Application for Inclusion in the Northern Ireland Performers List

Schedule 1(3) to the Health and Personal Social Services (Primary Medical Performers Lists) Regulations (Northern Ireland) 2004 requires an applicant to the Primary Medical Performers List to make the undertakings listed below.

- I consent to a request being made by the Board to any employer or former employer, licensing, regulatory or other body in the United Kingdom or elsewhere, for information relating to a current investigation, or an investigation where the outcome was adverse, into me or a body corporate referred to in this paragraph and, for the purposes of this sub-paragraph, “employer” includes any partnership of which I am or was a member.

- I agree that should the Health and Social Care Board consider it necessary to request further information, documentation or references from me in order to make a decision on my application, I will provide such further information, documentation or references within 28 days (or such longer period that the Health and Social Care Board may agree).

- I understand that failure to provide any information requested within the specified time frame may lead to my application being discontinued.

I undertake that:

1. (a) I will participate in appropriate and relevant appraisal procedures.
2. (b) I will co-operate with the NPSA, when requested to do so by the Board.
3. (c) I will provide the Board with an enhanced criminal record certificate issued under section 113B of the Police Act 1997.
4. (d) I will notify the Board if I am included or apply to be included, in any other primary medical services performers list held by a Board or equivalent body.
5. (e) I will notify the Board in writing within 7 days of its occurrence if I –

1. (i) am charged in the United Kingdom with a criminal offence, or am charged elsewhere with an offence which, if committed in Northern Ireland, would constitute a criminal offence
2. (ii) am convicted of a criminal offence in the United Kingdom;
3. (iii) am convicted elsewhere of an offence which would constitute a criminal offence if committed in Northern Ireland;
4. (iv) have, in summary proceedings in Scotland in respect of an offence, been the subject of an order discharging me absolutely (without proceeding to conviction);
5. (v) have accepted and agreed to pay a penalty under Section 109A of the Social Security Administration (Northern Ireland) Act 1992, a penalty under Section 115A of the Social Security Administration Act (Northern Ireland) 1992 or a procurator fiscal fine under section 302 of the Criminal Procedure (Scotland) Act 1995;
6. (vi) have accepted a police caution in the United Kingdom;
7. (vii) am bound over following a criminal conviction in the United Kingdom;
8. (viii) become the subject of any investigation into my professional conduct by any licensing, regulatory or other body;
9. (ix) am informed by any licensing, regulatory or other body of the outcome of any investigation into my professional conduct, and there is a finding against me;
10. (x) become the subject of any investigation or proceedings by another Board or equivalent body, which might result in me being disqualified, conditionally disqualified, removed or suspended from a list, or equivalent list;
11. (xi) am disqualified, conditionally disqualified, removed or suspended from or refused admission to any list or equivalent list;
12. (xii) am, was in the preceding 6 months, or was at the time of the events that gave rise to the charge, conviction or investigation, a director or one of the persons with control of a body corporate and that body corporate–

1. (a) is charged in the United Kingdom with a criminal offence, or is charged elsewhere with an offence which, if committed in Northern Ireland, would constitute a criminal offence;
2. (b) is convicted of a criminal offence in the United Kingdom;
3. (c) is convicted elsewhere of an offence which, if committed in Northern Ireland, would constitute a criminal offence;
4. (d) becomes the subject of any investigation into its provision of professional services by any licensing, regulatory or other body; or
5. (e) is informed by any licensing, regulatory or other body of the outcome of any investigation into its provision of professional services, and there is a finding against it, together with details of the occurrence, including approximate dates, and where any investigation or proceedings were or are to be brought, the nature of that investigation or proceedings, and any outcome;
6. (f) If I am a provider of primary medical services under a general medical services contract, I will comply with the requirements of paragraph 116 (gifts) of Schedule 5 (other contractual terms) to the General Medical Services Contracts Regulations;
7. (g) If I am not a provider of primary medical services but perform primary medical services in accordance with a general medical services contract, I will comply with the requirements of paragraph 116 (gifts) of Schedule 5 to the General Medical Services Contracts regulations as though I were a provider of primary medical services.

Declaration to be made by ST2 Trainee GP’s only where the performer is an ST2 Trainee, unless the performer has an acquired right under regulation 5(1)(d) of the Vocational Training for General Medical Practice (European Requirements) Regulations 1994

I will:-

1. (i) not perform primary medical services except when acting for, and under the supervision of, my GP Trainer;
2. (ii) withdraw from the primary medical services performers list if any of the events in paragraph 4 takes place;
3. (iii) until the coming into force of Article 10 of the 2003 Order apply for a certificate of prescribed experience under regulation 10 of the Vocational Training Regulations or a certificate of equivalent experience under regulation 12 of those Regulations as soon as the I am eligible to do so, and provide the Board with a copy of any such certificate; and
4. (iv) after the coming into force of Article 10 of the 2003 Order, provide the Health Board with evidence of my inclusion in the GP Register;

The events to which the above applies are–

1. (a) the conclusion of any period of training prescribed by regulation 6(3) of the Vocational Training Regulations or after the coming into operation of Articles 4 and 5 of the 2003 Order, any period of general practice training required pursuant to those Articles, unless–

1. (i) it forms part of a vocational training scheme which has not yet been concluded, or
2. (ii) the ST3 Trainee provides the Board with–

1. (a) a certificate of prescribed experience under regulation 10 of the Vocational Training Regulations,
2. (b) a certificate of equivalent experience under regulation 12 of those Regulations, or
3. (c) after the coming into operation of Article 10 of the 2003 Order, evidence of the applicant’s inclusion in the GP Register;

the failure satisfactorily to complete any period of training within the meaning of regulation 9 of the Vocational Training Regulations or after the coming into operation of Articles 4 and 5 of the 2003 Order, of general practice training within the meaning of those Articles; and

the completion of a vocational training scheme, unless the ST3 Trainee provides the Board with–

1. (i) a certificate of prescribed experience under regulation 10 of the Vocational Training Regulations,
2. (ii) a certificate of equivalent experience under regulation 12 of those Regulations, or
3. (iii) after the coming into operation of Article 10 of the 2003 Order, evidence of the GP Registrar’s inclusion in the GP Register.