It is important that we have up-to-date information on all foundation trainee pharmacists undertaking NHS England commissioned training programmes within London (those employed by hospitals or those undertaking the national foundation trainee pharmacists in General Practice programme in London). This includes information on a trainee’s personal contact details, designated supervisor details and multi-sector rotation(s) information.

Please complete the form below to inform us of any changes.

Trainee Details

Title
Forename of Trainee
Surname of Trainee
Trainee Group
Name of employing Trust/Organisation

If your Trust/Employer is not listed on the dropdown, please enter below.

Trust/Employer Other

What change is required?

What change are you informing us of?

If you are informing us of more than one change or selected Other please note additional changes below

More than one change; please state

Change of Personal Details

name
Trainee Personal Email
Trainee Trust/Work Email
name
Telephone (work)
Mobile (emergencies only)

Placement Information Update

If you are have a placement, which is longer than 3 months, away from your employing organisation, please confirm the details below.
Please also complete the Educational Supervisor/Designated Supervisor section to inform us who your placement ES/DS will be.

Please provide the name of where your placement is
Please confirm the number of months you will be at this placement
Confirm the date when the placement starts

Educational Supervisor/Designated Supervisor Update

Educational Supervisor/Designated Supervisor Add/Change Type
Supervisor Forename
Supervisor Surname
Supervisor Email
If you are requesting to change an Educational Supervisor/Designated Supervisor, Please State Previous ES Name
Has the previous ES/DS left the trust

Additional Changes Required

If you have a change which doesn't appear on the above list, please enter below.

Other information to be updated:

Please refer to the NHS England privacy notice https://www.england.nhs.uk/contact-us/privacy-notice/ for information on how we manage your data.

Please note: If you are a Foundation Pharmacist completing this form with an Educational Supervisor change.
Please download, complete and submit the learning agreement to lasepharmacy@hee.nhs.uk.

Learning Agreement