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

Policy Reference: Version: 3 Status: For approval

Type: OperationalPolicy 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 2011Next review date April 2013Location of hardcopy master Primary Care Directorate, Rushbrook HouseLocation 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

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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

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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

1.1 On 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.

1.2 The 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.

1.3 This 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.

1.4 Each 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.

2.2 NHS 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.

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3.0 POLICY AGREEMENT PATH

3.1 See front cover of this document.

4.0 DEVELOPMENT OF THIS POLICY

4.1 This 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

6.1 DEFINITIONS

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)

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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:

8.1.1 Discretionary 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;

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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,.

8.1.2 Mandatory 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.

8.2 Deferral

8.2.1 An 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

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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 Practitioner may 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.

8.3.3 A 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 requirementsIn 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.

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

10.4 All 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 addition NHS Suffolk reserves the right to require the applicant to meet with the appropriate 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 or current 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

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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.

.

10.8 Stage 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

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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:http://www.eoedeanery.nhs.uk/medical/page.php?area_id=63

11.4 Within the first six months of clinical practice, the GP must provide a satisfactory clinical reference which applies to work carried out within the UK.

11.5 Dentists, Optometrists or Ophthalmic Medical Practitioners will meet with the Professional Advisor to compile an action plan in order to meet the training or developmental needs of the individual. The applicant will only be included conditionally on NHS Suffolk’s performers list until the action plan is completed.

12.0 APPLICATIONS FROM GP REGISTRARS AND DENTAL VOCATIONAL TRAINEES

12.1 GP Registrars and Dental Vocational Trainees must apply to join a performers list before their vocational training in general practice begins. However, it is not always possible to complete the admission process before the date on which they are due to begin training.

12.2 The Regulations allow GP Registrars/Dental Vocational Trainees registered with the GMC/GDC respectively, to perform primary medical/dental services despite not being included on a performers list, as long as:

they have applied to join the performers list before the date on which the training is due to begin;

and until either NHS Suffolk notifies them of the decision on the application, or until two months after the date on which the training begins,

which ever is the earlier.

12.3 Should the application process not be completed by the end of the two month period, the Registrar/Vocational Trainee ceases to be able to perform in primary medical/dental service until such time as the application process is successfully completed. This situation does not occur very often, but where it is anticipated, ASP will give advance warning to the applicant, the practice and NHS Suffolk and continue to keep all parties updated until the situation is resolved.

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http://www.eoedeanery.nhs.uk/medical/page.php?area_id=63

13.0 SIGNIFICANT BREAKS IN CAREER HISTORY

13.1 See section 8.3.

14.0 PERIOD OF TIME TO PROCESS AN APPLICATION

14.1 Where possible an applicant to the performers list should send the application, all the necessary forms and original certificates to the ASP office at least 8 weeks before the planned date of inclusion. ASP staff will make every effort to complete the process within the eight weeks.

14.2 There are however a number of issues that might potentially delay

approval. These include the requirement to attend an interview with the relevant professional advisor, delays in Enhanced Disclosure Certificate CRB checks and receipt and suitability of references, which are beyond the control of ASP staff. In addition, where NHS Suffolk has concerns about the inclusion of an individual there are other processes which might need pursuing, for example conditional inclusion.

15.0 SUMMARY OF ROLES AND RESPONSIBILITIES

15.1 ASP will provide the administrative and managerial support for the application process. The majority of decisions will be straightforward and made at a senior manager level in that organisation. Where there are concerns about an application ASP must inform the Head of Primary Care.

15.2 Where there are concerns in respect of an application the Head of Primary Care will review the available information and ensure that the application follows the appropriate path.

15.3 The Professional Advisors will review references and accompanying information relating to an application and decide whether or not they are acceptable, and identify any concerns.

15.4 Where there are concerns about an application the Decision Making Group will consider all the information and make a recommendation to the Responsible Board Member.

15.4 A Performers List Panel will be convened as necessary and will determine those applications requiring judgement and discretion.

16.0 ADDITIONAL RESOURCES REQUIRED

16.1 No additional resources are required.

17.0 ADDITIONAL TRAINING REQUIRED

17.1 No additional training is required

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18.0 REVIEW PERIOD FOR THIS POLICY

18.1 The policy should be reviewed every three years and/or when amendments to the relevant regulations or guidance are issued by the Department of Health.

19.0 COMMUNICATION OF THIS POLICY

19.1 The policy once approved will be circulated to the relevant NHS Suffolk departments, Anglia Support Partnership and the Local Medical, Dental and Optometry Committees.

19.2 The policy will be accessible via the Extranet for performers/contractors, applicants to the lists and primary care practice staff.

20.0 PROCEDURES and GUIDELINES REFERENCED IN THIS POLICY

The NHS (Performers Lists) Regulations 2004, as amended ‘Delivering Quality in Primary Care – Advice for Primary Care Trusts on

list management’ – August 2004’ NHS Suffolk’s policy on the Management of Primary Care Lists – revised

2011

21.0 COMPLIANCE MONITORING

21.1 Each application is either checked and authorised by a senior manager or determined by the Performers List Panel.

22.0 PROCESS FOR WAIVERS

22.1 Where someone is aware of circumstances that would cause non-compliance with this policy they must contact the policy owner to inform them of the situation.

22.2 The policy owner will review the situation with the manager responsible for the area to determine if compliance can be achieved immediately or whether there has to be some longer-term action to resolve the situation. In the latter case the policy owner will issue a waiver that will specify the agreed period of non-compliance and will include an agreed action plan, with an implementation date, to achieve compliance.

22.3 The waiver will be filed with the hardcopy policy and will be attached to the electronic copy of the policy. The policy register will be updated to show the existence of a waiver against this policy.

22.4 The policy owner will monitor current waivers and will report instances of failure to meet the agreed action plan to NHS Suffolk’s Decision Making Group for discussion and action.

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23.0 POLICY CIRCULATION LIST

Suffolk Local Medical CommitteeSuffolk Local Dental CommitteeSuffolk Local Optical CommitteeAnglia Support PartnershipNHS Suffolk’s Decision Making GroupNHS Suffolk’s Clinical AdvisorsAll practitioners, via the Suffolk Extranet

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APPENDIX A

ACCESS TO NHS SUFFOLK’S DENTAL PERFORMERS LIST BY ASSESSMENT

Introduction

From 1 April 2006 dentists, who are not already on the Performers List of a PCT, will need to apply to the PCT, wherein they wish to work, to join that PCT’s list.

Those dentists who do not have a Vocational Training Number, or who have not completed an appropriate period of Vocational training as defined in the Regulations, must be assessed by the appropriate Professional Advisor in consultation with the Postgraduate Deanery to decide whether the dentist can be admitted to the list based on having experience and training equivalent to Vocational Training.

An Assessment Panel will be convened by the Deanery Dental Workforce Support Advisor (DWSA) to assess the dentist’s previous experience and training and, where necessary, recommend an appropriate programme of Vocational Training, the satisfactory completion of which, will allow admission to the PCT’s Performers List.

Who may need to be admitted by assessment?

Dentists who have not completed, or who are not undertaking, Vocational Training

Dentists who do not qualify for exemption under Para 31 (5) of the Performer List Regulations

Process:

1) GDS1 Performers List application form forwarded to dentist2) Dentist applies to PCT for entry onto PCT Dental Performers list,

completing the GDS13) PCT staff ask dentist to submit portfolio of evidence.4) PCT staff copy portfolio to adjudication panel members.5) Deanery convenes assessment panel. 6) Panel considers evidence (email and/or telephone conference).7) Panel makes recommendation to PCT. 8) PCT notifies dentist of decision. (see Decision below)

Assessment Panel:

The panel will consist of:

A deanery representative, nominated by the Postgraduate Director An external assessor – (normally an ex-DVTA assessor) The Dental Practice Adviser from NHS Suffolk

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Documentation:

The panel will examine the application, and compare the dentist’s previous training and experience with the published competency framework (see Annexe 1 of GDS1).

If necessary, the panel will define, in consultation with the Postgraduate Director, an appropriate programme of Vocational Training to be undertaken by the applicant.

The Deanery will keep records of all cases and decisions and will produce an annual audit report of activity and outcomes, to assist in refining the process.

Timescale:

The panel should convene within 2 weeks of receiving an application and notify its conclusions within 3 working days of convening.

Decision:

The panel may recommend:

That the dentist’s training and experience is equivalent to the published competency framework and he/she should be admitted to the Performers List

That a defined programme of Vocational Training should be undertaken and completed

Reporting:

The panel will forward a report back to NHS Suffolk, providing details on the decision reached.

Completion of Vocational Training programmeOn satisfactory completion of the defined programme, the Postgraduate Director will provide NHS Suffolk with a certificate of completion of Vocational Training

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APPENDIX A CONTINUEDFLOW CHART OF ASSESSMENT PROCESS

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PerformerApplication

Has Dentist VT number

Assessment panel* reviews applicant portfolio against

equivalence competencies

No

Training needs

programmeprescription

Clinical component

needed?

No

Yes

Occ. HealthECRBD

Performerlist

Equivalence No

Complete portfolio

mentored byDPA/RRA

Yes

VT approved Training

Practice & Trainer

Approve environment and trainer

for VT

CompletePortfolio

mentored by VT Trainer

Yes

* Assessment Panel

Panel membership included= PCT/DVTA/Deanery

APPENDIX B

LANGUAGE REQUIREMENTS For Doctors whose English is not their first language

The NHS (Performers Lists) Regulations 2004, as amended, paragraph 6 (2) (b) states:

“The grounds on which a Primary Care Trust must refuse to include a performer in its performers list are that…….it is not satisfied that he has the knowledge of English which, in his own interests or those of his patients, is necessary in performing the services, which those included in the relevant performers list perform, in its area:”

The following language test attainment levels are the Trust’s preferred evidence of satisfactory knowledge of English. The preferred testing bodies require the examinee to attend for testing in person, thus providing greater assurance of the examinee’s identity and hence the veracity of the evidence provided to the Trust. Applicants will be required to prove that they are able to communicate effectively with patients and colleagues.

Medical Performers List

For doctors from outside the European Economic Area (EEA) member states, their English knowledge is checked by the General Medical Council as part of the registration process.

For doctors from EEA member states it has been agreed that they must have one of the following:-

Evidence of graduation from a UK or Irish Republic medical school (trained in English)

Holds an appropriate vocational training certificate

A stamped International Language Testing System (IELTS) Academic certificate Test Report with a score of at least 7.0 in each of the sections, including Academic Reading & Writing Modules passed within the last two years. Other language testing scores may be considered in line with the tests outlined at Appendix B.

Dental Performers ListFact sheet 17- Language testing for Dentists applying for inclusion in PCT Dental Performers Lists (July 2009)

17

For overseas dentists from outside the EEA, their knowledge of English is checked by the General Dental Council (GDC) before being admitted to the GDC’s Register.

Dentists from EEA member states or an exempt person must meet the language standards set out in Fact sheet 17. NHS Suffolk will accept one of the following;-.

Evidence of graduation from a UK or Irish Republic dental school (trained in English)

Successfully completed a years vocational training in the UK

A stamped IELTS Academic certificate Test Report with a score of at least 7.0 in each of the sections, including the Academic Reading & Writing Modules, passed within the last two years

*A language testing certificate which demonstrates a level of attainment comparable to a minimum of the academic IELTS level 7.0 in each module. See Appendix B.

Ophthalmic Performers List

For optometrists from outside the EEA, their knowledge of English is checked by the General Optical Council.

*A list of comparable exams and levels equivalent to IELTS level 7.0 provided by the Department of Health and which may be considered by NHS Suffolk are detailed at appendix B.

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APPENDIX B

*A list of comparable exams and levels to IELTS level 7.0 provided by the Department of Health and acceptable to Suffolk PCT are detailed below.

NB:Attainment of the required level of English language competency must have been achieved within the previous two years.

English Language Testing Qualifications

Awarding body Title of Qualification Score equivalent

International English Language Testing System (IELTS)www.ielts .org

International English Language Testing System (IELTS)

(Both Academic Tests in Reading & Writing)

7.0 (GPs,

Dentists and Optometrists)

Trinitywww.trinitycollege.co.uk

Certificate in Integrated skills in English (ISE 3)

ISE 3(GPs, Dentists and Optometrists)

University of Bathwww.bath.ac.uk/ubelt

English Language Assessment(UBELT)

UBELTMinimum score of 3.5 in all sections (GPs, Dentists and Optometrists)

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http://www.trinitycollege.co.uk/

CompleteNo - Return to applicant for completion

Checked against statutory refusal criteria. Confirmed by senior manager whether grounds for

refusal

YesNo

Yes

STAGE 1Application form and necessary documents delivered to office in

person by applicant

APPENDIX CPERFORMERS LIST APPLICATIONS – FLOWCHART

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Senior manager recommends refusal -proceed to Stage 5

Concerns raised

Concerns raised

STAGE 2

Declaration check

No concerns

All other checks

No concerns

STAGE 3Clinical Advisor checks references. Interview if necessary

No concerns

Applicant admitted to list

No Yes

STAGE 5

a) Applicant notified of concerns and invited to submit written representations to PCT

b) Refer application for DMG/RBM decision:

More information required

Acceptance Deferment Conditional

acceptance Refusal

c) Applicant notified ofdecision and rights of appeal

Concerns raised

Concerns raised

STAGE 4

Equality Impact Assessment TemplateThis template is to help you to write your Equality Impact Assessment (EIA).Please fill in the boxes and delete the guidance notes (GN) in the shaded boxes when you have finished.

Title of policy: Policy for admission to NHS Suffolk’s medical, dental and optometric performers lists

Description of policy: This policy describes the application process for those clinicians wishing to apply to join the relevant Suffolk performer list. It also describes how applications will be processed and sets out the procedures for managing applications which are not straight forward.

GN: The description should include:

● a summary of the policy’s aims and intended outcomes

NB: we use the word ‘policy’ to refer to what we are assessing. This could include strategies, functions, procedures, practices, decisions and projects.

● an explanation of how the policy fits into NHS Suffolk’s strategic objectives.

Part 1: Assessment of impactHow will the policy meet the needs of different communities and groups?

AgeThe policy only applies to clinicians applying to join the list who are able to demonstrate the necessary qualifications and NHS experience. The policy allows for conditional inclusion for those clinicians that do not have sufficient experience of the NHS.

DisabilityThe policy applies to all clinicians applying to join the list who are able to demonstrate the necessary qualifications and NHS experience.

EthnicityThe policy applies to all clinicians applying to join the list who are able to demonstrate the necessary qualifications and NHS experience.

Gender (including transgender)The policy applies to all clinicians applying to join the list who are able to demonstrate the necessary qualifications and NHS experience.

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Religion or beliefThe policy applies to all clinicians applying to join the list who are able to demonstrate the necessary qualifications and NHS experience.

Sexual orientationThe policy applies to all clinicians applying to join the list who are able to demonstrate the necessary qualifications and NHS experience.

Socio-economic disadvantageThe policy applies to all clinicians applying to join the list who are able to demonstrate the necessary qualifications and NHS experience.

People living in rural areas (rurality)The policy applies to all clinicians applying to join the list who are able to demonstrate the necessary qualifications and NHS experience.

Other: (includes other groups who may find it difficult to access or use services such as family carers, people who are homeless, prisoners, street workers)The policy applies to all clinicians applying to join the list who are able to demonstrate the necessary qualifications and NHS experience.

GN: See pages 2 – 4 of the guidance for further information and examples of the groups / characteristics

Positive impact: Reducing inequalities

How is the policy likely to have a significant positive impact on equality by reducing inequalities that already exist?

Explain how it will meet our duty to:

1. Promote equal opportunities

The policy enables a supportive approach to be taken to clinicians who may not have worked in the NHS before (eg because they have recently moved to England from overseas) to enable them to join the list under supervision.

2. Get rid of discrimination

The policy enables a supportive approach to be taken to clinicians who may not have worked in the NHS before (eg because they have recently moved to England from overseas) to enable them to join the list under supervision.

3. Get rid of harassment

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4. Promote good community relations

5. Promote positive attitudes towards, encourage participation by, and enable more favourable treatment of, disabled people

6. Promote and protect human rights

GN: See pages 4 & 5 of the guidance for further information on our duties under human rights legislation

Negative impact: Potential discrimination

Could the policy have a significant negative impact on equality in relation to each of the following groups or characteristics?

GN: You must assess each of the 7 areas separately and consider how your policy may affect people’s human rights.

You need to ask yourself:

● In what ways might the policy create problems or barriers to any community or group?

● How might any group be excluded because of the policy?

AgeThe policy should not have a negative impact in this area as it considers applicants’ qualifications and NHS experience

DisabilityThe policy should not have a negative impact in this area as it considers applicants’ qualifications and NHS experience

EthnicityThe policy should not have a direct negative impact in this area as it considers applicants’ qualifications and NHS experience

It may however have an indirectly negative impact as those most likely to be interviewed for an application interview will be clinicians who do not have sufficient experience of working in the NHS (this could be because they may have moved to England from overseas) or because English is not the applicant’s first language.

Applicants must be able to communicate efficiently with patients and as such must be able to meet the English language requirements set out in the policy.

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Gender (including transgendered people)The policy should not have a direct negative impact in this area as it considers applicants’ qualifications and NHS experience

Religion or beliefThe policy should not have a direct negative impact in this area as it considers applicants’ qualifications and NHS experience

Sexual orientationThe policy should not have a direct negative impact in this area as it considers applicants’ qualifications and NHS experience

Socio-economic groupsThe policy should not have a direct negative impact in this area as it considers applicants’ qualifications and NHS experience

People living in rural areasThe policy should not have a direct negative impact in this area as it considers applicants’ qualifications and NHS experience

Other: (includes other groups who may find it difficult to access and use services, such as family carers, people who are homeless, prisoners, street workers)The policy should not have a direct negative impact in this area as it considers applicants’ qualifications and NHS experience

Part 2: EvidenceEvidence

What is the evidence for your answers above?List the main sources of evidence on each group – both quantitative and qualitative

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GN: See pages 5 - 6 of the guidance for further information on how to find and analyse the evidence

You need to look at and think about:

● quantitative research

● qualitative research

● national / international evidence

● results of any consultations with, or feedback from, local communities

● information which may be held by the voluntary / Third sector

● remember to list the source of the evidence

● if there is little or no evidence, say what you will do to find some evidence and give examples of the types of evidence you might find

AgeNo evidence identified. Complaints from applicants will be monitored.

DisabilityNo evidence identified. Complaints from applicants will be monitored.

EthnicityEvidence from Medical Director at NHS Worcestershire which already operates a similar policy has confirmed that there has only been one challenge to the PCT which was not upheld by the First Tier Tribunal. This was for a GP where there were both language and performance concerns. Dr Leach’s view was that the Tribunal viewed the interview process positively as it allowed the PCT to take a proportionate approach. The GP concerned has since chosen not to work.

Gender (including transgender)No evidence identified. Complaints from applicants will be monitored.

Religion or beliefNo evidence identified. Complaints from applicants will be monitored.

Sexual orientationNo evidence identified. Complaints from applicants will be monitored.

Socio-economic disadvantageNo evidence identified. Complaints from applicants will be monitored.

RuralityNo evidence identified. Complaints from applicants will be monitored.

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Other: (includes other groups who may find it difficult to access or use services, such as family carers, people who are homeless, prisoners, street workers)No evidence identified. Complaints from applicants will be monitored.

Part 3: Conclusion

Conclusion of Equality Impact Assessment

Please summarise your findings.The policy has the potential to reduce barriers and inequalities that currently exist by enabling applicants not yet able to provide sufficient experience of working with the NHS to be conditionally included on the list under supervision. However, there is not enough evidence to make this assessment with as much confidence as we would like.

The policy does have the potential to have a negative impact on applicants unable to demonstrate sufficient communications skills in the English language. This is wholly justified given that clinicians must be able to communicate efficiently with patients during the consultation and be able to make suitable referrals, treat patients safely and keep accurate records.

The policy has been reviewed by the PCT’s legal advisors, Hempsons.

GN: We suggest that you chose, adapt and explain one of the statements from pages 6/7 of the guidance. If you chose statement F, you will need to consider the need for legal advice.

Part 4: Next stepsAction Plan

GN: If you have chosen statements C, D, E or F from the list on pages 6/7 of the guidance, you will need to prepare an action plan.

There is further information on creating an action plan on page 7 of the guidance and a suggested template for an action plan is attached as Appendix 1.

Part 5: For the record

Name and title of people who carried out the EIA:Sadie Parker, Head of Primary Care

Date EIA completed:5 January 2012

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Signature of Director

Name of Director who signed the EIA (please print):Martin Royal, Director of Corporate Services

Date EIA was signed:6.1.12GN: All EIAs must be signed off at Director level before they are submitted to the relevant decision-making body for approval and published on the NHS Suffolk website (see Appendix 1 of the guidance).

Directors must be sure that:

● the policy has been informed by the outcome of the EIA

● that you have gathered all the relevant evidence and used any feedback from previous involvement / consultation and / or consulted and involved stakeholders from each group as appropriate

● have an action plan (if required) to reduce any (potential) adverse impact.

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