RCPCH GLOBAL HEALTH CONSULTANCY
Application Form
The RCPCH Global Health Consultancy (GHC) is an initiative of the RCPCH. The GHC is a register of
paediatricians with expertise, skills and experience relevant to the undertaking of assignments, work and
projects in international as well as low-resource settings. It will also include trainee and consultant
paediatricians with an interest in contributing to the RCPCH’s international work but may not as yet have any
experience of working overseas. The Consultancy will act as a means to identify, train and recommend
members for both voluntary and paid work on behalf of the RCPCH responding to the need to improve the
health and well-being of infants and children internationally.
As well as placements overseas, significant contributions can be made to global child health without leaving the
UK – for example, by hosting RCPCH Visiting Fellows or other colleagues from overseas in your institution. This
register is intended to capture all of our members who are interested to improve the health and well-being of
the world’s children.
Applicants to the GHC must be Ordinary Members or Fellows of the RCPCH. All candidates must be in good
standing with the College. In accordance with the College’s election regulations, applications from candidates
who are suspended from practice will not be accepted without written permission from the President.
A. Personal and Contact Details
Name (surname in block capitals):
Address:
RCPCH Membership Number:
RCPCH Membership Category:
Telephone:
Mobile Phone:
Email:
Date of Birth:
Nationality:
Current Employer:
Term of Current Employment:
Position:
GHC Application form v2
Deanery:
Subspecialty:
B. Qualifications
Please detail all tertiary qualifications, starting with the more recent first.
Qualification
Awarding Institution / University
Date (mm/yyyy)
C. Professional Experience in the NHS / UK
C.1 Please tick to indicate your areas of clinical experience:
Community child health
Nephrology
Child Protection
Neurology
Emergency care
Neurodisability
Endocrinology and Diabetes
Oncology
Gastro, Hepatology and Nutrition
Palliative medicine
General Paediatrics
Pharmacology
Immunology, inf. diseases and allergy
Primary care
Intensive care
Respiratory
Metabolic Medicine
Rheumatology
Neonatal medicine
Other
If Other, please give details:
GHC Application form v2
C.2 Please tick to indicate any other areas of professional experience:
Academic Research
Global health
Advocacy
Medico-legal experience
Child Protection
MHPS trained
Clinical Risk
NCAS trained / experienced
Community health
Professional Issues
Disability
Service Design and Improvement
Education and Training
Statistics and health surveys
Ethics and Law
Team and multi-professional working
Informatics
Other
If Other, please give details:
C.3 Please provide a brief statement (up to 500 words) regarding any training, capacity building or policy
work as part of the NHS or other roles you may have undertaken and that may be applicable to international
work, with a focus on clinical, health research and leadership skills learnt.
C.4 Please list any research you have conducted, and publications (particularly those in peer reviewed
journals).
GHC Application form v2
C.5 Please list any other professional bodies or organizations with which you hold an affiliation
Organization / Body
Type of affiliation (general
member, trustee, student, etc)
1.
2.
3.
D. International Experience and Languages
D.1 Please tick to indicate any experience and/or familiarity with paediatric care, practice and systems in the
following regions:
Europe
United States
Africa
Latin America
North Africa and Middle East
West and Central Asia
South Asia
East and South East Asia
Australia and New Zealand
Pacific
D2. Please list any specific countries in which you have worked.
D.3 Please indicate the languages in which you are fluent or have a native level of knowledge, and languages
of which you have working knowledge.
Native / fully professionally fluent
a.
Working knowledge
a.
GHC Application form v2
b.
b.
D.4 Please list any international, overseas and global health experience which you have not listed in your
professional and employment history.
Position held
Location
From (mm/yyyy)
To (mm/yyyy)
Brief description of responsibilities
E. Interests and Availability
E.1 Please indicate which of the following activities are of most interest to you
Training and capacity building
Developing new protocols
Auditing local services
Supervising and mentoring
Paediatric education
Awareness raising activities
Paediatric practice
Policy making
Fostering new partnerships
Health research (statistics, baseline studies,
surveys)
If other, please give details:
E.2 Please indicate whether you are interested in paid activities only, volunteering (usually travel expenses
and living allowances etc are covered but otherwise unpaid) or both types of engagement (tick both boxes)
Volunteer (unpaid) positions
Paid opportunities
E.3 Please indicate the length of time you would be willing and able to spend engaged in activities
considering any current employment positions or other commitments
Up to two weeks
Up to one month
GHC Application form v2
Up to three months
Up to six months
Six months to one year
One year or longer
E4. Please add any further comments regarding availability, including, for instance, any periods when you
would not be available, restrictions on time away from work, OOPE or planned retirement.
F. Referees
Please provide contact details of two professional referees who may confirm your skills and/or experience.
These references would only be taken-up should you be considered for a specific project/activity.
Referee 1
Referee 2
Name:
Name:
Phone:
Phone:
Address:
Address:
E-mail:
E-mail:
Member number (if known):
Member number (if known):
Relationship (supervisor etc):
Relationship (supervisor etc):
Please attach an updated CV and a recent passport photograph to this application form.
G. Consent
I confirm that all details in this application as well as the attached CV are correct, and that I will notify the GHC
on ghc@rcpch.ac.uk with any changes. I consent to the College following up with the listed referees if
required.
Signed:
Date:
Notes for Applicants
1. In order for an application to be processed, applicants must submit this application form together with an
GHC Application form v2
updated CV and a recent passport photo.
Paid consultancies are conducted on a self-employed or seconded basis and fees and other expenses are
payable by the College against submitted invoices agreed in advance.
3. Members of the Consultancy register are responsible for ensuring that if fees are invoiced by them on an
individual basis the work has been conducted in their non-employed time and that they are responsible for any
declarations or payments with respect to tax.
4. Please note that submission of an application form, completion of induction and availability does not guarantee
selection and should not be relied upon as a source of work or income.
5. Eligibility is restricted to those who:
- Are members of the College and are in good standing
- Are registered with the General Medical Council
- Are up to date with current and continuing professional development in paediatrics and the medical field more
generally
- Have a good applied knowledge of the RCPCH and its work, particularly as this relates to international work
- Are professional, reliable and able to represent the College within a varying settings and with a range of
stakeholders
- Are able to commit to completing a consultancy assignment and meet all deadlines set should they accept such an
assignment
- Are sensitive and receptive to cultural differences both generally as well as in the ways in which these impact the
paediatric and medical setting
- Possess strong communication, analysis and judgement skills
- Possess strong leadership and team skills
- Possess skills sharing and mentorship abilities
- Can undertake the writing of reports required of the set assignment, including final evaluation documentation
required by the College
- Are willing and able to contribute to the further development of the Global Health Consultancy through a sustained
involvement
2.
6. Additional desirable attributes will depend on the specific projects but are likely to include members who:
- Have received leadership and management training, and have been in a team lead position or have had mentorship
responsibilities
- Are aware of the restrictions of working on low resource settings and are able to apply principles and processes to
such settings
- Are able to make informed assessments of data, including data from different sources, and are able to assimilate,
weigh and evaluate the value of different data sources
- Are able to plan for the collection, analysis and presentation of data, as well as to assess shortcomings in data and
establish systems through which such data collection can be sustainable
- Are able to understand mechanisms for service delivery and service user involvement and be capable of
implementing and feeding back on such services
- Are willing to travel outside of the United Kingdom to complete an assignment, once such an assignment has been
agreed to by the GHC and the individual
Please complete this form and send it together with an updated CV, recent passport photo to
ghc@rcpch.ac.uk
GHC Application form v2