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The National Health Service (General Medical Services Supplementary Lists) (Scotland) Regulations 2003

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1.  An application shall contain the following information:–

(a)full name, sex, date of birth and private address and telephone number;

(b)medical qualifications and the institution which awarded them;

(c)where appropriate evidence concerning the applicant’s qualifications and experience in accordance with the National Health Service (Vocational Training for General Medical Practice) (Scotland) Regulations 1998(1);

(d)professional registration number in the Medical Register and date of first registration;

(e)details of professional experience (including start and finish dates for each appointment together with explanation of gaps between appointments) divided into–

(i)general practice experience;

(ii)hospital appointments; and

(iii)other (including obstetric) experience,

together with additional supporting particulars including reasons for dismissal from any post;

(f)details of any medical list (or equivalent or similar list in any country outside Scotland) from which the applicant has been removed or suspended or to which admission was refused together with reasons for removal, suspension or refusal;

(g)name and addresses of two referees who are willing to provide clinical references relating to two recent posts as a medical practitioner which lasted at least 3 months without a significant break and which may include a current post, or, where this is not possible a full explanation and an alternative referee or referees;

(h)such other information which the Board may reasonably require in order to determine the application; and

(i)whether in assisting in the provision of contraceptive services, intra uterine devices will be fitted.

(1)

S.I. 1998/5.

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