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
(Not public access)
Name & job title of main
contact of Service /
Organisation
Telephone
Email
Address
For telephone contacts, please provide description where relevant, e.g. Helpline; Direct line for GPs; Minicom etc.
Telephone 2
Telephone 3
Telephone 4
Fax
E-mail
Website
Service Description (for the public via Heron and NCC sites)
Description of the service offered
(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.)
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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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?
Target Audience
What is the age range that your service provides services for?
Minimum age:
Maximum age:
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
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?
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
2 of 5
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
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.)
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
Compliments, Concerns and Complaints
Who can service users contact to compliment or complain about the service? Eg PALS, Communications 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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This information is only needed for sites attended
by patients - and it is needed for each location.
Access & Facilities
Is your main entrance accessible by wheelchair?
Yes
No
If not is there an alternative entrance that is?
Yes
No
Are all entrances well signposted?
Yes
No
If you provide services above ground floor level, do you have a lift which
is wheelchair accessible?
Yes
No
Do you have disabled toilet facilities?
Yes
No
Are people with impaired vision needs catered for? (e.g. Braille signs)
Yes
No
Do you have an induction loop hearing aid system?
Yes
No
Do you have any British Sign Language (BSL) trained staff?
Yes
No
Do you have typetalk / text phone?
Yes
No
Yes
No
Are there plenty of available spaces?
Yes
No
Is it fee paying?
Yes
No
Are there disabled parking spaces available?
Yes
No
Is the parking surface of uneven construction which may cause
difficulties for wheelchair users?
Yes
No
Yes
No
Is the site accessible by Public transport?
Yes
No
Is the site accessible by community transport?
Yes
No
If yes, what is the number?
This information is only needed for sites attended
by patients - and it is needed for each location.
Parking
Is there onsite parking?
If yes:
If no:
Please give details of the nearest car park including details of whether
free or fee paying and disabled spaces / access.
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 on request.
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
4 of 5
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
5 of 5