This process ensures that if you have special circumstances and a requirement to train in a particular location, you are treated in a fair and consistent way.

Special circumstances is different to reasonable adjustments. Those who require reasonable adjustments to attend interview or take up a training post should ensure that they state this on their application form and make contact with the Lead Recruiter as soon as an interview invitation is received to discuss their requirements. Reasonable adjustments will not be managed through the special circumstances process. 

If you fall into one of the following eligibility criteria, you can apply to have your circumstances taken into consideration, allowing you to be pre-allocated into a post, subject to it meeting the requirements of your training programme.

  • Criterion 1 – you are the primary carer for someone who is disabled, as defined by the Equality Act 2010.

  • Criterion 2 – you have a medical condition or disability for which ongoing follow up for the condition in the specified location is an absolute requirement.

Applying for special circumstances 

If you wish to be considered for special circumstances pre-allocation, you should ensure that you state this on your application form and submit the required form and supporting evidence by email. Requests for consideration of special circumstances received in any other way will not be accepted.   

You can apply under both criterion if you meet the requirements. In this instance, you should complete the combined form and submit it with evidence to confirm eligibility under both criterion. 


Requests for special circumstances and supporting evidence must be supplied by the following deadlines.

Recruitment round Deadline
Recruitment round Round 1 2023 Deadline Thursday 1 December 2022 by 4pm
Recruitment round Round 1 Re-advert 2023 Deadline Wednesday 12 April 2023 by 4pm
Recruitment round Round 2 2023 Deadline Thursday 8 December 2022 by 4pm
Recruitment round Round 3 2023 Deadline Tuesday 15 August 2023 by 4pm

Special circumstances cannot be considered in this process, outside of the timelines listed above. If you develop special circumstances after the deadline for the recruitment round in which you have applied, you should ensure that they only rank preferences in geographical locations in which you are able to accept an offer. Should an offer ultimately be made, contact should be made directly with the region where an offer has been made to explore opportunities for consideration of special circumstances.   

Supporting evidence

To be eligible for special circumstances you must complete the criterion appropriate special circumstances application form and forward this, together with the following supporting evidence, as a single scanned document, as soon as the Oriel application has been submitted to the Medical and Dental Recruitment and Selection (MDRS) team via email [email protected]. Applications and evidence not submitted in the correct format will be returned to applicants, with a request to resubmit in the correct format. Evidence submitted in the incorrect format will not be accepted. 

Criterion 1 – Primary carer of someone with a disability

Written statement confirming your role as primary carer

The letter should be on headed paper from a general practitioner or social services professional. It should confirm the applicant’s role as primary carer for this person, together with confirmation of the disability and be dated within 6 months of the application deadline.

The examples below are taken from real special circumstances applications.

Examples of evidence registered with (xxxxxx) as a primary carer for her husband. the designated primary carer for her mother.

...(xxxxx) is her only carer.

... the only carer she has.

Care Plan

Care plan on headed paper from a general practitioner or social services professional, dated within 6 months of the application deadline. Where an official care plan is not available, details of caring responsibilities and activities should be provided, attested by the general practitioner of the person who is being cared for.

The examples below are provided to help you understand the requirements of a care plan, based on evidence submitted by applicants in previous recruitment rounds.

Alternatively, you can provide an Educational Health and Care Plan (EHCP) for the child being cared for or, where this is unavailable, confirmation that an assessment has taken place and that the development of the EHCP is in progress.

Proof of address e.g. driving licence, utility bill dated within 3 months of the application date must also be provided.

Examples of evidence

Council produced Education, Health and Care Plan

Description of care duties required e.g. cleaning, shopping, personal hygiene, administering medication. Provided on headed paper by a General Practitioner or Social Worker who has known you for at least 6 months

Description of care duties required e.g. cleaning, shopping, personal hygiene, administering medication. Written by the applicant but attested as accurate by a General Practitioner or Social Worker who has known you for at least 6 months. Signature and organisation stamp required to confirm authenticity

Alternative evidence

It has been recognised by the Medical and Dental Recruitment and Selection (MDRS) special circumstances team that obtaining documentation from primary care services is becoming more challenging. Where possible, you should provide a written statement confirming your role as primary carer and a care plan. In light of increasing difficulty obtaining documentation to support primary carer status, a countersigned copy of the MDRS Special Circumstances – Supporting Evidence for Primary Carer form 2023 will be considered as part of the special circumstances application in the event that you has not been able to obtain a care plan or written status confirming your role as a primary carer.

The MDRS Special Circumstances – Supporting Evidence for Primary Carer form 2023 must be completed in full and countersigned by a professional from the list below. The counter signatory must have a relevant professional relationship with the person you are the primary carer for.

Examples of recognised professions include:

  • Chiropodist
  • Dentist
  • Nurse
  • Optician
  • Pharmacist
  • Social worker
  • Headteacher
  • Doctor – (either General Practitioner or treating doctor)
  • Allied Health Professional
  • Midwife

Primary Carer where the person who is being cared for is your child

If you are a Primary Carer where the person who is being cared for is your child, in addition to the completion of the MDRS Special Circumstances – Supporting Evidence for Primary Carer form 2023 please also provide the following evidence.

  • The full version of the birth certificate (detailing parent(s) name(s)) for the child who you are the primary carer for. This is to confirm that you are the parent of the child they have detailed. The birth certificate must also include the full name of the child. The short version of the birth certificate which contains only the child’s details will not be accepted.
  • For legal guardians, a copy of the legal document that confirms your status for the child named in the birth certificate. If you are a legal guardian then you may submit the short version of the birth certificate.
  • Letter of referral for further assessment from General Practitioner.

Criterion 2 – Medical condition or disability

Report written by the current medical specialist treating your condition or Occupational Health physician

The report must be provided on headed paper and must be current i.e. written for the purpose of this application. Older medical evidence will not be accepted as there is no way of the panel confirming that this is still the current situation.

The written report must contain all of the following information.

  • Description of current medical condition or disability.
  • Description of ongoing treatment and frequency – What treatment is required? Where is this delivered? How often is the applicant required to attend hospital?
  • Explanation of the reasons why the follow up treatment cannot be delivered elsewhere in the UK.
  • The impact transferring care elsewhere would have on the applicant.

It must also include where the applicant lives in adapted housing that could not be easily replicated elsewhere, confirmation of this from the GP or local council in written form, dated within 6 months of the application deadline. You will also provide proof of address e.g. driving licence, utility bill dated within 3 months of the application date.

If any of this information is missing, the special circumstances application will be rejected.

Joint application evidence

Where more than one applicant has caring responsibilities for an individual, a joint application can be submitted, with a single set of evidence. You must both be named as main carers in the evidence. 

Applicants undergoing fertility treatment together, and applying in the same recruitment round, can submit a joint application. You must be named in the supporting evidence. 


Special circumstances applications will be reviewed by a national eligibility panel and a decision on whether the application has been successful will be communicated. 

If you are unhappy with the decision of the national eligibility panel, you are permitted to submit an appeal to the national appeals panel. Appeals must be based on new evidence being submitted. The decision of the national appeals panel will be final. 


If approved as having special circumstances, you will be pre-allocated into the region of your choice, subject to the following criteria being met.

  • You are deemed appointable at interview/selection centre. 

  • You ranked highly enough to receive an offer e.g. if there are 10 posts available, applicant will need to rank in the top 10.   

You will also be considered to have ranked highly enough, where there are applicants ranked above yourself who would not be eligible to receive an offer due to limited preference choices and preferred posts being unavailable. 

Where Locum Appointment for Training posts are being appointed through the vacancy, the applicant must rank higher than the lowest ranked National Training Number (NTN) offer in order to be pre-allocated on the basis of approved special circumstances. 

  • The region you wish to be allocated to can fulfil all requirements of the curriculum for the specialty for which you have applied.

If all of these conditions are met, you will be pre-allocated into your preferred region, before the main offers algorithm is run. You are pre-allocated to a region only. You are not guaranteed your preferred programme/post within that region. You will be offered the highest ranked post within that region that you would have been offered, had the normal offers process run. If you would not have been offered a post in the preferred region, you will be pre-allocated one of your ranked programmes within that region. 

If you do not rank highly enough to be offered a post in the first round of offers, you will be placed on a reserve list, pending more posts becoming available or offers being declined. There is no guarantee of matching special circumstances applicants to preferred locations after the first round of offers has been completed. An applicant without special circumstances who has accepted a post in the preferred location of an applicant with special circumstances will not be displaced to allow allocation of the applicant with approved special circumstances. 

When ranking preferences and have approved special circumstances, you must ensure that you only rank programmes/posts that you are willing to accept and undertake. You will be allocated based on these preferences. If it is not possible to pre-allocate an applicant with special circumstances, they will have opportunities throughout the recruitment process to amend their preferences, should they wish to be considered for appointment in another region.   

When selecting post preferences, you must ensure that you meet the eligibility for those posts.   

Carry over of approval 

Those who are approved for special circumstances, but who are not made an offer in their preferred region can carry over their approval to later recruitment rounds within the same recruitment year (i.e. 2023 Round 1, 2023 Round 2 and 2023 Round 3).   

For example, an applicant approved in Round 1 could apply again in Round 3, but would not need to resubmit evidence. Approved applicants cannot carry over approvals between recruitment years, even if the duration since approval is less than 12 months. 

The special circumstances application form will need to be completed, but there is no need to submit further supporting evidence, providing that personal circumstances have not changed since the application was originally approved. 

Less than Full Time Training

If you are applying to enter specialty training but are unable to train full time, you may apply for less than full time training (LTFT), providing you can show that training on a full time basis would not be practical for you for well-founded reasons. Well-founded reasons may include, for example, disability, ill health, caring responsibilities, religious commitments and unique opportunities for personal or professional development.

Less than full time training must meet the same requirements as full-time training, except that there will be fewer hours of work per week.

You will need to secure a full-time post in open competition before you can make an application to work LTFT. You should apply for eligibility through your current HEE local office/devolved nation Deanery ahead of this and indicate your desire to work less than full time on your application form.

If you are, or will be, on a Tier 2 visa, your pro rata salary must meet the minimum salary threshold for Tier 2. Please contact the Lead Recruiter if you are planning to apply for LTFT training and will require a Tier 2 visa.

Page last reviewed: 21 September 2022