GP Provider Development Programme

Application form This new programme has been designed to bring GP leads and senior managers together from across the country to support them in their endeavours to develop local GP Provider Organisations. We will also draw on our own knowledge and expertise. The programme will be designed to allow time and space for peer-to-peer learning, challenge and information sharing.

The programme will consist of six meetings over an 18 month period. Following initial telephone interviews with participants, we will tailor the programme to meet the needs of the group. Issues that may be covered include:

 governance mechanisms;  leadership role;  internal organisational development;  contracting.

The programme will be limited to a maximum of 10 GP Provider Organisations and a total of 20 participants. Each community will be invited to bring two people to the meetings – it is suggested that this is a lead GP together with the senior manager supporting the new organisation. The meetings will be one day in length and will be held at The King’s Fund.

The first learning network meeting will be held on 13 January 2016. Details of this and further meetings will be circulated in advance.

The fee for the learning network will be £5,200 (plus VAT) per community. This fee includes catering and venue costs for meetings; participants will cover their own travel and any hotel expenses.

Contact details Please print clearly in black ink or type.

Name of key contact:

Job title:

GP Provider Organisation:

Work address: Tel.:

e-mail:

This application is confidential and only to be used for the GP Provider Organisation programme. Please return to: Tracy Nottage - [email protected] - The King’s Fund | 11–13 Cavendish Square | London W1G 0AN

Payment details (Tick one)  I enclose a cheque for £ ______(+ VAT) payable to The King’s Fund

 Please charge £ ______(+VAT) to my/my organisation’s credit card account (delete as appropriate) Type of card ______(Note: we do not accept American Express) Card # ______Expiry date ______Issue # (Switch/Maestro only) ______Valid from ______

 Please invoice me/my organisation (delete as appropriate) Purchase order number (if applicable)

______

I understand that once this application is accepted, I/my organisation will become liable for the charges, including cancellation charges.

Name and address to which invoices should be sent ______

Phone ______

Email ______

Signed ______Date______

 I would like to receive regular email updates from The King’s Fund

Signature Date