Reflective Template:  Patient and Carer Involvement
Informal Evidence for Discussion

This reflective template has been designed to use with the SOAR Database (Scottish Online Appraisal Resource).  When you have completed this reflection, please upload it to SOAR / Form 3 and submit it to your interview to share with your Appraiser.	3-step guide to completing this form:

1)	Save this form (using “Save As”) to your computer (e.g. My Documents, Desk top), and customise the file name (e.g. Patient and Carer 2012)
2)	Proceed to filling out the form - when finished, Save and Close the document.
3)	Login to SOAR and Upload this file from where you had saved it (from step 1), either to the Documents Library, or directly to Form 3.	

This reflection template form should be used for Domain 3: Communication, Partnership and Teamwork.

If you have done the Patient Survey section, this section is strictly optional.
If you have completed this last year, please go to question 4.6.

The boxes will expand automatically as you type into them.
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4.1)	What arrangements do you have for obtaining patients’ views on your practice?

4.2)	If you are in a practice, is there a practice leaflet, newsletter, or website? Please describe briefly:

4.3)	If you are in a practice, is there any liaison with local organisations – patient participation group, carers group, local schools, day centres, churches and voluntary organisations etc?

4.4)	If you don’t have a practice base, do you ask for patient feedback from the places where you work? Can you describe any cases of positive or challenging feedback you have had?

4.5)	Do you have any supporting evidence that you would like to share e.g. practice leaflet, website address? (Please describe)?

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4.6)	Have there been any new developments or problems since last year?

4.7)	Have you had positive informal feedback from patients in the past year? (e.g. thanks, gifts etc.)