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* 1. Your Full Name

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* 2. Your NHS email

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* 3. What is your registered profession?

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* 4. Who is your regulatory body & registration number

Scope of Practice

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* 5. Independent prescribing?

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* 6. Competency framework level

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* 7. Clinical modules trained in

Urgent Care Experience

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* 8. Hours delivering urgent primary care in last 12 months?

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* 9. Types of assessment:

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* 10. Familiarity with telephone triage protocols (e.g., NHS Pathways)

Clinical Skills & Training

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* 11. Advanced life support certification

Date

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* 12. Safeguarding level (adults/children)

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* 13. Experience with point-of-care testing (e.g., ECG, blood glucose, CRP)

System Competence

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* 14. EHR experience

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* 15. Clinical governance participation

Availability & Preferences

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* 16. Desired hours/shifts per week and preferred start times

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* 17. Willingness to cover evenings/weekends/bank holidays

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* 18. Work location flexibility (clinic sites / community hubs / home visits)

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