8 Eastgate Avenue, Eastgate, Little Island, Co. Cork, Ireland Tel: + 353 (0)21 4297901 Fax: + 353 (0)21 4297943 info@locumexpress.ie www.locumexpress.ie Doctor Registration Information HSE Europe s Premier Locum Agency 1
Table of Contents: 1 Introduction to Locum Express 3 2 Changes to Working within the Health Services Executive 3 3 Registration with Locum Express 4 4 Terms and Conditions: Doctors 5 5 Approval to Request Health Screening Information 6 6 Specialties & Grades 7 7 Locum Express Safety Policy 8 8 Self Declaration Forms 9 2
1. Introduction to Locum Express Locum Express was established in July 2006 to provide a cost effective service for providing Medical Locums to hospitals in Ireland. By the end of 2006 we were providing locums on a regular basis to 3 hospitals in Ireland. We have continued to grow and have now established ourselves as a leading provider of Locums in Ireland. In November 2009 we were awarded contracts for the provision of Medical Locums to the majority of HSE hospitals in Ireland. We fully comply with the requirements of the Employment Agency Act 1971 and have a license issued by the Department of Trade and Employment. Unlike some other agencies we do not charge doctors fees for placement services. We are also a member of the National Recruitment Federation (NRF) and we comply with the NRF Code of Conduct. Finally, Locum Express is also registered with the Data Protection Commissioner and complies with the Data Protection Acts. Why should you consider working for Locum Express? We have been awarded Contracts to provide Medical Locums to all HSE hospitals and institutions within the following catchment areas; Dublin, North East, West and Midlands. We have an extensive list of Clients and are Ireland's most active agency. Locum Express has clients throughout Ireland and the excellent service provided has resulted in a 98% repeat business rate. We have long standing and personal relationships with our Doctors. We provide a fast, professional and reliable 24/7 service. We can help you to organise Locum work in overseas locations. If you are interested in travelling and working overseas, we have relationships with Locum Agencies in the UK, Mainland Europe, Australia, New Zealand & South Africa and we can assist you in finding work in these locations. 2. Changes to working within the Health Services Executive As a result of the award of Contracts to provide Medical Locums to the HSE there will be changes in the documentation and arrangements for working within the HSE. These are summarised as follows: Documentation Police I Garda Vetting - The requirement for Garda Vetting is mandatory. Locum Express will continue to arrange for Garda Vetting on all Doctors. The Doctor will be required to pay a fee of 25 to have the vetting completed. Doctors who have worked outside of Ireland will also be required to provide a police clearance for any jurisdiction where they have worked. Completion of a Pre-placement Health Declaration Form (as attached). The HSE now require each locum doctor to have an Independent Occupational Health Assessment letter. The Doctor is required to pay a once-off fee of 60 to have this completed. Statutory Declaration form (as attached). The HSE now require each doctor to have a Statutory Declaration form completed by the doctor and must be notarised by a Notary public, Peace Commissioner, Commissioner of Oaths or practicing solicitor. Other Changes Payments to Doctors: There will no longer be any Employer I Employee relationship between the Doctor and the HSE and the HSE will no longer make payments to Doctors. Doctor payments will be made by Locum Express. Contracts with Locum Express: In order to allow Locum Express to make payments to a Doctor there will need to be a contract in place between the Doctor and Locum Express. These will be issued to Doctors individually. The changes to the payment of Doctors by Locum Express will allow payments to be made faster and more consistently. 3
Insurance: Doctors will be required to hold the following insurances. o Public Liability insurance with a limit of indemnity of 6,500,000, any one occurrence, with an indemnity to the Executive arising from the provision of the Services, which insurance will also cover claims arising from the activities of any subcontractor engaged by the Agency. o Employers Liability insurance with a limit of indemnity of 12,700,000 any one occurrence, with an indemnity to the Executive arising from the provision of the Services, which insurance will also cover claims arising from the activities of any subcontractor engaged by the Agency. European Working Time Directive (EWTD) 93/104/EC: was transposed into Irish Law by means of the Working Time Act 1997. A subsequent Directive, 2000/34/EC, amended the EWTD to limit the working hours of doctors in training by means of a phased in implementation process as follows: o An average of 56 hours on-call on-site per week from 1 Aug 2007 o An average of 48 hours on-call on-site per week from 1 Aug 2009 There are specific definitions and requirements related to implementation of the EWTD for doctors in training and all Doctors will need to understand these requirements and comply with the Directive. 3. Registration with Locum Express The following information and documentation are required to complete your registration: a. An up to date CV with a minimum of 5 Years work history (if less the five years include all work history). CV should outline full work history and explain any gaps in employment. Also CV should have written evidence of all relevant training/education undertaken. The CV should preferably be sent electronically b. Minimum of three up-to-date written references and Contact details of at least 3 referees (2 within the last 6-12 months). c. A Notarised copy of your current Irish Medical Council Registration. d. A copy of your General Medical Council Registration (if you have this). e. Notarised copies of graduate and postgraduate qualifications - Bachelors degreei MRCPII FRCSI and other training. f. Occupational Health Clearance I Occupational Health Screening Status. Please note: You may also be required to get a validated Blood sample, if you do not have this already and if you wish to work in Emergency Medicine, Obstetrics & Gynaeco logy, Paediatrics, Surgery or Anaesthetics you may be required to be EPP Cleared if you do not have this already. g. Copy of your up to date ACLS or equivalent. h. Copy of your up to date ATLS (only required if you wish to work as a Registrar in Emergency Medicine {A&E). i. Notarised Copy of passport (photo page}, (Scanned in color or posted, we cannot accept faxed copies). j. Copy of your Work Permit I Visa I GNIB (only for non EU Nationals, Scanned in colour or posted, we cannot accept faxed copies). k. Statutory Declaration Form (enclosed). The HSE now require each doctor to have a Statutory Declaration form completed by the doctor and must be notarised by a Notary public, Peace Commissioner, Commissioner of Oaths or practicing solicitor. Note: Garda Vetting (will be completed once you become registered with Locum Express). l. Pre Placement Health Questionnaire (Attached). The HSE now require each locum doctor to have an Independent Occupational Health Assessment letter. The Doctor is required to pay a onceoff fee of 60 to have this completed. In addition to providing the above information, please complete and return signed copies of the documents in the remaining sections: 4
4. Terms and Conditions: Doctors 1) Doctors working in jobs sourced by Locum Express do so as employees of Limited Companies and therefore are responsible for their own tax returns made to the Revenue Commissioners. 2) Neither Locum Express nor the HSE are employers of the Doctor, as the Doctor is a an employee of a Limited Company. 3) It is the responsibility of the Doctor to submit their completed time sheet to Locum Express when they have finished a locum position. It must contain the Doctor's Signature and an Approval Signature. Payments cannot be processed without an approved timesheet and an invoice. 4) Doctors are paid according to the Locum Express rate card in effect. Rates paid to Doctors and the Locum Express rate cards are confidential. 5) Doctors are responsible for ensuring they have adequate medical indemnity, employer's liability and public liability insurance. 6) The Doctor must complete an appropriate insurance form on arrival to the Hospital I Healthcare facility. This will be provided by the Hospital/ Healthcare facility. 7) Locum Express or the Client can terminate the Locum contract with the Doctor at any time. 8) Locum Express accepts no responsibility for Clients that cancel locum cover. 9) Doctors are responsible for complying with the European Working Time Directive. 10) Doctors are responsible for complying with the requirements of the Locum Express Safety Policy (copy enclosed) and becoming familiar with the Safety Statement that is in effect at any place of work. 11) These Terms & Conditions are in addition to any Contractual arrangements in place and apply for each position offered and filled by Locum Express. 12) Locum Express reserves the right to change these terms and conditions. I accept the terms and conditions of Locum Express Name (Block Capital Letters): Signature: Date: 5
5. Approval to Request Health Screening Information If you do not have your Occupational Health Screening information, please fill out following form: APPROVAL TO REQUEST HEALTH SCREENING INFORMATION SECTION A: (for completion by Doctor) Name: DOB: Address : Hospital of last screening: I hereby give my consent for Locum Express to obtain the following information on my Occupational Health screening. I do* / I do not* wish to see this completed form before it is sent to Locum Express. Signed: Dated: SECTION B: (for completion by Occupational Health) Information supplied by: Position: Date: Department Stamp: 6
6. Specialties & Grades Please indicate your working preferences in the following table. Please tick the appropriate boxes: Specialty Accident & Emergency SHO Registrar Consultant Accident & Emergencv-Paeds Accident & Emergency-Medical Anaesthetics Ears, Nose & Throat General Medicine Medicine - Rheumatology Medicine - Cardiology Medicine - Renal Medicine - Endocrinology Medicine- Respiratory Medicine - Geriatrics Medicine - Infectious Diseases Medicine - Oncology Medicine - Haematology Medicine - Gastroenterology Medicine - Cardiology_ Medicine - Neurology Medicine - Nephrology Paediatrics Neonatology Obstetrics & Gynaecology Orthopaedics Urology General Surgery Cardiothoracic Surgery Brest Surgery Colorectal Surgery Paediatric Surgery Plastic Surgery Psvchiatry Radiology Name (Block Capital Letters): Signed: Date: 7
7. Locum Express Safety Policy You are required to read and comply with the requirements of the Safety Policy: 1) Locum Express is committed to securing the safety, health and welfare of all its employees at work, and to the prevention of risks to safety, health and welfare of visitors, contractors and members of the public affected by the company's activities. The company will provide staff with the resources, information, training and supervision necessary to achieve this purpose. Locum Express continually seek to improve our health and safety policy. 2) The statement is based on an identification of hazards and assessments of the risks to safety, health and welfare on the premises. 3) Locum Express acknowledges its responsibilities with regard to the environment. A ll hazards and risks will be assessed and appropriate steps taken to eliminate or minimize them. 4) Safety, health and welfare are a line responsibility at LOCUM EXPRESS and the employer and employees are responsible for safety in their own areas.all employees and contractors who work on Client sites must become aware and adhere to their safety statement and requirements. 5) The Safety Statement will be altered as necessary as conditions change, and kept up to date. The provisions of this statement and the operation of the company Safety Policy will be reviewed not less frequently than annually. 6) Suggestions for improvements to this Safety Statement and to the arrangements for securing safety, health and welfare at work on the premises are welcome and staff and others to whom this statement applies should feel free to put forward suggestions at any time. Locum Express strives to foster and promote a positive safety culture throughout the company. 8
8. Self Declaration Forms Schedule One: Pre-placement Health Declaration Form Section 1: Personal details Surname: Surname at birth: First names: PPS Number: Address: Date of Birth: Home Telephone: GP Name: Gender: Mobile Telephone: GP Telephone: GP Address: Section 2: Present and previous employment Please provide details of your previous three posts, starting with your present or most recent post Job Title Employer Address From To Section 3: Sickness absence Please indicate time lost from work or education in the last 2 years due to illness Date and length of absence Reason for absence Section 4: Questionnaire Please tick the appropriate Yes or No box for the following questions. Please give details 1. Do you have, or have you ever had, any medical conditions or operations in the past 5 years? 2. Are you at present attending a doctor for medical care, taking any medication or on a waiting list for hospital assessment or treatment? 3. Have you ever suffered a work-related illness, or given up work because of ill health? 9
4. Do you have any impairment/ disability (physical or mental) or specific learning disability which may affect your ability to work? 5. Have you ever suffered from tuberculosis (TB)? a. Within the past 12 months b. Has any family member or close contact been treated for TB? c. Have you had a cough for more than 3 weeks? d. Have you coughed up blood? e. Have you had any unexplained weight loss? f. Have you suffered from night sweats or fever? If you answered yes to any of the above, please give details 6. Have you ever had any kind of back, joint or muscle problem? 7. Have you ever had:dermatitis, Eczema, Psoriasis or any other skin condition? 8. Have you ever had any mental illness which might affect your ability to work? (including anxiety, depression, self-harm, eating disorders, psychological or emotional problems) 9. Have you ever had a drug or alcohol problem? 10. Do you have difficulty with your eyesight (including colour blindness)? 10
11. Do you have difficulty with your ears or hearing? 12. Have you ever suffered from any of the following: loss of consciousness including fainting attacks, blackouts, dizziness, epilepsy? 13. Have you ever suffered from any of the following; heart disease or circulatory problems: including high blood pressure, varicose veins? 14. Have you ever suffered with chest or lung problems; Asthma, Bronchitis? 15. Do you have any allergies; including allergies to drugs, food or latex? 16. Have you ever received treatment for a bowel or gastric problem? 17. Have you ever suffered a disorder of the bladder or kidneys? 18. Do you have any other medical condition not previously mentioned in questions 1-17 above? 11
Section 5: Immunity and Immunisation Status Healthcare Workers with Patient Contact : General requirements All healthcare workers with patient contact are required to provide information relating to their immunity to TB, Mumps, Measles, Rubella, Varicella and Hepatitis B (anti-hbs). Please include copies of previous laboratory test results. lmmunisations and Immunity Status (Please complete) Exposure Prone Procedures (EPP) In addition to the above, employees who may be involved in exposure prone procedures are required to submit evidence of non-infectivity to hepatitis 8 and C. The following are required: o Hepatitis 8 core antibody (Anti-H8c) o Hepatitis 8 surface antigen (HBsAG) o Hepatitis C antibody Tests must be carried out on identified validated samples {IVS). Only results from an Irish or UK occupational health service that has confirmed the identity of the person by checking appropriate photographic ID e.g. passport, driving licence or a photographic ID card will be accepted. For International recruitment, please refer to International recruitment documentation. Your Consultant or Manager will be advised that you cannot undertake Exposure Prone Procedures until all the requisite information has been received. If you are aware that you have any infectious disease or other health related condition that may impact upon your work, you have a responsibility to discuss these with the Occupational Health Professional. Specific requirements of Health Care Workers performing Exposure Prone Procedures Hepatitis B antibody (Anti-HBs) Date checked: Result: Hepatitis B core antibody (Anti-HBc) Date checked: Result: Hepatitis B surface antigen (HBsAG) Date checked: Result: Hepatitis Be antigen (HBeAG) Date checked: Result: (If Hepatitis B surface antigen test is positive) Hepatitis B viral load Date checked: Result: (If Hepatitis B surface antigen I Hepatitis Be antigen test is positive) Hepatitis C antibody Date checked: Result: Hepatitis C virus RNA Date checked: Result: (If Hepatitis C antibody test is positive) 12
The above tests for Hepatitis B & C must be taken and processed in line with Identified Validated Specimen (IVS) standards and must be completed, signed and stamped by an Occupational Health Professional. To facilitate an efficient process,iagree that the Occupational Health Professional can obtain my immunisation and screening results from the Occupational Health Professional in my previous employment Official Stamp Please provide the name and address of your last Occupational Health Provider. Name of occupational health provider: Address: Section 6: Declaration by Applicant I declare that I understand, accept and confirm the entitlement of the (agency) to reject my application or terminate my employment (in the event of a contract of employment having been entered into) where I have omitted to furnish the Agency with any information relevant to this health assessment or where I have made any false statement or misrepresentation relevant to this health assessment Signed: Date: Print Name: 13
Subject: Statutory Declaration Form Dear Doctor, Please find attached HSE Statutory Declaration form for your attention. The HSE now require all doctors to have a Statutory Declaration filled out and stamped and signed by a notary public, practising solicitor or a Commissioner for Oaths. If you have any further queries regarding the above, please do not hesitate to contact us at the office on +353 21 4297901. Yours Sincerely, Locum Express 14
Statutory Declaration - New Employees I, of in the County of (aged over 18 years) SOLEMNLY AND SINCERELY DECLARE as follows: 1. This Declaration relates to my application for the position of with the Health Service Executive as to my suitability for that position. 2. I hereby declare that to the best of my knowledge and belief there is nothing in relation to my conduct, character or personal background of any nature that would adversely affect the position of trust in which I would be placed by virtue of my appointment to the above position. I further declare that by making this declaration, I shall undertake, as soon as practicable, to bring to the attention of the Health Service Executive any matter which may adversely affect that position of trust. I further declare that I have given my irrevocable consent to the Health Service Executive to make or cause to be made full enquiries with the Central Vetting Unit of An Garda Siochana in relation to my suitability to hold the above position with the Health Service Executive. 3. I further declare that I understand, accept and confirm the entitlement of the Health Service Executive to reject my application or terminate my employment (in the event of a contract of employment having been entered into) where I have omitted to furnish the Health Service Executive with any information relevant to my application or to my continued employment with the Health Service Executive, or where I have made any false statement of misrepresentation relevant to this application or my continuing employment with the Health Service Executive. 4. I refer to the extract from the Public Service Management (Recruitment and Selection) Act 2004, annexed hereto upon which I have endorsed my name prior to making this declaration. I say that I have read, understood and accept the provisions therein and in particular that any incorrect, false or misleading information provided during the recruitment process or any action prohibited under the Act shall jeopardise any employment with the Health Service Executive and I make this declaration with such prior knowledge. 5. I make this Solemn Declaration consciously believing it to be true for the satisfaction of the Health Service and pursuant to the provisions of the Statutory Declarations Act 1938. Declared before me by whose identity has been established to me prior to the taking of this Declaration by the production of the relevant documentation(see below) to me of Passport/National Identity CardfTravel Document Number issued on by the authorities of which is an issuing authority recognised by the Irish Government or who is identified to me by in turn is personally known to me at on the day of, (month), (year) 15
Signed: Print Name: Practising Solicitor/ Commissioner for Oaths / Notary Public / Peace Commissioner* duly authorised by Statute to take and receive statutory declarations * Delete as appropriate A.Uix Stamp Here 16
Relevant documentation is defined in section Part 5 section 49 (b) of the Civil Law (Miscellaneous) Act 2008 as follows: (b) by inserting the following after subsection (3): (4) In subsection (2) 'relevant document ' means- (a) (b) a valid passport issued by or on behalf of an authority recognised by the Government, a national identity card issued by the authorities of- (i) a Member State, (ii) the Swiss Confederation, or (iii) a Contracting Party to lhe EEA Agreement (c) a document which is equivalen t to a passport, issued by or on behali of an authority recog nised by the Government, which establishes the identity and nationality of the person to whom the document relates, (d) a travel document issued by the Minister for Justice, Equality and Law Reform under section 4 of the Refugee Act 1996, or (e) a travel document other than a document to which paragraph (d) refers issued by the State solely for the purpose of providing the holder with a document which can serve in lieu of a national passport. (5) In subsection (4), 'EEA Agreement' means the Agreement on the European Economic Area signed at Oporto on the 2nd of May 1992 as amended for the time being.". The Public Service Management (Recruitment and Selection) Act 2004, Part 5, Obligations' of Candidates in Respect of Recruitment and Selection Procedures 53.-This Part applies to- (a) The carrying out under this Act of any recruitment and selection of persons for positions within the public service, and (b) The selection for promotion of civil servants or the staff of any other public service body. 54.-ln respect of a competition for a position within the public service, a person shall not- (a) Knowingly or recklessly make an application that is false or misleading in a material respect for the position, (b) In purported compliance with a requirement for the position, knowingly or recklessly provide any information or documentation that is false or misleading in a material respect, (c) Canvass any person, with or without inducements, on his or her own behalf or on behalf of a candidate for the position, (d) Personate a candidate at any stage of the recruitment and selection process concerned, (e) Knowingly or maliciously obstruct a person engaged in the conduct of the competition or otherwise interfere with the general conduct of that competition, 17
(f) Knowingly and without lawful authority take any action that could result in the compromising of any test material or of any evaluation of it, (g) Interfere improperly with the competition process or competition records so as to confer an advantage or a disadvantage on any candidate. 55.- (1) In respect of paragraphs (a) to (g) of section 54, a person who contravenes any of those paragraphs is guilty of an offence. (2) A person who knowingly aids, abets, counsels or procures another person to commit any offence under subsection (1) or conspires with another person for the commission of any such offence is guilty of an offence. (3) A person who is guilty of an offence under this section is liable- (a) On summary conviction to a tine not exceeding 3,000 or to imprisonment for a term not exceed ing 6 months, or to both, or (b) On conviction on indictment to a fine not exceeding 10,000 or to imprisonment for a term not exceeding 2 years, or to both. 56.- (1) Where in respect of a competition a person has been found guilty of an offence under section 55 and was or is a candidate at the competition then- (a) Where he or she has not been appointed to a position as a result of that competition, he or she shall stand disqualified as a candidate, (b) Where he or she has been appointed to a position as a result of that competition, he or she shah forfeit that appointment. (2) Notification of forfeiture under subsection (l)(b) shall be given in writing to the person concerned by the office holder concerned. (3) Noth ing in this section shall be read as restnctmg the imposition of any appropriate sanction including, as a consequence of the application of the procedu res referred to in section!3(1){g), disqualification or forfeiture. I have read, understood and accept the Obligations' of Candidates in respect of Recruitment and Selection Procedures as outlined above. Signed: Print Name: Date: 18