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Independent Prescriber Information Cornwall & Isles of Scilly

Cornwall & IOS LPC are working closely with both NHSE and Kernow ICB to bring on some form of IP in community pharmacies in Cornwall. As such we are trying to gather a database of Pharmacists here in Cornwall in all sectors who intend to or have an appetite to qualify as an IP.

We are asking you to simply complete the below form, the information will be kept within the LPC as a database and will only be shared with the ICB if you agree you are happy for us to share this information.

IP Cornwall

Name *

Name

First

Last

GPhC number *

What timescales would you see yourself looking to begin IP training? *

Would you be willing/able to work in another pharmacy/PCN as part of an IP pathfinder site? (for example, another branch of a pharmacy you own or work for)

Yes

Not sure

IP area of clinical interest? (this may be an area that you are already developing competence in or an area that you would be interested in)

Where do you practice? (select all that apply) *

Community Pharmacy

General Practice

PCN

Hospital

Other (please state)

Other

Name of practice location *

Address of practice location *

Address of practice location

City

State/Province

Zip/Postal

Country

Cornwall & Isles of Scilly will keep your information secure on a database. Are you happy for us to share your information with Cornwall & Isles of Scilly ICB?

Yes

If you are human, leave this field blank.

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