Nurse Practitioner Candidacy Program. Application for funding

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1 Nurse Practitioner Candidacy Program Application for funding

2 WA HEALTH Vision Healthier, longer and better quality lives for all Western Australians. Our mission To improve, promote and protect the health of Western Australians by: Caring for individuals and the community Caring for those who need it most Making best use of funds and resources Supporting our team Our values Care - Respect - Excellence - Integrity - Teamwork - Leadership Caring for individuals and the community Good health is essential for a good quality of life, and a good healthcare system is essential for a strong community. At WA Health we play a major part not only in individual health care, but in the health of our entire community. Caring for those who need it most Our WA public health system is designed to promote fairness in all its programs, policies and standards. Our goal is to make sure that the health services we provide are available to those people who need them most, and serve to improve the health and wellbeing of those whose need is greatest. Making best use of funds and resources At WA Health, we understand that Western Australians expect high-quality, accessible and fairly distributed health services in exchange for their tax dollar. We are absolutely committed to using the resources entrusted to us to provide WA taxpayers with an optimum service and value for money. Supporting our team Each and every staff member, whether directly or indirectly involved in care, has an important role to play in ensuring healthier, longer and better lives for our patients. The success of our public health system is built on the skill and passion of our people working together. 1

3 APPLICATION FOR FUNDING Please refer to the Nurse Practitioner Candidate Application Guidelines for details of the policy and funding framework, eligibility, selection criteria for funding of services, funding deliverables and requirements for support and endorsement of applications. HEALTH SERVICE Key contact for submission - Name Position/Title Postal address Post code: Telephone Number TARGETED/ AREA Clinical Specialty Services Complete separate application for each area. OVER VIEW OF PROPOSED MODEL Briefly describe the proposed model of care that a NP role will support (max 500)words) What specific service gaps does the proposed model and specific NP role address? How does this align with relevant key strategy/policy directions? SPECIFIC SELECTION CRITERIA Provide summary information that demonstrates the organisation s capacity to successfully manage workforce initiatives of this size/type or previous experience in service development initiatives. 2

4 1. Provide brief information about the organisations commitment to developing and expanding NP services (to date and current) including appointment of NPC in targeted area. 2a. Will the service be seeking a second NPC support package? 2. Describe the level of support at both executive level and the specific clinical sponsors (who are considered clinical leaders in area) and their roles within the organisation for this initiative. 3. Describe to what extent your organisation is committed to collaborating with other health services or organisations. 4. Briefly describe the processes that will be used (existing or new) to engage stakeholders, consumers and community in model development. 5. Describe how the organisation will recruit/appoint/deploy appropriate support such as, to enable the work to commence. 6. Describe the proposed governance arrangements including project management roles and governance structures (including roles and responsibilities for all sites if collaborative model). EG Memorandum of Understanding, 7. If a collaborative model, the details of all collaborating sites and evidence of the agreement for all sites must be provided. 3

5 ANY OTHER INFORMATION IN SUPPORT OF THIS APPLICATION REQUIRED ATTACHMENTS Letter of support (collaboration agreement) from public health service employing Nurse Practitioner Candidates: Chief Executive Officers of all health services involved are required to sign forms. DECLARATION BY HEALTH SERVICE In submitting this application, the signatory to the application confirms having read the application 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. Name Signature Date If you are unable to insert an authorised electronic signature, a hard copy is required by Nursing and Midwifery Office. SUBMISSION OF APPLICATION An electronic copy of application should be marked: Attention: Chief Nurse and Midwifery Officer and submitted via no later than Friday Feb 11 th at 5pm. E: If you are unable is required by DHS to be delivered 4

6 This document can be made available in alternative formats on request for a person with a disability. Department of Health 2012

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