Foundation training for general dental practice application form for



Download 267.94 Kb.
Page3/3
Date conversion24.11.2016
Size267.94 Kb.
1   2   3

N/A not applicable

SECTION 2.4 Trainer Responsibilities Applicant



1st

2nd

If appointed, will you (joint applicant to complete second column):



appoint a suitable candidate in accordance with the Deanery appointment process and employ the FDP as a salaried performer under the standard Trainer/FDP contract? (Details are attached.)

 

 



  1. for new trainers, attend the Trainer induction course (two days for new trainers), any trainer study days and participate in the trainer appraisal process

  2. for experienced trainers attend any trainer study days, participate in the trainer appraisal process and undertake those activities and learning as agreed in your Personal Development Plan (These courses seek to indicate methods of preparing the practice for a FDP and help to develop the skills required to become a good Trainer and teacher.)

 

 



be available for the FDP for day-to-day guidance in the practice on a minimum of six sessions a week? (One session being half-a-day.)

 

 



provide help on request to the FDP?

 

 



Complete the FDT personal development portfolio (PDP) and carry out all assessments that this contains. Assist the FDP to complete the PDP. Report all problems completing the PDP to the Course Programme Director

 

 



provide a protected teaching time (tutorial) of at least one hour per week during normal practice working hours?

 

 



for full-time trainer applications to employ the FDP for 28 hours per week during those weeks with a study day and 35 hours at all other times (and pro rata for part-time applications)

 

 



provide for the FDP satisfactory facilities, materials and experienced chairside and clerical assistance?

 

 



ensure that the FDP is reasonably occupied, has clinical freedom and can experience a wide range of NHS dentistry?

 

 



ensure that the FDP attends the study days course? (Absence for reasons other than sickness shall only be allowed in exceptional circumstances. Repeated and unexplained absences may be interpreted as a withdrawal from the scheme by both the Trainer and the FDP.)

 

 






attend meetings when reasonably requested to do so by the Course Programme Director (These are usually held each term in the afternoon/evening at the postgraduate centre concerned.)

 

 



attend fourteen sessions of FT-related postgraduate education during the training year? (this should include at least one session per term on the study days course.)

 

 



Keep the Course Programme Director and your PCT etc., informed of any alteration in the circumstances of your practice, your training involvement, your commitments or your FDP’s, that would affect the Trainer/FDP contract?

 

 




Strictly Confidential - for HEKSS use only Part 2; Page 7
PLEASE READ THE FOLLOWING STATEMENTS BEFORE

SIGNING THIS FORM

(In the case of joint applicants, both must sign this form)
1. I/we have read both parts of the form and have completed the sections to the best of my/our knowledge.
2. I/we agree to a practice inspection, if appropriate, and will make approximately one hour available to the visitors.
3. I/we accept that references will be taken up. I/we give consent for the Deanery to approach:-


  • the GDC, to ask whether a certificate of good standing would be issued, if requested

  • any Deanery where I/we are or have been a trainer, to seek confirmation of suitability to be appointed as a Trainer to HEKSS.

I/we also consent for the Deanery to contact the Area Team on whose performer list I am included and also the Area Team in whose area I work (if this is different). The Deanery will ask the Area Team for information on:-

a) Breaches of the practice contract and any action taken which may affect the suitability of the practice for Foundation Training.

b) Type of contract – full or limited – details, if training limited

c) If contract activity at the practice is stable or increasing/reducing

d) Date of last practice inspection and next practice inspection due. Any outstanding items after the last practice inspection.

e) Any performance issues or serious substantiated complaints affecting the applicant

f) Any performers list issues relating to the applicant(s) including conditional inclusion, suspension, contingent removal or removal

g) Any current investigation or previous investigation by the Area Team or NHS counter fraud operating services, where the outcome was adverse.

4. I/we are registered on the HEKSS Dental Education Booking System (DEBS)

(www.kssdentaltraining.co.uk)

5. I/we shall accept the decision of the selection committee.

6. I/we understand that if I am/we are selected as Trainer/s, I/we will be required to comply with the Deanery policy and procedures for appointing FDPs and to employ the FDP under the standard Trainer/FDP contract.

SIGNED:_________________________________________________ DATE:________________
NAME _________________________________________________ (please print)

SIGNED:_________________________________________________ DATE:_______________

(Joint Applicant)



NAME _________________________________________________ (please print)
Strictly Confidential - for HEKSS use only Part 2; Page 8

For applications where the applicant is not the provider/group contract holder
Details of Provider – names of partners/Corporate Body etc.


I/we agree to HEKSS obtaining the above information from the Area Team responsible for the contract(s) at the practice(s), which this application relates to.


I/we will support the applicant in ensuring that they, and their FDP, comply with the terms and conditions for dental foundation training with HEKSS (General Information for Approval as a Trainer Booklet).
SIGNED:_________________________________________________ DATE:________________
NAME _________________________________________________ (please print)
Authorised Signatory on behalf of ________________________________________________________
When this form has been completed and signed, please scan and email to Iris Handy, Dental Foundation Training Officer (ihandy@kss.hee.nhs.uk) by the notified closing date. Receipt will be acknowledged. Please email the following to us – we cannot accept posted documents. Please ensure your email details the applicant’s name and practice address:-


  1. a copy of your practice information leaflet




  1. your latest Area Team practice inspection document




  1. a copy of your latest NHS End of Year Statement of Activity for your GDS/PDS contract*




  1. a copy of the recent Mid-Year Statement of Activity for your GDS/PDS contract*




  1. for current or recent trainers – a copy of your latest NHS End of Year Statement of Activity for your FDP’s NHS contract and a copy of the recent Mid-Year Statement of Activity for your FDP’s NHS contract*




  1. a copy of your verifiable CPD record - to show for each verifiable CPD event: date, subject, venue, number of hours CPD, reflection – please use the GDC template, as follows:

http://www.gdc-uk.org/Dentalprofessionals/CPD/Documents/GDC%20CPD%20log%202011_FINAL.pdf


  1. Please list all core CPD in the last five years, i.e.:-


Medical Emergencies

Disinfection and Decontamination

Radiography and radiation protection [IR(ME)R]

Legal And Ethical Issues

Complaints Handling

Oral Cancer: improving early detection


  1. For existing trainers – all DFT associated CPD attended in the last two years




  1. All general CPD (not included under Item a) in the last two years.

* Please note that you are responsible for providing year end and mid-year reports and if you are unable to find copies you can obtain duplicates from Dental Services (NOT the Area Teams). 


PLEASE DO NOT SEND CPD CERTIFICATES

Data Protection Act 1998 – Dental Foundation Trainers
You are providing us with personal information. This document lets you know about how we will use the information and seeks your agreement to the processing of your data in the ways described below. You will be contacted separately for your agreement if we need to use your information in a different way. The Data Controller is Health Education England. Any questions should be directed to the Dental Foundation Training Officer, Health Education Kent, Surrey & Sussex, 7 Bermondsey Street, London SE1 2DD.
Information contained in or derived from this application will be held in manual files and entered into a database. The information will be shared with the selection panel, which will be comprised of personnel from a number of organisations representing Postgraduate Dental Education as well as employees of the University of London. The information will be utilised for selection and for the production of monitoring statistics. Additionally the information will be used to carry out checks on your appropriateness for the position. These checks will involve contacting the Department of Health to identify whether you have breached any terms of NHS Service and the General Dental Council to identify whether there are any disciplinary proceedings against you. The time period that the checks cover will be the proceeding 6 years. Information supplied by unsuccessful applicants (including information derived from verification checks and interview notes) will be held for 6 months and then disposed of confidentially.
Information from successful applicants will be kept for the purposes of administrating your role as an agent of HEKSS; for the administration of accounts and records in respect of your expenses; in respect of your educational role with trainees; and for research purposes. The application form will be kept for the duration of your time as a Trainer. The type of information held will include personal details, education and training details, financial details and data classified under the Data Protection Act as sensitive i.e. racial or ethnic origin. The sensitive data will be held for the purpose of monitoring equality of opportunity only. The types of people/organisations that will have access to all or some of this information will be: the General Dental Council and your Area Team.
Data subjects have the right to be told about and to be provided with intelligible copies of any personal data held on computer or in a paper-based filing system upon request.
In addition, if you are approved as a Trainer/Trainers, certain data (namely your name and practice address) will be placed on the HEKSS Dental website. If you object to this please contact the Dental Foundation Training Officer, Health Education Kent, Surrey & Sussex, London SE1 2DD.
_____________________________________________________________________________

I hereby consent to the processing of all data, including sensitive data, outlined above.


Signed: ________________________________ Date: _______________________



MONITORING INFORMATION
This section of the application form will be detached from your application form. The information collected will only be used for monitoring purposes in an anonymised format and will help the organisation analyse the profile and make up of applicants and appointees to jobs in support of their equal opportunities policies.
NHS organisations recognise and actively promote the benefits of a diverse workforce and are committed to treating all employees with dignity and respect regardless of age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex and sexual orientation. We therefore welcome applications from all sections of the community.


* Date of Birth




* Gender

 Male

 Female

 I do not wish to disclose this



Equality Act 2010


* I would describe my ethnic origin as:


Asian or Asian British

Bangladeshi

 Indian

 Pakistani

 Any other Asian background
Black or Black British

 African

 Caribbean

 Any other Black background





Mixed

 White & Asian

 White & Black African

 White & Black Caribbean

 Any other mixed background
White

 British

 Irish

 Any other White background




Other Ethnic Group

 Chinese

Any other ethnic group

 I do not wish to disclose this





Equality Act 2010


* Please select the option which best describes your sexual orientation

 Lesbian

 Gay


 Bisexual

 Heterosexual

 I do not wish to disclose this


* Please indicate your religion or belief

 Atheism

 Buddhism

 Christianity

 Islam


 Jainism

 Sikhism

Judaism


 Hinduism

 Other


 I do not wish to disclose this


Equality Act 2010
The Equality Act 2010 protects disabled people - including those with long term health conditions, learning disabilities and so called "hidden" disabilities such as dyslexia. If you tell us that you have a disability we can make reasonable adjustments to ensure that any selection processes - including the interview - are fair and equitable.


* Do you consider yourself to have a disability?

 Yes

 No


 I do not wish to disclose this information

Please state the type of impairment which applies to you. People may experience more than one type of impairment, in which case you may indicate more than one. If none of the categories apply, please mark ‘other’.

 Physical Impairment  Learning Disability/Difficulty

 Sensory Impairment  Long-standing illness



 Mental Health Problem  Other



K:\DENTAL\DENTAL FOUNDATION TRAINING\KSS\Applications 2014-2015\TRAINING APPLICATION 2014


1   2   3


The database is protected by copyright ©dentisty.org 2016
send message

    Main page