General Medical Services Regulations (Northern Ireland) 1997

Regulations 9(1), 10(1) and 11(1)

Part IIA Information and undertakings to be included in any application to practise

1.  Full name.

2.  Sex.

3.  Date of birth.

4.  Private address and telephone number.

5.  Whether or not his name is included in the medical list and, if so, cypher number.

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

7.  Notification of address or addresses of proposed practice premises.

8.  Notification of the geographical boundary of the proposed practice area by reference to a sketch, diagram or plan.

9.  Undertaking that, if accepting as a patient a person who, at the time of acceptance or succession, is residing at a place outside the practice area, he will visit him at that address.

10.  Proposed place of residence (including telephone number and distance from main practice premises) and an undertaking to inform the Board whenever changing permanent residence.

11.  Telephone number at which prepared to receive messages.

12.  Name and private address of—

(a) any intended partnership and whether or not the names of the partners are included in the medical list; and

(b) members of group (other than those already specified in sub-paragraph (a)) with whom doctor intends to practise.

13.  Whether the applicant intends to practise as—

(a) a full-time doctor;

(b) a three-quarter-time doctor;

(c) a half-time doctor;

(d) a job-sharing doctor; or

(e) a restricted doctor.

14.  Where the applicant intends to practise as a job-sharing doctor, the name of the other job-sharing doctor with whose hours the applicant’s hours are to be aggregated for the purposes of regulation 13(d).

15.  Notification of the proposed days and hours of attendance.

16.  In the case of an application by a doctor for the inclusion of his name in the medical list as a restricted list principal, the name of the establishment or organisation, with which patients are connected, to whom the applicant will be limiting the provision of general medical services, and the number of such patients.