Dear

Thank you for your recent request to join the XXXXXXXXX Dental/Medical/Ophthalmic Performers List.

I have enclosed the necessary application forms and a list of documents required in order that your application can be processed. Please note your application will not be accepted without the necessary documents and a fully completed application form. A delay in providing the necessary documentation will affect your proposed start date.

Please be aware that all applications to join the XXXXXXXXXX Performers List are subject to checks in accordance with the Health and Social Care Act 2001, National Health Services Performer List Regulations 2004 as amended and Criminal Records Bureau procedures, therefore please note that your application can take up to three months to process once we have received all the necessary completed forms and documents.

Once you have completed your application form please contact xxxxxxxxxxxxxxx on xxxxxxxxxx to arrange a mutually convenient date and time for you to present your application and original documentation in person, please note a performers List application can not be submitted with out a prier arranged appointment.

I would inform you that if the information, references or documentation you supply are not sufficient for the PCT to reach a decision on your application, further information, references or documentation will be requested from you which may lead to a delay in the processing of your application.

In accordance with the Performers List Regulations a Dental/Medical/Ophthalmic Practitioner may not perform any Dental/Medical /Ophthalmic Services within the NHS in England, unless his/her name is included in an English PCT Dental/Medical /Ophthalmic Performers List.

The relevant regulations for the Performers List are available on the following website: – Statutory Instrument 2004, No, 585 and Statutory Instrument 2005, No. 3491.

If you have any queries regarding the above, please do not hesitate to contact me.


Application for inclusion onto the Dental/Medical/Ophthalmic Performers List

Checklist of forms/documents required

You are required to arrange an appointment to enable you to submit your application by contacting the XXXXXX PCT on 00000000000

Please note we only accept fully completed applications which must include the original documents outlined below, we are unable to accept photocopies. Incomplete applications will not be accepted.

You must bring the following ORIGINAL documents with your application forms.

Completed Application for inclusion in the dental/medical/ophthalmic performers lists

Current Registration Certificate

All professional indemnity cover certificates (showing number of sessions able to work if less than full time)

A Certificate of Prescribed or Equivalent Experience (evidence of completion of vocational training (if applicable)

OR

A written statement of exemption from the need to have required prescribed experience (if applicable)

Completed Criminal Records Bureau application form and appropriate forms of ID, please see CRB website for acceptable forms of ID –

ADD IN PROCESS FOR LOCAL CRB PROCEDURE i.e. contact HR Dept

Work permit documentation – if appropriate (please include letter from Home Office and stamped passport verification)

Practitioners from EEA member states must enclose the appropriate certificate to support his/her knowledge of English (ILETS certificate or equivalent – only valid for a 2 year period)

Practitioners from EEA member states must provide a translated overseas criminal records certificate

Current detailed CV (please note that professional experience section of the application must also be completed in full)

Pre-employment Occupational Health Declaration Form together with proof of your immunisation details or record of your previous occupational health screening (in the envelope provided – AS APPROPRIATE TO INDIVIDUAL PCTS)

Additional Information for all applicants

Mandatory refusal / admissions to the Performers Lists

From the information provided within this application under the National Health Services (Performers List) Regulation 2004, paragraph 6 (2), PCTs must refuse to include a Dentist /Doctor/ Optometrist in its Dental/Medical/Ophthalmic Performers lists if -

a)He/she has not provided satisfactory evidence that he/she intends to perform the services in its area;

b)He/she is a Contractor and the relevant Scheme is not one that lies within the area of Primary Care Trust you are applying to join;

c)He/she is included in the Medical/Dental/Ophthalmic Performers List of another Primary Care Trust, unless he/she has given notice in writing to that Trust that he/she wishes to withdraw from that list;

d)It is not satisfied he/she has the knowledge of English which, in his/her own interests or those of his/her patients, is necessary in performing the services, in the Primary Care Trust’s area;

e)He/she has not undertaken Vocational Training and has neither completed Vocational Training nor is exempt under paragraph 5 from the requirement to undertake Vocational Training;

f)He/she has been convicted in the United Kingdom of murder;

g)He/she has been convicted in the United Kingdom of a criminal offence, committed on or after the day prescribed in the relevant part and has been sentenced to a term of imprisonment of over six months;

h)He/she has been nationally disqualified

i)He/she had not updated his/her application in accordance with regulation 7(4);

j)In a case to which regulation 15(4) applies, he/she does not notify the Primary Care Trust under regulation 15(5) that he wishes to be included in its performers list subject to the specified conditions;

Guidance to completing your Dental/Medical/Ophthalmic Performers lists application form.

Please note that your application to join the performers list cannot be processed until all the original documents, forms and certificates which have been outlined over page have been received and statutory checks have been undertaken. The average time in order to process an application is approximately xxxxxxx weeks.

ADD IN PROCESS FOR CRB DISCLOSURE LOCAL TO OWN PCTxxxxxxxxxxxxx

Guidance for completing the appropriate form:

Please note: the appropriate sections you are required to complete

Type of application Sections to complete

Dental application / 1, 2, 6, 7, 8, 9, 10, 11, 12, 13 and 14
Medicalapplication / 1, 3, 6, 7, 8, 9, 10, 11, 12, 13 and 14
Ophthalmic application / 1, 4, 6, 7, 8, 9, 10, 11, 12, 13, and 14

If applying as a Vocational Trainee please complete the following sections

GP Registrar / 1, 3, 5, 6, 7, 8, 9, 10, 11, 12, 13 and 14
Dental Foundation Year 1 / 1, 2, 5, 6, 7, 8, 9, 10, 11, 12, 13 and 14

Additional information:

The relevant regulations for the Performers List are available on the following website: – Statutory Instrument 2004, No, 585 and Statutory Instrument 2005, No. 3491.

Immigration Status

To obtain further information on immigration status and permission to work in the UK please contact:

UK Border Agency,

Lunar House

Wellesley Road

Croydon

CR9 2BY

Tel: 0870 606 7766