West Midlands Public Health Practitioner
Development Scheme2015-17
Cohort 7Application Form
to be returned to Sally Jamesby 14th August 2015
Author:Sally James, Public Health Workforce Specialist
Date:23rd March 2015 / Version:01
Publication/ Distribution:
Workforces across the West Midlands, who promote, protect, advocate for, develop and improve health with local communities and groups. They may be based in public health teams, local government, primary care or any of the health and social care organisations including voluntary and third sectors.
Purpose Summary of Document:
This application form should be submitted by public health practitioners to be considered for recruitment onto theWest Midlands Public Health Practitioner Development Scheme. The Scheme aims to provide support to public health practitioners in developing portfolios of evidence against the UK Public Health Register (UKPHR) Public Health PractitionerStandards, to enable them to register with the UKPHR as practitioners (level 5 of the Public Health Skills & Knowledge Framework PHSKF).
Applicants must have read and accepted the related Public Health Practitioner Development Scheme Framework andGuidance Document before submitting an application.

Selection Criteria
Applicants must be committed to full participation in all elements of the Scheme to develop their portfolio within the timescale specified. This means commitment to attend the Applicant Induction Day on 21st September, full attendance at all three / up to four learning sets between December 2015 and October 2016, and an absolute commitment to undertake the associated commentary writing in between times.
Applicants must be able to demonstrate:
  • Employment within the West Midlands geographical area
  • Approximately two years’ public health experience, usually having occupied a public health practitioner post at NHS Agenda for Change band 5 and above or equivalent in other sectors; operating at Level 5 or above on the Public Health Skills & Knowledge Framework (formerly PHSCF)
  • Self-assessment against the Public Health Practitioner Standards.Applicants must be able to demonstrate (through completing the self-assessment form)a broad range of relevant experience with only a few gaps,each of which should be relatively easy to address within the timescale for portfolio submission
  • A signed commitment to completing a portfolio against the Public Health Practitioner Standards for Registration in the timescale specified. This must be a genuine commitment to completing a portfolio by the end of March 2017 at the latest
  • A signed commitment from their line manager for active support and encouragement through practitioner attendance at learning sets, writing time for portfolio development and relevant CPD events to address “gaps”, to a maximum of 8 days in the period specified. Applicants are encouraged to include participation in the Scheme in their Personal Development Plan. Line managers will be kept updated of an applicant’s progress in their journey towards registration.
The signed application form commits the practitioner to submitting a completed portfolio by 31st March 2017.
Application Form
  • Section A: applicant details
  • Section B: supporting information
  • Section C: for completion by Line Manager
  • Section D: for completion by Director of Public Health
All sections must be completed and posted or scanned/emailed,together with a completed self-assessment form by 14th August 2015as follows:

FAO Lavina Pitters
Lead Administrator
Health Education West Midlands
St Chads Court
213 Hagley Road
Birmingham B16 9RG
Tel. 0121 695 2253
Any other queries, please contact sally or see website below:
Sally James
Public Health Workforce Specialist

Tel. 0121 695 2481

You will be notified of the decision regarding your application by 3rd September 2015.

West MidlandsPublic Health Practitioner Development Scheme 2015-17

Cohort 7Application Form

Please complete all sections below & attach a completed self-assessment:

Section A: Applicant details

Name:
Job Title:
UK Public Health Skills and Knowledge Framework level or Agenda for Change / KSF Banding of current post(or equivalent):
Length of time in current position:
Employing Organisation:
Employer’s Address:
Postcode:
Telephone number:
Email:
Mobile phone number:

Your personal information will be held and used in accordance with the Data Protection Act 1998. Health EducationWest Midlands will not disclose such information to any unauthorised person or body but where appropriate will use such information in carrying out its various functions and services.

(continued…)
Section B: Supporting information

Please detail in no more than 200 words why you are applying to the Public Health Practitioner DevelopmentSchemeCohort 7and any progress you have made to date on developing your portfolio:
Using the baseline self-assessment form, please summarise belowany competence gaps you have already identified your plans to address them:
CompetencyRef
(e.g. Standard 4) / Proposedactivity to address gap (i.e. training, shadowing etc.) / Target completion date

Terms and Conditions:

In submitting an application to the Scheme applicants will have read and fully understood the Public Health Practitioner Development Scheme Framework & Guidance Document.

Applicants must be committed to full participation in all elements of the Scheme to develop their portfolio within the timescale specified. This means commitment to attend the Practitioner Induction Day on 21st September 2015, full attendance at all three / up to four learning sets between December 2015 and October 2016, and an absolute commitment to undertake the associated commentary writing in between times.The signed application formcommits the practitioner to submitting a completed portfolio by 31st March 2017.

Declaration:

I confirm that the information I have given is accurate, and should I be accepted onto the Scheme I agree to abide by its principles and to participate fully, including in the evaluation process.

Applicant Signature
Date

Please ensure that your Line Manager and Director of Public Health complete the following sections before submitting your application

Please also attach a completed self assessment form to this application

(continued…)

Section C: for completion by Line Manager

Please provide belowa signed written statement of support for the applicant (not more than 200 words), detailing the ways in which you feel they are suitable and ready for the Scheme. By completing the statement, it is assumed that you fully support the applicant’s participation in the Public Health Practitioner Development Scheme(should they be accepted) and confirm that they will be afforded the required time off, study leave etc. (up to a maximum of 8 days) to ensure maximum participation in the Scheme and its constituent parts.

Line managers will be kept updated of applicant’s progress in their journey towards registration. Applicants are encouraged to include participation in the Scheme in their Personal Development Plan and appraisal.

Please acknowledge the competence gaps identified and provide any additional and relevant information.

Line manager details:

Signature / Position
Print name / Date
Email / Phone
number

Section D: for completion by Director of Public Health

Please signbelowto confirm your support for the applicant’s participation in the Public Health Practitioner Development Scheme(should they be accepted). Please also include any additional comments you may wish to make.

Signature / Position / Director of Public Health
Print name / Date
Email / Phone
number
Any additional comments from DPH:

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