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F2 Special Circs 2012-13

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					WALES FOUNDATION SCHOOL

GUIDANCE NOTES, PROCESS & APPLICATION FORM FOR
FOUNDATION YEAR 2 APPLICANTS WITH SPECIAL CIRCUMSTANCES 2012-13

This document describes the process by which Foundation Programme Year 2 applicants with
special circumstances are approved and managed within the F2 application and appointment
process.

There are sometimes special circumstances when it is desirable for a foundation doctor to
secure a post in a specific geographical area. Subject to approval of their special circumstances
application, foundation doctors will be provisionally allocated to a particular post before the
matching process begins.

Applicants are still required to submit an F2 application form. This must be done between
Monday 28th November 2011 and Monday 12th December 2011.

Applicants will not be required to rank 8 rotations in accordance with the F2 matching scheme,
but will be required to rank 3 locations (in order of preference) in which they want to work for
their F2 year. These locations must be listed on the Special Circumstances application form
contained within this document and must be appropriate to the special circumstances declared.

To enable pre-allocation of a post, the Special Circumstances application form must be
completed by Monday 7th November 2011.

The Foundation School will assign approved applicants to one of their chosen locations,
according to their needs and availability of suitable rotations but the relevant Foundation
Programme Director will determine the rotation. After the meeting between the applicant and
the local foundation programme director, there may be a need for discussion with the
educational supervisors to ensure that the rotation will be suitable for the applicant’s needs.

The closing date for receipt of Special Circumstances application forms is Monday 7th November
2011. Foundation Doctors whose circumstances change after this date should contact the Wales
Foundation School for advice.

The Wales Foundation School will review the form and determine whether to approve or reject
the application. You will be informed of the outcome by Monday, 25th November 2011. **

You will be required to meet with the Foundation Programme Director of your allocated
location, between Tuesday 13th December 2011 and Friday 6th January 2012.**

** In the event that you are not satisfied with the location you are assigned to or the proposed
rotation, then you will be able to opt out of the special circumstances process and rank 8 F2
rotations in the Foundation School in Round 1 of the matching scheme, in the same way as all of
the other applicants. Your special circumstances will not be taken into consideration when you
are matched to a rotation and there is the potential to be placed anywhere in Wales.
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Version: 2012/13
Special Circumstances

The Wales Foundation School can only consider applications from trainees for allocation on the
grounds of special circumstances if they can demonstrate that they meet at least one of the
following criteria:-

Criterion 1:   The applicant is a parent or legal guardian of a child or children under the age
               of 18 who reside primarily with them and for whom they have significant caring
               responsibilities.

It is expected that the applicant and their child(ren) in this category will remain in their present
residence and application for pre-allocation will be to the foundation school local to that
address.

The current postal address where the applicant and child reside (at the time of their application)
will be in appropriate proximity to the foundation training offered by the school.

If the applicant and the child(ren) do not normally reside together, this should be referred to on
the application form, and information supplied as to why the caring responsibilities remain
equally significant.

Supporting evidence required (mandatory for all applicants):

      Copy of birth certificate(s) of child(ren)
      Statement confirming that the applicant has significant caring responsibilities for the
       child(ren). (Form A1)

Please note: This criterion is based on childcare responsibility current at the time of the
application. Pregnancy is not part of this criterion. An applicant whose sole criterion is that she -
or his partner - is currently pregnant will not be regarded as eligible for special circumstances.

Criterion 2:   The applicant is the primary carer for someone who is
               disabled (as defined by the Equality Act 2010) (expected to be a partner, sibling
               or parent).

If the person they are caring for is not their partner, sibling or parent, applicants will be
expected to explain clearly and put a strong case as to why they are taking on the role of
primary carer for this person.

The current postal address of the applicant must be in appropriate proximity to the foundation
training offered by the school.

Applicants will be required to complete a care plan to demonstrate how they will combine the
responsibilities of foundation doctor and primary carer and that local support resources have
been fully considered.


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Supporting evidence required (mandatory for all applicants):

      Statement from GP/Social Services confirming the applicant’s role as primary carer for
       this person (Form A2)
      Care plan (Form A3)

Please note: Applicants who provide care for a person as part of a group of carers e.g. a family,
are not eligible to apply under this criterion,


Criterion 3:   The applicant has a medical condition (physical or psychological) or disability
               for which local follow up is an absolute requirement, as confirmed by a report
               from an Occupational Health physician or an appropriate medical specialist.

It is expected that the current postal address of the applicant will be in appropriate proximity to
the foundation training offered by the school.

Supporting evidence required (mandatory for all applicants):

      A report by an Occupational Health physician or medical specialist, in which they will be
       required to (Form A4):

          describe the current medical condition (be it physical or psychological) or disability
          describe the nature of the ongoing treatment and frequency of follow up required
          state why the follow up must be delivered locally, rather than by other treatment
           centres in the UK.


Criterion 4:   The applicant is a member of the armed forces.

       Supporting evidence required (mandatory for all applicants):

          Copy of Armed Forces ID card




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Process

1.   If the trainee believes they meet at least one of the special circumstances criteria, they
     should complete the Special Circumstances Application Form contained within this
     document.

2.   Applicants should submit their application form together with the mandatory supporting
     documentation to Sioned Edwards at the address shown below prior to the deadline of 7th
     November 2011:

     Sioned Edwards
     School of Postgraduate Medical & Dental Education
     Cardiff University
     1st Floor
     Neuadd Meirionnydd
     Heath Park
     Cardiff
     CF14 4YS Email: edwardsse@cf.ac.uk Tel: 02920 687416




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Special Circumstances Application Form for F2 Applicants
Please complete this form in BLOCK CAPITALS and black ink and submit to the Wales Foundation
School. Please ensure you have read the above guidance notes before completing your form.

APPLICANT DETAILS:
Surname:                                                                First name:
Current address:
for correspondence


Home Tel:                                                               Mobile Tel
Email:
Gender:
Age group of applicant: (please tick)                      22 - 25                     26 - 30                  over 30

                                                   Special Circumstances Criteria
Please tick all criteria that apply and the supporting documentation supplied with your application. Details of each criterion and
forms can be found in the Guidance Notes & appendices.

     Criterion 1: I am a parent or legal guardian of a child or children under the age of 18 who resides primarily with me and for
       whom I have significant caring responsibilities.

 Supporting documentation required:

           Copy of birth certificate(s) of child(ren)

           Statement Confirming Significant Caring responsibility form (Form A1)

      Criterion 2: I am the primary carer for someone who is disabled (as defined by the Equality Act 2010) (expected to be a
       partner, sibling or parent).

 Supporting documentation required:

      Letter from GP and/or Social Services, confirming primary carer role (Form A2)

      Care Plan form (Form A3)



         Criterion 3: I have a medical condition (physical or psychological) or disability for which local follow up is an absolute
            requirement, as confirmed by a report from my Occupational Health physician or an appropriate medical specialist.

 Supporting documentation required:

      Report from Occupational Health physician or an appropriate medical specialist form (Form A4)




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 PLEASE REMEMBER TO ATTACH SUPPORTING DOCUMENTATION

 Applicant’s explanation of special circumstances: please see guidance notes.
 Please outline the detail of your special circumstances; you should include as much detail as possible. Please continue on a
 separate sheet if necessary but limit additional info to one side of A4 paper and attach any supporting documentation.




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 LOCATIONS: Please list your three preferred locations in order of preference below:

 Abertawe Bro Morgannwg University HB (East)

 Abertawe Bro Morgannwg University HB (West)

 Cardiff and Vale University HB

 Cwm Taf HB (South)

 Cwm Taf HB (North)

 Aneurin Bevan HB

 Hywel Dda HB (Carmarthenshire)

 Hywel Dda NHS HB (Ceredigion)

 Hywel Dda NHS HB (Pembrokeshire)

 Betsi Cadwaladr University HB (East)

 Betsi Cadwaladr University HB (Central)

 Betsi Cadwaladr University HB (West)


 SIGNATURE: Please sign and date this form and submit to the Wales Foundation School.

     I confirm:
      I have indicated which special circumstances criteria I wish to be considered under and have
         explained my particular circumstances
      I have attached all required supporting documentation
      The information contained within my application and the supporting documentation is correct
         and truthful
      I understand that this information will be treated confidentially, but give my permission for all the
         information in this application to be shared with appropriate Foundation School/Health
         Board/Deanery staff.
      I give my permission for information in this application to be used in anonymised form for review
         and evaluation of the process and outcomes of foundation training.
 I hereby formally apply to the Wales Foundation School for pre-allocation to an F2 rotation on the grounds of special
 circumstances.




 Signature                                                                Date:           /            /


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 To be completed by the Foundation School:
 Please list the members of the panel who considered this
 application:




 What date did the panel convene?
 Do you approve and support trainee’s application for pre-allocation   YES           NO
 on grounds of special circumstances?

 Approved Location:

 If NO, please give reasons:




 Signature                                                                   Date:


 Name

 Position


 email


 tel


The completed form needs to be returned to Sioned Edwards at the address shown below by Monday 7th
November 2011:-

Sioned Edwards
School of Postgraduate Medical & Dental Education
Cardiff University
1st Floor
Neuadd Meirionnydd
Heath Park
Cardiff
CF14 4YS
Tel: 02920 687416
Email: Edwardsse@cf.ac.uk




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