Expressions of interest for practices to host a GPEP1 registrar in 2023/2024

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* 1. Please select your region

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* 2. What is the name of your Practice?

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* 3. What is the physical address of your practice?

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* 4. What is the postal address of your practice? (if different from above)

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* 5. Please enter the HPI ID (If known) for your practice

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* 6. Does your practice have Cornerstone Accrediation?

Yes

Other (please specify)

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* 7. Does your practice have Teaching Practice Accreditation?

Yes

Other (please specify)

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* 8. What is the name and email addresss of your Practice Manager

Name

Email Address

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* 9. What is the name and email address of your key contact for GPEP? (if different from above)

Name

Email Address

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* 10. Please list the accredited teachers that will be involved in the registrars teaching

Name

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* 11. Please list all the years that you have had a registrar in the past

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* 12. Does your practice identify as a hauora Māori provider or Māori practice

Yes

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* 13. If yes, which of the following statements apply?

We are a Health Provider privately-owned by a majority or all-Māori shareholding

We are a Health Provider owned by an iwi, hapū or other kaupapa Māori community organisation

We are a Health Provider owned by another kaupapa Māori corporate framework

Other (please specify)

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* 14. Does your practice identify as a Pasifika Health Provider or Pasifika Health Practice?

Yes

Other (please specify)

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* 15. If yes, which of the following statements apply?

We are a Health Provider privately-owned by a majority or all-Pasifika shareholding

We are a Health Provider owned by a Pasifika community or church organisation

We are a Health Provider owned by another Pasifika corporate framework

Other (please specify)

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* 16. What is the Characteristics/Demographics of your training practice?

Rural

Provincially Rural

Urban

High Needs

High Maori patient base

High Pasifika patient base

High Immigrant patient base

High proportion of one age demographic eg Under 5 or over 65.

If there is a high proporation of age please list below

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* 17. Does your practice offer specialist services?
eg skin or podiatry clinics?

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* 18. Anything else that is not listed above that could be beneficial to a registrar’s learning experience?
Examples could include providing accommodation, access to wider health services, community activities or outreach services which the registrar could participate in like school/community clinics.

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* 19. Can your practice provide the registrar with after hours or on call experience?

Yes, please specify below

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* 20. Are there languages your practice staff are fluent in?

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* 21. What type of registrar would you prefer?
Please note if you are interested in a College Employed registrar you will be required to complete a Health and Safety check which is our obligations under the Health and Safety Act. Also if you are a new training practice you will be required complete a Health and Safety pre-qualification form.

College Employed

Practice Employed

Have capacity for both College and Practice Employed at your Practice

Other (please specify)

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* 22. Would you prefer your registrar to be full time or part time?

Full Time

Part Time

Either Full time or Part Time

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* 23. If you could take a College Employed registrar can you please advise of your capacity to host during the year

First Attachment Only (30 January 2023-28 July 2023)

Second Attachment Only (31 July 2023-26 January 2024)

We could have a registrar in both attachments

We could have two registrars per attachment

We are unable to take a registrar for the next intake

Other (please specify)

Expressions of interest for practices to host a GPEP1 registrar in 2023/2024

Question Title

* 1. Please select your region

Question Title

* 2. What is the name of your Practice?

Question Title

* 3. What is the physical address of your practice?

Question Title

* 4. What is the postal address of your practice? (if different from above)

Question Title

* 5. Please enter the HPI ID (If known) for your practice

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* 6. Does your practice have Cornerstone Accrediation?

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* 7. Does your practice have Teaching Practice Accreditation?

Question Title

* 8. What is the name and email addresss of your Practice Manager

Question Title

* 9. What is the name and email address of your key contact for GPEP? (if different from above)

Question Title

* 10. Please list the accredited teachers that will be involved in the registrars teaching

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* 11. Please list all the years that you have had a registrar in the past

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* 12. Does your practice identify as a hauora Māori provider or Māori practice

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* 13. If yes, which of the following statements apply?

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* 14. Does your practice identify as a Pasifika Health Provider or Pasifika Health Practice?

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* 15. If yes, which of the following statements apply?

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* 16. What is the Characteristics/Demographics of your training practice?

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* 17. Does your practice offer specialist services? eg skin or podiatry clinics?

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* 19. Can your practice provide the registrar with after hours or on call experience?

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* 20. Are there languages your practice staff are fluent in?

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* 22. Would you prefer your registrar to be full time or part time?

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* 23. If you could take a College Employed registrar can you please advise of your capacity to host during the year

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* 24. If there is anything else you would like the College to be aware of in your ability to host a registrar please provide it below

* 17. Does your practice offer specialist services?
eg skin or podiatry clinics?