Extended Hours Access 2020/21 - Practice Data Collection Form

Please note that this form contains mandatory fields which have an asterisk (*) at the end of the field name.  Failure to fill in these fields will result in the form not being saved.  Before clicking on the submit button, please check to see that all mandatory fields have been filled in.  As a visual aid, the line under the field will turn red to indicate that the data for the field is required.

- This form has been developed for Practices to submit their extended hours provision for the quarter

- Practices should complete this form for their own Practices and for any other Practice that it provides extended hour on behalf of

- BHNC will then collate the returns on the behalf of each Primary Care Network and submit one return to South East London Primary Care Team 

- The completed form should be retained on file by the practice

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Are there days of the week extended hours are not routinely offered by the Practice (tick appropriate days)

Week Commencing

Total Number of Weekly Practice Extended Hours Offered 

Number of Appointments Offered

Number of Booked Appointments

Number of Attended Appointments

Number of Cancelled/DNA Appointments

Number of Unused Appointments

Quarter Totals

0.00

0.00

0.00

0.00

0.00

0.00

When entering figures below, only use 2 decimal places to the right of the decimal point.  (For example: 7.25)

Month One

Month One Totals

0.00

0.00

0.00

0.00

0.00

0.00

Month Two

Month Two Totals

0.00

0.00

0.00

0.00

0.00

0.00

Month Three

Month Three Totals

0.00

0.00

0.00

0.00

0.00

0.00

Confirm that the Practice Population Recieved EH In Line With The DES Requirements, Each Week *

Declaration To Be Completed By The Practice

Once Completed, please click Submit to send form to PCN Lead who will coordinate the PCN return to the SEL PC Team

Before clicking on the submit button, please ensure that ANY fields highlighted RED are filled in as they are mandatory fields and the form will not be saved if mandatory fields are left blank.  As each month submission usually require at least 4 weeks worth of data, enter the last week with zero (0) value if it is highlighted as a mandatory field

Thank you

Contact Us

Bexley Health Neighbourhood Care

River House (Behind the Old Mill)

Bexley High Street

Bexley

Kent DA5 1JX

Tel: 020 8298 1965

Email:  BHNC.GPfed@nhs.net

Care Quality Commission

(CQC) regulates BHNC GP Federation C.I.C. to provide care at BHNC GP Federation C.I.C. - Head Office


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