You must complete form MPL 1 if you wish to be included in a Medical Performers List. However, if you are already included in a Performers List in the UK please complete form MPL 4A.
We strongly recommend that you read the guidance notes before completing the application form:
Application forms can be downloaded in step 3 of the process.
Please note that doctors applying for inclusion in (or amendment to) the Doctors’ Dispensing List can access the appropriate forms via the Pharmacy Services/Pharmaceutical List site
Contact our Contracts Management team: -
North Wales inclusions - 01495 30 0783
South East Wales inclusions - 01495 30 0739
Mid West Wales inclusions - 01495 30 0776
If you are currently included on the Performers List and need to change your status on the list, or are joining/ moving to a new/ different practice within the same Health Board (HB), please complete and submit a Change of Status form.
Data Protection Legislation covers the personal information provided by you on this Application Form. A Confidentiality Agreement, comprehensive training and specific Information Governance protocols govern all NHS staff that will process your information and this process is undertaken in a fair and lawful manner, only seen by those who require it for legal purposes. The personal information you provided is only used for compatible purposes and this will be in line with your expectations.
We will not knowingly release your personal details to any other organisation for any purposes without obtaining your explicit consent unless there is a justified, legal basis for doing so. However, this will be informed to you at the earliest possible stage.
If you would like any further information relating to the confidentiality of the information you provided, please contact the NWSSP Information Governance Manager on 02920 902272 , e-mail firstname.lastname@example.org or visit https://nwssp.nhs.wales/about-us/information-governance/
As part of the application process you are required to undergo an Enhanced DBS check. Before completing the on-line DBS form it is important that you read the guidance notes entitled Completing the On-Line Disclosure and Barring Service Application Form (Doc, 152kb) as these notes contain important information in relation to the passwords and codes needed to complete the form.
Once you have completed the on-line form you will need to make an appointment for a face-to-face interview in order that your documents and on-line application may be validated by an authorised officer. A face-to-face interview can be undertaken via video link (Doc, 142kb) providing the authorised officer is in receipt of your original documents. This face-to-face interview must be undertaken within 3 months of completing your on-line DBS form. Failure to attend within 3 months will be considered as ‘application withdrawn’ and your on-line form will be removed from the database.
Please ensure you make a note of the reference number (given upon completion of the form) as you will be asked for it when booking a face-to-face appointment. You can arrange an appointment by e-mailing email@example.com or by telephoning your nearest NWSSP Primary Care Services office
Please note that you cannot be included in a Medical Performers List until we have had sight of your enhanced DBS disclosure certificate in order to confirm that there has been a satisfactory outcome to any information received. Please note that having a criminal record may not necessarily be a bar from inclusion in a Health Board’s Medical Performers List
You may access an on-line DBS application form by using the following link: https://disclosure.capitarvs.co.uk/cheqs/.
If you require further assistance regarding the completion of the on-line DBS application form please contact us on tel: 01495 300739/300776 or by email to: firstname.lastname@example.org
You must complete:
We strongly recommend that you read the appropriate guidance notes before completing the application form:
It is important to us to get your feedback on the application process so that we can improve our service.
Please take a moment to complete our questionnaire.
Thank you for using the online application process.