AvMA - – New experts application form

Personal details

Name

Title

Qualifications

Contact address (incl postcode)

Telephone

Fax

Email

In addition to your full CV we will also require additional information set out below

Professional registration

PIN and registration year

Current post

Year appointed: as consultant

We do request that all our experts have been in a consultant post for at least 5 years.

Year appointed: to current post

Specialism

Special interests

Current hospital/trust

Are you currently working in the NHS?

Yes
No

How many years have you been preparing reports for clinical negligence cases?

How many clinical negligence reports have you done?

How many times have you given oral evidence in court in a clinical negligence case?

Have you ever been criticised by a judge in a reported case in your role as a medical expert?

Yes
No

If so please provide the case citation and any information you feel may be relevant

Have you ever been sued in your capacity as a medical expert?

Yes
No

Have you had any medico-legal training?

Yes
No

Are you engaged in any other medico-legal work? If so, please give details.

Have you read our expert protocol?

Yes
No

What percentage of your clinical negligence caseload is claimant work?

What is your current hourly rate?

What is your current turnaround time for reports?

We would be grateful if for audit purposes you provided a suitably anonymised clinical negligence report (liability or causation and not a condition and prognosis report) and the name of a claimant lawyer you have written a medical negligence report for (not personal injury) who would be willing to act as a referee. Alternatively, we require the names of two AvMA accredited panel members who you have written reports for who would act as referees. Please see the Help and Advice Section on our website for AvMA panel members. If you have not done any clinical negligence work, could you please provide the names of two consultant colleagues who would be willing to provide you with a reference. We also require a short up to date CV and would be grateful if you would send one.

Would you be willing to speak on your subject at AvMA events?

Yes
No

Would you be willing to contribute an article to the Journal of Patient Safety and Risk Management?

Yes
No

General Data Protection Regulation (GDPR) requirements

Are you happy for us to send information by post to you directly?

Yes
No

Are you happy for us to email you directly?

Yes
No

Are you happy for us to forward you information from a third party? For example information on training

Yes
No

Are you happy for us to forward your information to a third party? For example to our member solicitors

Yes
No

Privacy notice: The information we send you may include our lawyers service/medical expert newsletter, questionnaires/surveys to assist us with policy work/government consultations, information on conferences etc. We will always store your personal details securely. To view our privacy notice please visit www.avma.org.uk/privacy

File upload

Please upload your CV and a suitably anonymised clinical negligence report (if applicable)

Drop files here or

Max. file size: 10 GB.

Email

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