How To Register A Pharmacy

Transcription

1 Restoration of Pharmacy Premises Application form

2 OFFICE USE ONLY PCT OWN INSP PREM 1. Details of pharmacy premises to be restored 1.1 Trading Name 1.2 Has there been a change in the Trading Name? 1.3 If please provide former Trading Name 1.4 Address 1.5 Post code 1.6 Premises registration number 1.7 Date premises ready for inspection 1.8 Proposed opening date This date should be at least 3 weeks before the intended opening date. The proposed opening date is the date the premises will begin its registerable activities 1.9 Proposed closing date The proposed closing date must be completed if restoring exhibition premises 2. Body Corporate/NHS Trust making application (if applicable) 2.1 GPhC Owner number If the Body Corporate/NHS Trust does not currently own registered pharmacy premises please leave section 2.1 blank. 2.2 Name of body corporate/nhs trust

3 2.3 Address of body corporate/nhs trust 2.4 Superintendent registration number 2.5 Superintendent name 2.6 Director information to be completed by Bodies Corporate only Title First Names Surname (Family names) GPhC Registration Number (if applicable) Please continue on a separate sheet if necessary. 3. Sole traders or Partnership making application (if applicable) 3.1 Sole trader/partner GPhC registration number 3.2 Name of sole trader/partner 3.3 Partner GPhC registration number 3.4 Name of Partner 3.5 Sole trader s home address/ Principal address of partnership

4 4. NHS contractual arrangements (if applicable) 4.1 Name of hospital, PCT, healthboard 5. Nature of business 5.1 Type of pharmacy High Street/Community Hospital Exhibition Mail Order/Internet 5.2 Has planning permission been granted for the pharmacy? 5.3 If an internet pharmacy will be operated from the premises, please enter the website address: The GPhC is now able to supply an Internet Pharmacy logo to authenticate your on-line pharmacy. If you wish to make an application for this, please see separate form Application for an Internet Pharmacy Logo. This is available on the Registration page of the GPhC s website, 6. Registered pharmacy services and activities You are required to provide details of the type of activities undertaken or to be undertaken at the premises. A. The GPhC will only register pharmacy premises if the principal activity at the premises is the retail sale or supply of Pharmacy (P) medicines and / or Prescription Only Medicines (POMs). If it is not your intention to carry out retail sales of Ps & POMs** and you are unable to tick to either 6.1 or 6.2 your premises will not be registered. You may tick more than one box in Section A. 6.1 For the main purpose of retail selling Pharmacy (P) medicines. 6.2 For the main purpose of dispensing and supplying (licensed) medicines in accordance with a prescription. **The retail sale of medicines also includes the supply of medicines against a (NHS or private) prescription which is a supply corresponding to retail sale.

5 B. Please indicate any ancillary activity that may be undertaken at the premises. You may tick more than one box in Section B. 6.3 Pre-packing or assembly of medicines for the purpose of supply from your proposed registered pharmacy or from another registered pharmacy within the same legal entity (ownership). ( e.g. breaking down bulk containers into quantities more appropriate for use against prescriptions. These pre-packs can be distributed to other registered pharmacy branches under the same ownership for their use against prescriptions.) 6.4 To assemble and /or prepare unlicensed medicines in accordance with the limited exemption provided by Section 10 of The Medicines Act (i.e. to obtain, dispense and supply unlicensed medicines or extemporaneously prepare medicines in accordance with a prescription and/or to prepare and supply Chemist s nostrums for sale.) 6.5 To wholesale medicines to another legal entity in accordance with the limited exemption provided by Section 10 of The Medicines Act (e.g. supply stock to a doctor, dentist, hospital trust or any other person or body who can be lawfully wholesaled to). 6.6 Other (please specify any other registerable activity you intend to carry out below) If you propose to wholesale, assemble or manufacture medicines and if it is likely that these activities could constitute more than an inconsiderable part of the business of the proposed registered pharmacy then you will be required to apply to the Medicines and Healthcare products Regulatory Agency (MHRA) for the appropriate licence to cover these activities. 7. Contact details of Individual Making the Application 7.1 Name 7.2 Registration number (if applicable)

6 7.3 Position held in body corporate (if applicable) 7.4 Phone number 7.5 address 8. Declaration 8.1 I am a person applying for restoration of the pharmacy premises described above and I hereby declare that I am or will be a person lawfully conducting a retail pharmacy business at the premises within the meaning of Part 4 of the Medicines Act The information that I have provided in this application for registration is complete, true and accurate. 8.3 I understand if the declaration is not completed to the satisfaction of the Registrar, the Registrar may refuse to restore the premises in Part 3 of the Register. 8.4 Name 8.5 Registration number (if applicable) 8.6 Position held in body corporate (if applicable) 8.7 Signature 8.8 Date

7 9. Documentation to be submitted with the application 9.1 A description of the premises to which the application relates. Please tick to confirm that a description of the premises included with application 9.2 One set of A4 size plans of the pharmacy layout - please see section 11.3 for details. Please tick to confirm plans included with application 9.3 A completed payment form. Please tick to confirm the payment form is included with application 9.3 If the Body Corporate (e.g. Limited Company or NHS Trust) does not currently own registered pharmacy premises, please submit a completed application to nominate a superintendent pharmacist. A link to this is available on the Pharmacy Premises page of the GPhC s website Please tick to confirm the nomination of superintendent form is included with application If the correct documentation is not submitted with this application and we have to return the application more than once then a 46 administrative fee will be charged. Please the completed form along with a copy of your supporting document to premises@pharmacyregulation.org, or post your completed form to: Premises Registration, The General Pharmaceutical Council, 129 Lambeth Road, London SE1 7BT.

8 10. Payment Form (The fees below apply from 1 September 2011) 10.1 Registration number of Superintendent, or Sole Trader, or Partner Postcode of premises to be registered Credit or Debit Card information Charge this card with the sum of (Payment by credit card will incur a surcharge of 2%): To restore the pharmacy premises to the register you must pay the application fee of 102, plus the appropriate restoration entry fee: Please charge this card with the sum of:. Debit Card: 221 ( 102 application fee plus 119 Restoration Entry Fee following Voluntary Removal) Credit Card: ( 102 application fee plus 119 Restoration Entry Fee following Voluntary Removal plus 2% surcharge) Debit Card: 789 ( 102 application fee plus 687 Restoration Entry Fee following removal for n Renewal) Credit Card: ( 102 application fee plus 119 Restoration Entry Fee following Voluntary Removal plus 2% surcharge) Please indicate whether you are paying by Debit card Credit card Type of card Please tick one Mastercard Visa Visa Purchasing Visa Delta Maestro Solo Card number (insert the exact amount of digits in your card number only) CSC number (The last 3 digits on the back of the card) of the card) Valid From Date / Expiry Date / Issue number Issue number for Maestro or Solo cards only. If your card does not have an issue number please enter NA in the boxes. Name of cardholder Address of cardholder The name exactly as it appears on the debit or credit card Postcode Signature To be signed by the cardholder Date (dd/mm/yy)

9 10.4 BACS information Account number Sort code Bank Nat West When paying the restoration fee of either 221 or 789 by BACS you must enter the postcode of the premises (1.5) as the BACS reference 11. Important information (please retain these pages for your records) 11.1 Restoration Process The restoration of a pharmacy premises will take up to 3 months from receipt of a fully completed application (including the correct fee). Your application will be acknowledged in writing and a premises registration number will be issued. The premises will be subject to a visit by a GPhC inspector. Once approved, the premises will appear on the Society s register search at Names of Directors Body Corporate If the GPhC does not hold a current list of Directors for the Body Corporate that is making the application it will be required that a list of all Directors be submitted with this application Plans The plans you submit should: Identify the dimensions of the registered area (please indicate area in m 2 ). Be drawn to scale. Identify the dimensions of the dispensary (please indicate in m 2 ). Clearly show the internal layout showing the areas in which medicinal products are intended to be sold or supplied, assembled, prepared, dispensed or stored. Detail the postal address of the building in which the premises is situated. Detail any other relevant information including access points Change of Ownership If you intend to transfer the ownership of the pharmacy premises in the future, the person or body seeking ownership of the registered premises should be advised to contact the premises section of the GPhC. The prospective owner must complete a transfer of ownership application. It is a requirement that the application to transfer ownership must be lodged with the GPhC within 28 days of the date of transfer. The fee payable for processing a transfer of ownership application is Extensions or alterations If you intend to alter the registered pharmacy premises by making a change to the layout or a physical alteration to the structure of the registered premises, you are required to advise the GPhC of the planned change. Please submit one set of scaled plans. A new premises application is not required. If the planned alterations extend into an entirely new building, or where the proposed extension does not coincide with a proportion of the registered area of the existing registered premises, then an entirely new premises application is required. If in doubt please call the premises section for guidance on

10 11.6 Death or bankruptcy Please contact the registration section for guidance on Registerable activities If you propose to wholesale, assemble or manufacture medicines and if it is likely that these activities could constitute more than an inconsiderable part of the business of the proposed registered pharmacy then you will be required to apply to the Medicines and Healthcare products Regulatory Agency (MHRA) for the appropriate licence to cover these activities Restoration of pharmacy premises applications by The GPhC now accepts restoration of pharmacy premises applications via . To submit this form via , please complete as normal, scan and as a PDF to premises@pharmacyregulation.org Please submit the application and plans in one document.