Practice Profile
General information
Name and Role
Practice name
Address
Telephone number
Mobile number
Email
Number of GPs
Number of partner GPs / salaried GPs
Number of other staff
Number of registered patients
Services
Please describe the scope of NHS services you provide (tick all that apply)
GMS
PMS
APMS
Dispensing
Do you provide enhanced or additional services, if so, which?
Please describe any non-NHS services you provide
Please detail other co-located services / facilities / current special interest activity
Current development plans
Please outline your current practice development plans including:
Practice-based commissioning plans
GPwSI activities
Any other tenders / commissioned services planned but not presently delivered
Do you have any plans to combine or co-locate with other local practicies?
YES
NO
Present location
Number of surgeries / branch locations
Are the properties
OWNED
RENTED
If leased, what is the remaining term?
Are all the rooms fully utilised?
YES
NO
Is relocation being considered?
YES
NO
Have new premises been identified?
YES
NO
If so, is funding in place for these?
YES
NO
Practice aspirations
How would you like to see your practice / service develop over the next five years?
Contact
How would you like to find out more about Virgin Healthcare?
Face to face meeting
Telephone discussion
Thank you
Marketing consent
By providing your details to us on this questionnaire, you also consent to us contact you from time to time about Virgin Healthcare products and services offered by us that we believe you may be interested in.
Please tick here if you
DO NOT
want to hear more about Virgin Healthcare products and services in the future.
Legal Stuff
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Please read our Privacy Policy at
www.virginhealthcare.net
which explains how we use and safeguard your information.