Submit an example

Your name and contact details

We need your name and email address to let you know that we have received your submission. We may also need to contact you if we have any queries about your submission.

*Name:
*Job title:
*Organisation name:
*Address:
Town:
County:
*Postcode:
*Telephone:
*Email address:
Fax:
*Strategic health authority:	-- Please select below -- North West Health Authority North East Health Authority Yorkshire and the Humber Health Authority East Midlands Health Authority West Midlands Health Authority East of England Health Authority South West Health Authority South Central Health Authority South East Coast Health Authority London Health Authority Other
*Type of organisation:	-- Please select below -- Primary care trust Acute trust Mental health partnership trust Foundation trust Ambulance trust Local government National or regional NHS Not-for-profit Patient organisation Academic Other
Sector:	-- Please select below -- Primary care Secondary care Tertiary care Education Voluntary Social services Other
	Are you willing to share your contact details and the content of your submission on our website so other users can contact you? Yes No

Type and title of submission

To help us to understand the context of your submission we need to know more about it.

Title of submission (avoid generic titles like 'implementing NICE guidance')

Description (please keep to a maximum of three sentences)

[Max. 1000 characters]

Does the submission specifically refer to the implementation of NICE guidance?

Submission type:

Please tick the category or categories that most closely reflect the nature of your submission.

Implementation policy
Job description
Terms of reference for implementation team
Financial plan
Staff induction programme
Audit tool
Other (please specify)
Other submission type:

Category of Submission (for Shared learning award purposes)

General Clinical Public Health

Industry sponsorship:

Is the submission industry-sponsored in any way?

Yes No

If yes, please give details

[Max. 250 characters]

Your submission

Aim:

Please provide a brief paragraph summarising the overall aim of the implementation initiative.

[Max. 2000 characters]

Objectives:

Using a numbered list, please describe the most important objectives (maximum of 3).

[Max. 2000 characters]

Context:

Briefly describe your starting point - for example, what baseline assessment did you undertake, what was happening prior to the intervention and why was it needed?

[Max. 2000 characters]

Results*:

Using a numbered list, describe the main results against the objectives.

[Max. 2000 characters]

Monitoring and evaluation:

If applicable, briefly describe how you monitored progress and evaluated results. Please indicate whether you will be publishing these results and if so, where.

[Max. 2000 characters]

Key learning points:

What did you learn that could be transferred to other organisations facing similar challenges? Please give pointers as if you were coaching someone on what might be successful and what to avoid.

[Max. 2000 characters]

Attach supporting material

Where possible please collate all supporting material into one MS Word file not exceeding 2 Mb. If you need to submit multiple files please email them to the Shared learning coordinator . Your submissions will not be edited by NICE

Thank you

Your submission will automatically be entered into the new Shared Learning Award. If you do not want your submission to be entered for the award, please tick this box

Thank you for your submission. If you have answered all of the necessary questions, checked your answers and are happy with your form please press 'Submit'.