For Respiratory Medicine Portfolio Pathway, you need evidence that you are practising at UK specialist level across Respiratory Medicine and General Internal Medicine. The difficult parts are usually breadth, current independent practice, procedures, acute medicine exposure, structured reports and mapping evidence to the respiratory and GIM CiPs.
That is why a thin evidence folder can look fine at first glance and still fail the specialty test. Respiratory assessors are not just asking whether you have seen respiratory patients. They are asking whether your total evidence proves the work of a UK respiratory physician who can also carry the internal medicine responsibility attached to the specialty.
What assessors are really testing
The GMC's Portfolio Pathway is for doctors who have not completed a GMC-approved UK training programme but can show the knowledge, skills and experience required for UK specialist practice. For Respiratory Medicine, the SSG says the guidance must be read alongside the Respiratory Medicine and General Internal Medicine curricula. It also makes the point that applications are assessed against the high-level learning outcomes in the curriculum, not against progress through a training programme.
In practice, that means your portfolio has to answer five questions:
Do you cover the right clinical breadth?
Assessors need to see more than one strong subspecialty. Respiratory evidence should cover acute and chronic respiratory disease, cancer pathways, infection, respiratory failure, procedures, outpatient work, MDT practice and interface work.
Can you carry the GIM element?
For this route, respiratory evidence is not enough on its own. You need credible evidence across the internal medicine capabilities expected of a group 1 physician specialty.
Are you currently independent?
The SSG asks applicants to demonstrate current practice at the level of being entrusted to act independently in all specialty CiPs. Old training evidence helps only if it is backed by recent proof that the capability has been maintained.
Are procedures evidenced properly?
Respiratory medicine is procedure-sensitive. Vague claims that you "do pleural" or "cover NIV" are weaker than DOPS, logbooks, consultant reports and structured evidence of safe independent practice.
Does the portfolio feel like NHS specialist practice?
MDTs, appraisal, MSF, patient feedback, audit, QI, clinical governance and structured reports matter because they show how you practise in the UK system, not just what you know clinically.
The weakest respiratory applications are often not weak because the doctor is clinically poor. They are weak because the job has boxed them into a narrow service, with too little GIM, too little procedure evidence, too little recent consultant observation or too little governance evidence.
Respiratory Medicine plus General Internal Medicine
Respiratory Medicine is listed as Respiratory Medicine with General Internal Medicine in the current GMC SSG. That wording matters. The SSG says the relevant high-level learning outcomes for General Internal Medicine will also be demonstrated by meeting the respiratory guidance, and it tells applicants to read the specialty and General Internal Medicine curricula.
For candidates in non-substantive consultant posts, this can be the difference between a plausible application and a frustrating one. Some respiratory trust-grade consultant roles are excellent for clinics and ward work but weak for acute take. Some locum consultant posts give huge respiratory service responsibility but poor access to formal supervision, procedures or governance. Some SAS roles offer continuity and procedures but not enough recognised independent decision-making.
Specialty breadth
- Thoracic malignancy and palliative respiratory care.
- Integrated respiratory medicine and long-term disease management.
- Complex infection, TB, public health and atypical pneumonia.
- Respiratory failure, NIV, oxygen therapy and escalation decisions.
- Tertiary interface work such as pulmonary hypertension, transplant and rare disease pathways.
- Respiratory drugs, delivery systems, therapeutics and diagnostics.
Internal medicine breadth
- Managing acute unselected take and deteriorating patients.
- Managing acute care within a specialty service.
- Continuity of care for medical inpatients.
- Outpatient management of long-term conditions.
- Medical problems in other specialties and special cases.
- MDT working, discharge planning, resuscitation and palliative care.
The six respiratory specialty CiPs
The respiratory curriculum describes specialty Capabilities in Practice, or CiPs. The SSG says applicants must demonstrate current practice at the level of being entrusted to act independently in all specialty CiPs. That is a high bar. You are not trying to show that you once rotated through an area. You are trying to show that you can practise independently as a specialist across the expected scope.
The respiratory CiP map
Use this as a gap-check, not a substitute for the SSGThoracic malignancy and terminal disease
Diagnostic pathways, MDT working, cancer care, palliation and decision-making with patients and relatives.
Integrated respiratory medicine
Long-term respiratory disease across primary, secondary and community interfaces, including continuity of care.
Complex respiratory infection
Pulmonary infection, immunocompromised patients, TB-type thinking, public health, notification and contact tracing.
Respiratory failure across settings
Acute and chronic respiratory failure, oxygen therapy, NIV, CPAP, escalation and links with HDU or ITU.
Tertiary subspecialty interface
Rare and complex disease, pulmonary hypertension, transplant, cystic fibrosis and joint care with specialist centres.
Drugs and therapeutic modalities
Respiratory therapeutics, delivery systems, guideline-based treatment and relevant therapeutic procedures.
Procedures and practical skills
The SSG is unusually specific about procedural evidence. It says evidence must be provided for each procedure for which an applicant must be competent to perform unsupervised. For Respiratory Medicine, it describes either a structured report concentrating on mandatory procedural skills by a senior colleague, or one summative DOPS for each listed procedure.
This is where many senior doctors need to be honest about their current role. If you are functioning as a consultant in clinics but have not done independent bronchoscopy recently, or if pleural ultrasound is done by another team, you cannot paper over that with old evidence and confidence. You need a plan.
Respiratory procedure evidence areas
Exact requirements must be checked in the live SSG. These are the procedure and technical-skill areas the current guidance flags for Respiratory Medicine evidence.
The evidence map: what to collect
A good respiratory portfolio does not look like a storage folder. It looks like a mapped argument. Each document should earn its place because it proves a capability, procedure, professional behaviour or current practice claim.
The GMC SSG page says the SSG explains how much evidence is enough, how to organise it, how recent evidence needs to be and who referees should be. For respiratory applicants, the practical starting point is a spreadsheet with four columns: SSG requirement, evidence you have, evidence gap and owner/date for closing the gap.
| Evidence type | Strong respiratory example | Weak version |
|---|---|---|
| Structured reports | Consultants who directly observe your respiratory and GIM work comment on independence, procedures, MDTs and safety. | A senior name who knows your reputation but not your current clinical practice. |
| WPBAs | CbD, Mini-CEX, ACAT and DOPS spread across acute, outpatient, inpatient, procedure and MDT settings. | Multiple assessments from one narrow clinic or one friendly assessor. |
| MSF and patient feedback | Feedback covering your whole scope, including colleagues, MDT members and patients who see your communication style. | Small or narrow feedback that only captures one service area. |
| Audit and QI | A completed project with respiratory relevance, implemented change, reflection and follow-up evidence. | An old presentation with no closed loop or personal contribution. |
| CPD and knowledge | SCE, comparable assessment, CPD mapped to SSG gaps and evidence of application to practice. | Generic attendance certificates with no link to competence or change. |
Download: Respiratory evidence map
A two-page worksheet for mapping respiratory scope, GIM, procedures, referees and a 90-day portfolio reset plan.
Common gaps in respiratory applications
Because Respiratory Medicine is clinically broad, a doctor can be very strong in one part of the specialty and still have a portfolio gap. The important question is not whether you are impressive. It is whether the evidence covers the full assessment framework.
Current, broad, observed practice
- Recent work across respiratory wards, clinics, acute care and MDTs.
- Direct consultant observation of procedures and independent decisions.
- Clear GIM evidence alongside specialty evidence.
- Audit, QI, MSF and patient feedback that match your actual scope.
Narrow senior work
- One subspecialty service with little acute or GIM exposure.
- Historic procedures that have not been maintained recently.
- Referees who cannot comment on day-to-day respiratory practice.
- Evidence uploaded in volume but not mapped to CiPs or procedures.
A 90-day action plan before you submit
If you are serious about applying, spend 90 days testing the portfolio before you spend months polishing it. That gives you enough time to identify whether the remaining gaps are paperwork gaps or job-design gaps.
Respiratory Portfolio Pathway reset
Map the SSG
Build your evidence spreadsheet against every respiratory CiP, GIM CiP, procedure, referee requirement and professional evidence area.
Close easy gaps
Book DOPS, request consultant reports, start missing feedback, locate audit/QI evidence and organise acute or clinic logs.
Test job fit
If the remaining gaps require work your current role cannot provide, decide whether the practical answer is a different post.
Is your current Trust supportive enough?
This is where the recruitment question becomes legitimate rather than salesy. Respiratory Portfolio Pathway evidence is heavily shaped by the environment. You need the right service mix, the right senior observation, the right procedures, the right GIM exposure and the right governance opportunities.
A Trust can be clinically excellent and still be a poor Portfolio Pathway environment for you if your job plan traps you in one narrow area, gives you no SPA time, limits procedure access, excludes you from acute take or keeps promising support that never becomes evidence.
BDI Consultants does not review Portfolio Pathway applications, sell mentorship or influence GMC or Royal College decisions. What we can do is help senior respiratory doctors understand which NHS roles are more likely to give them the case mix, supervision and consultant-level responsibility they need while working towards the Specialist Register.
If you cannot name the three consultants who would write strong respiratory and GIM structured reports for you today, your next priority is not formatting. It is building the right working relationships and evidence base.
Sources
| Document | Publisher |
|---|---|
| Portfolio pathway application guide | General Medical Council |
| Specialty Specific Guidance for Portfolio pathway applications | General Medical Council |
| Respiratory Medicine with General Internal Medicine SSG | General Medical Council |
| Curriculum for Respiratory Medicine Specialist Training 2022 | JRCPTB / Federation of the Royal Colleges of Physicians |
| Portfolio Pathway for physicianly specialties | Federation of the Royal Colleges of Physicians |
| ARCP and PYA guidance for respiratory trainees | British Thoracic Society |
| Good Medical Practice | General Medical Council |
Frequently asked
Is Respiratory Medicine Portfolio Pathway linked to General Internal Medicine?
Yes. The GMC Respiratory Medicine SSG is for Respiratory Medicine with General Internal Medicine. It says the relevant high-level learning outcomes for General Internal Medicine will also be demonstrated by meeting the requirements in the guidance. Applicants should read both the respiratory curriculum and the General Internal Medicine or Internal Medicine curriculum before building their portfolio.
Do I need the Respiratory Specialty Certificate Examination for Portfolio Pathway?
The Respiratory Medicine SSG refers to evidence of completion of the Respiratory Medicine Specialty Certificate Examination or a comparable qualification. If you do not hold MRCP(UK) and SCE, the SSG indicates that you may need to demonstrate the same level of knowledge through a detailed mapping exercise or comparable assessment. Do not assume clinical experience alone replaces knowledge evidence.
Which respiratory procedures matter most for the application?
The SSG expects evidence for procedures the applicant must be competent to perform unsupervised. It lists respiratory areas including pleural aspiration, chest drain insertion, focused pleural ultrasound, safe sedation, bronchoscopy, non-invasive ventilation, lung function, sleep studies, allergy skin testing and TB. The safest approach is to map each procedure to DOPS or a senior structured report.
Can an overseas respiratory consultant apply directly?
They can apply if eligible, but direct overseas applications are often harder because NHS-style evidence is difficult to reproduce outside the UK. The SSG specifically notes that features such as MDT meetings, appraisal, multisource feedback, patient feedback, safety work, audit and QI may not be covered in the same way outside the NHS. Many applicants build stronger evidence from a UK SAS or trust-grade consultant-level post first.
How long does Respiratory Medicine Portfolio Pathway usually take?
The application itself depends on GMC and Royal College assessment timelines, but the longer part is usually building the evidence. For Respiratory Medicine, the bottleneck is often case mix, GIM exposure, procedural sign-off, consultant reports, acute work, MDT evidence and recent audit or QI. A strong applicant may need months; a doctor in the wrong post may need a new role before the portfolio becomes realistic.
What should a respiratory doctor collect first?
Start with the live SSG, then build a gap map across respiratory specialty CiPs, GIM CiPs, procedures, structured reports, MSF, patient feedback, audit or QI, CPD and evidence of current independent practice. Do not start by uploading everything you have. Start by proving breadth, independence and recency.