The National Health Service (General Medical Services) Regulations 1992

Regulation 5(5)

PART IIIC INFORMATION TO BE INCLUDED IN REPORT BY FHSA TO MEDICAL PRACTICES COMMITTEE IN RESPECT OF A RESTRICTED LIST APPLICATION

1.  Full name of applicant.

2.  Date from which applicant proposes to provide general medical services.

3.  Copy of the applicant’s application to the FHSA.

4.  Copy of evidence concerning the applicant’s qualifications and experience produced in accordance with the National Health Service (Vocational Training) Regulations 1979(1).

5.  The name of the establishment or organisation, to which patients connected to them, the applicant will be limiting the provision of general medical services, and the numbers of such patients.

6.  The area of the FHSA’s locality in which the establishment or organisation is sited.

7.  A statement that the FHSA has confirmed that the applicant is a registered medical practitioner and that his name as entered on the application is currently included in the Medical Register.

8.  A statement that the applicant is a British or European Community national or, if not, that the FHSA has checked that the applicant is entitled to work as a self-employed practitioner in the United Kingdom.

9.  Whether the application is in respect of a new practice or an extension of the doctor’s current practice.

10.  Whether the application is made by the successor to any other doctor and if so the name of that doctor.

11.  Whether or not the application is supported by the FHSA, including details of its reasons for supporting or not supporting the application and any report from the Local Medical Committee or Community Health Council.

12.  Any other information which the FHSA considers to be relevant to the determination of the application.

(1)

S.I. 1979/1644.