VNPP Funding Round 4.12 - NP models
Chronic Disease Management & Aged Care
Application Template
Instructions
For details of the policy and funding framework, eligibility, selection criteria, and funding deliverables and
conditions, respondents should first refer to:

VNPP Round 4.12_Application Guidelines1.

Nurse Practitioner Candidate Support Packages Funding Guidelines2
Name of Service Provider
Key Contact for submission - Name
Position/Title
Telephone Number
(Mobile)
(Work)
Preferred E-mail *
* Please Print
APPLICATION FOR TARGETED AREA:
Complete a separate application for each targeted
area.
NUMBER OF NPC SUPPORT PACKAGES YOU ARE
SEEKING
1
http://www.health.vic.gov.au/nursing/furthering/practitioner
2
http://www.health.vic.gov.au/nursing/furthering/practitioner/np-candidates
Department of Health
OVER VIEW OF PROPOSED MODEL
Briefly describe the proposed model of care that a NP role will support (max 500 words)
Include elements such as which part of the care continuum is the model servicing, what are the service
parameters including hours of operation, site/settings, client groups or exclusions, referral pathways etc.
What specific service gaps does the proposed model and specific NP role anticipate it address? How does
this align with relevant key strategy/policy directions?
SPECIFIC DHS SELECTION CRITERIA (MAXIMUM of 3 A4 pages)
KSC 1: Provide brief information about your organisational commitment to develop and expand NP services
(to date and current) including appointment of NP candidate in targeted area within designated period.
KSC 2: Alignment of proposed NP service model with key organisational, state or national service/policy
framework for the targeted clinical area.
KSC 3: Provide summary information that demonstrates your organisation’s capacity to successfully
manage workforce initiatives of this size/type or previous experience in service development initiatives.
KSC 4: Describe the level of executive support for proposed model and the name, position title and role
within the organisation of the specific clinical sponsors (who are considered clinical leaders in area).
KSC 5: Describe to what extent your organisation is committed to collaborating with other health services
and agencies in the course of developing the NP model.
KSC 6: Briefly describe the processes that will be used (existing or new) to engage stakeholders, consumers
and community in model development.
KSC 7: Describe how you will support the appointed candidate or endorsed NP to manage any barriers to
practice, so ensuring the model remains responsive to the needs of the organisation and its clients.
If your organisation utilizes a steering committee for this purpose, a copy of the Terms of Reference
describing membership and frequency of meetings would be a highly valued additional attachment.
KSC 8: Describe how you will recruit/appoint/deploy appropriate project support such as, project coordinator,
to enable the work to commence within the required period.
KSC 9: Describe the proposed governance arrangements including project management roles and
governance structures (including roles and responsibilities for all sites if collaborative model).
If a collaborative model, the details of all collaborating sites and evidence of the agreement for all
sites must be provided.
ANY OTHER INFORMATION IN SUPPORT OF THIS APPLICATION.
Department of Health
Declaration by CEO
In submitting this application, the signatory to the application confirms they have read the VNPP Round
4.12 - NP models (CDM / Aged Care) Guidelines and declares that the information contained in the
application, including all attachments, is to the best of their knowledge true accurate and complete in all
material particulars.
CEO Name
Signature
Date
……./…..../2013
NOTE:
If a collaborative model, a letter of agreement/support is required from CEO’s of all services involved.
If you are unable to insert an authorised electronic CEO signature, a hard copy is required by DH to
be delivered within two weeks of the closing date.
Submitting your Application
Applications (using the VNPP Round 4.12 Application template) should be sent electronically to:
Dan.Schiftan@health.vic.gov.au no later than Friday 29 November 2013.
Department of Health