Workload Transfer Form

This form should be used to inform Bro Taf LMC of any non contractual and non resourced workload shift. We will collate any recurrent themes and escalate to the Health Boards. Please blank out all patient identifiable information, with only the NHS number visible on any form/evidence submitted.

Name

First Name

Last Name

Email

Practice

From which department did the request originate?

Briefly outline the issues experienced

Action taken by the Clinician or Practice

Has the practice received this request before?

Workload Transfer Form

Registered Office

Legal