Membership Scheme

Membership Scheme

Membership Scheme

Introduction – Role Purpose

The Membership Scheme will enable the Clinical Commissioning Group (CCG), patients and the public to work together to better understand and help shape local health services.

As a member you can choose your level of involvement, as a minimum you will receive user friendly information from the CCG to enable you to formulate and give your views on local health services to the CCG. You can be a ‘virtual member’ in contact with the CCG by phone, post and electronic means, but you can also attend public meetings if they are of interest to you. By communicating in this way we can learn about the issues affecting health services within our local area and shape the services for the better.

Organisational membership

To enable a wider more diverse membership as well as individual membership you can join representing an organisation or group.

Benefit of being a Member

By being a member you can join us in shaping health services by having:

  • Access to up-to-date information about the CCG
  • The opportunity to have your say
  • Straightforward information and uncomplicated methods of response.

As a member you will have the opportunity to:

  1. Promote the CCG and Membership Scheme with your family and friends
  2. Read newsletters and information distributed to you
  3. Partake in regular surveys
  4. Attend CCG public meetings/forums/focus groups as appropriate on a regular basis
  5. Represent your organisation or group at meetings or at events
  6. Take an active role in projects and activities

There are three levels of involvement

Level 1

To be a level 1 member you must ensure that you are:

  • Registered with a GP practice in the CCG area or represent patients from the CCG area
  • Interested in local health services
  • Over 14 years old

Our commitment to you:

To enable you to take part in the CCG we will provide you with a:

  1. Welcome pack which will include information on the NHS and CCG
  2. Regular correspondence

Level 2

To be a level 2 member you must ensure that you are:

  • Registered with a GP practice in the CCG area or represent patients from the CCG area
  • Interested in local health services
  • Willing to attend meetings and have your say.
  • Over 14 years old

Our commitment to you:
To enable you to take part in the CCG we will provide you with a:

  1. Welcome pack which will include information on the NHS and CCG
  2. Regular correspondence
  3. Involvement in feedback, consultations and surveys
  4. Officer available for queries

Level 3

To be a level 3 member you must ensure that you are:

  • Registered with a GP practice in the CCG areaor represent patients from the CCG area
  • Have an interest in local health services
  • Willing to attend meetings and have your say
  • Have the time to commit to projects you are involved in
  • Adhere to appropriate policies and codes of conduct
  • Over 16 years old

Our commitment to you:

To enable you to take part in the CCG we will provide you with a:

  • Welcome pack which will include information on the NHS and CCG
  • Regular correspondence
  • Involvement in feedback, consultations and surveys
  • An induction sessionto be held quarterly for new members
  • Officer available for queries and support

Removal from the Membership Scheme

You can at any time ask for your details to be removed from the membership scheme. If the CCG feel you have gone against the Code of Conduct you may be asked to leave the scheme.

Application Form

Contact Details

Fields marked with a red asterisk * are requiredTop of Form

Title:
First Name:*
Surname:*
Address:*
Area:
Post Code:
Home Tel:
Mobile Tel:
E-Mail:

How would you prefer to be sent information regarding Warrington CCG?

PostE-Mail

Are you an: Individual Group representative

Making the Most of your Membership

Please tell us what level of membership you are interested in

Level 1

Level 2

Level 3

How did you find out about the Membership? (Please state below)

Area of interest (indicate as many as appropriate)

Preventing premature deathsUrgent care programme

Primary CarePrescribing

Planned careFrail older people

Mental HealthEnd of Life

Acute children’sLong Term Conditions

Are you interested in more information about your local Patient Participation Group (PPG) in your GP Practice?

YesNoGP Practice

About You (This section is optional)

This section is optional. We ask for your details to ensure our engagement work is as representative as possible.

Gender:MaleFemale

How would you describe your sexual orientation?HeterosexualLesbian/Gay

BisexualPrefer not to say

Do you consider yourself to be transgender? YesNo

Do you consider yourself to have a disability? YesNo

Age Range: under 1818-24 25-34 35-44 45-54 55-64

65-7475-84 85+

Ethnicity: White British Black British White Irish Caribbean African

Indian Pakistani ChinesePolish Bangladesh Other

Declaration

I want to be a member of Warrington CCG. I am not a Member of Staff of the CCG or one of its constituent practices. I am happy for you to use this information in accordance with the membership scheme.

Please tick

Thank you for taking the time to register.

Signature ……………………………………… Date ………………………………

Please return this completed form to:

Paul Steele

Warrington Clinical Commissioning Group, 110 Birchwood Boulevard, Arpley House, WA3 7QH

Email:

Tel: 01925 843774

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