- Latest available (Revised) - English
- Latest available (Revised) - Welsh
- Original (As made) - English
- Original (As made) - Welsh
This is the original version (as it was originally made).
1. Name of the Local Health Board to which the application is made.
2. Type of consent applied for (full or preliminary).
3. Type of application (for example: new inclusion; relocation within a Local Health Board’s area; relocation between neighbouring Local Health Board areas; relocation; change of ownership; preliminary consent).
4. Name and address of the applicant.
5. If the applicant is an individual or a partnership carrying on a retail pharmacy business, the applicant’s or each partner’s registration number in the General Pharmaceutical Council register.
6. If the applicant is a body corporate carrying on a retail pharmacy business, the name and registration number of the applicant’s superintendent in the General Pharmaceutical Council register.
7. The address of the premises from which the applicant applies to provide pharmaceutical services; or the location of the premises from which the applicant intends to provide pharmaceutical services if the application is for preliminary consent.
8. Whether the applicant is currently in possession of the premises or whether, for example, the premises are under construction or negotiation.
9. The days on which the pharmacy will be open for the provision of pharmaceutical services and the opening hours on those days.
10. Confirmation that all essential services will be provided and, if applicable, which appliances the applicant undertakes to supply.
11. Details of directed services that the applicant applies to provide.
12. If the application is to provide pharmaceutical services of a different description to those currently provided at the listed premises, details of those services.
13. Where regulation 16 applies to the determination of an application, the applicant must state the reasons why the applicant considers the application will meet a need identified in the relevant pharmaceutical needs assessment of the Local Health Board in which the premises specified in the application are situated.
14. Where the prejudice test in regulation 16 applies to the determination of an application, the applicant must state the reasons why they consider that granting the application will not prejudice the proper provision of primary medical services, dispensing services or pharmaceutical services in the controlled locality in which the premises specified in the application are situated.
15. Where the applicant applies to relocate (whether within the Local Health Board’s area under regulation 19, between neighbouring Local Health Board areas under regulation 20 or on a temporary relocation basis under regulation 21) the applicant must provide details of the proposed relocation including the address of the applicant’s existing listed premises.
16. Where the application involves a relocation between neighbouring Local Health Board area under regulation 20 the applicant must state—
(a)the name of the Local Health Board where the existing premises are located,
(b)that the applicant consents to the removal of their name from the pharmaceutical list maintained by the Local Health Board in whose area the existing premises are located and in respect of those existing listed premises with effect from the date on which the provision of pharmaceutical services from the new premises will commence, and
(c)how the applicant intends to meet a need identified in the pharmaceutical needs assessment of the neighbouring Local Health Board, if the application involves a relocation to meet such a need.
17. The applicant must provide details of whether—
(a)for the patients who are accustomed to accessing pharmaceutical services at the existing premises, the location of the new premises is significantly less accessible,
(b)the same pharmaceutical services will be provided at the new premises as are provided at the listed premises, and
(c)the provision of pharmaceutical services will be continuous or interrupted and the reasons for any interruption.
18. If the application is for a temporary relocation, the applicant must state the circumstances that require a temporary relocation.
19. Name of the person included in the pharmaceutical list currently providing pharmaceutical services from the premises.
20. The applicant must provide details of whether—
(a)the same pharmaceutical services will continue to be provided from the premises, and
(b)the provision of pharmaceutical services will be continuous or interrupted and the reasons for any interruption.
21. The applicant must give an undertaking that if the application is granted the applicant will provide the pharmaceutical services, and if applicable supply the appliances, at the premises in respect of which the application is granted in accordance with the applicable terms of service.
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Original (As Enacted or Made) - English: The original English language version of the legislation as it stood when it was enacted or made. No changes have been applied to the text.
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