Before you begin — please ensure you have the following to hand: GMC/NMC/professional registration number, your Responsible Officer's details, contact details for two referees, and your professional indemnity insurance information.

Personal Details

Title *

Full Name *

Date of Birth *

Email Address *

Address *

Post Code *

Job Title / Specialty *

Qualifications *

Professional Registration Number *

Sub-specialisms

Biography

Professional Website (URL)

Substantive Employer

Employer Name *

Employer Address

Responsible Officer

Name *

Email *

Telephone

Proposed Sessions & Procedures

Proposed Session for The Vesey *

List of Procedures You Wish to Carry Out * (HRG Codes)

Please list all procedures you intend to perform for The Vesey confirming they are within existing scope of practice.

Professional Memberships

References

Please provide the email addresses of two professional referees. References will be contacted directly.

Reference 1 Email *

Reference 2 Email *

Financial Interests Declaration

Do you or any member of your direct family have a financial interest in any hospital or healthcare facility at which you hold practising privileges or have referring rights? *

YES NO

Do you or any member of your direct family have a financial interest in any equipment at a hospital or healthcare facility at which you hold practising privileges or have referring rights? *

YES NO

Regulatory Declarations

Have you been convicted in the UK of any offence or been convicted elsewhere of any offence which, if committed in the UK, would constitute an offence, if the offence relates to the conduct required in carrying on a regulated activity? *

YES NO

Have you ever been erased, removed or struck-off a register of professionals maintained by a regulator of healthcare or social work professionals? *

YES NO

Are you aware of any investigation by a regulatory body or the potential of an investigation? Are you aware of any patient complaints that may lead to an investigation? *

YES NO

Right to Work in the UK

We are legally required to verify every applicant's right to work in the UK before privileges or employment can begin. British and Irish citizens can prove this with a valid passport (uploaded below). All other nationals should provide a Home Office online right-to-work share code, which you can generate at gov.uk/prove-right-to-work, together with your date of birth.

Nationality

Right-to-work share code (if applicable)

Document Uploads

Please upload clear copies (PDF, JPG or PNG). Photo ID and proof of address are used for identity and right-to-work checks; clinicians must also provide professional indemnity.

Passport (photo page — select more than one file if you need to include additional pages)

Driving licence (front and back if applicable)

Proof of address (utility bill, dated within 3 months)

Professional indemnity certificate (clinicians)

Trouble uploading? You can also email documents to RECEPTION@THEVESEY.CO.UK with your full name in the subject line.

Required Fees & Subscriptions

Enhanced DBS Check (required)
All Practitioners must have an enhanced DBS Check. This is chargeable at £65.20.

Pay DBS Fee →

Billing, Invoicing & Reconciliation — SOP

Invoice Requirements

Each invoice must contain: date and time of consultation/procedure; type of activity (Consultation/Procedure); rate of pay; an identifier to reconcile the patient against Medesk records (Initials/NHS number/hospital number); clinician name or full company details (if corporate entity); address; email; telephone; bank details including sort code and account number.

Submission

Following the end of each calendar month, and no later than the 14th of the subsequent month, a single invoice should be submitted for clinical services, electronically in Word or PDF format, to: invoices@thevesey.co.uk — and not include any cc'd persons. Invoices not in this format will be rejected. Invoices in Excel spreadsheet format will be rejected.

Invoices should only be sent once. Sending invoices multiple times or statements will result in delays.

Invoices Must NOT Contain

Patient identifiable information such as patient name or address.

Payment Schedule

Once approved, invoices are scheduled on payment runs twice monthly on the 2nd or 4th Friday of each month. Approved invoices should be settled within a 28-day window from approval.

Queries

For invoice queries: invoices@thevesey.co.uk (include invoice number as subject). All queries responded to within 48 hours via email only.

Escalation

For any payment delays: Ben.royal@thevesey.co.uk

Declaration & Consent

Before commencing private patient activity within The Vesey, Practitioners MUST:

Undertake and consent to DBS check (chargeable at £65.20 as of September 2026)
Agree to all terms and conditions
Accept and agree to abide by the terms of the Practising Privileges Policy

All Medical Professionals with practising privileges may have profile details published on The Vesey website to comply with CMA requirements.

BY SUBMITTING THIS FORM, I confirm that the information supplied is an accurate record of my current medical practice and accurately reflects any personal and professional details. I agree to abide by the Practising Privileges Policy and all terms and conditions of The Vesey Private Hospital Ltd. *

Once submitted, our Registered Manager and General Manager will review your application and contact you within 5 working days. For queries contact hello@thevesey.co.uk or call 0121 387 3705.

Application Received — Thank You

Your practicing privileges application has been submitted successfully. Our Registered Manager and General Manager will be in touch within 5 working days.

In the meantime, please ensure you have completed your DBS fee payment using the link above.

Welcome to the NHS Practicing Privileges Application

Personal Details

Substantive Employer

Responsible Officer

Proposed Sessions & Procedures

References

Financial Interests Declaration

Regulatory Declarations

Right to Work in the UK

Document Uploads

Required Fees & Subscriptions

Billing, Invoicing & Reconciliation — SOP

Invoice Requirements

Submission

Invoices Must NOT Contain

Payment Schedule

Queries

Escalation

Declaration & Consent

Application Received — Thank You