Surname (Family name):...... Initials:......

CLINICAL ACADEMIC STAFF ADDITIONAL INFORMATION (FOR STUDENT GPs)

This section is for completion by Clinical Academic Teaching or Research Staff only. The information requested here is required by the Higher Education Statistics Agency (HESA), which collects data from all universities regarding their staff. Staff are only known to HESA by a code number allocated by their first University employer.

We are obliged under the Data Protection Act to maintain HR records as accurately as possible. We can only do this with your co-operation. Please therefore ensure that you notify us of any changes to the information you provide on this form.

Thank you for your co-operation.

Human Resources

Name
Regulatory Body
Reason required by HESA: To identify the appropriate regulatory body for staff currently registered to practice in medical, health and social care professions.
Please tick up to two codes in the table below which identify the regulatory bodies with which you are registered:
General Medical Council (GMC) / □ 01
General Dental Council (GDC) / □02
General Optic Council (GOC) / □03
The Nursing and Midwifery Council (NMC) / □06
Health Professions Council (HPC) / □07
General Osteopathic Council (GOsC) / □12
General Chiropractic Council (GCC) / □13
Royal College of Veterinary Surgeons (RCVS) / □14
General Pharmaceutical Council (GPhC) / □15
Healthcare Professional Specialty
Reason required by HESA: To monitor the number of staff working in higher education institutions (HEIs) with particular clinical specialties.
Please tick up to three codes in the table below which identify your healthcare professional specialty:
Anaesthetics / □01
Obstetrics & Gynaecology / □02
Ophthalmology / □03
Paediatrics & Child health / □04
Pathology / □05
Psychiatry / □06
Radiology / □07
Surgery / □08
Physicians/Medicine / □09
Public health medicine / □10
Occupational medicine / □11
Dentistry / □12
General practice / □13
Infection/Microbiology / □15
Oncology / □16
Medical education / □17
Emergency medicine / □18
Others in medicine or dentistry / □21
Nursing / □31
Midwifery / □32
Health visiting / □33
Physiotherapy / □34
Radiography / □35
Occupational therapy / □36
Podiatry / □37
Speech & language therapy / □38
Art therapy / □39
Paramedic / □40
Orthoptics / □41
Prosthetics & orthotics / □42
Dietetics / □43
Healthcare scientists / □44
Pharmacy / □45
Clinical psychology / □46
Others / □51