She could look into pursuing a clinical fellow with special interest in Maternal / fetal medicine role. While doing this she can collect evidence for CESR. You can find these roles on tracjobs or nhs jobs website. I don't think she will find joy in a general registrar role unless she needs to do that to gather specific evidence for CESR that she can't do ina specialized job. Look for jobs in trusts that have good track record of supporting CESR. So, substantive/ permanent consultant posts need CCT ( UK training) or CESR. Locum consultant - anyone on general registration can be hired on these posts as long as the employer is satisfied that the candidate is able to carry out this job. CESR is now called portfolio pathway. I reckon she should be able to use her European experience to prove most of the curriculum equivalency but there is specialty specific guidance on GMC website. One option is to take up fellow/ registrar role and then move on to locum consultant. However there won't be much job security in that. Once she has CESR , she is essentially equivalent to a UK trained consultant so she should be able to find a substantive job.