Human Resources
NHS Tayside
Ninewells Hospital
Level 9
DUNDEE DD1 9SY
Telephone Number (01382) 660111
Fax Numbers (01382) 632098 & 496237
www.nhstayside.scot.nhs.uk
Date
Your Ref
Our Ref
Enquiries to
Extension
Direct Line
Email
As Postmark
FS/18/13
Miss Fiona Small
34186
01382 660111 ext 34186
fiona.small@nhs.net
Dear Doctor
POST OF CONSULTANT IN GENERAL ADULT PSYCHIATRY, PERTH CHP
Further to your enquiry regarding the above post, I am now pleased to provide you with an information and
application pack.
Your application should be submitted by e-mail to medicalrecruitment.tayside@nhs.net in the form of the
following documents:




1 copy of your CV, including the names and e-mail addresses of 3 referees, including your current
or most recent employer.
Your completed Immigration Status Form and a copy of your passport/current immigration status
documents. NB British and EEA Nationals must also enclose a copy of their passport to verify
nationality.
Your completed Declaration Statement in respect of Fitness to Practice and Criminal Convictions.
Equal Opportunities Form. (see below)
If you do not include all the above documents your application will not be accepted.
As an Equal Opportunities Employer, it is NHS Tayside’s policy to ensure that all applicants are given the same
consideration in relation to job selection, promotion and treatment. In this connection, I enclose an Equal
Opportunities Form which you should return with your application. This information is for statistical purposes
only and will be kept in strict confidence.
It would also be helpful if you could include details of your registration on the Specialist Registrar of the
General Medical Council or your expected date of completion of training.
Please quote reference number FS/18/13 when submitting your application. If you are unable to submit all the
above documents by e-mail you can post them to the address at the top of this letter.
The closing date for receipt of completed applications is Monday 14 October 2013. Interviews are scheduled to
take place on Monday 11 November 2013. Owing to the number of applications received and to make the best
use of resources, we are unable to acknowledge receipt of applications.
Yours faithfully
Fiona Small
Workforce Services Adviser
NHS TAYSIDE
CONSULTANT IN GENERAL ADULT PSYCHIATRY
PERTH & KINROSS CHP
NORTH (WEST) COMMUNITY MENTAL HEALTH TEAM
& INPATIENT UNIT
Perth & Kinross is a scenic part of Scotland with Perth at its centre and within easy reach of major cities
and the Highlands. There are attractive lifestyle opportunities and housing is relatively affordable. We are
seeking to recruit a Consultant in General Adult Psychiatry to join our small, but successful service,
currently undergoing re-configuration. The beautiful new Murray Royal Hospital provides modern wards and
other superb facilities.
The post is full time and will provide community care to the population of North West Perthshire (4 PA) as
well as acute inpatient care for half of Moredun Unit (6 PA). This is an enhanced replacement post. The oncall provision in Tayside is under review, but participation in on-call is expected. There are currently 12
Consultants on the rota in Murray Royal, availability supplement 3%.
Murray Royal Hospital provides undergraduate placements to medical students from Dundee, General
Professional Training is on an Area basis and ST 4-6 training is accredited in General Adult Psychiatry,
CAMHS, Forensic Psychiatry, Old Age Psychiatry and Psychotherapy. There are excellent relationships
with the Department of Psychiatry of the University of Dundee.
Applicants must be on the Specialist Register or be within 6 months of the anticipated award of CCT or
CESR(CP) at the time of interview for the post.
Informal enquiries are welcome - Please contact Dr Richard Day, Consultant Psychiatrist, telephone 01828
626000, E-mail r.k.day@dundee.ac.uk ; Dr Judith English, Consultant Psychiatrist, telephone 01738
414478, E-mail judith.english@nhs.net ; Dr Werner Pretorius, Clinical Lead, telephone 01738 413070, Email werner.pretorius@nhs.net.
Closing date for applications is Monday 14 October 2013.
The interview date is scheduled for Monday 11 November 2013.
JOB DESCRIPTION
CONSULTANT IN GENERAL ADULT PSYCHIATRY
PERTH & KINROSS – Inpatient Unit and North (West) CMHT
PERTH AND KINROSS
Perth and Kinross covers about 2000 square miles and has a population of about 146,000. The population
is projected to increase over the coming years. Around half the population live in Perth City with the
remainder dispersed mainly in small towns in the surrounding area. The area is relatively affluent, but with
some pockets of relative deprivation. It is a beautiful part of the country with easy access to sporting,
recreational and arts facilities. There are motorway links to the central belt and the Highlands are only a
short drive away. There are good state and independent schools, and housing is relatively affordable.
NHS TAYSIDE
In 2006 Tayside Mental Health services were devolved to Community Health Partnership in Angus, Dundee
and Perth & Kinross, but with elements of service remaining on a Tayside basis. Integration of Health and
Social Care has started. NHS Tayside is currently re-organising the acute hospital services with the
development of a Mental Health Directorate. A Directorate for Mental Health, Associate Medical Director
and Associate Nurse Director have been appointed. Mental Health Services has its own Clinical
Improvement Board, chaired by the Associate Medical Director, Dr Neil Prentice.
GENERAL ADULT PSYCHIATRY SERVICES IN TAYSIDE
Perth and Kinross GAP services are part of Tayside GAP services. For over 150 years the base of the
provision of GAP services has been Murray Royal Hospital, Perth. The original hospital dated from 1827,
but all the hospital site and inpatient facilities in Murray Royal Hospital have been re-provided, with fit-forpurpose assessment and longer-term treatment wards in General Adult Psychiatry, as well as new
Psychiatry of Old Age wards and both Low Secure and Medium Secure Units in Forensic services. The
medium secure unit will provide beds for the North of Scotland consortium comprising Tayside, Grampian,
and Highland Health Board regions. The hospital is a short distance from the city centre, close to
community amenities.
Along with many services across Scotland, GAP services in Perth and Kinross have faced substantial
change over the last few years. In May 2004 NHS Tayside Board agreed additional funding for adult
services, with year on year increments. One of the earliest changes was re-configuration of the community
services in Perth and Kinross, with the development of our current configuration of two rural teams and one
large city team.
NHS Tayside is committed to shifting the balance of care from the hospital site to providing more care in
the community and bed numbers across Tayside within General Adult Psychiatry are projected to reduce
over the coming years.
THE POST
The vacant post is Consultant Psychiatrist in General Adult Psychiatry and is for ten programmed activities.
The final job plan will need to be agreed between the post holder, Lead Clinician and Perth CHP
management. SPA activities, including supervision of trainees, teaching at under-graduate level, and audit
will be negotiated in the job plan."
This appointment is subject to the terms and conditions of service of Hospital, Medical and Dental Staff and
Doctors in Public Health Medicine and the Community Health Service in Scotland and the National Health
Service (Scotland) superannuation regulations.
The post is based in Murray Royal Hospital, Perth. The incumbent will agree a job plan with the Clinical
Lead. There is continuing commitment for General Psychiatry clinical areas during office hours. On call
arrangements in Tayside are currently under review, as changes to medical training with reduced trainee
numbers and requirements of the European Working Time Directive are met. The post-holder may
contribute to the out-of-hours arrangements, which at present are a non-resident on-call Consultant rota
covering Perth and Kinross Mental Health Services, with approximately 12 Consultants on the rota, at 3%
supplement.
DUTIES OF THE POST
The incumbent will be responsible for the provision of community care for adults (16-65) registered with
General Practitioners in Aberfeldy, Dunkeld, Pitlochry and Stanley (16 – 64 y/o population 10,000). Clinical
activity will be kept under review and if necessary adjustments will be made to sector configurations. The
incumbent will also be responsible for the provision of acute inpatient psychiatric care for half of GAP
inpatients. The current bed-base is 30 beds in one ward, but beds are planned to reduce to 24 in the near
future, with an Acute Mental Health Response Team providing Intensive Home Treatment as well as Early
Supported Discharge. IPCU services in Tayside are currently delivered in Carseview Centre, Dundee, but
is under review. Medical staffing of AMHRT is currently under review.
Secretarial/administrative support for clinical work is organised within the community bases. All consultants
have their own PC provided in their offices. A dedicated office is available Murray Royal Hospital. Four
WTE Junior medical staff (made up of FY2, GPST and Psychiatric CT doctors) are attached to General
Adult Psychiatry services and as Modernising Medical Careers is fully implemented their posts will be redesigned to meet their training needs and deliver service.
Close liaison will be expected with General Adult Psychiatry colleagues both within Perth and Kinross and
across Tayside, as well as other Psychiatry colleagues.
MANAGEMENT
Clinical line management for this post is via the Clinical Lead for Adult Psychiatry, currently Dr Werner
Pretorius, and then the Clinical Director of Perth and Kinross CHP, Dr Morag Martindale. The incumbent
will be expected to contribute to the management of General Adult Services in Perth and Kinross and
attend regular meetings with the Clinical Lead and other colleagues. Professional line management is via
the NHS Tayside Associate Medical Director for Mental Health, Dr Neil Prentice and the Medical Director
for NHS Tayside, Dr Andrew Russell.
TEACHING AND RESEARCH
Formal education and training is of medical students from Dundee Medical School, Foundation doctors, GP
trainees and Psychiatric trainees. Four medical students are on placement in General Adult Psychiatry in
Perth at any one time and consultants share responsibility for their teaching. The incumbent may hold
educational responsibility for attached trainees. At present there are Higher Specialist placements in
General Adult Psychiatry, Old Age Psychiatry and Forensic Psychiatry. There are close links with the
Department of Psychiatry in Dundee, which is based the University of Dundee at Ninewells.
SERVICE ORGANISATION
NHS Tayside is the main commissioner of services. Perth, Dundee and Angus each have a local Planning
and Strategy Group which co-ordinates implementation of Tayside strategy at a local level. The Consultant
responsibilities within Murray Royal will be:
General Adult Psychiatry
Dr Stephen Curran
Perth City CMHT
Dr David Hayward
Perth City CMHT
Dr Judith English
South Perthshire CMHT
Dr Richard Day
North Perthshire CMHT (East)
This Post
North Perthshire CMHT (West) & Half of Inpatients
Dr Werner Pretorius
Half of Inpatients
Rehabilitation Psychiatry
Dr. Moyra Guthrie
In-patient Rehabilitation & Enhanced Care
Dr Elizabeth Caesar
In-patient Rehabilitation & Enhanced Care
Old Age Psychiatry
Dr Susan Angus
South CMHT, Crieff Ward 1
Dr Peter Connelly
Strathmore CMHT
Dr Gary Cousland
North CMHT, Atholl Unit, Leven Ward, ECT
Dr Neil Prentice
Perth CMHT, Garry & Tummel Wards, ECT
Dr Lee Robertson
Perth Memory Clinic, Liaison
Forensic Psychiatry
Dr Daniel Bennett
Medium Secure & Prison
Dr Stuart Doig
Low & Medium Secure
Dr Andrea Friel
Community, Low Secure & Prison
Dr Karen Richard
Community & Low Secure
Vacancy
Medium Secure
Dr Tom White
Seconded to Scottish Government
Child & Adolescent
Dr Judith Piggot
P&K Community& Tayside ASD
Dr Anna Morris
P&K Community & Tayside ED
Dr Michelle Quilter
P&K Community & Angus Community
Substance Misuse Service
Dr Tim Elworthy
Outpatient & Inpatient Substance Misuse Services
There are 20 Consultant Psychiatrists in Dundee and 9 Consultant Psychiatrists in Angus. Psychotherapy
Services are hosted in Dundee, Learning Disability and Substance Misuse Services are hosted in Angus.
Off-site are supported accommodation projects with the Scottish Association for Mental Health, Community
Integrated Care and Richmond, with a further project under development. Perth Association for Mental
Health is active in day care in the city with Springwell, Meadowell and Fourways in rural Perthshire.
Presently, day services are provided jointly by Local Authority, Mental Health and voluntary sector. These
services are currently undergoing major development, with a complete reorganisation of rural projects.
Perth Royal Infirmary, a District General Hospital, is three miles distant and good relationships are
maintained with their staff. Formal Liaison Psychiatry is presently restricted to Ninewells Hospital in Dundee
(Dr. Mitch Stewart), but the provision of liaison services to PRI is recognised as a commissioning priority. At
present emergency assessments are undertaken by trainees (including assessments of self-harm), elective
assessments are directed towards the relevant Consultant.
TEACHING, AUDIT AND RESEARCH
Teaching has been described above.
Great importance is being given to the Clinical Governance agenda locally. The Board has radically
overhauled the clinical governance and audit structures. Dedicated Clinical Governance and Audit
facilitators have been appointed. This has resulted in a marked increase in such activity whilst also bringing
clearer focus. There is now much greater capacity to engage in constructive audit, overseen and supported
by the new structures.
The Tayside-wide training programme is managed by the Regional Adviser, Dr Sandra Duke and the
Training Programme Directors who determine placements throughout Tayside. The MRCPsych course for
psychiatric trainees is held in the Carseview Unit, on the Ninewells Hospital campus (Dundee). The
incumbent may be invited to contribute to this teaching.
For Consultants’ own continuing professional development £1000 is available per annum. The Library in
Murray Royal Hospital subscribes to a wide range of journals and has a generous budget for purchase of
textbooks. A part-time Librarian is in post and computer facilities in the library include internet access.
The medical library in Carseview Unit complements this library. The conference suite within Murray Royal
offers excellent facilities and is a popular setting for Tayside and Scottish meetings.
The University of Dundee Academic Department of Psychiatry (Clinical & Behavioural Neurosciences) is
based at Ninewells Hospital and Medical School (Level 5) as part of the Centre for Neuroscience. The
research interests of the Section are organised around the themes of Affective Disorder, Behavioural and
Developmental Neuroscience, Neurodegeneration, Neuro-immaging, Addiction and Psychological
Treatment Methods. The Section was rated “5” in the 2001 Research Assessment Exercise. The Section
has two principal undergraduate teaching commitments: an introductory Psychiatry block in the Systems in
Practice Phase of the Dundee medical curriculum; and a Clinical Psychiatry attachment in the Preparation
in Practice Phase. The Section also offers a variety of Student Selected Components throughout the
curriculum. The Medical Undergraduate Curriculum was rated “excellent” in the most recent Teaching
Quality Assessment. In addition to research based PhD programmes, the Department offers Cognitive and
Behavioural Psychotherapy diploma and MSc courses. NHS Consultant medical colleagues are generally
offered honorary academic appointments as Senior Clinical Tutors in Psychiatry. Honorary status as a
Clinical Senior Lecturer may be conferred at the discretion of the Medical School. Further details of Section
activities and contact details can be found at http://www.dundee.ac.uk/medschool/neuroscience/clinicalbehaviour.
RESPONSIBILITY FOR RECORDS MANAGEMENT
All records created in the course of the business of NHS Tayside are corporate records and are public
records under the terms of the Public Records (Scotland) Act 1937. This includes email messages and
other electronic records. It is your responsibility to ensure that you keep appropriate records of your work
in NHS Tayside and manage those records in keeping with the NHS Tayside Records Management Policy
and with any guidance produced by NHS Tayside specific to your employment.
Informal enquiries are welcomed – please contact Dr Richard Day, Consultant Psychiatrist, Telephone
01828 626000; E-mail r.k.day@dundee.ac.uk, Dr Judith English, Telephone 01738 414478 E-mail
judith.english@nhs.net or Dr Werner Pretorius, Clinical Lead, Telephone 01738 413070; E-mail
werner.pretorius@nhs.net.
Person Specification Form
POST
A
CONSULTANT IN GENERAL ADULT PSYCHIATRY, PERTH
REF: FS/18/13
REQUIREMENTS
ESSENTIAL
DESIRABLE
Qualifications
MBChB or Equivalent.
Full registration with the GMC with a
license to practice.
CCT in General Adult Psychiatry, or
within 6 months of obtaining this / on
Specialist Register or eligible for
inclusion at the time of interview.
Training in clinical and / or
educational supervision
Attended Section 22 Training
Course
Additional formative qualifications
in evidence-based treatments or
therapy models
Eligible for recognition as Approved
Medical Practitioner with regard to
Mental Health (Care and Treatment)
(Scotland) Act 2003.
B
C
Experience
Ability
Must be able to demonstrate a high
level of clinical experience and
competence in general psychiatry,
including in-patient, community and
out-patient experience.
Experience implementing inpatient improvement strategies
Experience of multidisciplinary
teamwork.
Experience of managing medical
complications in patients with
mental health problems
Wide knowledge of General Adult
Psychiatry. Diagnostic, assessment
and clinical management skills.
Attendance at BAP training
Up to date CPD and knowledge of
evidence-based treatment options
Understanding of the needs of adults
with mental illness, their carers and
supporters, and commitment to
working in partnership with these
groups to develop services
Experience of treating patients
with personality disorder
Knowledge of evidence-based
psychotherapies, including DBT
Evidence of skills in psychological
formulation of complex clients
Ability to make links and form
effective relationships with
colleagues in related services
Ability to train and supervise junior
medical staff and staff from other
disciplines, and to support them in
managing complex high risk clinical
situations
Ability to communicate with clarity
and in an empathic, emotionally
attuned manner
Good written, verbal and
interpersonal communication skills
Ability to take full responsibility for
the independent management of
patients
D
Motivation
Keen to be involved in development
of services.
Demonstrated service
development work
Demonstrated service
improvement work.
Evidence of involvement in wider
Mental Health agenda
E
Interpersonal Skills
Well-organised and skilled in good
time management.
Leadership training
Effective interpersonal skills and
demonstrated ability to relate to and
work within a team.
Experience of providing leadership
to a mutli-disciplinary team
Previous experience responding to
360’ feedback
Leadership skills/potential.
Honesty, warmth, enthusiasm and
efficiency.
Comfortable in open communication
with patients and colleagues alike.
Commitment to patient-focused care.
Ability to co-ordinate the separate
components of the service into a
coherent whole in conjunction with
others
Ability to constructively engage with
being challenged by colleagues,
learning from others and respecting a
diversity of views.
Ability to manage anxiety when
treating ‘at risk’ clients
F
Audit
Experience of participation in regular
clinical audit
Appreciation of audit requirements
for Consultant staff under revalidation
G
Research
Evidence of ability to carry out
medical research.
Completion of an audit which
resulted in a change of practice to
benefit a patient group.
Presentation or publication of a
completed audit cycle.
Research experience.
Publication of peer-reviewed
paper.
H
Management Ability
Understanding of current issues in
the NHS.
Management training.
Previous management experience
Experience of managing and / or
supervising colleagues
I
Other requirements
Demonstration of organisational
ability
Satisfactory fitness for employment.
A full current driving licence.
Prepared by
Dr Werner Pretorius
Date
1st April 2013
PROPOSED CONSULTANT JOB PLAN
Responsible for:
1) 0.4 WTE - North (West) CMHT, including Aberfeldy, Dunkeld, Pitlochry and Stanley
2) 0.6 WTE - Inpatient Care for half of P&K GAP inpatients
DAY
Monday
- morning
HOSPITAL/ LOCATION
TYPE OF WORK
MRH
Ward Round
- afternoon
MRH
Clinical supervision
Inpatient Work
Tuesday
- morning
PITLOCHRY
Outpatient Clinic
-afternoon
MRH
Inpatient Work
SPA
Wednesday
- morning
MRH
Outpatient Clinic
- Afternoon
MRH
Inpatient Work
Thursday
- morning
North CMHT Base
CMHT Allocation Meeting
-afternoon
MRH
Inpatient Work
SPA
Friday
- morning
MRH
Ward Round
- afternoon
MRH
Urgent outpatient work
Administration
SPA
Inpatient Work Includes Patient Reviews, CPA / discharge planning meetings, MH(C&T)(S)A work, meeting with
relatives, coordination with CMHT colleagues, clinical supervision and clinical administration
IMPORTANT NOTICE
IMMIGRATION STATUS
Please be aware that all job applicants, including British and EEA nationals must enclose photocopies of their
passport (outside front cover, page containing personal details and resident permit/visa stamps). If you have been
issued with a Biometric Residence Permit, a photocopy (front and back of card) must also be enclosed.
Shortlisted applicants will be required to bring their original documents with them, for inspection, when attending for
interview.
1
Are you a national from Austria, Belgium, Cyprus,
Denmark, Finland, France, Germany, Greece,
Iceland, Ireland, Italy, Liechtenstein, Luxembourg,
Malta, Netherlands, Norway, Portugal, Spain,
Sweden, United Kingdom or Switzerland?
YES
NO
2
Are you a national from the Accession States (A8
Countries) – Czech Republic, Estonia, Hungary,
Latvia, Lithuania, Poland, Slovakia or Slovenia?
YES
NO
3
Are you a national from the Accession States (A2
Countries) – Bulgaria and Romania?
YES
NO
If you have circled ‘NO’ to the above sections please tick the box which relates to your current immigration
status, and provide expiry dates:
Tick
Status
Expiry
Date
I hold a Tier 1 (General) Visa as a highly skilled worker
I require a Certificate of Sponsorship
I hold refugee status
I have indefinite leave to remain in the United Kingdom
I have right of abode
Any other immigration status – please specify:
Print Name: ………………………………….........................
Signature:…………………………………………………….
Date: ………………………………………………………….
APPOINTMENT AND REVIEW PROCEDURES
Declaration Statements and Statements of Policy
Statement of Policy regarding fitness to practise proceedings by a licensing/regulatory body and
relating to criminal investigations in the UK or overseas.
Registration with the General Medical Council or General Dental Council imposes on doctors and
dentists the duty to provide a good standard of medical care for, and to behave appropriately,
towards patients. NHS Employers also have a duty to ensure that patients receive a good
standard of medical care and ensure as far as possible the safety of patients. We therefore need
to establish if you have been found guilty of a criminal offence, been bound over or cautioned or
are currently the subject of proceedings which might lead to a conviction, an order binding you
over or a caution, in the UK or any other country.
Applicants for posts in the NHS are exempt from the Rehabilitation of Offenders Act 1974.
Application forms will include a declaration for applicants to complete declaring any previous or
pending prosecutions or convictions, including those considered ‘spent’ under this Act. Forms will
also include a declaration of any cautions or bind overs.
We also need to establish if you have been the subject of any fitness to practise proceedings in
the past, or any fitness to practise proceedings are being contemplated, by a licensing or
regulatory body in the UK or another country and this is also reflected in the declaration.
This information will be treated in confidence and will not debar you from appointment unless the
selection panel considers that it renders you unsuitable for appointment. In reaching such a
decision we will consider the nature of the conviction/action, how long ago it took place and any
others factors that may be relevant.
Failure to disclose a criminal offence, having been bound over or cautioned or that you are
currently the subject of criminal proceedings which might lead to a conviction, an order binding you
over or a caution, or fitness to practise proceedings undertaken or being undertaken by an
appropriate licensing or regulatory body, may disqualify you from appointment, or result in
summary dismissal/disciplinary action and referral to the General Medical Council [General Dental
Council] for consideration if such a discrepancy came to light.
If you would like to discuss what effect any previous convictions, police investigations or fitness to
practise proceedings taken or being taken either in the UK or by an overseas licensing or
regulatory body might have on your application, you may telephone the Employment Services
Adviser, Medical Staffing, on 01738 473302, in confidence, for advice.
Model Declaration Statement regarding
(a) any criminal offence, being bound over or cautioned, or current proceedings which might lead
to a conviction, an order binding you over or a caution and
(b) fitness to practice proceedings taken or being currently contemplated by a licensing/regulatory
body
1. Have you been convicted of a criminal offence, been bound over or cautioned or are currently
the subject of any police investigations, which might lead to a conviction, an order binding you
over or a caution in the UK or any other country?
YES / NO
Note: Applicants for posts in the NHS are exempt from the Rehabilitation of Offenders Act 1974.
You are required to declare prosecutions or convictions, including those considered ‘spent’ under
this Act.
If yes, please provide details of the criminal offence, order binding you over or caution or details of
any current proceedings which might lead to a conviction, an order binding you over or a caution,
including approximate date, the offence, and the authority and country which dealt with the
offence.
2. To the best of your knowledge have you been or are you currently subject to any fitness to
practise proceedings by an appropriate licensing or regulatory body in the UK or any other
country?
YES / NO
If yes, please provide details of the nature of proceedings undertaken, or contemplated, including
approximate date of proceedings, country where proceedings were undertaken and the name and
address of the licensing or regulatory body concerned.
I hereby declare that the information given here is true.
Signature:______________________________________________
Date:__________________________________________________
EQUAL OPPORTUNITY MONITORING FORM
Job reference number:
FS/18/13
Equal opportunities monitoring
We want to ensure that our job opportunities are open to all. The only way we can ensure
there is equal opportunity is to monitor applications we receive, and compare the profile of
people who apply with those appointed. Therefore this form asks you for your ethnic
origin, gender, disability, religion, sexuality and age. The information you provide is
confidential and is not used in the selection process. It will be separated from the
rest of your application when we receive it.
1) If you are currently an employee of this NHS Board, will getting this job be a
promotion?
Yes

No

2) You are:
Female 
Male 
3) Have you undergone, are you undergoing or do you intend to undergo gender
reassignment? For example, this includes having changed your sex (gender).?
Yes

No 
Prefer not to say 
4) What is your age?
I am ___ years old, and my date of birth is: _ _ / _ _ / _________
5) Do you have a physical or mental health condition or disability that:


Yes

has a substantial effect on your ability to carry out day to day activities?
has lasted or is expected to last 12 months or more?

No 
If you answered ‘yes’ please tick if it is either of the following:
Learning Disability
Long standing illness
Mental health condition
Other (please describe):

Prefer not to say 



Physical impairment
Sensory impairment


Again, if yes, please describe any particular arrangements you would need for your
work location:
(Continued on next page)
o
2-
6) What is your ethnic group?
Choose one section from A to F, then tick the appropriate box to indicate your cultural
background
A: White
 Scottish  Irish
 Gypsy Traveller
B: Mixed
 Any mixed background
 Other British
 Polish
 Any other White background
C: Asian; Asian Scottish; Asian British
 Pakistani
 Indian
 Chinese
 Bangladeshi  Any other Asian background
D: Black; Black Scottish; Black British
 Caribbean
 African
 Any other Black background
E: Other ethnic background
 Any other background
F: Prefer not to answer 
7) To which religion, religious denomination or body do you actively belong?
 (Christianity)- Church of Scotland
 (Christianity) - Roman Catholic
 Hinduism
 Sikhism




 Judaism
 Islam
 No religion (none)
Christianity (Other)
Other faith / belief
Buddhism
Prefer not to answer
8) Which of the following best describes your sexual orientation?
 Bisexual
 Heterosexual
 Other
 Gay Man
 Lesbian/Gay Woman
 Prefer not to answer
9) Where did you see the Advertisement for this Post?
Newspaper (which one?)
Professional Journal (which one?)
Vacancy Bulletin
SHOW (NHS Scotland Website)
Job Centre Plus
Other (please specify)
Thank you.
equaloppsmonform