NHS TAYSIDE by pengxiang


									Workforce Directorate
NHS Tayside
Ninewells Hospital
Level 9
Telephone Number (01382) 660111
Fax Numbers (01382) 632098 & 496237

                                                    Date           As Postmark
                                                    Your Ref
                                                    Our Ref        FS/03/12

                                                    Enquiries to   Miss Fiona Small
                                                    Extension      34186
                                                    Direct Line    01382 660111 ext 34186
                                                    Email          fiona.small@nhs.net
Dear Doctor


Further to your enquiry regarding the above post, I am now pleased to enclose an information and
application pack.

Your application should be submitted to this department in the form of the following documents:

         your completed Immigration Status Form and a *photocopy of your
          passport/current immigration status documents – NB British and EEA Nationals
          must also enclose a photocopy of their passport to verify nationality
         8 copies of your CV, including the names and addresses of 3 referees, including your
          current or most recent employer. It would also be helpful if you could include details of
          your registration on the Specialist Registrar of the General Medical Council or your
          expected date of completion of training.
         your completed Declaration Statement in respect of Fitness to Practice and Criminal
         Please quote FS/03/12 when submitting your application.

*Please be aware that failure to enclose documentation confirming your current
immigration status will result in your application being rejected.
As an Equal Opportunities Employer, it is NHS Tayside’s policy to ensure that all applicants are
given the same consideration in relation to job selection, promotion and treatment. In this
connection, I enclose an Equal Opportunities Form which you should return to this office with your
application. This information is for statistical purposes only and will be kept in strict confidence.

The closing date for receipt of completed applications is Monday 9 April 2012. Interviews are
scheduled for Monday 30 April 2012. Owing to the number of applications received and to make
the best use of resources, we are unable to acknowledge receipt of applications.

Yours faithfully

Fiona Small
Workforce Services Adviser

                                    MEDICINE DIRECTORATE


Applications are invited for this whole time post as Consultant for the Tayside CAMHS Outpatient
services. Applicants with experience in risk assessment in children and adolescence would be well
placed to meet the current service requirements.

Tayside CAMHS provides a comprehensive mental health assessment and treatment service for
children and young people from birth up to the time they leave school. The service operates with a
multidisciplinary, multi-agency ethos and has strong links with the local authorities and the
voluntary sector.

The CAMHS service is a dynamic, forward-looking service with strong links to the University of
Dundee, with an active interest in teaching and research. The clinical service has undergone
considerable redesign in the past few years and now have a comprehensive range of integrated
services with an experienced and highly motivated workforce. Multi-disciplinary teams have a
strong commitment to evidence based practice and to teaching and training.

Comprehensive outpatient services are complemented by a team of Primary Mental Health
Workers, a Day Service for 5-14 year olds and a small Adolescent Inpatient Unit. Outpatient
services are currently delivered from two outpatient bases, one in Dundee and one in Perth.
Strong links are maintained with local authorities, the voluntary sector and Adult Mental Health

Applicants must be on the Specialist Register or be within 6 months of the anticipated award of
CCT in psychiatry or CESR(CP) at the time of interview for the post.

This post is open primarily to applicants who do not require to be sponsored under the the UKBA
Points Based System. Applications from applicants who do require sponsorship will be considered
only if no suitable UK/EEA national or anyone not requiring sponsorship is identified for the post.

For further information or enquiries please contact Dr Judith Piggot, Clinical Lead, Consultant Child
and Adolescent Psychiatrist tel. 01382 204004. Applicants can also contact Dr Peter Fowlie,
Clinical Director, Ninewells Hospital, tel 01382 660111.

To download further particulars about the post, please visit www.bmjcareers.com or
www.jobs.scot.nhs.uk. Applications in the form of 8 copies of a current CV, including names and
addresses of 3 referees, should be forwarded to Workforce Directorate, Level 9, Ninewells
Hospital, Dundee, DD1 9SY or to fiona.small@nhs.net. You must include the further particulars
forms available at the above websites. Please quote reference number – FS/03/12

Closing date for receipt of completed application forms – Monday 9th April 2012

Interviews are scheduled to take place on Monday 30th April 2012.
                                                NHS TAYSIDE

                                             JOB DESCRIPTION

                              Consultant Child and Adolescent Psychiatrist


Applications are invited for this whole time post as consultant for the outpatient Tayside CAMHS
Service. Applications for part time working will be considered. This is a replacement post which has
become available following one of the current consultants moving to consultant post in Young
Peoples Unit. Clinical responsibility will be within the CAMHS outpatient service. This post is
available immediately.

Tayside CAMHS is based primarily within a campus clinic base in Dundee with a satellite clinic in
Perth and satellite clinics in Angus. The service is part of the Women and Child Health Clinical
Group within the Acute Delivery Unit of NHS Tayside. Through the Child Health Strategy Group it
has strong links with statutory and voluntary services, across 3 local authority areas, which are
concerned with providing care for children and young people. NHS Tayside serves a population of
approximately 394 000.

Tayside CAMHS provides comprehensive mental health assessment and treatment services for
children and young people from birth up to the time they leave school. The service operates with a
multidisciplinary, multi-agency ethos and has strong links with the local authorities, the voluntary
sector and the University of Dundee. Currently we are in the process of implementing CAPA with
training for staff planned and this is expected to influence the model of service delivery within

Dundee with a population of around 170,000 is the principal city in Tayside and is situated on the
north bank of the River Tay. It is conveniently near the three other large cities in Scotland -
Edinburgh, Glasgow and Aberdeen, none more than an hour and a half away by road or rail, and
London is just six hours away by Intercity rail link and less than two hours by air. Perth, known as
“the Fair City,” is located at the very heart of Scotland. Perth’s status as former capital of Scotland
has given it a wealth of historical associations and a centuries-old tradition of welcoming visitors. It
is the regional centre for the predominantly rural county of Perthshire and Kinross. The population
is increasing, and several international companies have their headquarters in Perth.

Between Dundee and Perth there is a flourishing professional repertory theatre and regular visits
by the Royal Scottish National Orchestra add an extra dimension to what is an active local musical
scene. The river and its estuary, the coasts of Angus and Fife and the nearby hills and mountains
of Angus and Perthshire offer scope for almost any outdoor activity. Golfers are particularly well
served with St. Andrews and Carnoustie within half an hour's drive. Hillwalkers, skiers and
fishermen fair equally well. There is a good range of relatively inexpensive housing in Tayside.

Outpatient Services

Tayside CAMHS operates out of two main clinic bases one in Perth and one in Dundee.

The Centre for Child Health is a modern purpose-built clinic shared with Speech & Language Therapy. It
is part of a campus-based service in the centre of Dundee that is also home to the Day Service and
Young People’s Unit. This excellent facility provides office and therapy space within a park setting and
caters mainly for patients from Dundee and Angus.

Pitcullen House, in the grounds of Murray Royal Hospital in Perth, provides services for patients from
Perth & Kinross. It is an old Victorian building. This clinic will be re-sited in the near future as part of the
hospital development plans at Perth Royal Infirmary.

There are currently no fixed out-patient clinical services based in Angus. However discussions are
ongoing to facilitate the delivery of clinical services in Angus.

Tier 3 outpatient services are organised into two pan-regional teams with staff working to care pathways
and protocols across the whole area.

The outpatient teams are:

1. Developmental Disorders Team

Sees patients with attention deficit/hyperactivity disorder, moderate to severe learning disability, autism
spectrum disorder, Tourette’s, etc.

2. Emotional Disorders Team

Sees patients with mood or anxiety disorders, eating disorders, deliberate self-harm, post traumatic stress
disorder, psychosis etc.

Two emergency response team nurses are attached to the EDT and provide week day cover for self-harm
and other psychiatric emergencies.

Both teams in the outpatient service work across a variety of therapeutic modalities and have staff trained
to a high level in psychopharmacology, Systemic Practice, Cognitive Behavioural Therapy and
Behavioural Therapy.

Day Service

A day service for P1-S2 pupils operates out of Dudhope House and provides an assessment service and
a group-based intervention programme for children aged 5-14 years.

Young People’s Unit

This inpatient unit for adolescents aged 12 and up currently operates 6 beds. Within the framework of the
National Implementation Plan, discussions are underway with the North of Scotland Planning Group
(NoSPG) to commission a new 12 bed regional unit in Tayside. Initial agreement to proceed with this has
now been approved by the Scottish Government.
3.      THE POST

Employing Authority           NHS Tayside

Grade                         Consultant

Specialty                     Child and Adolescent Psychiatry


Outpatient clinical work will be conducted both within the Centre for Child Health and at other clinical sites
within Tayside (e.g. in Perth and Angus). The main base for the post holder will be Dudhope Centre for
Child development, Dundee. Appropriate travel time will be incorporated into the job plan.

5.      CONTRACT

10 PAs
The post holder will share on call with 8 other consultant colleagues.


This is a replacement post. The main duties associated with this post will be to provide assessment and
clinical care for children and adolescents in Tayside with emotional and developmental disorders. The
outpatient teams currently provide services for children and young people from birth up to the time they
leave school.

Duties will include direct clinical work with an appropriate caseload, consultation with other agencies,
supervision of staff (this will include junior medical staff and but may also include nurses, both trained
and training clinical psychologists, occupational therapists and other associated medical specialists),
attending team meetings and taking part in the planning of service delivery.

The precise job plan for the new post holder, depending on training, experience and interests will be
influenced by wider developments e.g. implementation of CAPA across the service and provision of non
inpatient tier 4 services. The department is moving towards a CAPA based service, and it is anticipated
that all the outpatient consultants will move to working predominantly in one of the three locality teams
(Perth, Angus and Dundee).

The post holder will also have an interest in managing more complex cases where there is a combination
of mental illness/developmental disorders and offending. This will involve working with young people in
the Rossie Secure Accommodation in Montrose and taking a lead role in developing risk assessment
within Tayside CAMHs. Rosie Secure Accommodation has places for up to 18 young people, aged 10-16.
There is currently no dedicated CAMHs service for Rossie and they are seen throughout the department
depending on their clinical need. The post holder will work alongside existing CAMHs staff, including the
wider consultant group, to take a lead in ensuring the clinical needs are met. There are national
discussions taking place with Graham Monteith, CAMHs nurse advisor for Scottish government, related to
mental health input to children’s secure units.

Developmental Disorders Team Staff:
3.2 WTE Consultant Child and Adolescent Psychiatrists
4.4 WTE specialist nurses (band 6)
2.8 WTE learning disability nurses
1.7 WTE Clinical Psychologist
Family therapist (part time)
0.5 WTE Specialty Trainee 1-3
0.4 WTE Staff Grade Psychiatrist (based in Perth)1.4 WTE Staff Grade Paediatrician attached from
Community Paediatrics (1.3 WTE in Dundee, 0.1 WTE in Perth
 Emotional Disorders Team Staff

 2.5 Consultant Child and Adolescent Psychiatrists
 2 WTE specialist nurses
 2.8 WTE psychologists
 1 CBT specialist
 Family therapist (part time).
 2 WTE emergency response nurses
 1 WTE Foundation Year 2 doctor

 On Call
 Consultant on call is supported by cover from ST 1-3 doctors from psychiatry providing emergency
 services for Tayside.

 Research and Audit
 The service has links with the University of Dundee, Section of Psychiatry within the Centre for
 Neuroscience and is highly active in research, particularly in the areas of Attention Deficit/Hyperactivity
 Disorder and paediatric psychopharmacology.

 There is an active Clinical Governance Working Group within the service and all members of staff are
 encouraged to undertake and/or supervise audit.

 Continuing Professional Development
 NHS Tayside is committed to supporting Continuing Professional Development and all consultants are
 expected to have a Personal Development Plan developed within a peer group system.

 Up to date Child Protection Training is required.

  7.        JOB PLAN
The job plan will be agreed between the successful candidate and an appropriate medical manager –
Clinical lead for CAMHS, Clinical Director for Women and Child health or the Associate Medical Director for
Medicine. The job plan will be reviewed annually. The following weekly timetable is indicative only. While
initially the post holder will have minimal formal managerial and teaching duties, reflected in the SPA
allocation below, it may be appropriate for the DCC/SPA to be adjusted by agreement at subsequent job
plan review meetings. The job plan will be split 9 DCC: 1SPA.

       DAY                     LOCATION                  WORK DONE

 Monday         am       Centre for Child Health Indirect clinical work – consultation, school liaison, etc
                pm       Centre for Child Health or  Outpatient clinic
                         other clinical site in Tayside
 Tuesday        am       Centre for Child Health Clinical admin
                pm       Centre for Child Health or  Outpatient clinic
                         other clinical site in Tayside
 Wednesday      am       Centre for Child Health or  Outpatient clinic
                         other clinical site in Tayside
                pm       Centre for Child Health SPA – Division/in-house teaching/medical staff meeting/CPD
 Thursday       am       Centre for Child Health / Team meeting and staff supervision
                pm       Centre for Child Health Outpatient clinic
 Friday         am       Centre for Child Health or  Assessment of complex patients (high risk CAMHS cases)
                         other clinical site in Tayside
                pm       Centre for Child Health Clinical admin
Support Services
Appropriate secretarial time and office space is available to support this post and the associated
multidisciplinary clinical team. Secretarial support will come from the relevant teams, and there will also be
an identified secretary to assist the post holder with non-clinical administrative tasks.


 Appropriate office space will be available for the post holder’s use. The office space will be shared, as is
 the case with all current consultant office space. A variety of clinical rooms are available on a bookable
 basis at both the Centre for Child Health and Pitcullen House, including one-way screening facilities and a
 Snoozelen room. IT facilities will also be available.

 Within the Centre for Child Health there is an excellent Seminar Room equipped with PowerPoint, video
 linking, etc, which is bookable for meetings of up to 50 people.

 There is a Reading Room with a good range of reference books, journals and internet access.

 9.      THE SERVICE

 Tayside has a population of approximately 394,000, of which 142,000 live in Dundee, 110 000 live in
 Angus and 142 000 live in Perthshire. The current consultant complement is 6.6 WTE (increasing to 7.6
 when all new staff are in post) clinical posts with an additional 6 sessions of academic time provided by
 the Senior Lecturer.
 The outpatient teams are tier 3/4 services that see children with anxiety disorders, mood disorders, eating
 disorders, psychosis, post-traumatic and adjustment difficulties within the Emotional Disorders Team and
 attention deficit hyperactivity disorder, autistic spectrum disorder, Tourette’s and moderately and severely
 learning disabled children with a psychiatric problems within the Developmental Disorders Team.
 Tayside CAMHS is represented on NHS Tayside’s Child Health Strategy Group with good links to the
 Child Health Commissioner. A needs assessment and recent nationally commissioned audit reports have
 highlighted the difficulties faced by the service with demand outstripping supply and the service is working
 actively to improve this situation, reduce waiting times and expand services for patients. Several new
 posts have been funded to facilitate the first stages of this process. In addition a service development plan
 that has proposed substantial increases in funding for CAMHS is currently being considered by the NHS
 Tayside Board.
 Tayside CAMHS is managed by a local service team within the Women & Child Health Clinical Group,
 which is part of the Medical Directorate within the NHS Tayside Delivery Unit structure.
 The Lead Clinician for Tayside CAMHS represents the service on the Women & Child Health Executive
 Group and, alongside the Clinical Nurse Manager, has day-to-day managerial responsibility for the
 service. Women & Child Health has a full-time Clinical Director and at service and directorate level there
 is support from Finance, Human Resources, Administrative & Clerical Management Services and
 Pharmacy. The current Clinical Director is Dr Peter Fowlie, Consultant Paediatrician.
 Paediatric services in Tayside are provided by the Delivery Unit through the Paediatrics Directorate, part
 of the larger Women & Child Health Clinical Group. There are both community and acute services. Acute
 services are based primarily at Ninewells Hospital in Dundee with a small unit at Perth Royal Infirmary.
 Community Services serve all 3 local authority areas in Tayside and operate from sites in Perth, Angus
 and Dundee.
 The 3 local authorities of Angus, Dundee City and Perth & Kinross operate statutory social work and
 education services and Dundee City, through the Child Health Team, provides social work services for
 CAMHS patients. There are residential social work services for young people in all 3 areas and a small
 close support unit, The Elms, in Dundee.
Medical Staff


Dr D. Coghill               Developmental Disorders Team 0.6 WTE
                            Reader (University of Dundee)– academic sessions 0.6 WTE

Dr S. Duke                  YPU/Day Service 1.2 wte
                            Regional Advisor for Psychiatry

Dr J. Olver                 Emotional Disorders Team 0.7 WTE
                            Acting Training Programme Director

Dr S. Seth                  Developmental Disorders Team 1.0 WTE (0.6 WTE)

Dr J. Piggot                Developmental Disorders Team 1.0 WTE

Dr J. Graham                Emotional Disorders Team 1.2 WTE

Dr E. Skouta                Emotional Disorders Team Team 0.6 WTE

Dr Naomi McCaig             Developmental Disorders Team 0.6 WTE

Specialist Registrars/Specialty Trainees

Dr H Smith                  ST5

Staffing within CAMHS

Primary Mental Health Workers              1 WTE Team Leader
                                           7.5 WTE Band 6 for Tayside

Day Service                                7.6 WTE Nurses
                                           1.6 Clinical Support Workers

Young People’s Unit                        22 WTE Nurses
                                           4 Clinical Support Workers
                                           Speech and Language Therapist
                                           Art Therapist

Nursery Nurses                             1 WTE nursery nurse for waiting patients in Dundee
                                           1 WTE nursery nurse for waiting patients in Perth

Outpatient nursing staff                   7.2 WTE

Clinical Psychology Staff

Dr S. Macdonald                            1 WTE Consultant Clinical Psychologist/Lead Clinician
Dr D. Stuart-William                       0.6 WTE Consultant Clinical Psychologist (YPU)
                                           6.6 WTE Clinical Psychologists
                                           5 Trainee Clinical Psychologists
Occupational Therapy Staff
                                              2 WTE Senior I
                                              1 WTE Senior II – Head of Service

Teaching Staff

Day Service/Young People’s Unit               3 WTE teaching staff funded by Dundee City Council

Administrative & Clerical Staff

Developmental Psychiatry Team (Dundee) 4 WTE Clinical Team Secretaries

Emotional Disorders Team (Dundee)             1 WTE Clinical Team Secretary

Management                                    1 WTE Management Secretary

Day Service                                   1 WTE Clinical Team Secretary

Primary Mental Health Team                    0.6 WTE Team Secretary

Perth                                         1 WTE Clinical Team Secretary

Young People’s Unit                           1 WTE Clinical Team Secretary

1 WTE Receptionist based at the Centre for Child Heath
1 WTE Senior Clerical Officer (Medical Records) based at the Centre for Child Health

Social Work

2 social workers funded by Dundee City Council.

10.     The University of Dundee

The medical school was originally part of the University of St. Andrews, but became the Faculty of
Medicine of the University of Dundee when the latter received its Charter in 1967. The present
annual intake of medical students is 150 and the total number of students at the University is
11,000. The University is also a centre for medical education and research.

The University of Dundee enjoys an international reputation for research excellence in the Biomedical
Sciences. Excellent opportunities exist for the conduct of clinical research, including structural and
functional neuroimaging, within the Clinical Research Centre at Ninewells Hospital in Dundee. The
University has an excellent track record for child and adolescent psychiatry research. The main research
focus is on ADHD, conduct disorders, depression and paediatric psychopharmacology. Current research
projects include neuropsychological studies, clinical trials, genetics and pharmacogenetics, quality of life.

The current academic staffing in the Section of Psychiatry and Behavioural Sciences consists of three
Professors, Keith Matthews (Head of Section and Deputy Head of Division, Honorary Consultant
Psychiatrist), Douglas Steele (Professor of Neuroimaging and Honorary Consultant Psychiatrist) and
David Balfour. Professor Balfour is a non-clinical professor of neuropharmacology. David Coghill is
Reader in Child and Adolescent Psychiatry. There are four Clinical Senior Lecturers (General Adult
Psychiatry - Richard Day, Addiction Psychiatry - Alex Baldacchino and Brian Kidd, Old Age Psychiatry -
Neil Prentice, ), one Teaching Sub-Dean (ACT funded) – Audrey Morrison and one Clinical Lecturers
(Cognitive Behavioural Psychotherapy – John Swan, with one non-clinical Lecturer in Neurobiology -
Caroline Stewart. There are a number of post-doctoral research staff and graduate students.
Research in Psychiatric and Behavioural Neuroscience covers 3 major topics: Addictions, Affective
Disorders, and Development & Neurodegeneration. Major funding support for the activities of the Section
has come from the MRC, the Wellcome Trust, The Alzheimer’s Research Trust, the Scottish Government
Health Department’s Chief Scientist’s Office, the European Union and industrial partners.
The Section makes major contributions to the delivery of the Dundee undergraduate medical and life
sciences curricula (medicine was rated "excellent" in the most recent Teaching Quality Assessment).
NHS consultant medical colleagues are offered honorary academic appointments as Senior Clinical
Tutors in Psychiatry. Honorary status as a Clinical Senior Lecturer may be conferred at the discretion of
the Dean. Further details of Departmental activities and contact details can be found at


The appointment will be for 10 programmed activities per week. The salary of the appointment is subject
to the Terms and Conditions of Service for the Consultant Grade in Scotland. Salary range £74,504 to
£100,446 per annum (from 1 April 2009).

Candidates must hold GMC registration with a licence to practice. Applicants must be on the
Specialist Register or be within 6 months of the anticipated award of CCT or CESR(CP) at the time
of interview for the post.

The appointment will be subject to the Terms and Conditions of Service of the Consultant Grade
(Scotland) and the General Whitley Council Conditions of Service as amended from time to time
(and any reference in those Terms and Conditions to an employing authority shall be construed as
if it were to include a reference to NHS Tayside).

Membership of the NHS Superannuation Scheme is not compulsory, but all medical and dental staff are
entitled to choose if they wish to join the scheme. Until such time as a positive option not to join the
scheme is expressed, a member of staff will be regarded as a member of the scheme from the first day of
service. This will not affect any individual right to make alternative arrangements. Initially the employment
covered in this contract will be contracted out of the State Pension Scheme.

The successful candidate will be expected to reside within an approved distance of Centre for Child
Health, Dundee.


All records created in the course of the business of NHS Tayside are corporate records and are
public records under the terms of the Public Records (Scotland) Act 1937. This includes email
messages and other electronic records. It is your responsibility to ensure that you keep
appropriate records of your work in NHS Tayside and manage those records in keeping with the
NHS Tayside Records Management Policy and with any guidance produced by NHS Tayside
specific to your employment.


For further information or enquiries please contact Dr. Judith Piggot, CAMHS Clinical Lead, Consultant
Child and Adolescent Psychiatrist, on telephone number 01382 204004. Applicants can also contact Dr
Peter Fowlie, Clinical Director, and/ or Dawn Sturrock, Clinical Services Manager, Women and Child
Health Clinical Group, Ninewells Hospital, telephone number 01382 660111.


Applications in the form of 8 copies of a current CV, including names and addresses of 3 referees,
should be forwarded to Workforce Directorate, Level 9, Ninewells Hospital, Dundee, DD1 9SY or to
fiona.small@nhs.net. You must include the further particulars forms available at the above
websites. Please quote reference number – FS/02/12

The Board is committed to the principle of equality of opportunity in employment and accordingly its
advertising and recruitment literature will not imply that there is a preference for any one group of
applicants, e.g. by the use of discriminatory job titles or material depicting or describing certain sexual or
racial groups.

In general the short-listing process will be conducted so as to give all candidates equal consideration
against defined selection criteria. The following criteria will therefore be applied equally to all candidates
irrespective of age, sex, religion, ethnic origin or disability and avoiding judgements on the basis of
assumptions or stereotypes.


CRITERION                               EXPECTED MINIMUM

1. Length of Service/             E     Minimum of 3 years higher training in Psychiatry
2. Qualifications                 E     MRC Psych or equivalent

Accreditation by relevant         E     Completion of Specialist Registrar Training and inclusion on
committee                               the GMC specialist register or within 6 months of CCT

                                  E     Appropriate Mental Health Act experience.

                                  D     Appropriate experience working with the Adults with
                                        Incapacity Act.
3. Advanced clinical training     E     Broad knowledge of psychiatric disorders in childhood and
and experience                          their management

                                  E     Specialist experience in the assessment and management
                                        of developmental disorders in children and adolescents.

                                  D     Specialist experience managing complex cases and risk

                                  D     Specialist training in one or more psychological treatment
                                        modalities an advantage.
4 General experience              E     Evidence of good multidisciplinary team working

                                  E     Knowledge and experience of working with education, social
                                        work and youth justice systems

                                  E     Child protection training
5 Particular requirements         E     Full GMC Registration
and/or areas of special

6 Research and                    D     Research experience and publications
7 Management Training             E  Basic management experience to provide leadership to
                                     multidisciplinary clinical team
NOTE: Criteria marked with an "E" have been identified as essential for the post concerned.

Declaration Statements and Statements of Policy

Statement of Policy regarding fitness to practise proceedings by a licensing/regulatory body and
relating to criminal investigations in the UK or overseas.
Registration with the General Medical Council or General Dental Council imposes on
doctors and dentists the duty to provide a good standard of medical care for, and to
behave appropriately, towards patients. NHS Employers also have a duty to ensure that
patients receive a good standard of medical care and ensure as far as possible the safety
of patients. We therefore need to establish if you have been found guilty of a criminal
offence, been bound over or cautioned or are currently the subject of proceedings which
might lead to a conviction, an order binding you over or a caution, in the UK or any other

Applicants for posts in the NHS are exempt from the Rehabilitation of Offenders Act 1974.
Application forms will include a declaration for applicants to complete declaring any previous or
pending prosecutions or convictions, including those considered ‘spent’ under this Act. Forms will
also include a declaration of any cautions or bind overs.

We also need to establish if you have been the subject of any fitness to practise proceedings in the
past, or any fitness to practise proceedings are being contemplated, by a licensing or regulatory
body in the UK or another country and this is also reflected in the declaration.

This information will be treated in confidence and will not debar you from appointment unless the
selection panel considers that it renders you unsuitable for appointment. In reaching such a
decision we will consider the nature of the conviction/action, how long ago it took place and any
others factors that may be relevant.

Failure to disclose a criminal offence, having been bound over or cautioned or that
you are currently the subject of criminal proceedings which might lead to a
conviction, an order binding you over or a caution, or fitness to practise
proceedings undertaken or being undertaken by an appropriate licensing or
regulatory body, may disqualify you from appointment, or result in summary
dismissal/disciplinary action and referral to the General Medical Council [General
Dental Council] for consideration if such a discrepancy came to light.

If you would like to discuss what effect any previous convictions, police investigations or
fitness to practise proceedings taken or being taken either in the UK or by an overseas
licensing or regulatory body might have on your application, you may telephone the
Employment Services Adviser, Medical Staffing, on 01738 473302, in confidence, for

Model Declaration Statement regarding                                                                  Formatted: Font: Not Bold

(a) any criminal offence, being bound over or cautioned, or current proceedings which
    might lead to a conviction, an order binding you over or a caution and
(b) fitness to practice proceedings taken or being currently contemplated by a
    licensing/regulatory body
1. Have you been convicted of a criminal offence, been bound over or cautioned or are
currently the subject of any police investigations, which might lead to a conviction, an order
binding you over or a caution in the UK or any other country?

Note: Applicants for posts in the NHS are exempt from the Rehabilitation of Offenders Act
1974. You are required to declare prosecutions or convictions, including those considered
‘spent’ under this Act.

If yes, please provide details of the criminal offence, order binding you over or caution or
details of any current proceedings which might lead to a conviction, an order binding you
over or a caution, including approximate date, the offence, and the authority and country
which dealt with the offence.

2. To the best of your knowledge have you been or are you currently subject to any fitness
   to practise proceedings by an appropriate licensing or regulatory body in the UK or any
   other country?
If yes, please provide details of the nature of proceedings undertaken, or contemplated,
including approximate date of proceedings, country where proceedings were undertaken
and the name and address of the licensing or regulatory body concerned.

I hereby declare that the information given here is true.


                                       NHS TAYSIDE

Job reference number:                                                FS/03/12
Equal opportunities monitoring

We want to ensure that our job opportunities are open to all. The only way we can ensure
there is equal opportunity is to monitor applications we receive, and compare the profile of
people who apply with those appointed. Therefore this form asks you for your ethnic
origin, gender, disability, religion, sexuality and age. The information you provide is
confidential and is not used in the selection process. It will be separated from the
rest of your application when we receive it.
1) If you are currently an employee of this NHS Board, will getting this job be a
Yes             No    
2) You are:
Female          Male 
3) Have you undergone, are you undergoing or do you intend to undergo gender
reassignment? For example, this includes having changed your sex (gender).?
Yes               No            Prefer not to say 
4) What is your age?
I am ___ years old, and my date of birth is: _ _ / _ _ / _________
5) Do you have a physical or mental health condition or disability that:
      has a substantial effect on your ability to carry out day to day activities?
      has lasted or is expected to last 12 months or more?
Yes               No            Prefer not to say 
      If you answered ‘yes’ please tick if it is either of the following:
Learning Disability                              Physical impairment        
Long standing illness                            Sensory impairment         
Mental health condition       
Other (please describe):

      Again, if yes, please describe any particular arrangements you would need for your
       work location:

(Continued on next page)
                                            - 2-

Job reference number:                          FS/03/12

6) What is your ethnic group?
Choose one section from A to F, then tick the appropriate box to indicate your cultural
A: White          Scottish  Irish           Other British      Polish
                  Gypsy Traveller            Any other White background
B: Mixed          Any mixed background
C: Asian; Asian Scottish; Asian British
                  Pakistani      Indian                Chinese
                  Bangladeshi  Any other Asian background

D: Black; Black Scottish; Black British
                  Caribbean       African
                  Any other Black background

E: Other ethnic background
                  Any other background

F: Prefer not to answer 
7) To which religion, religious denomination or body do you actively belong?

                  (Christianity)- Church of Scotland       Hinduism
                  (Christianity) - Roman Catholic          Sikhism
                    Christianity (Other)                   Judaism
                    Other faith / belief                   Islam
                    Buddhism                               No religion (none)
                    Prefer not to answer
8) Which of the following best describes your sexual orientation?
                  Bisexual                                 Gay Man
                  Heterosexual                             Lesbian/Gay Woman
                  Other                                    Prefer not to answer

Thank you.

                                             IMPORTANT NOTICE

                                            IMMIGRATION STATUS

 Please be aware that all job applicants, including British and EEA nationals must enclose photocopies of
 their passport (outside front cover, page containing personal details and resident permit/visa stamps). If you
 have been issued with a Biometric Residence Permit, a photocopy (front and back of card) must also be
 Shortlisted applicants will be required to bring their original documents with them, for inspection, when
 attending for interview.

     1      Are you a national from Austria, Belgium, Cyprus,             YES              NO
            Denmark, Finland, France, Germany, Greece,
            Iceland, Ireland, Italy, Liechtenstein, Luxembourg,
            Malta, Netherlands, Norway, Portugal, Spain,
            Sweden, United Kingdom or Switzerland?

     2      Are you a national from the Accession States (A8              YES              NO
            Countries) – Czech Republic, Estonia, Hungary,
            Latvia, Lithuania, Poland, Slovakia or Slovenia?

     3      Are you a national from the Accession States (A2              YES              NO
            Countries) – Bulgaria and Romania?

 If you have circled ‘NO’ to the above sections please tick the box which relates to your current immigration

 status, and provide expiry dates:

 Tick                                                                             Expiry


            I hold a Tier 1 (General) Visa as a highly skilled worker

            I require a Certificate of Sponsorship

            I hold refugee status

            I have indefinite leave to remain in the United Kingdom

            I have right of abode

 Any other immigration status – please specify:

Print Name: ………………………………….........................


Date: ………………………………………………………….

To top