GPMR Application - General Practice Solutions

General Practice Manager Register (GPMR) – Application Form

Instructions for Applicants

This form must be completed in full by any individual seeking admission to the General Practice Manager Register (GPMR). The information requested is necessary to assess your eligibility, verify your professional credentials, and establish your record of achievement.

All information provided will be treated in the strictest confidence and processed in accordance with the UK General Data Protection Regulation (UK GDPR) and the Data Protection Act 2018.

Section 1 - Personal details

Full Name *

Date of birth *

Residential Address *

Email Address *

Contact Telephone *

Professional Registration Number (if applicable): *

Section 2 – Current employment

Current Position / Job Title *

Organisation / GP Practice Name *

Organisation Address *

Commencement Date *

Line Manager / Employer Contact *

Employment Status (e.g. permanent, fixed-term, self-employed) *

Section 3 – Professional employment history

Please set out details of your employment history for the preceding ten (10) years (or since leaving full-time education). You should ensure that your account is comprehensive, accurate, and includes all substantive posts held.

Section 4 – Qualifications and Professional Training

Highest Qualification Attained

Relevant Professional Training / Development Courses (including dates):

Section 5 – Professional References

Please provide details of two professional referees. At least one referee must be your current or most recent employer.

Referee 1 – Full Name

Referee 2 – Full Name:

Position / Job Title

Organisation

Email Address

Contact Number

Section 6 – Applicant’s Declaration

I, the undersigned, hereby declare that the information provided within this application is accurate, complete, and truthful to the best of my knowledge and belief. I acknowledge that the submission of false or misleading information may result in the refusal of my application or, where registration has been granted, my removal from the General Practice Manager Register (GPMR).

Applicant Signature

Clear

Full Name

Date

Section 7 – Application Process and Membership Benefits

Following the submission and processing of this application, you will be formally invoiced for the applicable registration fee. Upon receipt of payment in full, you will be issued with a secure username and password, which will provide immediate access to:

- The GPMR Community Forum – a national professional network of General Practice Managers, thought leaders, and experienced healthcare managers, providing a platform for the exchange of expertise, advice, and best practice.
- A dedicated member portal enabling you to upload supporting documentation and to book your Professional Assessment.
- The opportunity to undergo a formal assessment leading to national recognition as a registered General Practice Manager.
- Upon successful registration, access to the Professional Consultancy Service (ten hours annually, included in your registration) and an expanding portfolio of membership benefits, resources, and professional support.

Section 8 – Data Protection and Consent Statement

General Practice Solutions (“GPS”) acts as the Data Controller in relation to the information provided in this application. Your personal data will be processed strictly in accordance with the UK GDPR and the Data Protection Act 2018.

- The information you provide will be used exclusively for the purposes of assessing your eligibility, administering your registration, and maintaining your record on the GPMR.
- Your data may be shared with authorised assessors, referees, or professional bodies, solely for the purposes of verification.
- Data will be retained for the duration of your registration and for a period of up to six (6) years thereafter, in accordance with statutory obligations and accepted professional practice.
- You retain the right to request access to, rectification of, or erasure of your personal data, and to restrict or object to processing, subject to lawful exemptions.

By signing below, you confirm that

You have read and understood the above Data Protection and Consent Statement.
You consent to the processing of your personal data by GPS for the purposes of this application and your ongoing registration with the GPMR.

Signature

Clear

Full Name

Date