Physician Group Activity Support Application

Thank you for your consideration in applying for activity support funding from your Nanaimo Medical Staff Engagement Society (NMSES). NMSES is funded by the Specialists Services Committee’s Facility Engagement initiative.

IMPORTANT: Please read the following information before filling out your application.

Approval Process

Your project application must be completed in full and submitted to NMSES. All new project applications are put forth to the MSA Advisory Council for review at the monthly meeting. Following review, NMSES will inform you whether your project has been “Approved” as-is with possible conditions and/or suggestions, or has been “Rejected” and will provide an explanation.

If approved, the below conditions apply:

Communication and Reporting Requirements

Project Leads are required to submit bi-annual evaluation reports following funding approval to provide an update on the project’s progress, challenges, budget use, etc.

Some Project Leads may be required to present a review/update of their project at any Annual General Meetings that falls within the project’s lifespan.

Project Leads are required to submit sessional claims and reimbursement requests ASAP.

Use of Funds*

As per the funding guidelines of Doctors of BC, please note that the following list indicates the major activities that funds cannot be used to support (for a more detailed list of funding guidelines, please contact NMSES directly):

  • Clinical time, private enterprise, or profit
  • Partnerships or associations with Pharmaceutical companies
  • Backpay for project phases completed before project funding approval
  • Initiatives/education/projects that would otherwise fall under the responsibility of the Health Authority

Please click here for more information: Memorandum of Understanding

In order to ensure productivity, please note the following time restrictions for inactivity of funds:

  • After 3 months of inactivity NMSES will contact you for follow-up
  • After 6 month of inactivity your funds will be suspended upon review
  • After 12 months of inactivity, NMSES reserves the right to suspend and reabsorb funds. In order to reacquire funds, Project Leads will need to reapply.

*Disclaimer: Facility Engagement Funding Guidelines are subject to change as per the Specialists Services Committee & Doctors of BC. Projects that are funded at one point are not guaranteed future funding.

Please contact shain@nmses.ca with any questions or inquiries.

    Applicant Information

    Project/Initiative Information

    Health Authority (HA) Engagement

    Note: Any proposed activities involving patient care, flow, environment, data analytics, allied health, resources for sustainability would benefit from early consultation with HA.

    *Indicate how/if the HA has been/will be informed of the activity, consulted with, involved, and/or a collaborative partner, as applicable:

    This project would benefit from HA involvement as it requires input, data, implementation, financial or in-kind resources, etc.I need help finding the appropriate HA contacts.I am aware of the appropriate HA contacts and will include them below.

    Name:Title:Department:Contribution:
    1.
    2.
    3.

    YesNo

    YesNo

    HA engagementResearchMembership engagementQuality improvementQuality assuranceCapital projectsOther

    Project/Initiative Budget

    TypeAmount
    Sessional costs - general practitioner 
    How many general practitioners?  
    Total hours @ $134.77/hour$
    Sessional costs - specialist 
    How many specialists?  
    Total hours @ $158.97/hour$
    Operating/Administrative costs 
    Minimum 10 hours 
    Total hours @ $25.00/hour$
    Engagement/Event costs$
    Travel costs$
    Accommodation costs$
    Meal costs$
    Other costs
    		 
    $
    Other costs
    		 
    $
    Total requested for this project/initiative$

    Sign and Date

    I agree