Section 1: Your details

Name *

Email *

Organisation name *

Name of your product *

Target care setting of your product *

• Primary care
• GP practice
• Urgent/emergency care
• Health care trust
• Shared care records
• Social care
• Optometry
• Pharmacy
• Private providers
• Other: Other:

Is your product NHS commissioned/NHS funded? *

Section 2: Your development/use case

Which GP Connect capability (or capabilities) do you want to onboard to?

Access Record: Structured

• Yes
• No

Tick all that apply

• Medications
• Allergies
• Investigations
• Uncategorised
• Immunisations
• Consultations/encounters (this area of the record does not yet have approval to be consumed in live - register your interest by ticking)
• Problems (this area of the record does not yet have approval to be consumed in live - register your interest by ticking)
• Diary entries (this area of the record does not yet have approval to be consumed in live - register your interest by ticking)
• Referrals (this area of the record does not yet have approval to be consumed in live - register your interest by ticking)

Access Record: HTML

• Yes
• No

Access Document

• Yes
• No

Send Document (this product is undergoing a strategic interoperability review, during which we are not onboarding new suppliers - register your interest by submitting your use case)

• Yes
• No

For Send Document - please give an overview of what information you are planning on sending back to the patient's GP

If opted for Access Record HTML or Access Record Structured, please confirm your rationale for your chosen API *

Are you onboarding to GP Connect to comply with an NHS framework you are participating in (such as Digitising Social Care)? If so, which framework? *

Detail the user roles (and their professional certifications) that will have access to view the GP Connect data (n/a for Send Document use cases)

Detail how the data retrieved from GP Connect will be utilised within your application and for what purpose (n/a for Send Document use cases)

If you have chosen to onboard to Access Record: Structured, please confirm if the data will be displayed within a user interface for a clinician to view, embedded within a referral document, used to generate a report or process within a back-end workflow for another clinical purpose (or other)

Detail what event or action will trigger the GP Connect API call within your system (n/a for Send Document use cases)

Detail how your use case meets the definition of direct patient care *

Please confirm if the data will be stored, transformed or shared with any other systems other than your product *

Please email a data flow diagram to [email protected] showing how you intend to use GP Connect and how the data will flow via your product (including an example scenario) *

• Yes, I will email a data flow diagram to [email protected].
• No

Your use case will not be reviewed until this has been received. Failure to send will result in your use case being rejected.

Section 3: Clinical safety prerequisites

Confirm if the following prerequisites have been met:

A qualified Clinical Safety Officer is in place *

• Yes
• No

A clinical risk management process is in place that is compliant with DCB0129 *

• Yes
• No

A clinical safety case and hazard log will be established for this product *

• Yes
• No

Section 4: Information governance (IG) prerequisites

Confirm if you are committed to the following:

A UK location for processing or storing patient data *

• Yes
• No

Provide information about where you will be storing the data

A cycle of penetration testing of your product within the last 12 months and on an annual basis at a minimum *

• Yes
• No

Returning the appropriate level of end-user information to be able to meet the GP Connect IG model *

• Yes
• No