2 November 2011
This template application form has been developed by NHS PCC to assist PCTs and pharmacy contractors who wish to apply to temporarily provide services whilst a pharmacy contractor is suspended. It contains the information required by Regulation 54 of the NHS (Pharmaceutical Services) Regulations 2005, as amended. PCTs should note that temporary chemists are not obliged to use this template when applying to join their pharmaceutical list as long as they provide all the information required by the Regulation; however it is hoped that such applicants will find this template useful.
Where the applicant is not already included in the PCT’s pharmaceutical list they are also required to provide the information and undertakings specified in Part 3 of Schedule 4 of the NHS (Pharmaceutical Services) Regulations 2005, as amended. Without this information the application is deficient and cannot be determined.
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