POLICY FOR ADMISSION TO NHS SUFFOLK’S MEDICAL, DENTAL & OPTOMETRIC PERFORMERS LISTS

Policy Reference: / Version: 3 / Status: For approval
Type: Operational
Policy applies to: Applications for inclusion to the primary care performers lists
Policy applies to: Primary Care Performers: Doctors, Dentists &Optometrists
Required compliance: This policy must be complied with fully at all times by the appropriate staff. Where it is found that the policy cannot be complied with fully, this must be notified immediately to the owner through the waiver process.
Policy owner: /

Director of Corporate Services

Policy author: /

Head of Primary Care

Other contact: /

Medical Director, Performer List Support Officer

Date this version adopted
Last review date / December 2011
Next review date / April 2013
Location of hardcopy master / Primary Care Directorate, Rushbrook House
Location of electronic master

AGREED POLICY REVIEW / RATIFICATION / ADOPTION PATH:

Level 1: EMT
Date Agreed: 28 November 2011 / Level 2: LRCs
Date Agreed:
Level 3: NHS Suffolk Board
Date Agreed: / Level 4:
Date agreed: 25 January 2012

Index: Page:

1. / Introduction / 3
2. / Purpose of this policy / 3
3. / Policy agreement path / 4
4. / Development of this policy / 4
5. / Cross-reference to other related policies / 4
6. / Agreed definitions / 4
7. / Fitness to practice / 5
8. / Inclusion / 5
9. / Right of appeal / 7
10. / The application process / 7
11. / Applications from non-EEA nationals / 9
12. / Applications from GP registrars and dental vocational trainees / 10
13. / Significant breaks in career history / 11
14. / Period of time to process an application / 11
15. / Summary of roles and responsibilities / 11
16. / Additional resources required / 11
17. / Additional training required / 11
18. / Review period for this policy / 12
19. / Communication of this policy / 12
20. / Procedures and guidelines referenced in this policy / 12
21. / Compliance monitoring / 12
22. / Process for waivers / 12
23. / Policy circulation list / 13
Appendix A: Access to NHSS dental performers list by assessment guidance / 14-16
Appendix B: Language requirements / 17-19
Appendix C: Performers list applications - flowchart / 20
STATEMENT OF OVERARCHING PRINCIPLES

All Policies, Procedures, Guidelines and Protocols of the PCT are formulated to comply with the overarching requirements of legislation, policies or other standards relating to equality and diversity.

1.0 INTRODUCTION

1.1On 1 April 2004 the National Health Service (Performers Lists) Regulations 2004 were introduced and since that date any doctor wishing to work in primary care in England has to be included in an English PCT’s medical performers list. The Regulations were amended on 1 April 2006 to introduce a dental performers list and on 1 August 2008 to introduce an ophthalmic performers list. This means that all doctors, dentists, optometrists and ophthalmic medical practitioners who provide treatment to NHS patients in a primary care setting must be included on a PCT’s performers list.

1.2The effect of the NHS (Performers Lists) Regulations 2004 is to allow PCTs to regulate the performance of primary medical, dental and ophthalmic services in their areas. Formally, this means that PCTs have the power to prevent performers from performing primary care services, or to place restrictions (conditions) on individual performers with which they are obliged to comply.

1.3This applies whether a performer provides services as a contractor/performer, or is a performer who has been engaged or employed by a contractor to perform services (whether directly or via some other body or agency), or a performer who is employed to perform the services by a PCT.

1.4Each performer can only be on one English PCT list. However that listing allows him to provide services as a performer in any PCT area in England.

2.0 PURPOSE OF THIS POLICY

2.1 NHS Suffolk has a responsibility to clearly lay out the processes and procedures to be followed where a performer applies to be included in its performers lists. This policy applies to all general medical practitioners, general dental practitioners, optometrists and ophthalmic medical practitioners who apply to become primary care performers: all must be included on a performers list in order to treat NHS patients in a primary care setting. The aim of these procedures is to ensure that only those performers with the relevant qualifications and who fulfil the necessary criteria should be included in the lists to ensure that patient safety is protected. In preparing this policy NHS Suffolk has been mindful of the need for robustness, transparency, consistency and fairness.

2.2NHS Suffolk will not discriminate on the grounds of gender, faith, race, disability, age or sexual orientation in the operation of any of the procedures dealt with in this document. Every application will be dealt with according to individual circumstances and care will be taken to avoid any risk of imposing preferences or prejudices, or targeting individual applicants because they appear to the organisation, or to their staff, to fit a stereotype.

3.0 POLICY AGREEMENT PATH

3.1See front cover of this document.

4.0 DEVELOPMENT OF THIS POLICY

4.1This policy is based on the policy originally agreed in 2002 by the Primary Care Groups in Suffolk and the Norfolk, Suffolk and Cambridgeshire Strategic Health Authority for control of entry to general medical practitioner professional lists. In addition, the policy follows the guidance ‘Developing Quality in Primary Care – Advice for Primary Care Trusts on list management’ – issued in August 2004 and the NHS (Performers Lists) Directions 2010 and the DH Guidance on Delivering Quality in Primary Care- Language Knowledge 2010.

4.2This policy has been developed in consultation with the relevant Local Representative Committees as well as managers/officers from NHS Suffolk and Anglia Support Partnership (ASP).

5.0 CROSS REFERENCE TO OTHER RELATED POLICES

  • ‘Protecting Patients – Supporting Practitioners’ - revised 2011
  • Management of Primary Care Performers Lists – revised 2011
  • Common European Framework of Reference for Languages (2001)

6.0 AGREED DEFINITIONS

6.1DEFINITIONS

6.1.1'The Act' shall mean the National Health Service Act, 2006.

6.1.2‘Admission Procedures’ shall mean proceedings arising from an application by a performer for admission to the list under the Act and the Regulations.

6.1.3 ‘Anglia Support Partnerships’ (ASP) is the organisation that processes applications for inclusion in the performers lists on behalf of NHS Suffolk.

6.1.4‘Decision Making Group’ makes recommendations to the Responsible Board Member when there are concerns about an application.

6.1.5 'Lay Person' shall mean a person, who is not and never has been:

(i)A doctor, dentist, ophthalmic medical practitioner, optician or pharmacist:

(ii)A registered dispensing Optometrist;

(iii)A registered nurse, registered midwife or registered health visitor,

6.1.6 ‘The organisation’ shall mean NHS Suffolk (Primary Care Trust).

6.1.7 ‘performer’ means a GP, Dentist, Optometrist or Ophthalmic Medical Practitioner

6.1.8 ‘performers list’ means a list prepared and published pursuant to Regulation 3(1)

6.1.9 ‘Performers List Panel’ with the Responsible Board member as chair considers applications to the performers list where judgement and discretion are required

6.1.10 Any reference to “he/him/his” includes reference to “she/her/hers”.

6.1.11 'The Regulations' shall mean the NHS (Performers Lists) Regulations 2004, as amended.

6.1.12 ‘Responsible Board Member’ is the executive member of the PCT’s Board with formal responsibility for decisions in respect of admission, conditional admission, suspension, removal or contingent removal in respect to the performers lists and sits as Chair on the Performers List Panel

7.0 FITNESS TO PRACTICE

7.1 An application to a performers list must include:

  • Chronological details of the applicants professional experience.
  • Names and addresses of two referees who are willing to provide clinical references relating to two recent posts as a performer which lasted at least three months without a significant break or a full explanation and the names and addresses of alternative referees.
  • Particulars of any outstanding applications
  • Details of relevant qualifications including vocational training*
  • Details of any criminal convictions or cautions
  • Details of any involvement in NHS fraud investigations
  • Details of past investigations by licensing, regulatory or other bodies resulting in an adverse finding and any current investigations
  • Details of language qualifications**
  • An Enhanced Disclosure Certificate from the Criminal Records Bureau.

*Appendix A details the East of England Deanery arrangements for those dental applicants who do not have a Vocational Training Number, or who have not completed an appropriate period of vocational training as defined in the Regulations.

** Appendix B details language requirements accepted by NHS Suffolk

8.0 INCLUSION

8.1 Most applications are processed and approved without difficulty. Some applications cause concern and the regulations give the organisation the authority for the following measures:

8.1.1Discretionary Refusal

The grounds on which NHS Suffolk may refuse to include a performer in its performers list are, in addition to any prescribed in the relevant Part, that:

  • having considered the declaration required by regulation 4(4) and (if applicable) regulation 4(5), and any other information or documents in its possession relating to him it considers he is unsuitable to be included in its performers list;
  • having contacted the referees provided by him under regulation 4(2)(f), it is not satisfied with references;
  • having checked with NHS Counter Fraud and Security Management Service for any facts that it considers relevant relating to past or current fraud investigations involving or related to him, and, having considered these and any other facts in its possession relating to fraud involving or relating to him, the Trust considers these justify such refusal;
  • having checked with the NHSLA for any facts that he considers relevant relating to past or current investigations or proceedings involving or related to the performer, and, having considered these and any other facts in its possession involving or relating to the performer, the Trust considers these justify such refusal; or
  • There are any grounds for considering that admitting him to its performers list would be prejudicial to the efficiency of the services he has been included to provide,.

8.1.2Mandatory Refusal

The grounds on which NHS Suffolk must refuse to include a performer in its performers list are, in addition to any prescribed in the relevant Part, are that:

  • he has not provided satisfactory evidence that he intends to perform the services he has been included to provide in the Suffolk area;
  • it is not satisfied he has the knowledge of English which, in his own interests or those of his patients, it is necessary in performing the services he has been included to provide
  • he has been convicted in the United Kingdom of murder;
  • he has been convicted in the United Kingdom of a criminal offence, committed on or after the day prescribed in relevant Part, and has been sentenced to a term or imprisonment of over six months;
  • he is subjected to a national disqualification;
  • he has not updated his application in accordance with regulation 7(4); or
  • in a case to which regulation 15(4) applies, he does not notify it under regulation 15(5) that he wishes to be included in its performers list subject to the specified condition.

8.2Deferral

8.2.1An application can be deferred where there is an outstanding matter (e.g. criminal proceedings) involving the applicant where, if the outcome was adverse, it would be likely to lead the organisation to remove the applicant from its performers list if it had originally included him on it.

8.3 Conditional Inclusion

8.3.1 The organisation may consider that a performer can be included in a performers list subject to certain conditions. The aim of the conditions must be:

  • To prevent any possible prejudice by the performer’s inclusion to the efficiency of primary care services
  • To prevent any attempt by a performer to secure for himself or another person any financial or other benefit to which they are not entitled

8.3.2 Where a GP/Dentist/ Optometrist/Ophthalmic Medical Practitioner has not undertaken any substantive clinical work in the UK within the two years previous to an application the GP/Dentist/Optometrist/Ophthalmic Medical Practitionermay be included conditionally in the performer’s list.

The conditions may include:

  • The GP, DP, Optometrist or Ophthalmic Medical Practitioner will undertake an induction/ returner scheme organised by the East of England Deanery or in consultation with the PCT’s Clinical Advisor
  • The GP, Optometrist, Ophthalmic Medical Practitioner or Dentist will meet with the Clinical Advisor to discuss training or induction needs and an action plan with timescales for completion will be drawn up and a copy sent to the Head of Primary Care (with an additional copy sent to the Appraisal Manager for GPs).
  • In the case of a GP or Dentist, they will not work within the out of hours services.
  • Other conditions may be imposed depending on the individual circumstances.

8.3.3A review will be undertaken at the end of the induction/returner scheme training. If the performer fails to meet the required clinical standard or conditions imposed, a removal from the list may be initiated.

8.3.4 Withdrawal or Refusal - notification requirements

In the event that an application is refused or the applicant withdraws the application part way through the process, or if any information, references or documentation is not supplied pursuant to a request under Reg 4(7)or not supplied within the period specified in that request NHS Suffolk must consider disclosing those facts to the Secretary of State pursuant to the NHS (Performers Lists) Directions 2010.

9.0 RIGHT OF APPEAL

9.1 There is a right of appeal to the Health, Education & Social Care (HESC) First-Tier Tribunal (Primary Health Lists) against the following decisions:

  • Discretionary refusal to include a performer on a list
  • Conditional inclusion of a performer’s name on a list
  • Review and revision of conditions associated with conditional inclusion

10.0 THE APPLICATION PROCESS

10.1 The procedure is shown in diagrammatic form at Appendix C

10.2 NHS Suffolk has delegated responsibility for managing the process for Inclusion in the various performers lists to Anglia Support Partnership (ASP) and therefore ASP has management accountability to NHS Suffolk for its work. However, legal responsibility and accountability for decisions to include practitioners on the performers lists rests with NHS Suffolk.

10.3 Where ASP staff have concerns about an application they must contact the Head of Primary Care.

10.4All applicants are required to attend in person to present their documentation at one of the Anglia Support Partnership offices in relation to their application for the purpose of confirming their identification. In additionNHS Suffolk reserves the right to require the applicant to meet with theappropriate Professional Advisor. Applicants may be required to attend an application interview as set out in stage 3 of the process below.

10.5 Stage 1

Regulatory checks* will be carried out.

*The checks include:

  • Verifying the identity of applicants
  • Checking that information provided by or in relation to the applicant in relation to their application is complete, accurate and authentic;
  • Satisfying itself that the applicant intends to perform the relevant services in the PCT’s area
  • Satisfying itself that the applicant has the knowledge of English necessary to perform services which those included on a performers list perform in the PCT area.
  • Obtaining Clinical references
  • Current registration with the appropriate registering body and obtaining details of any past orcurrent investigations i.e. GMC, GDC, GOC including information on any past or current investigations
  • Evidence of current defence organisation membership
  • Self employed status for Non national/EEA member
  • Vocational training qualification
  • Confirmation of the necessary language test, which has been undertaken within the past 24 months
  • Family Health Services Appeal Unit / HESC First Tier Tribunal (information on current or past refusals to admit, conditional admission, removals etc)
  • NHS Counter Fraud Service
  • Enhanced Disclosure Certificate from the Criminal Records Bureau (CRB) check
  • Details of previous PCT performers list registration
  • Date of last appraisal and facilitator contact name within the PCT
  • Written evidence /undertaking that there is an intention to provide services in the area to which the application was made

10.6 Stage 2

References will be obtained and checked in respect of the content and the period to which they refer against the other information provided by the applicant. Where any problems or questions arise the Head of Primary Care will determine the extent of additional checks to be undertaken and/or any additional information required.

Otherwise the application will be cleared to:

10.7 Stage 3

Where the appropriate clinical advisers certify that the references are satisfactory and there are no adverse indications arising from the information, documentation, declarations or checks.

Applicants may be invited for interview with the relevant professional advisor at this stage in the process.

.

10.8Stage 4

The whole application is then checked and if found to be correct and complete by a senior ASP manager, it will be approved and a recommendation made to the PCT that the applicant be admitted to the list.

10.9 Stage 5

10.9.1 In all other cases the application will be referred to the Decision Making Group (see policy for the Management of Primary Care lists) which may:

  • request more information
  • admit the applicant to the list
  • recommend that the applicant is admitted to the list subject to conditions
  • defer the application pending the outcome of any current investigation by the police or any regulatory body
  • recommend the refusal of the application having regard to the provisions set out in Reg 6 and in particular the criteria at 6(4), 6(4)(A) and the overall effect of all the mattes being considered.
  • When the PCT has decided whether or not to include the applicant in the list it must notify the applicant within 7 days of the decision providing details of the decision. If the application has been rejected the PCT must set out its reasons and of any right of appeal under Reg 15 and the time period for lodging an appeal and how to exercise that right.

11.0 APPLICATIONS FROM NON EEA NATIONALS

11.1 Applicants from outside the EEA will need to supply evidence of their entitlement to work and remain in this country. Where an applicant intends to be a sole trader, partner, contractor and/or performer (i.e. not an employee) he will also have to demonstrate his ability to work as a self employed person. This is to be demonstrated by:

  • a stamped passport indicating the relevant level of entry clearance
  • a corresponding letter from the Home Office

11.2 If an applicant intends to be employed by a contractor as a performer

  • a work permit

11.3 Doctors who have no previous UK general practice experience will normally be required to undertake an induction programme in respect of the NHS as recommended by the Department of Health. In order to gain entry to an induction programme, doctors must contact the East of England Deanery who are the body responsible for the postgraduate education of GPs in the region. They will be included on the performers list as a registrar in this case. Alternatively, the applicant may be included conditionally on NHS Suffolk’s performers list until a Deanery generated action plan is completed. Details are available at: