Pharma-Vac Form

Call for Community Pharmacy-led Local Vaccination Service Expressions of Interest

Expressions of Interest (EOI) must have been submitted by 17:00 20 July 2022 to be part of the initial site selection process for Autumn/Winter 2022/23. As outlined by the site selection guidance, as system requirements change over time, or if there are insufficient EOI to meet Population Need then the commissioner may request further EOI from pharmacy contractors. They will publish the postcode and deadline for submission (at least a week) in the table below and publicise to local pharmacy contractors. When the dead-line is reached, NHS England regional teams will examine all relevant EOIs submitted (including those that were submitted before publication of the postcode).

Postcode	Dead-line for submission of EOIs	Other comments

A list of fields within this form can be downloaded HERE. We would highly recommend that you complete your responses in this document then copy / paste into the form to prevent data loss when submitting infomation.

All fields with a * are mandatory.
Please use the ‘Save and Continue Later’ feature available at the end of the form to save your application so far and return later.
If you wish to upload additional information in support of your application, please note that permitted file types are PDF, Word and Excel.
Pharmacy contractors with additional queries may contact england.pccovidvaccine@nhs.net.

The form below should be completed by Pharmacy Contractors who are not currently contracted to deliver COVID-19 vaccinations and wish to provide vaccinations under the Phase 5 agreement, subject to there being an identified Population Need. This includes, but is not limited to, Pharmacy Contractors that may have been commissioned to provide COVID-19 vaccinations in any previous stage but who are not currently commisioned to provide the service. The purpose of this Expression of Interest form is to provide the Commissioner with information to assess whether the Pharmacy Contractor will be able to meet the site designation criteria, and whether the proposed site is best placed to meet the Population Need identified by the Regional Team.

Guidance on the requirements of the Phase 5 COVID-19 Vaccination Programme 2022/23 and the site selection criteria for community pharmacy can be found HERE

The Next steps for COVID-19 vaccination letter to the system;
The Community Pharmacy National Enhanced Service Covid-19 Vaccination Programme: Phase 5 2022/23 specification ; and
The Community Pharmacy Phase 5 Site Selection Process .

If you have previously submitted an Expression of Interest and have a copy of the automated response that contained your responses, then you may not need to complete the entire form again. You will need to indicate that you wish to participate and submit some details about your location, but you can then refer to your previous submission and state the date that submission was made. You should ensure that the previous submission is still correct and provides sufficient information for the Regional Team to make a decision on site suitability.

Should you have any queries that are not answered by referring to the documents above then please contact england.pccovidvaccine@nhs.net.

"*" indicates required fields

Submission statement - please read and check box to proceed*

I am submitting this form for the purpose of Expressing an Interest in leading a Local Vaccination Service site. I declare that all information given in this application form is true and accurate to the best of my knowledge. The information submitted in this form will be used by NHS England to support the prioritisation of proposed sites for designation and should be completed in line with the process outlined in the accompanying guidance. Once sites are in the process of being designated, information submitted in this form will be used by the COVID-19 vaccination programme team.

Declaration agreed

Your contact details

Lead Contact name*

This should be the person that we can speak to about this expression of interest

Lead contact telephone number*

Please provide a UK mobile telephone number

Lead contact email address*

Enter Email Confirm Email

About your pharmacy

Pharmacy premises ODS code*

Check your code HERE

Trading Name of Pharmacy*

If there is more than one registered pharmacy with the same trading name, then please hyphenate the name with an appropriate locality, for example, The Best Pharmacy - Crewe

Registered Pharmacy Address

Please ensure that the address is complete and correct, and as registered with the NHS

Address Line 1 Address Line 2 Address Line 3 City ZIP / Postal Code

About your proposed site

Your proposed site should be where the majority of your vaccines will be administered and would be the place where vaccine is delivered. There will be flexibility to also vaccinate elsewhere with the consent of the Commissioner (for example a pop-up site). Vaccinations must only be offered where suitable facilities are available and patient dignity and confidentiality can be respected.

Are you able to administer at least 100 vaccinations per week at the pharmacy registered premises?*

Respond 'No' if you are only interested in offering vaccinations from an off-pharmacy site.

Yes

What is the MINIMUM number of vaccinations per week that you propose to administer from the pharmacy registered premises?*

Please enter a number from 100 to 5000.

Min. volume will be agreed with commissioner subject to population needs but must be 100 vaccinations per week or more and must be sustained over at least 12 weeks

What is the MAXIMUM number of vaccinations per week that you propose to administer from the pharmacy registered premises?*

Please enter a number from 100 to 5000.

Max. volume will be agreed with commissioner subject to population needs

Integrated Care System for your pharmacy registered premises*

This field will be used to direct your submission so please check under "Higher Health Authority" HERE

Would you like / would you be able to run your proposed site off-pharmacy premises?*

This may be desirable where a larger site is needed or to improve access. A supervising pharmacist will be required on any off-site premises throughout opening times. Please note, this would be the site that vaccine is delivered to, not a temporary pop-up site.

Yes

What is the MINIMUM number of vaccinations per week that you propose to administer from the off-pharmacy premises?*

Please enter a number from 100 to 5000.

Min. volume will be agreed with commissioner subject to population needs but must be 100 vaccinations per week or more and must be sustained over at least 12 weeks

What is the MAXIMUM number of vaccinations per week that you propose to administer from the off-pharmacy premises?*

Please enter a number from 100 to 5000.

Proposed volumes are indicative and will be agreed with the Commissioner based on the workforce, operational capacity and size of eventual premises, available vaccine and Commissioner requirements.

Integrated Care System for your off-pharmacy premises*

This field will be used to direct your submission so please check under "Higher Health Authority" HERE.

Location where you propose to offer off-site vaccinations*

Please detail below the location that you would like to offer off-site vaccinations. If you would be able to operate a site throughout the STP / ICS then please mark as ‘Any location’

Proposed site to offer off-pharmacy vaccinations (if identified)

Please detail below any specific site, preferably NHS, public sector or commercial estate that you consider may be suitable. Please note advice in the Site Selection Process. There is not a requirement to identify a location yourself at this stage, you should not approach landlords until directed by NHS England.

Please provide any additional site information that may be helpful

For example, if you expect to provide a regular pop-up site in another location or if there are alternative sites that you would like to propose.

About your ability to meet other Key Designation Criteria

What age of patients will your site vaccinate?*

To offer vaccination of those under 18 years you must meet the relevant sections in the Children’s checklist HERE

over 18 years of age

over 16 years of age (Checklist A)

over 12 years of age (Checklists A and B)

over 5 years of age (Checklists A, B and C)

Will you be able to vaccinate patients in Care Homes and/or Housebound patients if requested by the Commissioner?*

An important part of the vaccination programme is ensuring that all patients can access vaccinations. This means that we must take vaccinations to patients where they cannot attend a vaccination site. In some locations there will be a requirement for community pharmacy-led sites to vaccinate patients in care homes or in their own homes. The patients to be vaccinated would be agreed between the pharmacy contractor and NHS England.

Yes

Maybe

Are you able to offer at least 100 vaccines per week through a combination of published walk-in clinics and through the National Booking Service over each week of an expected 12-week period without affecting the delivery of your core NHS services?*

Yes

Are you satisfying all aspects of your Terms of Service (as set out in the Pharmacy Regulations) including in relation to opening hours?*

Yes

Have you read, and are confident that you can meet the requirements in the ES as currently published?*

A final version of the ES will be published when we have more specific information about vaccination recommendations.

Yes

Did the most recent GPhC inspection of the Pharmacy (if one has taken place) result in ‘Standards Met’ for all 5 principles.*

Yes

No inspection has taken place

Would you like to refer NHS England to a previous expression of interest that contains all relevant information?*

If you have submitted all relevant information previously and have a copy of the automated e-mail (from necsu.apps@nhs.net) detailing your responses that you could provide on request, then you don’t need to complete the form again. We would strongly advise that you review the submitted response in conjunction with the Site Selection Process to ensure that there is not additional information that you’d like to submit

Yes

What was the date that you submitted the previous expression of interest that you would wish for us to reconsider for Phase 5?*

The date will be on the automated confirmation sent to the Lead Contact e-mail from necsu.apps@nhs.net

Please upload your previous expression of interest responses

This automated response from necsu.apps@nhs.net will contain all the responses that you submitted.

Max. file size: 65 MB.

Is there anything additional that you would like to add?

This will be the final opportunity to review and provide information before submitting your expression of interest.

Sections below will gather further information for the commissioner to be able to select sites as described in the Site Selection Process. It is structured to help draw out relevant information that you may have but it is not necessary to fill in extensive information in all boxes, we appreciate that additional planning will be required following discussion with the commissioner.

Further Information about your pharmacy

Pharmacy premises GPhC number*

Check HERE

GPhC number of Pharmacy Superintendent*

Check HERE

Are your premises or Pharmacy Superintendent currently subject to statutory GPhC enforcement action or notices?*

Yes

Please provide further details*

Safety and Clinical Quality

Do the team at your proposed vaccination site have experience in administering COVID-19 vaccinations?*

This experience may be gained from administering vaccinations at any site, not just a community-pharmacy-led site

Yes

What experience do your team have of administering COVID-19 vaccinations?*

Please provide information that demonstrates their experience, for example was this a regular activity, one-off shift, or shadowing. You should comment on whether they gained experience in leadership of a vaccination site, the National Booking Service, or other activities. Please provide details of where and how team members gained this experience.

Do the team at your proposed vaccination site have other relevant experience that will help them to manage the COVID-19 vaccination service?*

For example, experience of handling other medicines with complex storage and usage requirements, in drawing up medicines from vials and/or administering other vaccines.

Yes

What other relevant experience do your team have that will help them to manage the COVID-19 vaccination service?*

Please comment on the relevant experience that your team can draw on, for example in delivering different vaccination or aseptic services, or otherwise demonstrate that they have an appreciation for the requirements of the service.

What experience do your team have in applying a quality improvement approach*

For example, you may wish to describe how you determine that other services are meeting the needs of the public, how you gather and analyse feedback or incidents, with examples of where changes have been made to improve your service.

Coverage / Access

All sites should offer patients the opportunity to access vaccinations at the weekend and in the evening. Actual delivery hours shall be agreed with the NHSE regional team having regard to the available vaccine supply and the vaccination programme.

When will your service be available to patients?*

Please give more information on specific days or times, particularly where you are proposing to offer services out of hours or at weekends, or where there are days when you are proposing that you will not be offering a vaccination service. Reference should be made as to how the proposed hours meet the needs of the local population.

Plans for your site*

Please outline your operational plans for your proposed site below. You may wish to describe how the will site run, how will patients and staff flow through the site, for example with different stations, why is this a good location, how big will it be? etc.

Addressing inequality

The vaccination programme are passionate about making the COVID-19 vaccine accessible to everyone in our community. Vaccination sites are encouraged to use behavioural insights, lessons learned, resources and shared examples from across the country to make sure that hesitancy can be overcome, and everyone can access vaccinations in a way that works for them.

How will your site meet the local population needs, include any examples of how the pharmacy contractor is meeting those needs already?*

You may want to reference particular examples of underserved or seldom heard parts of your local community and how you support them in other services.

How will your proposed service reduce health inequalities?*

People who face health inequalities include looked after children, carers, homeless people, offenders and ex-offenders, people with substance misuse issues, people who are poor or deprived, people living in remote or rural areas, refugees and asylum seekers.

How will your proposed service support patients with additional needs, including access, language or communication?*

You may wish to describe how your service will be able to support those with sensory or physical disabilities, cognition and learning difficulties, needs associated with social, emotional and mental health difficulties and/or communication and interaction conditions.

Describe how patients will access your site.*

Where a site has been located, you may wish to comment on access for those using their own or public transport including road network in the vicinity of the site, available parking and/or the use of stewards if appropriate.

Capacity

How will you provide this service without impacting usual pharmaceutical services?*

Describe suitable arrangements to prevent the disruption of other services or obligations placed on the Pharmacy Contractor by the Community Pharmacy Contractual Framework, and to ensure that the consultation room remains available, when required, for patients other than those requiring vaccination. You may want to comment on clinical leadership, how your team will manage clinical supervision, administration activities and keeping up to date with programme communications.

How will you ensure that vaccine wastage is minimised?*

Describe how you will prevent wastage, including wasted doses from multi-dose vials. You may wish to comment on how you will ensure that all doses are used at the end of a day, how you will recruit patients if you have a large number of patients who do not attend the clinic or if you have short-dated stock that would otherwise be wasted.

How will you manage patient flow on-site?*

You may wish to comment on experience managing high throughput services or flu vaccinations previously, patient flow throughout the site, maintaining distance between patients, ventilation at the site, vaccination and post-vaccination observation areas and, if on the registered premises, how existing footfall will be managed. You should consider any additional footfall relating to the administration of flu vaccinations that may be delivered during the same period.

Would the site be able to flex to accommodate and rapidly administer larger volumes of vaccine in a short time frame, if required?*

As the programme has developed, there have been circumstances that have meant that larger volumes were required rapidly, for example to use available stock at short notice, or to combat rapidly increasing infection numbers in the locality. Please comment on whether your site would be able to flexibly accommodate such requests.

Value for Money

Equipment required, set-up and ongoing costs will be used to review whether the site would provide good value for money. We expect that costs will be proportionate to the volumes of expected vaccinations and that for most sites, no equipment or set-up costs will be required.

Will there be set-up costs or equipment expected from NHS England in relation to this site?

Equipment may be available from the commissioner, any supplied remains the property of the NHS and is required to be maintained in good order and returned on request.

Yes

Please provide more information on expected set-up costs*

Please specify any anticipated set-up costs or equipment required. These estimated costs will be used to assess value for money and should a site be progressed, will be used to determine any allocation of funding. All anticipated costs or equipment, where reasonably known, should be included.

Will there be on-going costs in relation to this site that you propose would be claimed back from NHS England?*

Please tick all that apply

No additional costs

Lease Costs

Security Costs

Utility Bills

Other

Please provide more information on expected on-going costs*

Please specify any anticipated on-going costs. These estimated costs will be used to assess value for money and should a site be progressed, will be used to determine any allocation of funding. All anticipated costs or equipment, where reasonably known, should be included.

Workforce

Resources from the COVID-19 vaccination programme workforce and training team may be helpful to inform plans. The Local Vaccination Service toolkit for example, has examples of operating models, whilst the accompanying CP toolkit includes relevant learning for pharmacy sites.

What is your workforce plan?*

You may want to comment on how many additional members of staff you anticipate you'll have working on the site each day, what will their roles be and how will they be recruited.

Will you require additional workforce from the Lead Employer to operate this site?*

More information on the Lead Employer can be found in the CP toolkit referenced above

Yes

How many vaccination 'pods' will you be using?*

Consider each 'pod' as the location for a single vaccinator at a time. Describe whether you expect to have consecutive shifts or several people vaccinating at the same time?

Engagement with local systems*

How will you link with other local healthcare vaccine providers and systems to ensure the vaccination service is co-ordinated and offers the best delivery model for patients?

Is there anything additional that you would like to add?

This will be the final opportunity to review and provide information before submitting your response. You may wish to add photos or a plan of your clinic space below.

Add files here

Please attach only infomation that will augment your expression of interest and cannot be reported elsewhere on this form, for example photos of your propsed site or pictures of site plans (these do NOT need to be professionally drafted).

Max. file size: 65 MB.