Pharmacy template forms
There is a form for patients to apply to NHS England or the integrated care board in which they live to have their prescriptions dispensed by their GP due to serious difficulty in obtaining them from a pharmacy. There are also several forms for use by contractors to notify, apply for, or request changes to opening hours. Also included below are forms to notify of a closure of premises and entering administration. Finally, there are forms for use to ensure that applications for temporary arrangements are in place (either during a declared emergency or for other reasons beyond the contractor’s control).
- Chapter 33 annex: Annex 1 – application form – serious difficulty
- Chapter 36 annexes:
- Annex 1 – notification of opening hours on bank and public holidays
- Annex 2 – application form – application to change core opening hours – dispensing appliance contractors
- Annex 2 – application form – application to change core opening – hours pharmacy contracts
- Annex 2 – application form – application to reduce the total core opening hours of a 100 hour pharmacy
- Annex 9 – notification of an increase to the total number of supplementary opening hours
- Annex 9 – notification of a decrease in the total number of supplementary opening hours
- Annex 9 – notification of a redistribution of supplementary opening hours
- Annex 9 – notification of the introduction of a rest break into core opening hours
- Annex 9 – notification of the amendment of an existing rest break within core opening hours
- Annex 18 – temporary suspension of services
- Annex 19 – planned temporary suspension of services
- Chapter 38 annexes:
- Chapter 41 annexes:
For market entry and consolidation applications, please go to Primary Care Support England.
For other forms, please see the pharmacy manual list of annexes.
