CYP Transformation Programme: Asthma PilotSpecification of Support Requirements Name of Your GP Surgery: Please Select the Associated PCN: Central Dearne North North-East Penistone South Please confirm the Type of Support Service for Activation: CYP Asthma Pilot 1. Are you happy to be involved in this programme? Yes No (Please elaborate below) 2. Are you happy to data share high-risk children and young people with asthma with the community specialist practitioners based on quantitative derived criteria for risk? Yes No 3. Are you happy for those children and young people to be contacted to be invited for a second assessment? Yes No If yes, do you consent for Patients within the Selected Cohort to be Contacted Through Eclipse Patient Engagement Interface? Yes No Possibly - need more information Do You Prefer for Patients to be Contacted Through an Alternative Method? 4. Are you happy for action plans to be communicated back to you via email? If yes, please provide a suitable email address Yes No Email address if 'Yes': 5. Are you happy for the Practitioners to have access to the GP data via Eclipse? Yes No Who is the GP Clinical Lead for Asthma? First Name Last Name Email Would they be interested in being invited to a regular monthly update meeting for this programme: Yes No Who is the Nurse Lead for Asthma? First Name Last Name Email Would they be interested in being invited to a regular monthly update meeting for this programme? Yes No Who would be the Clinical Contact point for this Programme? First Name Last Name Telephone Email Thank you for completing your surgery application for the Barnsley Hypertension Protect.
