GEN2

Consultant report form

This is a request f or a consultant report on behalf of:

Applicant’s name

Applicant’s GMC reference number

Request

the applicant’s supervising

consultant/consultant colleague

Please complete all the parts and sign the declaration at the end.
The notes on pages 2-3 are intended to help you assess the performance of the applicant. Please read the notes
caref ully before completing Part B.
When you have completed the form
You are encouraged to discuss your report with the applicant. Please note that a copy of the completed report will be
shared with the applicant.

Please send your completed form as one PDF or zip file to: [email protected]

Please send the form directly to us by email, ensuring that you include the applicant’s name and GMC reference number
in the subject line. We only accept emailed forms from professional email addresses. We do not accept them from
personal webmail accounts such as hotmail, yahoo or gmail.

If you do not have a professional email address please include a supplementary cover sheet on o fficial letterhead
paper which also includes an official stamp.
The standards

Please use the notes in the table below to help you consider the aspects of a doctor’s practice which you should take into
account in your assessment of whether this doctor has reached the required standard.

Standard Description of standard

1 Good clinical care

Assessment of the patient’s condition based on Does this doctor make an adequate assessment of the
history, physical examination and recognition of patient’s condition based on the history and clinical signs and,
clinical signs if necessary, appropriate examination?
Providing or arranging investigations and Does this doctor provide or arrange appropriate and timely
treatment investigations and treatment? Are they competent when
making diagnoses and when giving or arranging treatment?
Judgement and patient management Is this doctor’s judgement reliable? Do they show awareness of
complications? Is their ward/out-patient management safe? Do
they recognise and work within the limits of their competence?
Do they consult and seek advice appropriately?
Practical skills Are this doctor’s practical skills adequate?

Involvement of doctors and other health care Does this doctor consult colleagues and refer to other
prof essionals in providing clinical care practitioners when indicated? Do they keep colleagues
inf ormed when sharing the care of patients?
Record keeping Does this doctor keep clear, accurate and contemporaneous
records which are adequate to inform others about the care of
patients? Do they report relevant clinical findings, decisions
made and information given to patients, and drugs or treatment
prescribed?
Use of resources Does this doctor pay due regard to efficiency and the use of
resources?
Use of technology Is this doctor competent in the use of IT which is necessary for
patient care, such as information storage and retrieval
systems?

2 Maintaining Good Medical Practice

Basic science Does this doctor have adequate knowledge of the physical,
behavioural, epidemiological and clinical sciences upon which
medicine depends?
Clinical knowledge and skills Does this doctor possess an appropriate level of understanding
of acute illness and of disabling and chronic diseases within the
specialty, and of relevant interventions in acute and chronic
illness?
Do they keep knowledge and skills up to date? Do they
participate regularly in educational activities? Do they take part
in regular and systematic medical and clinical audit? Do they
respond constructively to assessments and appraisals of
prof essional competence and performance?
Ethical and legal framework of practice Does this doctor observe and keep up to date with the laws
and statutory codes which affect their work?

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Standard Description of standard

3 Professional relationships

Prof essional relationships with patients Does this doctor establish and maintain the trust of patients?
Do they listen to and respect their views, and their right to be
involved in decisions about their care? Do they respect
conf identiality and the privacy and dignity of patients? Are they
accessible? Do they respond honestly and constructively to
complaints or if things go wrong?
Working with other doctors Is this doctor accessible? Do they work constructively as part of
the clinical team? Do they respect the skills and contributions
of others?
Working with other health care professionals Is this doctor accessible? Do they respect the skills and
contributions of other health care workers? Do they delegate,
consult and refer appropriately?
4 Treatment in emergencies Is this doctor willing and able to deal with common medical
emergencies and with other illness in an emergency? Can they
be relied upon to take prompt and suitable action within the
limits of their competence and to seek assistance where
necessary?
5 Communication skills Does this doctor give patients the information they ask for or
need about their condition, its treatment and prognosis, in a
way they can understand? Do they communicate adequately
with colleagues and other health care professionals?
6 Teaching and training (if applicable) Not all trainees will be involved in teaching or training others. If
applicable:
Does this doctor accept responsibility for teaching junior
colleagues? Do they ensure that juniors are properly
supervised? Are they honest and objective in assessing the
perf ormance of others?

7 Attitudes

Reliability and probity Is this doctor dependable? Do they display honesty and
integrity? Do they always act in the best interests of patients?
Initiative Does this doctor show an appropriate degree of initiative?

Timekeeping Is this doctor punctual and reliable? Do they contact the unit to
warn of a problem?
8 Administration Is this doctor efficient in the management of their own time and
prof essional activities? Can they be relied upon to deal with the
tasks required?
9 Occupational health Does this doctor follow safe practices relating to chemical,
physical and psychological hazards in the workplace?

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GEN2
Consultant report

Part A – details of the applicant, the post and the reporting consultant

Applicant’s name

Applicant’s GMC reference number

About the post

The title of the applicant’s post (for example:
Senior House Officer or Registrar)

substantive honorary locum

This post was (please tick) (permanent) (unpaid) (temporary)

Specialty

Name and address of hospital where the applicant was employed

Period of employment

From D D M M Y Y Y Y To D D M M Y Y Y Y

This post was (please tick) f ull time part time

Hours of clinical practice per week

Was the applicant required to hold registration or a licence to practise with a medical
yes no
regulator?

If ‘yes’, please give us the name of the relevant medical regulator.

Please provide the name of the authority that regulates doctors in the country or region the applicant was working in (for
example General Medical Council, UK). Do not provide the name of an individual person.

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If ‘no’, please explain why the applicant was allowed to work in a medical capacity without holding registration or a licence
with the appropriate medical regulator.

Please provide a detailed job description and list of the applicant’s duties during this post.

Your details

Your name

Your GMC ref erence number

Your job title

If you are not still currently employed at the

same hospital where you supervised the
applicant please confirm when you left that
post, and where you are currently employed
(including the organisation’s address)

Period of your supervision

From D D M M Y Y Y Y To D D M M Y Y Y Y

Did you have direct contact with the applicant throughout the above period? yes no

Were you required to hold registration or a licence with a medical regulator in order to
undertake your post as a Supervising Consultant/Consultant Colleague? yes no

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If ‘yes’, please give us the name of the relevant medical regulator.
Please provide the name of the authority that regulates doctors in the country or region you were working in (for example
General Medical Council, UK). Do not provide the name of an individual person.

If ‘no’, please explain why you were allowed to work in a medical capacity without holding registration or a licence with the
appropriate medical regulator.

Are you related to the applicant? yes no

If yes please state the relationship (for example: ‘father’)

Part B – Your assessment of the applicant’s performance against the standards

Please tick the boxes below to indicate whether, in your judgment, the doctor has achieved the required standard. Please
tick only one box for each standard.

Standard Standard not Not

Standard
achieved achieved assessed

1 Good clinical care

Assessment of the patient’s condition based on history, physical
examination and recognition of clinical signs

Providing or arranging investigations and treatment

Judgement and patient management

Practical skills

Involvement of doctors and other health care professionals in

providing clinical care

Record keeping

Use of resources

Use of technology

2 Maintaining Good Medical Practice

Basic science

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 Clinical knowledge and skills

Ethical and legal framework of practice

3 Professional relationships

Prof essional relationships with patients

Working with other doctors

Working with other health care professionals

4 Treatment in emergencies

5 Communication skills

6 Teaching and training

7 Attitudes

Reliability and probity

Initiative

Timekeeping

8 Administration

9 Occupational health

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Part C – your general assessment
Please provide a detailed assessment of the applicant’s performance, including specific examples for each of the
questions outlined below.

1. What is your assessment of the doctor’s overall performance? Please explain your assessment with specific examples.

2. If you were unable to assess any of the areas indicated in Part B, please give an explanation for this.

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3. If you have indicated that the applicant has not achieved the required standard in any of the areas indicated in Part B,
would you please substantiate your assessment with specific examples.

4. Do you support the doctor’s application for full registration? yes no

If ‘no’, please provide comments

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Your contact details

Address

Email address

This should be an official work email address not a webmail address such as yahoo, hotmail or googlemail.

Telephone number

This should be an official work telephone number, not a personal home telephone number.

Website address for the organisation

Declaration

I conf irm that the information that I have given is true and accurate to the best of my knowledge (please tick)

I conf irm that I am not aware of any issues bringing into question this doc tor’s fitness to practise. (please tick)

Signature

Date D D M M Y Y Y Y

Of f icial stamp

Last updated on 11/11/2022. Please make sure you are using the most up -to-date version of the form. GEN2

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