Trust Locum Enrolment Form
Please ensure you tick or mark X in one of the boxes below:
ENROL with NHS Professionals as a Trust Locum to work additional shifts at the
Trust. Please note whilst working additional shifts via NHSP:Online you are still an
employee of the Trust. Please complete ALL personal details below.
CHANGE information that is already held by NHS Professionals. Please include
Name & GMC details below.
ADD additional assignment code(s) to a Trust Locum profile – please note areas of
work and assignment types on pages 2 - 4. Include Name & GMC details below.
Once all forms have been fully completed & signed by a senior clinician please send
to: Laura.Bick@ouh.nhs.uk or by post to: Laura Bick, Human Resources, Carillion Building,
John Radcliffe Hospital.
Personal Details
Trust
Oxford University Hospitals NHS Trust
Full Name (please
print)
Gender
Date of Birth
NI Number
GMC Number
GMC Renewal Date
Contract End Date
Contracted Hours
Contact Number
Email Address
Declaration:
I understand that from the date that my substantive contract with OUH comes to an end I will
no longer be able to work as a Trust locum through NHS Professionals. I understand that if I
wish to work as a NHS Professionals’ locum at OUH after the end of my substantive contract I
will be required to complete the NHS Professionals’ full registration process which will include
compliance and recruitment checks carried out by NHS Professionals in line with National
Standards.
Signed: ______________________________________ Date: _____________________
Trust Use Only - Senior Clinician Approval
Name (printed): ________________________
Job title: _________________________
Signed: ______________________________
Date: ___________________________
HR Sign Off
I confirm that the above named doctor is currently employed by the Trust:
And is under contract until ________________
1
Yes / No
ESR no: _________________________
Assignment
Description
CON
Mark ‘X’ for ALL
assignments
applicable
Assignment
Description
Consultant
STA
ST1 (SHO)
AST
Associate Specialist
STB
ST2 (SHO)
SGR
Staff Grade
STC
ST3(SHO)
SPD
Specialty Doctor
STD
ST4 (SpR)
FYA
Foundation Year 1
STE
ST5 (SpR)
FYB
Foundation Year 2
STF
ST6 (SpR)
CLA
Clinical Attachment
STG
ST7 (SpR)
Field of Practice
A&E
General Acute and
Internal Medicine
Mark ‘X’ for
ALL assignments
applicable
Description
Area of
Work Code
Paediatric A&E
63
General Accident & Emergency
04
General Acute Care
00
Coronary Care
05
General Internal Medicine
500
Genito-Urinary Medicine
19
Intensive Care
08
Oncology
24
Endocrinology & Diabetes Medicine
503
Gastroenterology
505
Geriatric Medicine & Elderly Care
17
Neurology
23
Haematology
509
Rehabilitation Medicine
510
Renal Medicine & Dialysis
29
Respiratory Medicine
512
Rheumatology
513
Cardiology
13
Dermatology
516
Endoscopy
16
Acute Medicine
519
Hepatology
06
Allergy
09
Genetics
10
Immunology
11
Infectious Diseases
12
Occupational Medicine/Health
93
Musculoskeletal
96
Research
97
Pain Management
14
Palliative Care Medicine
15
Sleep Medicine
18
Sports and Exercise Medicine
20
Stroke Unit
536
2
Mark ‘X’ for
ALL codes
applicable
Field of Practice
Surgery
Psychiatry, Mental
Health and
Learning
Disabilities
Paediatrics
Community
Description
Area of
Work Code
General Surgery
520
Day Surgery
43
Cardiothoracic Surgery
521
Oral & Maxillofacial Surgery
522
Neurosurgery
48
Ophthalmology
49
ENT
44
Plastic Surgery
526
Trauma & Orthopaedic Surgery
54
Urology
56
Vascular
529
Breast
209
Bariatric
210
Cardiac
223
Colorectal
211
General Mental Health and Psychiatry
03
Acute Adult Mental Health and Psychiatry
70
Forensic Mental Health and Psychiatry
76
Forensic Child and Adolescent Mental Health & Psychiatry
75
Child & Adolescent Mental Health and Psychiatry
73
Learning Disabilities Mental Health and Psychiatry
77
Old Age Mental Health and Psychiatry
79
Substance Misuse Mental Health and Psychiatry
74
Paediatrics
60
Paediatric Intensive Care
61
Neonates
62
Paediatric Cardiology
541
Community Child Health
100
Paediatric Neurology
543
Paediatric Surgery
544
Paediatric Audiology
546
Paediatric Gastroenterology
547
Paediatric Endocrinology
548
Paediatric ENT
549
Paediatric Oncology
65
Paediatric Orthopaedics
67
Paediatric Respiratory
69
General Community
102
3
Mark ‘X’ for
ALL codes
applicable
Description
Area of
Work Code
Maternity
66
Materno -Foetal Medicine
550
Gynaecologic Oncology
551
Urogynaecology
556
Community Gynaecology
553
Reproductive Medicine
554
General Obstetrics and Gynaecology
45
Sexual Health
95
General Anaesthetics
40
Intensive Care Anaesthetics
561
Anaesthetics Maternity
562
Histopathology
514
Microbiology
218
Chemical Pathology
219
Radiology
220
Interventional Radiology
517
Dentistry
221
Orthodontics
222
Field of Practice
Obstetrics and
Gynaecology
Theatre and
Anaesthetics
Pathology
Radiology
Dentistry
Mark ‘X’ for
ALL codes
applicable
Process for Trust Locum Enrolment Form
Ref
Step Description
Notes
Dept /
Org
1
Either the Medical Locum or an
Please note – One form is to be completed per division for each doctor Trust
authorised person within Division needing additional assignment types and areas of work. If a code
2
3
completes Trust Enrolment
needs to be added for a different Division then the appropriate Division
Form.
needs to complete and authorise a form.
Form is signed off by a Clinical
Please note – Clinical member of staff can only sign off assignment
member of staff from Division.
code to be used in their Division.
Form is sent to the Trust HR
If emailing please send to: Laura.Bick@ouh.nhs.uk
Trust
Trust
department – this can either be
done electronically or via internal Internal post to: Laura Bick, HR Dept, Carillion Building, John Radcliffe
post.
Hospital.
Please ensure that you keep a copy of the form for your records
4
HR logs receipt and checks
If No, HR will return to Division to gain required information.
Enrolment form is accurate and
complete, adds ESR number
and signs form.
4
HR Team
5
HR forwards approved
If emailing please send to: Kayleigh.Sullivan@nhsprofessionals.nhs.uk HR Team
Enrolment form to NHSP Client
and copy Caroline.Davies@nhsprofessionals.nhs.uk
Relations Team, either via email
6
or delivered to Doctors Post
Or deliver to: Doctors Post Tray, NHSP, Carillion Building, John
Tray.
Radcliffe Hospital.
NHSP CRT logs receipt and
If No, form returned to HR to follow step 4.
CRT
check forms for completeness.
7A
NHSP CRT sends new
NHSP
Forward Enrolment form to: drsqueries@nhsprofessionals.nhs.uk
NHSP
CRT
Enrolment forms to NHSP
Doctors Recruitment Team for
action.
7B
NHSP CRT actions change
Ensure additional information or new assignment codes are added to
NHSP
forms or additional assignment
system.
CRT
NHSP Doctors Recruitment
For Doctors Recruitment Auditing. Ensure ESR number, NI number,
NHSP
Team uploads information to
Contract End Date and Assignment Codes are added.
Doctors
code requests.
8
NHSP:Online and updates
Recruitm
Enrolment spread sheet with
ent Team
Locum details.
9
NHSP Doctors Recruitment
Confirmation task is complete.
NHSP
Team emails CRT confirming
Doctors
Enrolment is complete.
Recruitm
ent Team
10
NHSP CRT emails Trust
Notifies Trust requester that the Medical Locum can be booked via
NHSP
requestor to confirm Enrolment/
NHSP:Online
CRT
additional assignment code has
been completed.
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