Pharmacy First Minor Ailments Service-Level 2:

Patient Group Directions Recordof Authorised Staff – Pharmacists Self Declaration

Before providing a Minor Ailments Service level 2 in West Cheshire pharmacists must:

  • Complete the CPPE Minor Ailments Service Declaration of Competence Self Assessment module and return a copy of the Declaration of Qualification and Competence Certificate to West Cheshire CCG (the commissioner)
  • Self declare their competence to work under the Patient Group Directions listed below by signing the Patient Group Directions “Record of Authorised Staff” and returning it to West Cheshire CCG (the commissioner)
  • Signing the “Record of Authorised Staff” assumes competence to provide treatment under all the Patient Group Directions listed below
  • Failure to competently provide the service or to ensure continued competence through appropriate CPD will be referred to the GPhC.

Patient Group Direction for the supply of: / Version:
Beclometasone nasal spray 500 micrograms for the treatment of seasonal allergic rhinitis (hay fever) / Version 1, date of introduction April 14, review date March 16
Chloramphenicol Eye Drops 0.5% for the treatment of superficial eye infections / Version 4, date of introduction November 2013, review date October 15
Chloramphenicol Eye Ointment 1% for the treatment of superficial eye infections / Version 4, date of introduction November 2013, review date October 15
Fusidic acid eye drops 1% for the treatment of superficial eye infections / Version 4, date of introduction November 2013, review date October 15
Fusidic acid ointment2%for the treatment of small localised lesions of impetigo / Version 1, date of introduction October 2014, review date September 16
Nystatin oral suspension 100,000units in 1ml for the treatment of oral candidiasis in infants / Version 4, date of introduction November 2013, review date October 15
Trimethoprim tablets 200mg for the treatment of uncomplicated unitary tract infections in women / Version 4, date of introduction November 2013, review date October 15

Copies of all protocols, PGDs and service documentation can be found in the materials section of your Webstar Service Pact module or the Community Pharmacy Cheshire and Wirral LPC site (services, commissioned Cheshire West and Chester, Clinical Commissioning Group).

Pharmacists Self Declaration

I declare that I

  • Have read understood and am competent to provide treatment under ALL the Patient Group Directions listed
  • Have undertaken any personal continuing professional development needed to deliver the service for the conditions included in the Patient Group Directions
  • Accept delegated responsibility
  • Will be professionally accountable for my actions

Pharmacists Name / GPhC No / Signed / Date

Return a copy of this declaration and a copy of your Declaration of Qualification and Competence certificate electronically to: