Acute Bacterial Conjunctivitis Tier 1 Service

Service News Updates:

January 2022 – NHSE&I announcement

extended care pharmacy services – sign ups for new providers has been paused.

The NHSE National Antimicrobial Resistance (AMR) Programme Board has requested that the DHSC UK AMR Board’s Research Co-ordination Group commission an National Institute for Health Research (NIHR) programme of work to look at the quality, safety, effectiveness and appropriateness of new and existing clinical services to manage infection provided by community pharmacies and other care settings, including the supply of antimicrobials without a prescription under the legal direction of a PGD. 

The Board has advised local commissioners to pause new services until this work has been undertaken.

Following this recommendation, a decision has been made regionally to suspend any new SLA sign up’s to the Midlands Region Extended Care Tier 1 and Tier 2 services with immediate effect.

This does NOT impact those pharmacies currently providing the service.

Community Pharmacies currently providing Tier 1 and Tier 2 services can continue to provide services to patients as normal. As a current provider, if you have a change in pharmacist, then they also can sign the PGD’s and provide the service(s). The suspension relates to the sign up of new sites only.  

The message informing pharmacies about this decision was sent by NHSE&I Midlands Region to all pharmacy NHS mail addresses and was also copied to all of the Midland Region LPCs.

Extended Care Jan 2022 NHSE&I Information letter

Service restarting Monday October 11th 2021

Please note the eye service was paused on 22.3.2021 but it is restarting with an updated PGD on 11.10.2021.

2021 Chloramphenicol Proforma

Service covers whole of NHSE&I Midlands footprint plus deferred treatment allowed.

Area Covered by Service: the service covers the whole NHSE&I Midlands footprint and this means that you are able to treat those registered with GPs in the East Midlands, Central Midlands and West Midlands areas. The PharmOutcomes modules have been edited to reflect this and when you enter the GP practice details, those in the correct region will be available to save while those outside the area are greyed out.

Temporary Residents: you may treat patients who are staying in the NHSE&I Midlands Region as temporary residents provided they are registered with a GP in England.  You will be asked to confirm their temporary resident status within the PharmOutcomes module.

Important note, this service is not intended to be delivered to patients who live outside the area and are only visiting for the day or reside just over the Midlands borders. Provision of services to out of area patients as temporary residents should be by exception.

Deferred Treatment: many infections get better without antibiotic treatment. Deferring treatment gives the patient the opportunity to avoid antibiotics, reducing the use of antibiotics reduces the risk of the patient suffering from side-effects as well as reducing the risks of antimicrobial resistance.  Info on how to record deferred treatment on PharmOutcomes can be found on the PharmOutcomes extended care info page on this website.

Letters from NHSE&I Dec 2020

Please note service SLA is the same across the region but you need to download the letter appropriate to your pharmacy location so the signed SLA goes to the correct team at NHSE&I

Extended Care Tier 1 Letter Dec 2020 EAST

Extended Care Tier 1 Letter Dec 2020 WEST


Service spec info can be found lower down on this page.

Community Pharmacy Extended Care Tier 1: Acute Bacterial Conjunctivitis Service for children aged 3 months to up to 2 years of age.  

Please read all of this information

Pharmacies currently signed up to deliver the service:

The service now runs across the whole NHSE&I Midlands Region and the lists of participating pharmacies can be found on the Extended Care FAQ page of this website


The service aims to provide any eligible patient who is registered with a GP practice contracted to NHS England & Improvement Midlands, with access to medication for the treatment of acute bacterial conjunctivitis via Community Pharmacy.  The service will be provided through Community Pharmacies contracted to NHS England & Improvement Midlands who have signed up to provide this service.

Aims of the Community Pharmacy Extended Care Service scheme

The overall aim of the scheme is to ensure that patients can access self-care advice for the treatment of a range of conditions, and, where appropriate, can be supplied with antibiotics or other prescription only medicines to treat their condition. This provides an alternative location from which patients can seek advice and treatment, rather than seeking treatment via a prescription from their GP or Out of Hours (OHH) provider, walk in centre or accident and emergency.

  • Educate patients to seek advice and treatment from the most appropriate healthcare setting
  • Improve patient’s access to advice and appropriate treatment for these ailments via Community Pharmacy
  • Reduce GP workload for these ailments allowing greater focus on more complex and urgent medical conditions
  • Educate patients with aim of reducing requests for inappropriate supplies of antibiotics
  • Promote the role of the pharmacist and self-care
  • Improve working relationships between doctors and pharmacists


The service is offered as a quicker alternative for patients to access healthcare. Patient may choose to refuse this service and continue to access treatments in the same way as they have done previously.

NB for mild to moderate Acute Bacterial Conjunctivitis First Line treatment is self care and NOT antibiotics.

Acute Bacterial Conjunctivitis – for moderate to severe infections

First Line treatment is also self care which includes:

  • Reassurance / advice on self-limiting nature of the condition.
  • Bathing / Cleaning eyelids with cotton wool soaked in sterile saline or boiled and cooled water to remove crusting

Second line

Treatment with Chloramphenicol.  For all patients who fall within the product license this product should be purchased OTC in line with NHS and CCG OTC guidance.

Patients aged 3 months to 2 years are exluded from the OTC product license and this Extended Care Tier 1 service allows contracted community pharmacists to provide this treatment to them.

All other patients, age 2 years to adult, who are excluded by the OTC product license and who require Chloramphenicol will need to be referred to a CUES optometrist or to their GP.


The service is only available for the treatment of acute bacterial conjunctivitis in children aged 3 months to up to 2 years.  First line treatment for acute bacterial conjunctivitis is NOT antibiotics and this PGD service allows supply to children  Only medicines specified in the PGDs may be supplied following the correct protocols and only in the pharmacies who have signed up to the service.

Service Spec

The 2020 service spec is written with a general PGD Service spec at the beginning and then individual specs for the UTI service and the new acute bacterial conjunctivitis service.  This means that pharmacies can sign up to one or both of these PGD services.

Dec 2020: new SLA released.  Please note this updated SLA allows for deferred treatment and also increase the geographical spread of the service to the NHSE&I Midlands footprint.  The SLA has been extended to 31.3.2022 and can be downloaded here.

Tier1 Extended Care Midlands Service Spec FINAL V1 2020-2022

The flow chart summarises the patient journey ABC Flow Chart

This sheet summarises the Tier 1 and Tier 2a service NHSE&I Midlands Extended Care Services UTI, ABC and Skin: NHS conditions local service revised October 2021 Tier 1 plus 2a

In order to provide the service,  the signed SLA should be returned to the relevant NHSE&I email for East at or for West at

October 2021 – Pharmacies which have already signed up to the service do not need to re-register for this restart, your sign-up will be carried forward.


2021 PGDs – this PGD covers the whole NHSE&I Midlands Region.

All pharmacists delivering the service should be familiar with and sign the PGD.  

Caution: PGD has been updated to version 2 because, due to an oversight, it has the old training requirements on it – you do not need to attend training event – the training is as outlined in the SLA

Chloramphenicol eye drops and eye ointment PGD FINAL V1.2


You need to keep a copy of the signed PGD in the service file in the pharmacy (signed by all pharmacists delivering the service) but you are not required to send the PGD signature page to Andy Pickard, NHSE&I or the LPC.  It is to be kept in your pharmacy records.

Service Paperwork

The service should be recorded live on PharmOutcomes.  The pro forma is supplied only for use in the event of an IT failure. 2021 Chloramphenicol Proforma

If you are not recording live on PharmOutcomes you need to get the patient to sign the declaration of exemption from NHS levy  Declaration of exemption

Service Recording on PharmOutcomes -more info here

Only pharmacies who have returned the signed SLA to NHSE will access to the new PharmOutcomes modules.  There are several modules for completion.

Pharmacist Enrolment

In order to record the consultations on PharmOutcomes the pharmacist must complete a pharmacist enrolment form within the new Acute Bacterial Conjunctivitis module. They must give the CPPE system permission to allow PharmOutcomes to access their CPPE record in order to confirm completion of the DoC for this service. If this was not done while on the CPPE website a link within the PharmOutcomes pharmacist enrolment module will take the pharmacist to the relevant part of the CPPE website.  For more information on PharmOutcomes and DoC please see the relevant pages on this website.

Community Pharmacy Extended Care  – Patient Registration

The new Community Pharmacy Extended Care Patient Registration module is to be used for the whole family of services, both Tier 1 and Tier 2 services share the same registration module.  This should reduce the number of times you have to record patient details.

If the patient has registered with another service at your pharmacy you will see their details in a drop down list – you can select this if it is the correct patient but you will still need to complete this registration module to record consent to this service specifically etc.

Consultation and Supply 

There is a separate module for each of the community pharmacy extended care Tier 1 and Tier 2 services and these are linked to the same registration module.

Deferred Treatment Record

There is a single deferred treatment record for the community pharmacy extended care services and this should be used to record supply of deferred treatment for any of the conditions covered by the service.  The deferred treatment module is linked to the same registration module.

In case of an IT failure we provide a pro forma for you to record the consultation 2021 Chloramphenicol Proforma

Service Requirements – as outlined in SLA and PGD.

Who can provide the service?

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 following:

All professional consultations, with a service accredited pharmacist, must take place in a confidential environment.

Pharmacist training requirements

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 CKS summaries on acute bacterial conjunctivitis. The requirement is that the pharmacist accesses the CKS summaries on acute bacterial conjunctivitis. Please access the summary; background information; diagnosis; management; prescribing information and evidence sections for each condition to ensure that you have up to date, relevant clinical knowledge
  • They must have satisfactorily completed the PHE Antimicrobial Stewardship for Community Pharmacy e-learning and e-assessment and are registered as an antibiotic guardian
  •  They must ensure that they have the correct clinical knowledge to provide the service and are familiar with NICE guidance on treating acute bacterial conjunctivitis.
  • The requirements of the SLA are understood and the PGD associated with the service is signed.

The pharmacist should then print their DoC 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 confirm on the CPPE website that they have completed and signed the DoC.

The accuracy of the DoC is the pharmacist’s professional responsibility.


Pharmacists must document their service readiness using a Declaration of Competence (DoC) specifically for this service.

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

DoC Process for this service:

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. (Acute bacterial conjunctivitis service is a Level 2 Minor Ailments Service involving supply of POM medication under a PGD).

The DoC framework document allows the pharmacist to assess their readiness against the mandatory core competencies (consultation skills and safeguarding) as well as suggesting other training they may find useful in regard to minor ailments and PGDs.

The pharmacist then needs to download their personalised Minor Ailments DoC (interactive PDF document).

Section 1 of the DoC will automatically contain details of all CPPE training and assessments they have undertaken and which are relevant to this service.

In section 2 of the pharmacist will need to add details of the mandatory training they have completed. Namely that they have worked through the CKS summaries on acute bacterial conjunctivitis. They must ensure that they have the correct clinical knowledge to provide the service.  They must also confirm that they completed the PHE Antimicrobial Stewardship for Community Pharmacy e-learning and passed the e-assessment and also that they are registered as an antibiotic guardian.

The pharmacist should then print their DoC and add the heading “Community Pharmacy Extended Care Service for Acute Bacterial Conjunctivitis”. It must then be signed and dated to complete the process. The pharmacist must confirm on the CPPE website that they have completed and signed the DoC.

The accuracy of the DoC is the pharmacist’s professional responsibility.

All Pharmacists working at participating pharmacies and providing the scheme should ensure that they continue, through continuing education and CPD, to keep up to date with guidance issued around of the treatment of acute bacterial conjunctivitis.

If your pharmacy is signed up to deliver a Community Pharmacy Extended Care Service you have signed an SLA agreeing to offer the service over all of your usual opening hours….

  1. What if you are signed up for the service but are not able to offer this service today?
  2. This situation should NOT be the norm, you need to ensure that any locums you use are service ready – all of the information on pharmacist requirements is available on this website on the relevant pages.  This service does not require the pharmacist to attend special training, simply to understand the service, ensure that their clinical knowledge is up to date and to be familiar with the PGDs.

If you are not able to offer the service on a particular day (for any reason) you must NOT refer the patient to NHS111 or back to the surgery – the whole point of this service is helping reduce demand and helping patients to be seen and helped by the community pharmacy.

Check out the FAQ pages here