Name of renal unit ………………………………….
Q1. For each pharmacist who has a commitment to the renal unit, please complete the following table:Pharmacist / AfC Band or Grade / Full time (FT) or Part time (PT) / If PT, specify hours / week or WTE* / What proportion of time WTE* is spent providing care to renal patients?** / Years of
post qualification experience / How long has pharmacist been in a renal post?
(Years) / Rotational?
Y / N / If rotational, how long is renal rotation? / Who funds the post?
Pharmacist
One
Pharmacist
Two
Pharmacist
Three
Pharmacist
Four
Pharmacist
Five
Pharmacist
Six
* WTE = Whole Time Equivalents
** This time includes providing pharmaceutical care to acute, chronic and dialysis dependent renal patients but excludes dispensing times.
Q2. What are the key responsibilities of your renal pharmacist(s)? (Please give examples below)Q3. Does your hospital perform renal transplant services? Yes / No (Delete as appropriate)
If no, go to Q4.
If yes, please complete the following table for each pharmacist who provides pharmaceutical care to transplant patients.
Pharmacist / Proportion of time spent providing pharmaceutical care to transplant patients (WTE), excluding dispensing.
Pharmacist One
Pharmacist Two
Pharmacist Three
Pharmacist Four
Pharmacist Five
Pharmacist Six
Q4. Does anyone else have responsibility for providing pharmaceutical care to renal patients? Yes / No (Delete as appropriate)
If no, go to Q5.
If yes, please complete the following table for each person providing pharmaceutical care to renal patients.
Pharmaceutical Care Provider
e.g. Renal pharmacy technician, ATO / WTE / AfC Band
or Grade / Please specify their main responsibilities
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Pharmacy Questionnaire July 2008
Q5. Do any of the pharmacists in Q1 work in renal outpatient clinics? Yes / No (Delete as appropriate)If no, go to Q6.
If yes, please complete the following table for each pharmacist who works in renal outpatient clinics.
Pharmacist / Time involved in clinic
hours / week or WTE / Type of clinic /
patients seen / Is pharmacist a supplementary prescriber?
Yes / No / Currently training / Is pharmacist an independent prescriber?
Yes / No / Currently training / Key responsibilities, including the use of prescribing skills
Pharmacist
One
Pharmacist
Two
Pharmacist
Three
Q6. Does your renal team provide a clinical pharmacy service to any renal satellite units? Yes / No (Delete as appropriate)
If no, thank you for taking the time to complete this questionnaire.
If yes, please complete the following table for each renal satellite unit your pharmacy department provides a service to.
Satellite Unit / Is the satellite unit in a separate trust?
Yes / No
If yes, please state location / Is the satellite unit NHS or provided by an Independent Service Provider? / What is the clinical pharmacy time involved? (WTE) / Key responsibilities
Satellite Unit
One
Satellite Unit
Two
Satellite Unit
Three
Thank you for taking the time to complete this questionnaire.
Please return this completed questionnaire by Wednesday 27th August and send to:
Patti Monkhouse, RPG Secretariat, 26 Oriental Road, Woking, Surrey. GU22 7AW
By email: or by Fax: 01483 727 816
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Pharmacy Questionnaire July 2008