T02 Current and proposed scope of practice — Blank form
2026 digital edition · Dr Naeem Aziz DGM FRCP · 1 min read
Print this blank worksheet and complete it privately. Responses are not collected by the website. Do not include identifiable patient information. This is a planning aid, not an official application form.
Blank reusable form
Read with chapter 2 and 4
Complete one record for a defined activity. Separate present practice from a proposal and record the source of corroboration. Scope applies to consultants and SAS doctors alike. Record breadth of work separately from authority to make and implement decisions.
Activity and setting
Name the activity, patient group and service setting without patient identifiers.
Current responsibility
Describe the decisions you make and what is led by another colleague.
Limits and uncertainty
State exclusions, unfamiliar work and the circumstances in which advice is sought.
Support in practice
Record who is available, how advice is accessed and the cover arrangement.
Evidence of the present scope
Identify observation, records or feedback and their limitations.
Proposed change if any
Say what would change and what requires authorisation. Write none if recognition is the aim.
Confirmation and review
Record who has checked the description, any disagreement and the review date.