Colleague Feedback Questionnaire

Please enter your NHS email. This will only be used to verify your submissions. We are aware copies of the MVR have been taken by pressure groups who may seek to spoof results. Therefore, all submissions need to be applied to a specific PA via their GMC/PAMVR and require an NHS email address to be attached. NHS email addresses will be dropped from the survey and anonymised. PAs can request their feedback after anonymisation and submission to the Leng review.

This data may be publicised by the Leng Review after anonymisation and upon submission you accept that this may be included after validation. Any submission without email addresses or correct PAMVR/GMC Number will be discounted.

Your NHS Email

Data validation only will be made anonymous after submission

PA's PAMVR/GMC Number

Please rate your colleague in each of the following areas by ticking one box in each line.

Clinical knowledge

Diagnosis

Clinical decision making

Treatment (including practical procedures)

Prescribing suggestions

Medical record keeping

Recognising and working within limitations

Keeping knowledge and skills up to date

Reviewing and reflecting on own performance

Teaching (students, trainees, others)

Supervising colleagues

Commitment to care and wellbeing of patients

Communication with patients and relatives

Working effectively with colleagues

Effective time management

Please decide how far you agree with the following statements by ticking one box in each line.

This PA respects patient confidentiality

This PA is honest and trustworthy

with PA's

This PA's performance is not impaired by ill health

This PA is fit to practise

Please add any other comments you want to make about this PA

Please note: please make sure all statements made are objective and constructive.

Your professional role

How recently have you been familiar with this PA's clinical practice?

During this period of your familiarity with this PA's clinical practice, how often did you have contact with the PA?