Extended Care Services: FAQs

This information applies to the Extended Care Service across the whole NHSE&I Midlands Region

This page will be updated as further questions are raised. Key information will be shared here so please keep checking for new information.
Updated 27/03/2021

 Q. Why has the Acute Bacterial Conjunctivitis (ABC) Service been ended (March 22nd 2021)?

A.  It has been brought to our attention that the SPC for Chloramphenicol eye drops has been updated and now includes a contra-indication for use in children under 2 years. The SPC states the following

Paediatric population: This medicinal product must not be given to a child less than 2 years old as it contains boron and may impair fertility in the future.

Chloramphenicol eye ointment is also now contra-indicated for use in children under 2 years.

As a result, NHSE&I have removed the service for the treatment of Antibacterial Conjunctivitis in children under 2 years with immediate effect. The module within PharmOutcomes has been disabled so no further entries can be made.

NHSE&I are aware that consultations may have been undertaken during the 48 hours leading up to the service ending which may not yet have been uploaded onto the PharmOutcomes system, so have sent separate communications to provide information on how these are to be dealt with.

Other stakeholders such as GP practices, CCGs and NHS111 are being notified of the cessation of the service.

Q. Who can provide the service?

A. This service may be provided by authorised Community Pharmacies contracted to NHS England Midlands, who are committed to making staff available to provide the service, subject to the conditions outlined on the service pages

Q. How do I know which pharmacies are signed up to the service?

A. NHSE&I are producing master spreadsheets with details of all the pharmacies signed up to either UTI, ABC or both Extended Care Tier 1 services. (This will be expanded to cover Tiers 2a and 2b if these are commissioned).

Below is the list for the East Midlands.  The document is an Microsoft Excel spreadsheet and lists every pharmacy; you can use the filter function on Excel to look for specific pharmacies towns or locations.

The lists will be updated periodically and pharmacies can sign up at any time. Please do not print the list today and treat it as the definitive list.

Q. I have signed up to Tier 1 but am not on the list yet -why?

A. The lists are prepared on a weekly basis so there is some lag between your signing and sending in the SLA and then appearing on the list.  If it is more than 2 weeks since you sent in an SLA please email the NHS team at East or West and check with them in case the SLA has been missed.

Q. I have signed up to Tier 2a but am not on the list yet -why?

A. The lists are prepared on a weekly basis so there is some lag between your signing and sending in the SLA and then appearing on the list.  If it is more than 2 weeks since you sent in an SLA please email the NHS team at East or West and check with them in case the SLA has been missed.

Please Note: you can only sign up to Tier 2a services if you have signed up to Tier 1 services. If you have not yet signed the Tier 1 SLA this will prevent you going onto the Tier 2a service.  If you do wish to deliver both Tier 1 and Tier 2a but have so far only signed up to Tier 2a, then you will need to sign and return Tier 1 SLA.

Q. How do I sign my pharmacy up to the service?

A. The SLA should be signed, and this needs to be stored in the services folder in your pharmacy.  You need to indicate on the signature page to which services you are signing up; UTI, ABC or both.

A copy of the signature page should be returned to NHSE&I and you will then be given access to the PharmOutcomes modules.  When access to the modules is turned on you should take this as confirmation that you have a contract with NHSE&I for the extended care services.

Please note that if you work for a multiple, you may not have the authority to sign up your branch to a local service – you should contact your Area Manager or Pharmacy Superintendent to ask about the process for your organisation.

Q. Where do I send the signed SLA?

A.  NHSE&I sent a letter explaining the process to the NHS mail address of every pharmacy in the regions.  You can download a copy here – there is one letter for the East of the region and one for the West.  The SLA is the same for the whole region, the reason we have two letters is to share the sign up workload at NHSE&I.

Please read the letter for info and to get the correct address for returning the SLA to.

Q. Is there any special training for pharmacists who are going to deliver the service?

A.  Pharmacists working at participating pharmacies can provide this Enhanced Service if they have completed the mandatory training requirements.

The requirements are;

  • That they have worked through the Clinical Knowledge Summary page for the condition related to the service they are aiming to provide (UTIs and/or infective conjunctivitis)
  • They must have satisfactorily completed the PHE Antimicrobial Stewardship for Community Pharmacy e-learning and e-assessment at https://www.e-lfh.org.uk/antimicrobial-stewardship-for-community-pharmacy-staff/ and are registered as an antibiotic guardian https://antibioticguardian.com/healthcare-professionals/
  • They must ensure that they have the correct clinical knowledge to provide the service and are familiar with appropriate NICE guidance
  • The requirements of the SLA are understood and the PGD associated with the service issigned.
  • The pharmacist must complete the Minor Ailments Declaration of Competence, hosted on the CPPE website, print this and add the heading “NHSE&I Community Pharmacy Extended Care Service Tier1”. It must then be signed and dated to complete the process. The pharmacist must also confirm on the CPPE website that they have completed and signed the DoC (for information on how to do this, please see our DoC page). The accuracy of the DoC is the pharmacist’s professional responsibility.

Q. What about locums or relief pharmacists?

A. You need to ensure that any relief pharmacists or locums you use are service ready; all of the information for these services are available on the relevant pages odf this website:

The service does not require the pharmacist to attend special training. However they must understand the service, ensure that their clinical knowledge is up to date and to be familiar with the PGDs.

As with all PGDs pharmacists must sign the pharmacy copy of the PGD in each pharmacy where they deliver this service.

Q. Which days should I offer the service?

A. When deciding to sign up to the service you should be aware that there is a requirement to offer the service during all of your opening hours so you must ensure that all of your pharmacists aretrained and your pharmacy team are briefed on how the service works.  NHSE&I understand that you may occasionally have to organise a locum at short notice, but for planned days off /holidays you must ensure that the service can be provided.

This is important because we will be promotinf access through GP practices and NHS111 and so you may receive referrals in the future. If patients come to you, only to be told that you “don’t do that today” this will have a negative impact on service perception by both patients and referring organisations, reducing confidence in the service.

Q. I have a patient who needs the service but I can’t deliver the service today – what should I do?

A. If you are not able to offer the service on a particular day (for any reason) you should check the list of service providers for your area, then contact another local pharmacy to confirm that they provide the service before advising the patient to contact them to arrange to be seen.

Pharmacies signed up to the extended care services can be found on the lists on this page; you can click here to go back to the list on this page.

You must NOT refer the patient to NHS111 or back to the GP practice– the whole point of this service is helping to reduce demand for appointments, and helping patients to be seen and supported by community pharmacy.

Q. How do I complete my DoC

A. The pharmacist will need to log in to the CPPE website and access the DoC section to download the DoC Self-Assessment Framework for Minor Ailments. (UTI and ABC services are a Level 2 Minor Ailments Service involving supply of POM medication under a PGD).  More information can be found on the services pages Simple UTI Tier 1 Service  and Acute Bacterial Conjunctivitis (ABC) Tier 1 Service

Q. Can I complete the service remotely?

A.  The SLA has been written to allow you to carry out a consultation face to face, or if it is more appropriate via telephone or video.  You will need to use your professional judgement to decide whether the patient needs to attend the pharmacy either to access medication or for a dipstick test.

Q. Do I have dipstick every UTI patient?

A.  No. You should NOT be dip-sticking every patient. The service is based on up to date guidance for diagnosing simple UTI and diagnosis is based on the woman having 3 of the listed ‘key symptoms’ with no exclusions.

Patient Symptoms – need 3 for treatment

The latest guidance states that use of Dipsticks is not a diagnostic indicator alone.

So you should only use a dipstick test to guide treatment decisions in otherwise healthy, non-pregnant women presenting with two or fewer symptoms of a UTI
If a female presents with only one or two inclusion criteria symptoms they can only be treated if there is a strong possibility of UTI when tested with a dipstick; these are the only patients who should have a dipstick test and for these patients to be eligible for treatment, it must be positive for nitrite and/or leucocytes.

Q. I don’t have a public toilet, how can I test urine if necessary? 

A. If a patient telephones ahead, you may choose to ask them to bring a urine sample with them “just in case” – remember you only need to dipstick if they have two or fewer of the inclusion symptoms.  If the patient comes to the pharmacy without calling ahead and it turns out that you need to test a urine sample,  it would be acceptable to ask them to go to either a public toilet or home (whichever is nearer) and return with a sample to allow you to do the dipstick test.

Q. Can I use my professional discretion and treat someone with one or two symptoms without using a dipstick test to confirm? 

A. No. The SLA clearly states that medication may only be provided under the strict terms of the PGD; every patient you treat must meet the inclusion criteria and have no exclusions as per the current PGD, as this is the legal basis for the supply of a POM.  The UTI PGD clearly states that treatment is dependent on a patient presenting with 3 symptoms from the list or if a female presents with one or two inclusion criteria symptoms they can only be treated if there is a strong possibility of UTI when tested with a dipstick. Thise is absolutley NO opportunity for you to “interpret” the service and treat a patient; their symptoms must fit the specific inclusion criteria. Making supplies outside of the strict inlcusion and exclusion criteria of the PGD would result in an unlawlful supply of a prescription-only medicine.

If you do not wish / are unable to test the urine from a patient with 1 or 2 symptoms you must refer that patient onwards to another practitioner (see below).

Q. If I am unable to either dipstick or unable to treat a patient, to whom should I refer the patient?

A. If you need to test a urine sample but cannot dipstick test for practical reasons which are specific to your pharmacy, please refer the patient to another pharmacy offering the Simple UTI Tier 1 service who may be able to dipstick the urine sample.  As part of this consultation, which you will be paid for completing, NHSE&I would expect you to call and check the pharmacy can support the patient, as this will prevent a wasted journey and frustration for the patient. Pharmacies signed up to the extended care services can be found on the lists on this page; you can click here to go back to the list on this page.

If you cannot dipstick for another reason (for example if the patient is unable or unwilling to provide a urine sample) you should refer the patient to their GP practice.

Q. I have carried out the consultation but the patient needs a dipstick test and I cannot do that, do I still record the consultation?

A. Yes, if you have conducted the full consultation and given advice and found an alternative health care provider for the patient to see, you should record the consultation and the outcome and save on PharmOutcomes.  You will be paid the professional fee for the consultation.

Q. How do I get my clinical waste bin?

A. Once NHSE&I receive your signed SLA your pharmacy will be put on the list to receive a bin. This will be delivered usingthe soonest available drop but will not be immediate. Please be patient as NHSE&I are working hard to arrange the contract across the region and you will get a bin as soon as possible.

Q. Can I use my clinical waste bin for waste from any other source?

A. NO; this bin is only for the extended care service and as a result will only have small capacity and you should NOT be dip-sticking every patient.

Q. How often will my clinical waste bin be collected?

A. Because the anticipated amount of clinical waste generated by this service is small, the clinical waste bins will be collected and a replacement provided 6 months after you first receive it and then again 6 months after that.

Q. Do you have an example SOP upon which I can base the one for my pharmacy?

A. NHSE&I have said they will not provide a template SOP, as this is for individual organisations to develop these.  It is felt that the SLA and PGDs together give adequate description of the service and it’s delivery and  many pharmacies have their own template for SOPs.

A simple local services SOP has been prepared by Simon Hay at South Staffs LPC and this can be downloaded, personalised and edited to suit your needs.  Many pharmacy SOPs for local services are written in this manner – (ie follow SLA, supply under terms of PGD etc) and provided that this type of SOP is stored with a copy of the service documentation it would fulfil the requirements to have a SOP for a locally commissioned service.

It is not intended that this example SOP replaces any SOP your company has already produced; it is here as an aid for those without a SOP to use as a starting point.  Do remember to add pharmacy details, relevant dates etc

Q. What do I do if I can’t get onto PharmOutcomes to do the consultation?

A. The requirement for all locally commissioned NHSE&I services is that they are recorded live on PharmOutcomes.  There may be an occasion where the IT fails and you are unable to access the system.

For this reason there are pro formas for each service that can be printed out and used to record the consultation.  If you have to record the service while “off-line”, using the pro forma will ensure that you collect all of the required data.

A copy of the pro forma can be downloaded from the PharmOutcomes module and from the service pages on this website and stored in your service file in case of IT failure. However, please be aware that if there is any variation in the service the pro forma may need to be updated to match.  For this reason we would recommend that you only print a small number of pro formas to keep in your service file and that if there are service or PGD updates you check on the system to check if a new version of the pro forma has been uploaded – future versions will be clearly dated.

Q. What about other services e.g. EHC, needle exchange, supervised consumption, smoking?

A.  These are commissioned on a smaller, more local footprint, funded by local authorities.  They do not fall under the remit of the NHSE&I commissioned extended care services.  If you require details of these services please consult your local LPC website or contact your LPC for information.