The CREST Form Explained (2027)

If you are applying for CT1 or ST1 training in the UK and you did not complete a UK Foundation Programme in the last three and a half years, you will almost certainly need a Certificate of Readiness to Enter Specialty Training, the CREST form. It is one piece of paper, signed by one consultant, and it is the document most likely to get an otherwise strong application thrown out at the eligibility check.

The rules are strict and the recruiters say so themselves: if you are required to submit a CREST and you do not, there is no second chance to upload it. If you submit an incomplete or out-of-date version, you get 72 hours to fix it, once. NHS England also says its recruitment teams cannot check your form for errors before you submit, because too many people need one.

For 2027 recruitment there is a new version of the form. The 2027 CREST is the current one, the 2024 form is still accepted for 2027 recruitment if it is still valid, and from 2028 the 2024 form will not be accepted at all.

This guide covers who needs a CREST and who does not, who can sign it, the three-month and three-and-a-half-year rules, exactly what the 2027 form asks your signatory to confirm, how to submit it on Oriel, and the ways it goes wrong. Every rule is taken from NHS England's own pages and the 2027 form itself, which we have read line by line.

Key Documents

• CREST form 2027 – the official page with the Word download and the 13 instructions
• Foundation competencies – the page that tells you which route applies to you, and whether you need a CREST at all
• Evidence of Foundation Competence Applicant Guide – the FAQ with the correction rules, overseas posts and who can sign
• Signatories' Guide – send this to the consultant you are asking to sign
• CREST checklist – the page-by-page list to tick before you upload

Round 1 2027 dates that matter for your CREST

What Is the CREST Form?

The CREST is a certificate, signed by a consultant who has supervised you, confirming that you have every professional capability a doctor finishing the UK Foundation Programme is expected to have. It stands in for the Foundation Programme Certificate of Completion (FPCC) that UK Foundation doctors receive automatically. Without an FPCC or a CREST, you do not meet the person specification for any CT1 or ST1 post, and no recruiter has discretion to waive that.

It exists because specialty training posts assume you arrive able to recognise a sick patient, run a cardiac arrest, prescribe safely and hand over properly. NHS England's guide puts it bluntly: CT1/ST1 posts are not set up to check whether each new starter has these skills, so they have to assume you do. The CREST is how someone vouches for that.

Three things about the 2027 version. It is the current form, revised, in NHS England's words, "to provide greater detail about the Foundation Year 2 capabilities required". For 2027 recruitment only the 2024 and 2027 versions are accepted, and a 2024 form only counts if it still meets the 2027 eligibility rules for your specialty. From 2028 recruitment the 2024 version is dead, so if you are getting a form signed now, use the 2027 one.

Do I Need a CREST Form?

It depends on your route into specialty training, not on your specialty. The same rules apply whether you are applying to GP, IMT, Core Surgical Training, psychiatry or anaesthetics. NHS England lists five situations, and the application form asks you questions to put you in one of them.

Your situation	Do you need a CREST?	What you submit instead
On a UK Foundation Programme now that finishes before the post starts	No	The name of your Foundation School. Any offer is conditional on your FPCC arriving before the start date.
Already completed a UK Foundation Programme within the 3½ years before the post starts	No	A scanned copy of your FPCC, uploaded to Oriel. You may be asked for the original later.
Already in a UK training post with a National Training Number or Deanery Reference Number	No	Nothing. Your competence was assessed when you entered training, however long ago.
Reapplying to a specialty you voluntarily resigned from	No	ARCP evidence of satisfactory progress plus the support-for-reapplication form. Only for the same specialty.
Everyone else: IMGs, UK graduates who trained abroad, FY1-only doctors, anyone whose FPCC is older than 3½ years	Yes	One CREST, 2027 version, signed by one consultant, uploaded as a single document.

Routes from NHS England's Foundation competencies page (reviewed 17 September 2026).

There is one group the CREST is not for. If you ever started a UKFPO-appointed two-year Foundation Programme or a standalone FY2 post and did not satisfactorily complete it, you cannot use a CREST. NHS England expects you to go back and finish Foundation training. The only exception is where exceptional circumstances, such as serious illness or caring responsibilities, forced you out. In that case the Postgraduate Dean of the area where you trained has to sign a Dean's Supporting Declaration giving the dates, the reason you left, confirmation that you met the Foundation competences and whether you completed any remediation. The first line of the applicant checklist on the form makes you confirm you are not in this group.

Two more rules sit alongside the CREST. You need 12 months of experience after full GMC registration, or the equivalent, by the post's start date; the three months with your signatory do not replace that. And if you are an IMG, the Medical Training (Prioritisation) Act 2026 means that for 2027 a valid CREST gets you into the process, but applicants in the priority group are considered for interviews and offers before you are.

Who Can Sign a CREST Form?

A consultant or equivalent who has worked with you for at least three continuous months, whole-time equivalent, wholly within the three and a half years before the advertised start date. "Consultant" is defined more widely than it sounds, and the list of people who can give your signatory evidence but cannot sign is where most of the confusion lives.

Can sign the CREST	Can give evidence to your signatory, but cannot sign
A consultant on the specialist register	A locum consultant who is not on the specialist register
A General Practitioner	A pharmacist
A Clinical Director or Medical Superintendent	A consultant who was still a trainee when they worked with you
An Academic Professor (a university stamp is accepted in place of a hospital stamp)	A retired consultant who has left clinical practice
A locum consultant with a CCT or CESR who is on the specialist register	Someone who became a consultant before 1997 and is not on the specialist register
A Specialty and Specialist (SAS) doctor acting as an educational supervisor	Any trainee below ST5

From the 2027 form's instructions and the Evidence of Foundation Competence Applicant Guide (reviewed 16 September 2026).

Your signatory must not be your spouse, partner or a family member, and the form now makes both of you declare that you are not related or in a relationship. It is your job, not theirs, to show they are on the specialist register on the day they sign. If you have worked in the UK for three months or more in an acute post in the last three and a half years, NHS England expects you to use a signatory from that post rather than someone overseas.

The Three-Month Rule and the 3½-Year Window

Your signatory must have worked with you for a minimum continuous period of three months whole-time equivalent, and that period must sit wholly inside the three and a half years before the advertised start date of the post you are applying for. The three months must also be finished by the application deadline, not just started.

What counts is a real, paid, supervised post. NHS England's list of what does not count is short and absolute:

• Clinical attachments and observerships – you are watching, not working, so they cannot evidence the three months and cannot be used to demonstrate a capability.
• Unpaid work – same reason.
• Telemedicine posts – excluded by name on the 2027 form.
• Locum bank work – cannot be used to confirm your competences at all. A locum post counts only if it is one continuous post that meets every other rule.

Working less than full time stretches the clock. "Whole-time equivalent" means a 60% post needs five months to count as three. If you are doing a PhD or working in a non-acute specialty, NHS England's advice is to arrange keeping-in-touch days or locum shifts that let your signatory see the acute skills, and it says in terms that a pure clinical attachment with observer status will not do.

The evidence behind each capability can come from other posts within the window; what cannot move is the three months with the signatory. The form has a table on page 2 where you list every post you drew evidence from, with employer and dates, so keep that list honest and complete.

What the 2027 CREST Form Asks Your Signatory to Confirm

The 2027 form is eight pages. Pages 3 to 5 are the heart of it: thirteen capability headings grouped under the three outcomes of the current UK Foundation curriculum, and your signatory must tick one of three boxes for every single heading, "Personally witnessed", "Evidence received" or "Unable to confirm". One "Unable to confirm" anywhere and you are not eligible for specialty training. The form says, twice, that capabilities must not be grouped together.

Section 1: an accountable, capable and compassionate doctor

• 1.1 Clinical assessment – assessing patients in acute, non-acute and community settings; sensitive history and examination including mental state, with a chaperone where needed; routine standardised assessments such as suicide risk, confusion, pain, VTE and nutrition scores; focused assessments done safely.
• 1.2 Clinical prioritisation – recognising and starting treatment for deterioration in physical and mental health; taking responsibility for the initial management of a critically ill patient while calling for help. This heading also asks for evidence of simulated skills: the ABCDE approach to a deteriorating patient, quality CPR and defibrillation (manual or AED), simple airway manoeuvres, standardised adult CPR, managing a cardiac arrest within a multidisciplinary team, the non-technical skills of leading and following in an emergency, and communicating with and managing disturbed or challenging patients with a mental health condition.
• 1.3 Holistic planning – diagnosing and formulating supervised treatment plans that weigh the patient's physical, psychological and social needs ethically.
• 1.4 Communication and care – explaining clearly, agreeing a plan and giving advice; delivering care safely including physical interventions, procedures, safe prescribing, blood transfusion and medical devices; using available technology. It also asks for evidence that you have passed the Prescribing Safety Assessment (PSA), or that your prescribing is at the standard needed to pass it.
• 1.5 Continuity of care – contributing to safe ongoing care in and out of hours; prioritising tasks and owning their completion; timely patient reviews; directing or leading handover and anticipating problems; competent written referrals and consultation summaries such as outpatient letters.

Section 2: a valuable member of the healthcare workforce

• 2.1 Sharing the vision – working confidently in the multi-professional team and, where appropriate, guiding it.
• 2.2 Fitness for practise – managing your own wellbeing.
• 2.3 Upholding values – acting as a responsible employee, including speaking up when others do not.
• 2.4 Quality improvement – taking an active part in improving care.
• 2.5 Teaching the teacher – teaching and presenting effectively.

Section 3: a professional, responsible for their own practice and portfolio

• 3.1 Ethics and law – professional practice in line with statutory requirements, shown through a professional portfolio.
• 3.2 Continuing professional development – developing your practice through experience, feedback, remediation if needed, reading and research.
• 3.3 Understanding medicine – understanding the breadth of medical practice and planning a career.

Read that list as a job description for the post you will use to get the form signed. Sections 2 and 3 are easy to evidence in any supervised post. Section 1.2 is the one that catches people in non-acute jobs: your signatory needs to have seen, or received reliable evidence of, you managing a deteriorating patient and taking part in a cardiac arrest. A resuscitation course certificate on its own is not enough. NHS England says in both guides that attendance at a training course is insufficient by itself to demonstrate a capability.

Page 6 is the signatory's declaration. Beyond their name, post, dates of supervision, GMC number and work email, they must tick four boxes: that they have viewed the UK Foundation Programme curriculum and know the standard expected of an FY2; that you worked for them continuously for three months whole-time equivalent within the window, and that attachments and observerships do not count; that they observed every capability or received reliable evidence for the rest; and that they are not related to or in a relationship with you. The form states it is invalid unless all four are ticked. It then needs a hospital stamp, or a confirmation on hospital letterhead if there is no stamp or it is not in English. The form also reminds signatories, quoting Good Medical Practice paragraph 71, that signing a misleading document puts their own registration at risk.

Page 2 is yours. Name, GMC number if you have one, the table of posts you drew evidence from, and three declarations: that you have attained every capability and worked for the signatory for the required period, that you follow Good Medical Practice on prescribing for yourself, friends and family, and that you are not related to the signatory. Sign it.

Overseas Signatories and the Extra Paperwork

A consultant working outside the UK can sign your CREST, but the burden of proof shifts to you. If your signatory is not on the UK specialist register, you must attach evidence of their current registration with their own regulator, current meaning on the date they sign. If the evidence is not in English, add an official translation. Historic GMC registration does not count; it is the registration tied to their current post that is needed. Miss this and NHS England's wording is that your CREST, and your application, will be rejected.

The practical details matter too. The signatory's contact email must be an institutional or work address, not a personal one. The hospital stamp must show the hospital's details, not just the signatory's name and title. If the form is signed digitally, an email from the signatory's work address confirming it is genuine must be scanned and uploaded with the certificate.

How to Submit the CREST on Oriel

You upload one document, once, and it is used for every CT1/ST1 application you make in that round. Scan the completed form and the proof of your signatory's registration together as a single file, upload it to Oriel, and attach it to each vacancy before the deadline. Do not email or post it to a recruitment office; it will not be considered.

One certificate per round is a hard rule. You cannot submit different certificates for different specialties, and you cannot submit several certificates from several posts to cover all the capabilities between them. If your evidence comes from more than one post, it all goes to one signatory who lists the other sources on page 7. For England, the Academic Clinical Fellowship round that opens in October is linked to Round 1, so a CREST uploaded for an ACF application is the one used for your Round 1 applications in the same year.

The form page is explicit that completing it correctly is your sole responsibility, and the foundation competencies page says recruitment teams cannot check forms before submission because of the number of applicants who need one. Work through the checklist on page 8 of the form, and NHS England's online checklist, before you scan anything. The checklist asks you to confirm each page: your name, GMC number, posts table and declaration on page 2; one box ticked for every capability and the signatory's signature, your name and the completion date at the bottom of pages 3, 4 and 5; the declaration, boxes A to D and the stamp on page 6; page 7 completed if "Evidence received" appears anywhere; registration evidence attached if the signatory is not GMC registered; and everything scanned as one document.

How a CREST Goes Wrong

Recruiters do not assess your competence. Your signatory did that. What the recruiters check at longlisting is whether you submitted a fully completed, correctly signed, current version of the right document, and the penalties for getting that wrong are graded.

The errors that trigger the 72-hour rule are mundane: a page without the signatory's signature at the bottom, a missing date, a capability with no box ticked, a page 7 left blank when "Evidence received" was used, a stamp that only shows a name. Because the correction has to go back to the original signatory, 72 hours is tight if they are on leave or abroad. Check the form page by page the day it comes back to you, not the day before the deadline.

How Long Is a CREST Form Valid?

The form stays valid for future rounds as long as its conditions still hold against the new start date. In practice that means the three months with your signatory must still fall wholly within the three and a half years before the start date of the post you are now applying for. A certificate signed in October 2026 for an August 2027 start could still be usable for later rounds, provided the supervised post is inside the window measured from the new start date and the version is still accepted.

The version rule is the one to watch. A 2024 form is accepted for 2027 recruitment only if it remains valid and meets the 2027 eligibility requirements for your specialty. From 2028 recruitment the 2024 form will not be accepted in any circumstances. If your 2024 form is still inside its window and you are applying for 2027 entry, it will do; if there is any chance you will be applying again in 2028, get the 2027 form signed now while your signatory is still reachable.

Working Abroad: Which Posts Count?

If you trained in a country without a Foundation Programme, NHS England gives three patterns of experience it is likely to accept as equivalent, all of them 12 months of internship or FY1 plus a further 12 months:

• 12 months' satisfactory completion of a pre-registration internship or FY1 post, and 12 months full-time satisfactory completion in posts approved for medical education by the relevant authority; or
• the same internship or FY1 year, and 12 months full time at a publicly funded hospital in at least two specialties with acute medical responsibilities; or
• the same internship or FY1 year, and a 12-month full-time Foundation Year 2 post.

An internship, for these purposes, is either a 12-month programme with at least three months each of surgery and medicine, a programme of at least ten months with those rotations plus up to two months' study, or the equivalent of 12 months full time post-qualification at a publicly funded hospital in at least two branches of medicine. You will not be asked to upload evidence of this experience with your application, but the recruiting office may ask for it later, so keep the paperwork.

The CREST itself can be signed by a consultant you worked for abroad, provided the three-month rule and the registration-evidence rules above are met. The signatories' guide says the work witnessed "could have taken place in the UK or anywhere else around the world". If you have not worked anywhere in the last three and a half years, NHS England's advice is to secure a post that will let you complete a CREST before you apply.

Is a CREST the Right Step for You?

NHS England asks this question itself, in a video on the foundation competencies page aimed at IMGs: are you ready to begin post-Foundation training, and do you have the skills to start GP or core specialty training? If the honest answer is no, it suggests two alternatives. A standalone FY2 post, recruited through the UK Foundation Programme website, is a one-year rotation that leads to an FPCC on completion, so you never need a CREST. A locally employed or Trust-grade post gives you NHS experience in a specialty that interests you, often with the same supervision as a training post, and a substantive consultant who can sign your CREST at the end of it.

The signatories' guide is franker still about why the question matters. It tells consultants that signing for an applicant who is not ready can end with that doctor struggling with the workload, falling behind, being removed from training and, for a visa holder, leaving the UK. Our guide to IMG jobs: Foundation, FY2 standalone or JCF compares those routes, and Making the Transition: IMG to NHS covers the first months in post.

Once the CREST is sorted, the application itself is the same one everyone else is making. Our IMT application guide, CST recruitment guide and Ophthalmology ST1 guide cover the scoring for three of the most popular routes, and most of the others start with the MSRA.

Frequently Asked Questions

Where do I download the CREST form?

From NHS England's CREST form page. It is a Word document (62 KB) and there is a separate reference version for reading. Use the 2027 version for anything you are getting signed now.

Can a GP sign my CREST form?

Yes. General Practitioners are included in NHS England's definition of "consultant or equivalent" for the CREST, as are clinical directors, medical superintendents, academic professors, locum consultants on the specialist register and SAS doctors acting as educational supervisors. The three-month rule applies to all of them.

Can my signatory be based overseas?

Yes, if they are a consultant or equivalent who supervised you for three continuous months within the window. You must attach evidence of their current registration with their own regulator, with an official English translation if needed, and their contact email must be a work address. If you have done three months in a UK acute post within the window, NHS England expects you to use a UK signatory instead.

Does a locum post count towards the three months?

A continuous locum post that meets every other rule can count. Locum bank work, ad hoc shifts, cannot be used to confirm your competences. Clinical attachments, observerships, unpaid work and telemedicine posts do not count under any circumstances.

I completed FY1 but not FY2. Do I need a CREST?

If you did FY1 as part of a UKFPO-appointed two-year programme and then left it, you cannot use a CREST and should contact the Foundation School where you trained about returning or about a Dean's Supporting Declaration. If you completed only a standalone FY1 post, the applicant guide says the CREST route is not available to you either. Check your situation with the recruiting office before applying.

What is an FPCC?

The Foundation Programme Certificate of Completion, awarded when you finish a UK Foundation Programme or a standalone FY2 post appointed through the UKFPO. If yours was awarded within the three and a half years before the post's start date, you upload the FPCC instead of a CREST.

Do I need a CREST for IMT, GP or CST specifically?

The requirement is the same for every CT1 and ST1 programme: evidence of Foundation competence, which is an FPCC, a CREST, or one of the other routes in the table above. Which one you need depends on your history, not on the specialty.

Can I reuse last year's CREST?

A 2024 form can be used for 2027 recruitment if the supervised post is still inside the 3½-year window measured from the new start date and it meets the 2027 eligibility rules. Earlier versions are not accepted, and from 2028 the 2024 form will not be accepted either.