UCL MEDICAL SCHOOL
Research Department of Primary Care and Population Health
P R A C T I C E
P R O F I L E
1. PRACTICE DETAILS
Practice name
Practice manager
Postcode
Email address
Telephone no.
Fax no.
Bypass Telephone no.
PCT
Website
Practice payee name
2. ABOUT YOUR PRACTICE
How many full-time equivalent GPs do you have?
Area of Interest
Name of Person
Do you have any staff with special interests
3. POST GRADUATE TRAINING STATUS
Is yours a training practice?
Yes
No
If YES, year first approved
Which doctors are approved Trainers? (names)
Who do you Train? (please check)
Registrars
PRHOs
SHOs
4. THE PATIENTS
List size
Do you have an appointment System?
Yes
If YES, what is your usual booking rate?
No
1 patient every
minutes
Does the practice have written information for Patients about medical student teaching?
5.
Yes
THE SETTING
Does your practice use a computer system?
Yes
No If YES please specify system
Do you have a computer available for student use?
Yes
No
Would students be able to access the internet from the practice?
Yes
No
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No
Do you have a library accessible to students?
Yes
No
Do you have a room for quiet study accessible to students?
Yes
No
Do you have any written information you can give Students about your practice?
Yes
No
6. EQUIPMENT AVAILABLE FOR TEACHING
Equipment
Number available
Equipment
Number available
Flip chart
TV/DVD/Video
Overhead projector
Video Camera
Slide projector
Whiteboard
Computers for student use
Other
7. TRAVEL DETAILS
Directions to practice:
including Tube station(s),
Train station(s), bus stop(s)
and average walking time
Outer London Practices
Inner London Practices
Approximate travel time from London:
hours
Is a car essential?
Approximate travel time from the following tube stations?
minutes
Yes
No
Checklist: Have you included?
Archway
hours
minutes
Belsize Park
hours
minutes
Euston
hours
minutes
A practice leaflet
A recent Trainer Report (if relevant)
This information will be entered onto an Intradepartmental database. Please advise us of any important
changes during the year. We will contact you annually in August/September for updates on this data.
Please return to:
Ms Rushmi Pelpola
Research Department of Primary Care and Population Health
UCL Medical School, Rowland Hill Street, London NW3 2PF
Email: r.pelpola@ucl.ac.uk Tel: 020 7472 6449 Fax: 020 7472 6871
…Thank you for taking the time to complete this form in full…
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