NHS GP GOLDEN HELLO SCHEME. APPLICATION FOR PAYMENTS UNDER THE "GOLDEN HELLO" SCHEME FOR GMS GPs

Transcription

1 ANNEX C NHS GP GOLDEN HELLO SCHEME APPLICATION FOR PAYMENTS UNDER THE "GOLDEN HELLO" SCHEME FOR GMS GPs This form is required for all new GPs, performing general medical services, who may be eligible for a payment under the NHS Primary Care GP "Golden Hello" Scheme. General The NHS GP Golden Hello Scheme was introduced from 1 April The scheme applies to: New GPs who take up their first eligible post in general practice; GPs who take up their first eligible post since leaving the GP Retainer Scheme; GPs who had not worked in general practice for a period of at least 3 months immediately prior to 24 September 2002 and who have subsequently returned to take up an eligible post. For the purposes of the scheme, an eligible post is defined as: Any post under GMS as a; GMS GP principal, salaried or assistant GP; With a total commitment of at least 20%; and i. the case of employed doctors, with an open ended contract (e.g. no fixed end date) or a contract of more than 2 years. Applicants applying for a first payment should complete PARTs ONE and TWO of this form. Applicants applying for extra payments due to changed circumstances should fill in PARTs ONE and THREE. All applicants should sign the declaration in PART FOUR. The form should be completed and returned to the Local Health Board. Monitoring the Operation of the Scheme Local Health Boards should make payments on the basis of the information contained in the application form and record these in the monitoring form at ANNEX D. To enable the Welsh Assembly Government to monitor the operation of the scheme, completed copies of both forms should be sent to: 1

2 Or, alternatively post to: Rachel Cooper Primary Care Division 1a Welsh Assembly Government Cathays Park Cardiff CF10 3NQ ( ) Further guidance on completing the application form is provided. We strongly recommend that applicants and Local Health Boards read this guidance before completing their relevant sections. 2

3 PLEASE COMPLETE IN BLOCK CAPITALS PART ONE TO BE COMPLETED BY ALL GPS APPLYING FOR PAYMENTS Name of Local Health Board 1. PERSONAL DETAILS OF DOCTOR Surname: Forenames: Date of Birth: If job-sharer please give name of the doctor with whom the position is shared: 2. PROFESSIONAL QUALIFICATIONS How are you qualified to practise as a GP? ( as applicable) JCPTGP certificate Date received: Other please specify: Date received: GMC Registration number: Date of first medical registration: 3. NAME AND ADDRESS OF PRACTICE Name: Address: Postcode: 3

4 PART TWO TO BE COMPLETED BY GPs APPLYING FOR A FIRST PAYMENT UNDER THIS SCHEME 4. CAREER Date on which eligible post was taken up (i.e. when you started work in the post for which you are claiming) Please state percentage commitment % Type of post: ( as applicable) a) As a non-principal (i.e. as an assistant or salaried GP) What type of contract do you have? ( as applicable) Open ended contract Fixed term contract Length of contract b) GP Principal 5. ELIGIBILITY Please indicate the circumstances under which you are eligible for a first Golden Hello Payment: ( as applicable) First eligible post in general practice First eligible post in general practice since leaving the GP retainer scheme First eligible post after not having held an eligible post in general practice for a period of at least 3 months prior to 24 September 2002 Go to Section 5A Go to Section 5B Go to Section 5C SECTION 5A - ONLY TO BE COMPLETED BY GPS TAKING UP A FIRST ELIGIBLE POST IN GENERAL PRACTICE LKJFA;LJAOFJ APODIHFTPOA Have you previously worded in an eligible post within the NHS general practice? ( as applicable) Yes No Have you ever received a payment under this scheme before? ( as applicable) Yes No SECTION 5B - ONLY TO BE COMPLETED BY GPS TAKING UP A FIRST ELIGIBLE POST IN GENERAL PRACTICE AFTER LEAVING THE GP RETAINER SCHEME Since leaving the GP Retainer Scheme have you worked in an eligible post in general practice except in your current post under which you are claiming a golden hello payment? ( as applicable)

5 Yes No Have you ever received a payment under this scheme before? ( as applicable) SECTION 5C - ONLY TO BE COMPLETED BY GPS TAKING UP A FIRST ELIGIBLE POST AFTER RETURNING TO GENERAL PRACTICE Date of last post in general practice Have you worked in an eligible post in the three months immediately prior to 24 September 2002? ( as applicable) Yes No Have you ever received a payment under this scheme before? ( as applicable) Yes No

6 PART THREE TO BE COMPLETED BY GPS APPLYING FOR EXTRA PAYMENTS DUE TO A CHANGE IN CIRCUMSTANCES 6. DETAILS OF FIRST PAYMENT Please state the sum received to date under the golden hello scheme Date sum received: Please attach details of sum received 7. CHANGE IN CIRUMSTANCES How have your circumstances changed? ( as applicable) Increased commitment in current post Please go to PART 7A Taking second post Please go to PART 7B Job Move Please go to PART 7C PART 7A - INCREASED COMMITMENT IN CURRENT POST Previous commitment (percentage) % New commitment (percentage) % Date of change in commitment : Length of time in current post: PART 7B - TAKEN SECOND POST Commitment in first post (percentage) % Commitment in second post (percentage) % Total commitment (percentage) % Length of time in first post Name of Practice and LHB that first post comes under

7 Date of taking up second post PART 7C JOB MOVE Previous commitment (percentage) % New commitment (percentage) % Date of taking up first eligible post Date of taking up new post

8 PART FOUR TO BE COMPLETED BY ALL APPLICANTS 8. DECLARATION OF APPLICANT I am applying for payment of the sum due under this scheme in accordance with paragraph 38 of the Statement of Fees and Allowances. I declare that all the information I have provided is true to the best of my knowledge. I understand that if my circumstances change I may be liable to return all or some of the money received under this scheme. I am not working exclusively as a GP locum. I am not employed on a fixed term contract of two years or less. I do not have a commitment of less than 20% of full-time. For doctors applying for payments under PART TWO: I have never received a payment under this or any related scheme. For doctors applying under PART THREE for extra payments due to a change in circumstances: I have received a payment under this scheme and attach details of payment received. Signature of Applicant : Date: 9. DECLARATION OF PRACTICE (if GP applying for payment is not a GP Principal) I/we wish to apply for direct reimbursement of the sum due under this scheme in accordance with paragraph 38 of the Statement of Fees and allowances. I understand that if the qualifying GP leaves this practice within the next two years the practice will be expected to co-operate with the Local Health Board if the Local Health Board has reason to seek to recover monies from the doctor concerned. Signature: Date Position within practice:

9 Guidance Notes on completing the form NHS GP Golden Hello Scheme. Part 1 This should be completed by all GPs applying for their first payment under the scheme and should be completed in respect of the position for which the GP is claiming a payment. Part 2 Part 2 refers to eligibility and eligible posts. For the purposes of the scheme, an eligible post, is defined as, any post taken, under GMS as a; GMS GP principal, salaried, assistant, associate; with a total commitment of at least 20%; and in the case of employed doctors, with an open ended contract (e.g. no fixed end date) or a contract of more than 2 years New GPs should not have worked in an eligible post previously. Former retainees should not have worked in an eligible post other than the one under which they are claiming a golden hello payment, since leaving the GP Retainer scheme. GPs returning to take up an eligible post should not have worked in NHS general practice in the 3 months immediately prior to 24 September 2002 N.B. a GP is only eligible to receive a Golden Hello payment once in his or her lifetime. Employment Contracts Open-ended contracts are considered to be any kind of open-ended employment agreement without a specific time frame or end-date. It some cases, it may only be a verbal agreement between the GP and practice or Local Health Board. Part 3 This part should only be completed by GPs who have already received a Golden Hello payment, and whose circumstances have since changed, (as per paragraph 22 of the Golden Hello scheme guidance) entitling them to a further additional payment.

10 Part 4 Part 4 contains the declarations to be signed by the applicant and employer. All applicants must complete the declaration in section 8. The declaration includes an understanding that the qualifying GP may be liable to return all or some of the payment received under this scheme if he or she leaves an eligible post within two years. The declaration at section 9 must be completed if the qualifying GP is not a self-employed practitioner. It should be signed by an appropriate representative of the GP practice e.g. a GP principal. The declaration includes a legal undertaking that if the GP s circumstances change, the practice provide will be expected to co-operate with the LHB in recovering monies from the GP i.e. by providing information as to the whereabouts of the GP, if known. It does not mean that the practice will be expected to repay any money that was passed on to the individual. Annex D The form at Annex D must be completed by the Local Health Board. Any oncosts (employers NI and superannuation contributions) will be reimbursed by the Department and therefore this part should include details of those costs, whether they are to be paid at the time the golden hello payment is made or at the end of the financial year. Employers superannuation costs need to be included even if they are to be paid directly by the LHB to the Pensions Agency. The LHB should reimburse practices the cost of passing on the golden hello payment to the employed doctor.

11 ANNEX D ANNEX D MONITORING FORM - TO BE COMPLETED BY THE LOCAL HEALTH BOARD AMOUNT PAYABLE Please complete either PART 1A OR 1B 1A AMOUNT PAID UNDER PART TWO NEW GPS AND THOSE LEAVING THE GP RETAINER SCHEME STANDARD PAYMENT ADDITIONAL PAYMENT EMPLOYERS N.I. CONTRIBUTION EMPLOYERS SUPERANNUATION CONTRIBUTION TOTAL AMOUNT PAID CHARGED TO: 1B AMOUNT PAID UNDER PART THREE STANDARD PAYMENT GMS EXTRA PAYMENTS DUE TO A CHANGE IN CIRCUMSTANCES ADDITIONAL PAYMENT EMPLOYERS N.I.CONTRIBUTION EMPLOYERS SUPERANNUATION CONTRIBUTION TOTAL AMOUNT PAID CHARGED TO: GMS 2. NAME OF LOCAL HEALTH BOARD COMPLOETING ANNEX D Name and Contact Number of Employee: Name and Address of Local Health Board: After completion of ANNEX D Monitoring Form please send the full form to Primary Care Division 1a, The National Assembly for Wales, Cathays Park, Cardiff, CF10 3NQ.