THIS FORM IS INTENDED TO BE COMPLETED IN MICROSOFT WORD. THE FORM
SHOULD BE COMPLETED BY THE GP WHO WILL BE TEACHING. COMPLETED
APPLICATIONS SHOULD BE EMAILED TO KERRY BOARDMAN
(KERRY.BOARDMAN@KCL.AC.UK)
TUTOR DETAILS
1.
Full Name
Enter your Full Name.
2.
GMC Number
Enter your GMC Number
GP Practice
3.
Email Address
Enter your email address
4.
Practice Name
Practice Name
5.
Address
First Line of Address
Second Line of Address
Town
Postcode Postcode
Payment for teaching details
6.
Practice Number (bypass if possible)
Telephone Number
7.
Practice Fax
Fax Number
You will also be asked to provide these details on letter headed paper once approved.
8.
Practice Account Name
Account in the name of
9.
Account Number
Account number
TEACHING EXPERIENCE
10.
Sort Code
Sort Code
Please answer the following questions about teaching in your practice at present.
11.
Does you practice currently teach medical students? If yes then from which medical school?
Please enter Yes or No and which Schools you take students from
12.
Is your practice a deanery approved training practice?
Choose an item.
13.
Are you a GP Trainer?
Choose an item.
14.
Do you have any formal teaching qualifications? Eg. ITTPC, TTT, TIPS, Diploma, Masters Degree.
Enter brief details here. Eg qualification and year awarded
15.
Briefly tell us about your teaching experience
Click here to enter text.
KCL KUMEC GP Tutor Application Form
Page 1

ADDITIONAL INFORMATION –If you have further details that would be useful please use the space below. For example if you are working as a locum or have specific requirements please let us know.
16.
Additional Information
Teaching availability
17.
Please indicate below which KUMEC programmes you would like to sign up for. If approved you will be allocated students based on this.
For the dates and details each year please see the guidance document sent with this form.
Year 1
Year 2
Phase 3
Phase 4
Comms 1:
One Pair
Two Pairs
Comms 1:
One Pair
Two Pairs
Comms 2:
One Pair
Two Pairs
Comms 2:
One Pair
Two Pairs
Comms 3:
One Pair
Two Pairs
Comms 3:
One Pair
Two Pairs
Number of Pairs: One Two Three Four Five
Stream A Number of Pairs: One Two Three Four Five
Stream B Number of Pairs: One Two Three Four Five
Rotation 1 Rotation 2 Rotation 3
Comms 4:
One Pair
Two Pairs
Comms 4:
One Pair
Two Pairs
Years 1 & 2 Phase 4 Phase 5
Phase 5
Seminars Leader
THIS AGREEMENT is made between the Department of Primary Care and Public Health Sciences,
King's College London School of Medicine at Guy's, Kings College & St Thomas' Hospitals, Capital
House, 42 Weston Street, London SE1 3QD , and the practice:
Named in Item 4 of this document
To clarify the duties and responsibilities of the Medical School and of the Practice in relation to teaching undergraduate medical students, and the remuneration for such teaching.
The Practice agrees to:
1.
Comply with standards set by the General Medical Council (GMC) and the Nursing and Midwifery
Council (NMC) and for colleagues in Primary Care to comply with the standards of their own professional bodies.
2.
Inform KUMEC if there is any change in a GP or nurse teacher’s registration status with the GMC or NMC if they are under investigation by their CCG or GMC / NMC.
3.
Seek approval from the KUMEC team if, during the course of the academic year, a Practice wishes to involve a new teacher in the teaching programme. KUMEC will check the new teacher’s registration status with the GMC / NMC and contact their CCG to ask them to confirm that there are no outstanding performance issues.
4.
Teach undergraduate medical student(s) allocated by the Medical School ("the medical students") on courses of study devised by the Medical School ("the teaching programme").
5.
Teach undergraduate medical student(s) for additional sessions, which may be arranged between the Medical School and the Practice.
6.
Understand the content and spirit of the Expectations and Responsibilities of Community Teaching
Network Teachers appended to this Agreement and comply with its standards.
7.
Ensure that medical students respect the dignity of patients and the confidentiality of medical information and seek prior consent from any patient involved in the teaching process.
KCL KUMEC GP Tutor Application Form
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8.
Ensure that identified Practice members will be either involved in or will support teaching activities.
The Practice agrees to return a completed form nominating a Practice Manager/Liaison Person and naming Practice Teachers.
9.
Ensure that all Practice members involved in teaching medical students are made aware of the
Expectations and Responsibilities and the content of Appendix 1.
10.
Ensure (a) that every appropriate member of the Practice is informed about the Medical School's training programme for teachers, and (b) that key members of the Practice are released to attend relevant training events to enable effective delivery of the teaching programme.
The Medical School agrees to:
1.
Automatically pay the Practice the amounts indicated in Appendix 2 for teaching allocated medical students, without the need for an invoice. Payments will be made at the end of each
semester or rotation as appropriate. Other non-placement teaching will be paid for on receipt
of an invoice.
2.
Represent the best interests of the Practice in all matters relating to academic and teaching activities with the Medical School’s Regional Office, and/or any other relevant bodies.
3.
Provide curriculum handbooks and appropriate supplementary teaching material for the Practice
Facilitators and Teachers.
4.
Provide regular feedback to the Practice on its teaching.
5.
Provide a comprehensive programme of training for members of the Practice determined by mutually identified training needs.
6.
Liaise with the Practice regarding the teaching programme and its development and communicate regarding assistance, advice or mediation in any matter relating to academic or teaching activity.
7.
Ensure that the medical students are made aware of desirable standards of conduct, dress and attitude in their contact with the Practice and its patients.
8.
Liaise with the Practice about medical student welfare, counselling and disciplinary issues when required.
9.
In line with best practice and current GMC / NMC guidelines and to ensure the quality of our teaching process, check the registration status of potential teachers with the GMC / NMC and write to the appropriate CCGs and Deaneries, or equivalents, annually to ask them to confirm that there are no outstanding performance issues for any of our teachers.
10.
Comply with the standards of the Data Protection Act 1998 with regard to information held in its computerised records relating to the teaching work of the Practice.
Both the Practice and the Medical School agree as follows:
(1) To abide by the contents of Appendix 1 which, it is agreed, forms an integral part of this
Agreement
(2) Annual renewal of this Agreement shall depend upon the Practice's wish to continue teaching under the terms of this Agreement, the Medical School's annual review of the Practice’s teaching activities (the result of which will be communicated to the Practice Manager/Liaison Person or
Teachers at the end of the teaching cycle) and funding being available to the Medical School, but shall always be at the absolute discretion of the Medical School.
(3) If, upon its review of the Practice’s teaching activities, the Medical School does not wish to renew this Agreement for a further period the following procedure shall apply:-
(i) The Medical School will notify the Practice in writing and a representative or
(ii) representatives of the Medical School will meet with members of the Practice.
The Medical School and the Practice will endeavour to negotiate a mutually agreed solution and, if appropriate, extra training and/or support may be arranged for members of the Practice involved in the teaching programme.
(iii) If no such solution can be agreed upon, the matter will be placed before the Director of
Community Education within the Medical School, who will endeavor to arrive at a compromise solution acceptable to both parties.
KCL KUMEC GP Tutor Application Form
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(iv) If, at the end of this procedure, no mutually satisfactory outcome has been agreed and the Medical School still does not wish to renew this Agreement, this Agreement shall terminate at the end of the relevant teaching cycle in respect of the medical students.
(4) If the Practice has difficulty in fulfilling its teaching responsibilities under the terms of this
Agreement, the Practice will notify the Medical School as soon as possible and the procedure outlined above will apply.
(5) This Agreement shall be governed by and construed and interpreted in accordance with the laws of England and Wales, and the parties hereby submit to the exclusive jurisdiction of the courts of England and Wales.
(6) This Agreement represents the entire agreement between the parties as to its subject matter and supersedes all prior negotiations, representations or agreements (written or oral) in relation to the subject matter.
(7) For the avoidance of doubt, no person other than the parties to this Agreement shall have any rights in respect of this Agreement by virtue of the Contracts (Rights of Third Parties) Act 1999 and the parties shall not require the consent of any person to any variation or amendment to this Agreement.
(8) The terms of this Agreement shall be confidential to the parties and neither party shall disclose any such terms to any third party save as required by law or other reporting obligation binding on the party.
(9) To maintain an accurate record of GMC or NMC registration numbers for all clinicians who teach KCL medical students in the practice; please confirm that the information held in the staff information table is correct. (If additional teachers are added within the period of this agreement the practice will notify the KUMEC office and provide their registration numbers.)
WHEN APPROVED TO BE SIGNED by:
_______________________________________________
Dr Anne Stephenson, Director of Community Education, on behalf of the Medical School
Electronic submission : By placing a tick in the box below, the authorized signatory for the practice
(named below) agrees to terms of the agreement above and the two agreement appendices which are linked in the text above. Please copy for your files.
Full name of person signing on behalf of the practice
Enter Name of practice authorised signatory
Ticking this box acts as your electronic signature. Tick here
TUTOR APPROVAL – FOR COMPLETION BY KUMEC STAFF
1.
Date of Approval
Click here to enter text.
2.
Students Allocated
Click here to enter text.
3.
Practice Visit requirements
Click here to enter text.
KCL KUMEC GP Tutor Application Form
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THE POSITION BETWEEN THE PARTIES IN RELATION TO THE MEDICAL STUDENTS
This document sets out the position between King’s College London, acting through the King’s College London
School of Medicine (the “Medical School”) and the practice named in the teaching agreement. I n relation to the medical students, in respect of the Annual Teaching Agreement (the “Agreement”). For the avoidance of doubt, this document forms an integral part of the Agreement:
1.
2.
3.
4.
5.
6.
7.
8.
9.
The medical students have the right to attend at the Practice for the purposes of being taught by Practice staff in accordance with the Agreement. This does not entitle the medical students to exclusive possession of any part of the premises of the Practice at any time. For the avoidance of doubt, their status is purely that of licensees on the premises.
For the avoidance of doubt, there is no contract of employment between the medical students and the
Practice. Accordingly, the Practice does not have duties and liabilities towards the medical students, which it would have if it were their employer. However, whilst on Practice premises, the Medical School will procure that the medical students will abide by all and any Practice policies which are notified to the medical students as applicable to them.
Whilst on Practice premises, medical students will remain accountable to the Medical School but will follow the reasonable instructions of the Practice and the instructions given on the Practice’s behalf by those individuals responsible for supervising the medical students during their teaching at the Practice. All King's
College London School of Medicine students are required to be a member of a medical protection organization from the beginning of Year 1. Showing this indemnity certificate is a compulsory log-book signup for their first GP allocation visit. The Medical Defense Union (MDU) and the
Medical Protection Society (MPS) consider the training and supervision of medical students on placement to be part of a GP’s work and do not require their members to inform them of their involvement in such work.
However they ask that medical students be signed up to a medical protection organization. The Medical and Dental Defense Union of Scotland (MDDUS) IN ADDITION ask that their members inform them if they are teaching medical students in the practice.
The Medical School has a duty to the Practice, its employees, agents and patients when placing a medical student with the Practice in accordance with the Agreement. If the Medical School is aware that a medical student’s professional competence and/or behaviour might be affected by personal or health problems whilst on an attachment to the Practice, then the Medical School will advise the Practice Manager/ Liaison
Person accordingly, provided always that this will not necessarily be sufficient to discharge the Medical
School’s duty of care in this regard.
If Practice staff consider a medical student’s behaviour to be offensive or unacceptable to the Practice environment, they have the right to require the student to leave the Practice premises without notice, pending a recommendation to the Medical School via the Head of the Medical School, that the medical student be suspended.
The Medical School shall procure that the medical students shall become members of a defence society.
During the medical students’ attendance at the Practice premises, they will be covered, when they are undergoing directly supervised training in accordance with the Agreement, under the NHS indemnity arrangements in respect of those patients of the Practice to whom the medical students are involved in providing care and treatment.
King's College London will take out Public Liability Insurance in case it is found guilty of negligence in a Court of Law.
Where any claim is made, whether or not legal proceedings are issued, arising out of or in connection with the attendance of the medical students at the Practice’s premises in accordance with this Agreement, the
Medical School will co-operate fully with any investigation by the Practice in connection with any such claim and will give all such assistance as may reasonably be required by the Practice regarding the conduct of any legal proceedings and shall procure that the medical students shall do likewise.
10.
The Practice does not accept any responsibility for the personal property of medical students while they are on Practice premises or for any vehicles of medical students parked on Practice premises.
11.
The Medical School shall procure that the medical students will co-operate with the Practice in discharging its duties under the Health and Safety at Work Act 1974 and other health and safety legislation and that the medical students will take reasonable care for the health and safety of themselves and others whilst on
Practice premises.
12.
The right of each medical student to attend at the Practice’s premises will automatically terminate on the termination of their placement with the Practice or on the termination (howsoever caused) of their course or their participation in the course, at the Medical School and on the death of the medical student.
The provisions noted at paragraphs 7, 8 and 9 above, shall survive the termination, howsoever caused, of the
Agreement.
KCL KUMEC GP Tutor Application Form
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KUMEC SCHEDULE OF PAYMENTS 2013-14 (rev June 2013)
Practice Based/Core Teaching Basic Payment: £70.00 per session, per pair of students
These are the total payments for the entire year:
Year 1
Community Group (four sessions)
Year 2
Community Group (two sessions)
GPEP
Semester 1 (four sessions)
Semester 2 (one session)
Phase 3
£280
£140
£280
£70
£1200 Per student pair, Seven half day sessions across three terms.
Phase 4
Eight events across semesters
(Pregnancy Study: four sessions)
(Consolidation & Review: four sessions)
Health Promotion (per pair)
Phase 5
Per student, per rotation
£560
£50
£2400
Seminar/ and Noncore Teaching
Year 1, 2, & Phase 4 and all other seminars £45 (per hour)
Phase 5 Seminars
Student Learning Centres (SLCs):
SLC administration costs
£140
£250 less than 10 events
£500 between 10 and 19 events
£750 20 or more events
£35 per event Consumer and hospitality costs at SLC
Any additional teaching and/or examining sessions, which may be arranged, will be paid for on an individual basis agreed between the Medical School and the Practice or the individual teacher where independent.
KCL KUMEC GP Tutor Application Form
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