You probably need a CREST form if you are applying to CT1 or ST1 and cannot show recent foundation competence through the UK Foundation Programme or another accepted training record. That includes most IMGs who have not completed the UK Foundation Programme and UK graduates whose Foundation Programme completion will be more than 3.5 years before the advertised post start date. You may also need it after voluntarily resigning, where you are applying to a different specialty from the one you left. NHS England only spells out the same-specialty ARCP route explicitly, so check the applicant guide against your own case if you are changing specialty.
You do not need CREST if you are currently in the UK Foundation Programme, because any offer is conditional on successful completion. Nor do you need it if you completed the programme within 3.5 years of the new post's start date, currently hold an NTN or DRN, or are reapplying to the same specialty and can use the permitted ARCP documentation from your previous training.
A Widening Access to Specialty Training (WAST) post defers the paperwork. You submit no further foundation-competence information at application, but must hold a fully completed and signed CREST by the start date of the post you applied for.
If you started but did not finish the UK Foundation Programme, you cannot use CREST at all. That includes starting an FY2 standalone post without completing it, or completing only an F1 standalone post. NHS England's expectation is that you return to the Foundation Programme. In exceptional circumstances such as illness or caring responsibilities, a Postgraduate Dean's letter on the standard proforma replaces CREST as the substitute document; it is not a supporting letter added to the certificate.
CREST proves foundation competence. It does not place you in a priority group for 2027 recruitment, and it does not replace the rest of the specialty person specification. If you are applying from outside the UK or trained abroad, our MSRA guide for IMGs deals with eligibility, prioritisation and the separate question of whether an application is likely to reach an offer.
Use the 2024 form
Only the 2024 CREST form is accepted. An old 2022 or 2023 form will be rejected even if every answer is complete and the same consultant signs it. Download the current Word document from NHS England's CREST page instead of opening a saved copy from a previous application round.
The September 2024 re-release causes needless confusion. It added an applicant checklist, but it is still the 2024 form. Both releases of the 2024 version count. Check the version named on the certificate. The date when somebody emailed the file tells you very little.
Do that check before the form travels between you and your assessor. Discovering an obsolete version after signatures, stamps and registration evidence have been assembled leaves very little room to recover.
Who can sign it
The phrase "consultant or equivalent" is narrower than it sounds. Under the official signatories' guide, an eligible signatory can be:
- a consultant;
- a GP;
- a Clinical Director or Medical Superintendent;
- an Academic Professor;
- a locum consultant with CCT or CESR who is currently on the GMC Specialist Register;
- a Specialty and Specialist (SAS) doctor acting as an educational supervisor.
A senior job title by itself is not enough. The signatory must hold the current registration required for that role, and you must include evidence of it. This catches two candidates who can look entirely credible on paper: a retired consultant and a locum consultant who is not on the Specialist Register. Neither can sign. A retired consultant's previous registration does not become current because they supervised you while still practising, and a non-Register locum cannot substitute experience for the stated registration requirement.
Then there is the supervision test. Your signatory must have worked continuously with you for at least three months full-time-equivalent, and that period must sit within the 3.5 years before the advertised start date of the training post. A consultant who remembers you well from an older job is not eligible merely because the working relationship was substantial. Equally, a suitably registered consultant who has only reviewed your portfolio and never completed the required period of supervision cannot sign.
The assessor does not have to be based in the UK. An overseas consultant or equivalent can sign if the seniority and supervision conditions are met. You must attach current evidence from the assessor's home medical regulator. If that evidence is not in English, it needs a certified English translation. Historic GMC registration does not replace evidence of current registration with the regulator that now governs the assessor's practice.
And the signatory must be independent. A spouse, partner or family member can never sign, however senior they are or however closely they have observed your work.
Every capability must be confirmed
CREST is not accepted on an overall impression that you are probably ready. Every professional capability on the form must be demonstrated. Your signatory may rely on appropriate evidence where they have not personally observed a capability, but they still have to make the judgement. If one entry says "unable to confirm", the certificate does not meet the eligibility requirement. There is no partial credit and no balancing a missing capability against stronger evidence elsewhere.
Ask the proposed signatory before completing the form whether they can confirm every capability from direct supervision or acceptable evidence. If they cannot, obtain the missing evidence while there is time. Asking for an optimistic tick is unfair to the signatory and unsafe for your application.
Submission is equally exact. Upload the completed certificate and the required signatory-registration evidence to the application as one document before the deadline. Do not split the form and regulator evidence into separate uploads, and do not plan to send missing pages later by email or post. NHS England's CREST checklist is worth using against the final merged file, page by page.
If a submitted CREST is flagged for a correctable error, the recovery window is only 72 hours from notification. The corrected form must be signed and dated by the original signatory. That is one reason to keep the signatory warned and reachable after submission. It is not a fresh chance to find a different consultant, and a late certificate cannot be rescued through the correction process.
The common failure points are mundane: the wrong form version, missing proof for an overseas assessor, an ineligible signatory, one "unable to confirm", or a submission after the deadline. Read the merged document once as if you were the administrator deciding whether it can proceed. This is paperwork where a boring final check earns its keep.
There is no fixed expiry date
A valid CREST can be used in a future recruitment round provided its conditions still apply to the new intended start date. That qualification matters. The 3.5-year window is recalculated against each post's advertised start date, so a certificate that worked for one round can fall outside the window for the next. Check the supervision dates again whenever you apply; do not write a private expiry date on the file and assume it governs every future application.
There is usually dead time while a CREST travels back and forth. A free ProMSRA question set will use some of it; the paid plans can wait until you have seen whether the bank suits you.
Questions about CREST
Do you need CREST if you finished foundation years ago?
Usually, yes, if your UK Foundation Programme completion will be more than 3.5 years before the advertised start date and you do not have another accepted route such as a current NTN or DRN. The calculation uses the post start date; the application date is irrelevant. CREST has no single expiry date, but the 3.5-year supervision window moves with each intended start date, so check it afresh for every round.
Can an old consultant abroad sign it?
Yes, if they are an eligible consultant or equivalent, supervised you continuously for at least three months full-time-equivalent within the relevant 3.5-year window, and hold current registration with their home regulator. Include evidence of that registration and a certified English translation where needed. They cannot be a family member.
What if one competency says "unable to confirm"?
Your application will not meet the foundation-competence requirement. Every capability must be demonstrated. Speak to the signatory before submission about evidence they can properly consider; once "unable to confirm" remains on the submitted form, strength elsewhere does not compensate for it.