scores and accepted evidence can change, so read the current GMC page rather than relying on a forum post or an older friend's experience.
What is the PLAB route?
PLAB is the GMC's own test for international graduates. It checks that you have the knowledge and skills expected of a doctor starting the second year of the UK Foundation Programme (F2). It suits doctors early in their careers, and those without a recognised postgraduate qualification.
| Part | Format | Where |
|---|---|---|
| PLAB 1 | Written test of 180 single best answer questions, answered in three hours. Each question starts with a short clinical scenario. | In the UK and a number of other countries |
| PLAB 2 | An OSCE of 16 scenarios, each lasting eight minutes, set in realistic settings such as a consultation or an acute ward. | The GMC's clinical assessment centre in the UK |
You can only book PLAB 1 after the GMC has checked your qualification and English. You must pass both parts before you apply for registration. The GMC also states that your registration application must be approved within two years of passing PLAB 2, so plan the gap between the exam and your application carefully.
PLAB 2 tests communication and professional behaviour as much as clinical knowledge. Many candidates who know the medicine still find the consultation style unfamiliar. Practising explanation, shared decision-making and safety-netting in plain English is time well spent.
Can I get GMC registration without PLAB?
Yes. PLAB is common but it is not the only way. The main alternatives are below.
An acceptable postgraduate qualification
The GMC accepts certain UK and international postgraduate qualifications as evidence of your knowledge and skills. UK royal college memberships such as MRCP, MRCS or MRCOG are well-known examples, and some overseas postgraduate qualifications are also accepted. The list is specific and has conditions, so check the GMC's guidance on acceptable postgraduate qualifications for the exact qualification you hold.
Sponsorship
A GMC-approved sponsor can confirm that you have the knowledge, skills and experience for full registration. If you meet their scheme criteria, they issue a Sponsorship Registration Certificate (SRC), which you include in your GMC application. Approved sponsors include some NHS bodies, royal colleges, universities and other organisations. Each has its own criteria, and the GMC tells applicants to contact the sponsor directly.
- The sponsor must be on the GMC's approved list. Otherwise you cannot use this route.
- The GMC's guidance expects recent, continuous clinical practice: three of the last five years, including ten of the most recent 12 months.
- An SRC for GMC registration is not the same as a visa sponsorship certificate. The GMC does not accept a visa certificate in its place.
- Training schemes such as the Medical Training Initiative usually work through sponsorship. They suit doctors who want a fixed period of UK experience before returning home.
Other routes
Some doctors qualify through a relevant European qualification. Historically, certain overseas licensing exams were also accepted, but only if passed before set cut-off dates. Check the GMC's current list if you hold USMLE, AMC or MCCQE passes.
What is the Portfolio pathway and who is it for?
The Portfolio pathway is for doctors who have not completed a GMC-approved training programme but can show the knowledge, skills and experience of a UK specialist or GP. It leads to entry on the Specialist Register or the GP Register. It replaced the routes previously called CESR and CEGPR, and royal colleges report that the change took effect in late November 2023.
Under the Portfolio pathway, evidence is assessed against the knowledge, skills and experience needed to practise as a UK specialist, mapped to the specialty's curriculum outcomes. The old wording about "full equivalence" to a training programme has been dropped. That makes the assessment more flexible, but it is still a large undertaking.
- Doctors not yet registered can apply for full registration and specialist or GP registration at the same time, through the GMC's Portfolio pathway with registration application.
- Once you open an application, the GMC gives you 24 months to submit it.
- Evidence must be anonymised, verified and, where needed, translated. You also need referees and a structured CV.
- GP applicants have extra steps outside the GMC, such as joining a performers' list and induction schemes.
Which GMC route is right for me?
There is no single best route. The right one depends on your stage of career, your qualifications and your plans. The table below is a starting point, not a decision.
| Your situation | Route often considered | Things to check |
|---|---|---|
| Recent graduate or early career, no postgraduate qualification | PLAB | PMQ acceptability, English scores, timing of the two-year window after PLAB 2 |
| Holding a UK royal college membership or another accepted postgraduate qualification | Acceptable postgraduate qualification | Whether your exact qualification is on the GMC's accepted list |
| In training at home and wanting a fixed period of UK experience | Sponsorship (for example a training scheme) | Sponsor criteria, recent practice requirement, whether a post is offered |
| Experienced specialist or GP outside UK training | Portfolio pathway (with registration if not yet registered) | Curriculum for your specialty, evidence and referees, time to gather evidence |
Amira finished her internship two years ago and has worked in general medicine since. She has no postgraduate qualification. PLAB fits her stage of career, so she checks her degree, books IELTS and plans PLAB 1. Tariq is a senior surgeon with eleven years' post-qualification experience and a national surgical fellowship. He looks first at whether his fellowship is an accepted postgraduate qualification. He also starts mapping his logbook against the UK curriculum, because he may later want specialist registration through the Portfolio pathway. Neither choice is "better". Each fits a different starting point.
What happens after registration?
Registration is the start, not the finish. Doctors new to UK practice often find that the hardest part is not the medicine. It is the culture: how teams work, how consent and capacity are approached, how incidents are reported, and how openly mistakes are discussed. The GMC offers a free induction for doctors new to UK practice. Many trusts also run their own induction for international doctors.
- Read Good medical practice and the GMC's guidance on consent, confidentiality and candour before you start.
- Start a portfolio from your first week, including reflections, feedback and CPD, because you will need it for appraisal and revalidation.
- Ask early about supervision and who to call out of hours. Asking is seen as safe practice, not weakness.
Where to go from here
If you are still choosing a route, our GMC Registration Routes for International Doctors course walks through each option in more depth, with checklists for documents and timelines. If you are an experienced specialist thinking about specialist registration, Portfolio Pathway (CESR) Planning helps you map evidence against a curriculum before you open an application. Once you have a start date, Adapting to UK Clinical Practice and NHS Culture covers the day-to-day differences that international doctors most often mention.
Whichever route you take, rely on the GMC's own pages for requirements, fees and timings. They are the only authoritative source.
Frequently asked questions
Can I get GMC registration without passing PLAB?
Yes. PLAB is one of several routes. You may instead use an acceptable postgraduate qualification, such as certain UK royal college memberships, or sponsorship by a GMC-approved sponsor, or the Portfolio pathway for specialist or GP registration. Some doctors also qualify through a relevant European qualification. Every route still requires an acceptable primary medical qualification and evidence of English.
What level is PLAB set at?
The GMC says PLAB checks that you have the knowledge and skills of a doctor starting the second year of the UK Foundation Programme, often called F2. PLAB 1 is a written test of 180 single best answer questions. PLAB 2 is an OSCE of 16 eight-minute scenarios held at the GMC's clinical assessment centre.
How long is a PLAB 2 pass valid for registration?
The GMC states that your registration application must be approved within two years of passing PLAB 2. If this window passes, you may need to retake parts of the test, so plan your English test, documents and application timing together. Check the GMC's PLAB pages for the current rules.
Is a Sponsorship Registration Certificate the same as a visa sponsorship?
No. A Sponsorship Registration Certificate is issued by a GMC-approved sponsor to support your registration application. A visa sponsorship certificate relates to immigration and comes from an employer. The GMC is clear that it does not accept a visa sponsorship certificate in place of an SRC. You may need both, for different purposes.
Has CESR been replaced by the Portfolio pathway?
Yes. The routes formerly called CESR (for specialists) and CEGPR (for GPs) are now the Portfolio pathway. Royal colleges report the change took effect in late November 2023. Applicants now show the knowledge, skills and experience of a UK specialist or GP rather than full equivalence to a training programme.
Do I need IELTS or OET for every GMC route?
Most international doctors need an IELTS or OET certificate meeting the GMC's minimum scores, usually awarded within the last two years. There is an exemption for nationals of a country where English is the first and native language who also qualified there. The GMC lists other acceptable evidence too, so check its English language guidance for your situation.
Related courses
GMC Registration Routes for International Doctors
This course explains how an international medical graduate can gain full registration with a licence to practise from the General Medical Council. It…
Portfolio Pathway (CESR) Planning
This course explains the GMC's Portfolio pathway, the route to the Specialist or GP Register for doctors who have not completed a UK training…
Adapting to UK Clinical Practice and NHS Culture
This course prepares internationally trained doctors and allied health professionals for the everyday realities of working in the NHS. It covers team…
Sources and further reading
- A guide to the PLAB test. General Medical Council.
- Our criteria for acceptable overseas qualifications. General Medical Council.
- Applying for registration using sponsorship. General Medical Council.
- Full registration for international medical graduates with a postgraduate qualification. General Medical Council.
- Portfolio pathway application guide. General Medical Council.
- Portfolio Pathway: changes to CESR name and evaluation. Royal College of Paediatrics and Child Health.
- Choosing a GMC route as an IMG. Medical Protection.
Practitioner Insight is an independent education provider. It is not affiliated with or endorsed by the GMC, MPTS, NMC, HCPC, GPhC or any NHS organisation, and this information is not legal advice. If you have been referred to a regulator, speak to your defence organisation, trade union or legal representative.
More guides
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Clinical Attachments in the UK: How to Get One and Make It Count
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