Inter / Intra Deanery Transfer - East of England Multi-Professional ...

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Inter-Deanery Transfer Application Form OTHER EDUCATIONALLY APPROVED ST POSTS Enclose the appropriate VTR2 forms or letter from JCPTGP/PMETB/RCGP or deanery Start Date End Date Specialty: dd mm yyyy dd mm yyyy Full time Part time Full time Part time Full time Part time GP REGISTRAR POSTS (ST3): If you have previously undertaken a GP Registrar post, please answer the following questions and enclose a VTR1 form if appropriate. Name of training practice: Full time Part time Start Date: dd mm yyyy Finish Date: Are you currently registered on a PCTs Performance List? YES NO If yes, give name of the PCT COMPLETED ASSESSMENTS: Inter / Intra Deanery Transfer Policy East of England Multi-Professional Deanery Updated January 2012 - 14 - dd mm yyyy Have you attempted any components of Summative Assessment/nMRCGP? YES NO If yes, please give details of components attempted or submitted, dates, and results if known. TRAINING REQUIREMENTS: Please confirm how much further training (whole time equivalent) you will require in order to complete your GP training from the proposed transfer date GP Registrar Post 6 months 12 months 18 months Hospital Component: 6 months 12 months 18 months 24 months Do you wish to complete your training flexibly (part-time)? YES NO Do you have any geographical restrictions as to where you can work in the proposed deanery? If yes, please give details. Are there any other considerations you wish to be taken into account? If yes, please give details.
Inter-Deanery Transfer Application Form REASON FOR REQUESTING A TRANSFER: You should provide a detailed case outlining your circumstances and reasons for requesting a transfer. Please highlight the reason(s) from the criteria below as applicable and give further information to support your request stating when these changes took place You should attach a more detailed explanation of the reasons for requesting the transfer (one side of A4) 8. Significant life event 9. Caring responsibilities 10. Committed relationship – e.g. Marriage, civil partnership 11. Other relationships, support networks 12. Length of Rotation 13. Impact on well being 14. Change of Location of spouse/partner (where partner has no choice in changing length or location of their employment). You must enclose an up-to-date CV. Please confirm that you have ⁯ (Tick to confirm) SIGNATURE: Please ensure your programme director signs and dates this section prior to submission I confirm that I have reviewed this IDT application. Please note any comments; Signature …………………………………………………… Date: / / SIGNATURE: Please sign and date this form and submit to your current DPGPE I hereby formally apply to transfer to deanery and confirm all above information is correct. I am aware that a deanery panel will meet to review this application. I acknowledge that I have the right of appeal if the panel decides I do not meet the criteria for transfer. Signature …………………………………………………… Date: / / Inter / Intra Deanery Transfer Policy East of England Multi-Professional Deanery Updated January 2012 - 15 -
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