RCOG/ACCEA F 2016 CLINICAL EXCELLENCE AWARDS SCHEME OPTIONAL FORM TO ACCOMPANY NEW – APPLICATION Supplementary questionnaire for assessment of medical leadership and managing a high quality service by consultants in the NHS Clinical Excellence Awards Scheme 2016 PLEASE USE THIS FORM FOR LOCAL APPLICATIONS ONLY Surname: Title: Address for correspondence: Forenames: Telephone number: Statement on overall contribution to medical leadership and management (1350 characters) Statements for the following domains (1-6) can be completed in conjunction with attached guidance 1. Statement and in COMMUNICATION demonstrating achievements “over above” (not core contributions) (900 characters) 2. Statement and in MANAGING AND DEVELOPING demonstrating achievements “over above” (not core contributions) PEOPLE AND TEAMS (900 characters) 3. Statement and contributions) in DEVELOPING THE SERVICE demonstrating achievements “over above” (not core (900 characters) 4. Statement and in DEVELOPING ONESELF demonstrating achievements “over above” (not core contributions) (900 characters)
RCOG/ACCEA F 2016 CLINICAL EXCELLENCE AWARDS SCHEME – OPTIONAL FORM TO ACCOMPANY NEW APPLICATION Supplementary questionnaire for assessment of medical leadership and managing a high quality service by consultants in the NHS Clinical Excellence Awards Scheme 2016 PLEASE USE THIS FORM FOR LOCAL APPLICATIONS ONLY Surname: Title: Address for correspondence: Telephone number: Forenames: Statement on overall contribution to medical leadership and management (1350 characters) Statements for the following domains (1-6) can be completed in conjunction with attached guidance 1. Statement demonstrating achievements “over and above” (not core contributions) in COMMUNICATION (900 characters) 2. Statement demonstrating achievements “over and above” (not core contributions) in MANAGING AND DEVELOPING PEOPLE AND TEAMS (900 characters) 3. Statement demonstrating achievements “over and above” (not core contributions) in DEVELOPING THE SERVICE (900 characters) 4. Statement demonstrating achievements “over and above” (not core contributions) in DEVELOPING ONESELF (900 characters)