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					SERVICE PROPOSAL
Application for Provision of Carpal Tunnel Services – Willing Provider

SERVICE SPECIFIC QUESTIONS Please ensure that you have read the Service Specification thoroughly before you complete this service proposal. Please use this format as a template for your application. You may provide as much detail as you consider necessary in order to demonstrate your previous experience and proposed intentions of how you intend to deliver the service. Firm evidence to back these statements should be provided wherever possible. 1 1.1 General Does your organisation have experience of delivering the services outlined in the specification? Yes / No

1.2

Please provide details of how your organisation proposes to deliver the service in accordance with the service specification (continue on a separate sheet if necessary)

1.3

Provide details on state of readiness following acceptance to the Willing Provider list to delivering the service. In particular identify timescales and capacity by proposed location/s.

1.4 2 Premises Please provide: 2.1 details of the premises the service will be provided from, including parking arrangements Documented evidence that the premises you will be using are suitable for the procedure / treatments to be carried out.
Demonstrate that facilities to be used meet the appropriate health and safety legislation, NHS Estates standards and Disability Discrimination Act. Demonstrate that hours of service reflect the needs of patients (including core hours of service).

2.2

2.3

Renu mb er 3

Professional Competency and Staff Please provide:

3.1 3.2

A schematic of proposed service management structure Evidence of professional eligibility to deliver the full service detailed in the service specification Experience of and commitment to the continued professional development of staff team Evidence of performance managing staff including appraisals Evidence of mandatory and professional training for skilling staff Evidence of Consultant Supervision arrangements for the service Patient Engagement Please provide evidence of: Experience and plans for engaging staff in

3.3

3.4 3.5 3.6 4

4.1 4.2

strategic planning and decision making How patients will be involved in the evaluation and shaping of services to improve outcomes Assurance that you will use the standard patient satisfaction survey (to be provided by the PCT) Access (these responses should be linked to staff resources required for robust service delivery) Please demonstrate how you would meet current access standards

4.3

5

5.1

5.2

Please provide details on how you propose to meet patients’ access to service needs if these are outside core practice hours Please provide details of how you will improve access to service for residents of most deprived wards Quality and Performance

5.3

6

6.1

Demonstrate how compliance with listed standards will be achieved, including any waiting times.

6.2

Evidence of successful improvement of organisational standards , including, where applicable, anticipated organisational QOF achievements. Details of a clinical audit programme to support delivery of the service
Demonstrate that contingency plans will mitigate risks to service provision (e.g. sickness).

6.3 6.4 7 7.1

Data Management Experience of effective data management. Please provide details on:  Maintenance of accurate and up-to-date (including electronic) client records

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Relevant policies and IT security measures in place to ensure client records are stored and accessed appropriately Patient information being held in accordance with the Data Protection Act and Caldicott. Data sharing protocols in place where appropriate

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7.2

Experience of delivery with a performance management framework. Please provide evidence of:     Experience of providing timely monitoring information Monitoring systems in place Mechanisms in place to address underperformance Evidence of developing and delivering a Quality Assurance framework