I am an approved GP Trainer in Health Education England Thames Valley I understand that a copy of this form and accompanying documentation will be supplied to the PCSE responsible for the area in which my training practice is located. Information supplied on this form will be recorded on a computer in accordance with the Data Protection Act 1998 Signature GP Date of – Trainer signature Name (PRINTED) Please complete all remaining sections of this form except for Section 13 and return it with the GPStR’s documents (see Section 17) to: School of General Practice, Health Education England Thames Valley, Thames Valley 4630 Kingsgate, Oxford Business Park South, Oxford OX4 2SU 13 TO BE COMPLETED BY THE DIRECTOR OF GP SCHOOL I confirm that the PCSE may commence payments in respect of this period of training in accordance with the agreement for the provision of postgraduate general practice education issued by Health Education England, Thames Valley. Signature GP Date of – Dean signature Name Additional Trainer’s Grant I confirm that this is a remedial training placement requiring significant additional trainer support and authorise a double trainer’s grant. Signature GP Date of – Dean signature 14 PREVIOUS / PRESENT EMPLOYMENT SECTION A Present or most recent NHS Hospital appointment (please state specialty eg Paediatrics) Was this a locum Grade of post (eg PRHO, SHO, StR, Consultant Yes / No post? Name of Hospital where this post was undertaken Address of Hospital where this post was undertaken (including postcode) Date commenced Date terminated (dd/mm/yy) (dd/mm/yy) Annual salary (excluding Salary scale: Increment date £ supplements) (dd/mm/yy) PRHO rotation SECTION B GP Registrar training post
I am an approved GP Trainer in Health Education England Thames Valley I understand that a copy of this form and accompanying documentation will be supplied to the PCSE responsible for the area in which my training practice is located. Information supplied on this form will be recorded on a computer in accordance with the Data Protection Act 1998 Signature – GP Trainer Date of signature Name (PRINTED) Please complete all remaining sections of this form except for Section 13 and return it with the GPStR’s documents (see Section 17) to: School of General Practice, Health Education England Thames Valley, Thames Valley 4630 Kingsgate, Oxford Business Park South, Oxford OX4 2SU 13 TO BE COMPLETED BY THE DIRECTOR OF GP SCHOOL I confirm that the PCSE may commence payments in respect of this period of training in accordance with the agreement for the provision of postgraduate general practice education issued by Health Education England, Thames Valley. Signature – GP Dean Date of signature Name Additional Trainer’s Grant I confirm that this is a remedial training placement requiring significant additional trainer support and authorise a double trainer’s grant. Signature – GP Dean Date of signature 14 PREVIOUS / PRESENT EMPLOYMENT SECTION A Present or most recent NHS Hospital appointment (please state specialty eg Paediatrics) Grade of post (eg PRHO, SHO, StR, Consultant Was this a locum post? Yes / No Name of Hospital where this post was undertaken Address of Hospital where this post was undertaken (including postcode) Date commenced (dd/mm/yy) Date terminated (dd/mm/yy) Annual salary (excluding supplements) £ Salary scale: Increment date (dd/mm/yy) SECTION B PRHO rotation GP Registrar training post
PAY1_HEE_TV_Jul2016.docx