Directory of Services (DoS) Data Collection Form
DoS information available via:
Heron; Knowledge Anglia; NHS Pathways (PDoS); Norfolk County Council
If your service has been commissioned by a CCG, please describe the service you are commissioned to
provide. If you offer different services to different CCGs, these need to be listed as separate entries.
Service Details
Service / Team Name
Organisation Type
NHS Acute
NHS Mental Health
Business
Statutory
NHS Community
NHS Primary Care
Charity / Voluntary
Parent Organisation
Directorate / Business
Unit
Contact Details
Confidential
Knowledge & PDoS
(Admin only)
(Professional access)
Name & job title of
Clinical Lead
Telephone
Email
Unless ‘Confidential’ or ‘Professional’ access is selected, all information will be made visible to the public
Name & job title of
Service Lead
(if different to above)
Telephone
Email
Service Address
(including postcode)
For telephone contacts, please provide description where relevant, e.g. Helpline; Direct line for GPs; Minicom etc.
Public Telephone
Prof Telephone
Fax
E-mail
Website
Target Audience
What is the age range that your service provides services for?
Minimum age:
Maximum age:
Address Knowledge Anglia, NEL CSU Anglia, Lakeside 400, Old Chapel Way, Broadland Bus. Park, NR7 0WG
E-mail servicedirectory@nhs.net | Telephone 01603 257253 or 01603 257255
Nov 14
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PDoS
Age groups: Please indicate all age groups seen (age ranges are determined nationally)
Adult (16+)
Gender:
Child (5-15)
Toddler (2-4)
Neonatal/Infant (0-1)
Male
Female
Male or Female
Older People (65+)
Is your service targeted towards a specific audience?
Men
Carers
End of Life / Palliative
Women
Parents
Mental Health
Teenage Parent
Learning Disabilities
Single Parent
NHS and Social Service staff
Black, Minority Ethnic Group
Father
LGBT (Gay, Bi and Transgender)
Baby / Neonatal
Mother
/ Pregnant women
Armed Services / Veterans
Families
Asylum Seeker / Refugee
Couples
Homeless
Children
Migrant Worker
Children (Pre School)
Disability
Prisoners / Offenders
Young Adult / Teenager
Deaf / Hearing Impairment
Sex Workers
Older people
Blind / Visual Impairment
Substance Misusers
Service Description (for the public via Heron and NCC sites)
Description of the service offered
Service Delivery
How is your service delivered? Eg clinic, through schools, outreach service etc.
Are interpretation & translation services available through your service?
Yes
No
Do you provide home visits?
Yes
No
Are there any costs related to using / accessing your service?
Yes
No
Yes
No
If so, are you able to accept direct payments (through personal budgets)?
If you do accept direct payments, what is the hourly, unit or day rate?
Address Knowledge Anglia, NEL CSU Anglia, Lakeside 400, Old Chapel Way, Broadland Bus. Park, NR7 0WG
E-mail servicedirectory@nhs.net | Telephone 01603 257253 or 01603 257255
Nov 14
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Brief Description of Services Provided (for Pathways DoS)
Maximum of 2500 characters
Service Description for Health & Social Care professionals only (via Knowledge Anglia)
Information for Health & Social Care Professionals only
Conditions / Symptoms / Problems (Max 2500 characters)
Bullet points re. what / who is seen by the service, including, where appropriate, details of:
- what aspects of the condition can be treated
- at what stage the condition is seen by this service
- symptoms that indicate urgent / routine referral
Information for Health & Social Care Professionals only
Services / Support / Procedures provided (Max 2500 characters)
Bullet points re. the services provided, e.g. treatment / therapy / prescribing / support / advice etc.
Include any tests, procedures or treatment that could be carried out during the patient’s initial appointment.
Information for Health & Social Care Professionals only
Exclusions (patients / clients / conditions that are not appropriate for the service) (Max 2500
characters)
Those conditions that should not be referred to this service, e.g.
- inappropriate conditions, age groups etc.
- services not actually commissioned from your organisation, but are sometimes miss-referred
Information for Health & Social Care Professionals only
Examination / Tests / Assessments (to be undertaken prior to referral) (Max 2500 characters)
List any that the referrer needs to have completed or referred the patient for, prior to referral into the service, and
the results of which need to be included in the referral information.
Address Knowledge Anglia, NEL CSU Anglia, Lakeside 400, Old Chapel Way, Broadland Bus. Park, NR7 0WG
E-mail servicedirectory@nhs.net | Telephone 01603 257253 or 01603 257255
Nov 14
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Special Educational Needs and Disabilities (SEND) / Local Offer Details
How do you make your service accessible to children and young people with SEND? Eg information about the
venue you use, equipment you have, training your staff have received and how you communicate with the children,
young people and their families.
Who can families contact for further information about how you make your service accessible to children and young
people with SEND?
Referrals are accepted from:
Public info
(Heron / NCC)
Patient / Self-referral
Health Professionals
No referral process, i.e. drop in / phone
Social Care Professionals
Voluntary Agency
Referrals info via NHS Pathways DoS: Please mark ALL those from whom you accept referrals
GP
Other Healthcare Professional (Registered)
Patient
Other Healthcare Professional (Non-registered)
Pathways referral (111)
Non Healthcare professional (eg Social Care)
Supporting information:
Referral method: e.g. telephone, letter, specific referral form, whether form should be faxed etc.
Key Information to include with the referral:
e.g. information required to assess the referral, including test / assessment results, if interpreter is required and
languages spoken, transport requirement and booking processes etc.
Referral form
Does your service use a referral form?
No
Yes - Please attach a copy and it will be added to the Knowledge site.
Protocol /
Flowchart
Do you have protocols/pathways that are relevant to your service?
Additional
information:
Does your service have any other information that should be available?
No
No
Yes - Please attach copies and they will be added to the Knowledge site
Yes - Please attach copies and it will be added to the Knowledge site
Service Notes
Information for Health & Social Care Professionals only
Any other notes about the service
e.g. what happens after the initial appointment / assessment, communication processes back to referring clinician
and patients’ GP etc.
Address Knowledge Anglia, NEL CSU Anglia, Lakeside 400, Old Chapel Way, Broadland Bus. Park, NR7 0WG
E-mail servicedirectory@nhs.net | Telephone 01603 257253 or 01603 257255
Nov 14
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Patient Information
Does your service have an information leaflet describing the service?
Yes
No
Yes
No
Yes
No
If this is available on your website, what is the exact URL (web) address link?
Does your service have other information leaflets that should be included in
the service information? e.g. condition info; treatment advice etc.
If these are available on your website, what is the exact URL (web) address link?
Do you provide a newsletter?
If yes, please provide details: (e.g. name, frequency etc.)
Health Professionals
Information for Health & Social Care Professionals only
Health Professionals that can be contacted by other health / social care professionals
ONLY include where felt appropriate, e.g. where staff have specialist skill areas and referrers / GPs need to identify
/ contact staff with specific queries.
Include: Name, Job title, Team name, specialist areas they can answer questions on, Tel, Fax, E-mail
Service Coverage
Which localities does the service cover?
All Norfolk
Norwich
South Norfolk
Great Yarmouth
North Norfolk
West Norfolk
Waveney
Cambridgeshire & Fenland
Suffolk (Central)
Suffolk (West)
Any towns, GP Surgeries and postcodes attached to the locality listed above will be
automatically ‘tagged’ onto your service record, but if your service caters for a specific
geographical area, location or GP Practice only, please list details below:
Opening Hours
Details of the following:
- sites at which the service is provided
- hours the service is available at each site
Address Knowledge Anglia, NEL CSU Anglia, Lakeside 400, Old Chapel Way, Broadland Bus. Park, NR7 0WG
E-mail servicedirectory@nhs.net | Telephone 01603 257253 or 01603 257255
Nov 14
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Compliments, Concerns and Complaints
Who can service users contact to compliment or complain about the service? Eg PALS, Communications etc.
This is only needed for sites attended by
patients
Access & Facilities
Details of the following:
- Disabled access; accessible entrances, toilets facilities, lifts etc.
- Impaired vision needs catered for (e.g. Braille signs)
- Impaired hearing needs catered for; induction loop hearing aid system, BSL trained staff, text phone etc.
Parking & Transport
Details of the following:
- Onsite parking available; availability of spaces, fees / costs involved etc. If no onsite parking, nearest
alternative
- Disabled access; disabled spaces available, construction of car park etc.
- Site accessible by public and / or community transport.
Search Categories / Keywords / Discriminators
Once your service information has been inputted into the appropriate directories, the Knowledge Team
will attach the relevant key words or search categories to the entries. For the NHS pathways DoS, you
will be contacted for approval, however for all other directories, if you would like to select your own
search terms, the full list is available via http://nww.knowledgeanglia.nhs.uk/111/search_terms.xls
Address Knowledge Anglia, NEL CSU Anglia, Lakeside 400, Old Chapel Way, Broadland Bus. Park, NR7 0WG
E-mail servicedirectory@nhs.net | Telephone 01603 257253 or 01603 257255
Nov 14
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Consent Form
Service Lead sign off
Service Name:
Contact Name:
E-mail:
I certify that the information in the attached form is an accurate description of the service we provide and
agree to the details being held on the following Directories of Services:
 HERON (www.heron.nhs.uk);
 Knowledge Anglia (nww.knowledgeanglia.nhs.uk);
 NHS Pathways (PDoS);
 Norfolk County Council’s Community Services Directory (www.norfolk.gov.uk) if appropriate.
 Name:
 Date:
 Signature:
Printed Directory Permission
There may be an occasion when your organisation could be selected to be incorporated within a printed
directory, attached to the Heron website. There are no costs involved. Do you give your permission for
your information to be included?

Yes
No
In accordance with the Data Protection Act 1998, to enable us to keep the information on these sites for
the next 12 months, we require the:
Completed / Updated forms to be returned, including the signed consent slip via;

E-MAIL (servicedirectory@nhs.net - Signatures need to be scanned in and emailed
along with the form)

FAX (01603 257 297)

POST (address below)
Address Knowledge Anglia, NEL CSU Anglia, Lakeside 400, Old Chapel Way, Broadland Bus. Park, NR7 0WG
E-mail servicedirectory@nhs.net | Telephone 01603 257253 or 01603 257255
Nov 14
7 of 7