Flexipool staff request form -

Practice name *

Contact name at practice *

First

Last

Please note this individual will be responsible for approving timesheets on a monthly basis. If you would like to nominate someone else in the practice to approve timesheets please add their name below.

Email address *

Phone number (direct line) *

Timesheet approver

First

Last

(if different to the main practice contact as named above)

Please specify which role you require cover for *

How long do you need the member of staff for *

Number of days/weeks/months or all or any of the dates listed

Could this role be covered by multiple people? *

e.g. would part time/job share be an option

Working hours *

Please specify daily working hours, and if flexible working is available e.g. around school pick-up, remote working, half days, morning/evening working

Start date

Shift times

Hourly pay rate or equivalent AfC Band

Only if not currently in the Flexipool induction pack

Any other details relevant to the post or specific training required

Please email us a job description or summary if available to ngps.flexipool@nhs.net. For GP requests, please state how many appointments, length of appointments, home visit requirements etc.