Honorary Contracts Guidance Notes

If you are planning to commence at University Hospitals of Leicester NHS Trust on an agreed work placement or to conduct/participate/undertake research involving University Hospitals of Leicester NHS Trust staff, patients, organs, tissues or data (in any way) you must have an Honorary Contract issued by the University Hospitals of Leicester NHS Trust of Medical Human Resources Department. If you do not have an honorary contract you are not authorised to work at University Hospitals of Leicester NHS Trust staff, patients, organs, tissues or data. If an honorary contract has been issued to you by another NHS Trust this will NOT cover your work at University Hospitals of Leicester NHS Trust. In order to obtain an honorary contract, please complete an application form and send to: Name: The Department of Medical Human Resources Trust Headquarters Gwendolen House Gwendolen Road Leicester LE5 4QF Tel: 0116 258. ext, ... 1. Contact details: Name, Address and Telephone Number (between the hours of 9 am to 5 pm Monday to Friday) and E-mail address. 2. Substantive employer/Supervisor & Place of Study: Please provide the name, address and telephone number of your current substantive employer or, in the case of a student, your supervisor details and place of study. 3. Proof of I.D.: This can be in the form of passport or birth certificate and driving license. 4. The details of your professional registration and CV: Registration number, expiry date, copy of your certification and your most recent CV and 2 referee contact details. 5. The name of the department in which you will be carrying out your studies or work placement. 6. Hepatitis B Clearance: If you are to undertake exposure prone procedures, your honorary appointment is subject to the production of a certificate of immunity against Hepatitis B. Exposure prone procedures cannot be undertaken until immunity is proved. If immunity cannot be proved the honorary contract may be terminated. 7. Access to children or vulnerable adults: As an Honorary appointee, you should not have unsupervised access to children or vulnerable adults. If the post involves access to children or vulnerable adults in our care, you must have the appropriate clearance from the Criminal Records Bureau in order to verify that you do not have any criminal convictions which would indicate unsuitability for work with children. 8. Will your duties include involvement in any research activity: This is to establish whether as an honorary appointee, you will be involved in any research activity. 9. If you will be working on a particular project, please provide the following details: a. Ethics committee reference number (if known) This is the number allocated to the research project(s) by the ethics committee.
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b. Study Title: - The full title of the research project(s) you are working on. 10. The date your involvement in the research/work placement will commence and the date your involvement will cease: If you do not know when you are likely to finish your work here at University Hospitals of Leicester NHS Trust, please add in a review date. We can always extend the contract, but we must have a date by which to do this. 11. Number of hours / sessions to be undertaken at the UHL. 12. Supervisors Details: Please provide Name, Address and Telephone Number. This is the person who is supervising your work on a day-to-day basis. This may be your university supervisor or an employee at University Hospitals of Leicester NHS Trust. 13. Authorisation and Accountability: a. Authorisation must be obtained in order for a contract to be issued. (An application will not be considered without this). The authorising signatory must be willing to take on the responsibilities as detailed in the declaration, be a University Hospitals of Leicester NHS Trust Employee and ideally be the lead investigator. (The lead investigator has responsibility under the Research Governance Framework for the management and conduct of the project, and this extends to ensuring that the research team are suitably qualified and that all staff hold appropriate Honorary contract status). If however, the lead investigator is not an University Hospitals of Leicester NHS Trust employee, then authorisation may come from one of the following: Line Manager, Head of Department, Divisional Clinical Director, Clinical Director in the Division or Directorate that you are working in. b. Please note that authorisation also needs to be obtained for an honorary contract to be issued where the contract does not involve research. The guidance notes should be read and the application form completed in all circumstances where an honorary contract is required. 14. Applicants signature and date: Once issued with an Honorary Contract, a signed copy must be returned to the department of Medical Human Resources before you commence. If our records show that you have not been issued with an honorary contract, the Trust has the right to ask you to cease your work until the appropriate documentation has been issued.

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Honorary Contract Application Form

Please complete using the guidance notes. Completed forms should be sent to: Name , Department of Medical Human Resources, Gwendolen House, Gwendolen Road, Leicester, LE5 4QF Tel: 0116 258 ext ...

1. Contact Details

Name: Address:

2. Substantive Employer Supervisor contact details

Tel No: E-mail: Name: Address:

3. 4. 5. 6. 7. 8.

Tel No: Place of Study: The details of your professional registration. Name of department in which you are carrying out your studies. Will you be undertaking exposure prone procedures? Will you have unsupervised access to children or vulnerable adults? Will your duties include involvement in any research activity? Ethics Committee Reference Number(s) if known & Study Title(s).

Yes/No

9. The date your involvement in the research/work placement will commence. The date your involvement will cease. (Please delete as appropriate) 12. Number of Hours: 13. Supervisor Details: Name: Address:

Finish Date

Review Date

Tel No:
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Authorisation / Accountability. Declaration: As the Responsible University Hospitals of Leicester NHS Trust employee for the honorary appointee, you are accountable for the actions of the honorary appointee whilst they are undertaking duties which fall under the capacity in which they are authorised to work. It is your responsibility that the individual has received the appropriate clearance in accordance with their role and that clear guidelines exist regarding the capacity in which they are authorised to work. In addition, it is your responsibility that the individual receives adequate supervision and adheres to the Legal and Trust guidelines as detailed in honorary contracts. By signing the application, you are agreeing to abide by the above statement. Name: Designation: Post Title for Honorary Contract Holder: Signature: Date:

14. Applicants Signature: Name: Designation: Signature: Date:

Have you attached copies of the following: Passport and/or Birth Certificate and driving license (Proof of I.D.) Professional Registration Certificate Up to date CV, including two referee details Certificate of immunity for Hepatitis B (if appropriate) Criminal Records Bureau (CRB) disclosure form Have you obtained the following: Signature of authority/accountable person Signed & dated the form

If you have any queries regarding these requirements please contact the Department of Medical Human Resources.

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