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Self-Referral Services.... Mapping Supporting the "Best-Fit Practitioner" Approach.

1.As part of the system-wide Best-Fit Practitioner initiative, we are building a comprehensive overview of self-referral services available across our system. Self-referral services are those that individuals can access directly when they have a health need. Your responses will help us understand:

1) What these services are
2) Who provides them
3) How people can access them
4) Who is eligible

Estimated completion time: 5-7 minutes.
Thank you for your valuable input.

If you have any questions about this form or need assistance, please contact Jayne Chambers, Transformation Team, at jaynechambers@nhs.net
2.Service Name?
Please provide the official and full and correct name of the service.
3.Who provides this service?
Select the main provider responsible for this service.
4.Is this service part of a NHS National Programme?
If yes, please specify which one.
5.Does your service provide self-referral options?
6.How can people access your self-referral service?
Select all that apply.
7.Who is eligible to use your self-referral service?
Please describe the eligibility criteria (e.g., age, location, specific conditions). If none write "none".
8.Are there any restrictions or exclusions for self-referral?
If yes, please detail any restrictions (e.g., specific populations, conditions not covered). If none, write “None”.
9.Please provide a brief description of your service.
Summarise the main purpose and key features of the service.
10.Does the service you provide have any plans for future self-referral pathways?
11.If you answered Yes or Maybe above, please provide the name of the future self-referral pathway or service.
12.Who will provide the future self-referral service?
Select the main provider.