*1.Organisation name(Required.)

*2.Borough(Required.)

*3.Project title(Required.)

*4.Lead contact name(Required.)

*5.Lead contact email(Required.)

*6.Portfolio role description(Required.)

*7.Number of newly qualified GPN fellows we have capacity to support(Required.)

*8.Is this a one or two session per week role?(Required.)

One session

Two sessions

*9.We are expanding our fellowships offer to include roles other than GPs and GPNs. Which professional groups would be most appropriate to support this project/portfolio role?(Required.)

General Practitioner (GP)

General Practice Nurse (GPN)

Allied Health professional (AHP)

Clinical pharmacist (CP)

Physicians Associate (PA)

Other (please specify)

10.We continue to evaluate the SPIN/New to Practice programme to find ways to improve the experience for our fellows and host providers. If you have previously hosted a GPN fellow, and would like to provide any feedback about your experience, please include details here