Primary Care Research Incentive Scheme (Picris) 2015/16 Guidance




Дата канвертавання25.04.2016
Памер54.9 Kb.








Primary Care Research Incentive Scheme (PiCRIS) 2015/16
Application Form

Please read the document entitled “Primary Care Research Incentive Scheme (PiCRIS) 2015/16 – Guidance” before completing this application form.


This application form should be submitted electronically, with e-signatures to your R&D Manager (contact details in Appendix 2 of Guidance document).
The deadline for submission of applications from R&D offices to the Health and Care Research Wales Support Centre is Friday 27th November 2015. Applications received after the deadline will not be assessed.

Further information/ queries

If you would like to discuss your application prior to submission, you may contact the following:


Iain Reid, Health and Care Research Wales Support Centre, Projects & Performance officer Iain.Reid@wales.nhs.uk
PiCRIS Mentors

Melissa Van der Bijl, North/Mid Wales Melissa.VanDerBijl@wales.nhs.uk

Mel Davies, South East Wales Mel.Davies@wales.nhs.uk

Mark Williams, South East Wales Mark.Williams@southwales.ac.uk

Dr. Mark Davies, South West Wales Mark.Davies17@wales.nhs.uk

Your local R&D office

Please see Appendix 2 of the PiCRIS Guidance document for contact details.



Section A: PiCRIS level:

Please tick the PiCRIS level you wish to apply for, ticking one box only.




Level

Please tick 1 box only

Application for Level 1:

Practice will be informed of Clinical Research Portfolio (CRP) and commercial studies and have access to the Support Centre training programme. Practices will recruit into (or commit to) 2 or more CRP or commercial studies within the funding period, undertaking a mixed portfolio. Performance management will be applied. Commercial studies may account for no more than 50% of the total.






Application for Level 2:

Practice will be informed of CRP and commercial studies and have access to the Support Centre training programme. Practices will recruit into (or commit to) 5 or more CRP or commercial studies within the funding period, undertaking a mixed portfolio. Performance management will be applied. Commercial studies may account for no more than 50% of the total.






Application for Sessional Funding:

Practice will be informed of CRP and commercial studies and have access to the Support Centre training programme. Practices will recruit into (or commit to) 7 or more CRP or commercial studies within the funding period, undertaking a mixed portfolio. Performance management will be applied. Commercial studies may account for no more than 50% of the total. At least one study must be an interventional study. Sessional practices can only count 1 Participant Identification Centre (PIC) study towards their total of 7 studies, but may still act as a PIC for more than 1 study







Section B: Contact details

Lead applicant ( person completing this application form) and current position:




Practice name and address:






Contact email and tel. no:






NHS Organisation:





Practice research lead ( or proposed research lead) and current position:




Contact email and tel. no:




Section C: Your application


  1. Please outline any current or previous research activity the practice has been involved in, giving study names and recruitment levels where appropriate.




Study name

Type of study (CRP; Commercial; student; feasibility; pilot; referral)

Recruitment or referral numbers

Comments












































































  1. Please provide information on any particular areas of strength or interest for research from the practice perspective.



  1. Please outline how the practice intends to meet the performance measures relating to the appropriate PiCRIS level within the funding period, as set out in Appendix 1 of the “Guidance” document, (including commitment to recruit to Clinical Research Portfolio (CRP) and/or commercial studies in primary care, completion of Good Clinical Practice training and accreditation under RCGP Research Ready scheme).(max 500 words).




  1. If you are participating in studies which will be active during the next funding period (April 2015- March 2016), please list them below.



Study name

Type of study (CRP; Commercial; student; feasibility; pilot; referral)

Comments

































































Section D: Research Capability


  1. In order to assess your practice’s capacity and capability to undertake research, please complete the boxes below:



    1. Please provide the demographics of the practice, including the practice list size. Does the practice profile differ significantly from the norm? If so, how?



    1. Is the practice is willing to consider commercial studies?

Yes No




    1. Please describe the existing infrastructure in place within the practice to support research. (This may include specialist clinics, clinical research space or equipment, IT systems, staff with specific research interest or experience)


Section E: Additional Information for Sessional Practices Only



  1. Please provide details of sessional funding being requested. The total should not exceed £8,500. (Please state the amount requested as well as the name, whole time equivalent and post of the person/ people funding will be utilised for.)




  1. Please describe how you will use the funding to increase research activity within the practice.



  1. Please describe any other research activities that the practice would be willing to support e.g. undertaking feasibility studies, pilot studies, acting as a Participant Identification Centre (PIC).



Section F: Declarations/ Signatures


  1. Lead Applicant (person completing this application)

Name…………………………………………………....................................... Signature…………………………………… Date……………………….........

Position……………………………………………….........................................
b. Practice Research Lead
Name…………………………………………………......................................... Signature…………………………………… Date………………………...........

Position……………………………………………….........................................




  1. R&D Director- NHS organisation (confirmation that this application is supported by the NHS organisation)

Name…………………………………………………........................................ Signature…………………………………… Date………………………...........

Position……………………………………………….........................................

Thank you for completing this application form. Please return to your NHS Health Board R&D Office.


The deadline for submission of applications from R&D offices to the Support Centre is Friday 27th November 2015.




База данных защищена авторским правом ©shkola.of.by 2016
звярнуцца да адміністрацыі

    Галоўная старонка