Infected Eczema Tier 2a Service

Community Pharmacy Extended Care Tier 2a: Infected Eczema.  Please read all of this information

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

Letters from NHSE&I

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 2a West Letter FINAL version

Extended Care Tier 2a East Letter FINAL version

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.

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

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


The Community Pharmacy Extended Care Service includes a suite of PGDs which will allow pharmacists to treat patients presenting with certain conditions that otherwise would have to be seen by prescribers in General Practice.  The service is open to any eligible patient who is registered with a GP practice contracted to NHS England and Improvement (NHSE&I) Midlands Staffordshire and Shropshire Area.

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.

The service is only available for the treatment of infected eczema in patients aged 1 year and above. 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 updated runs to 31.3.2022

The 2021 service spec is written with a general PGD Service spec at the beginning and then individual specs for the Impetigo, Infected Insect Bites and Infected Eczema services.   This means that pharmacies can sign up to one, two or three of these PGD services.

Please note the SLA allows for deferred treatment and runs to 31.3.2022 and can be downloaded here.  There are two versions of the SLA but the only difference is that the East and West versions have the appropriate NHSE&I contact email on them.

Tier2 Extended Care Service Spec West FINAL V1 260221

Tier2 Extended Care Service Spec East FINAL V1 260221

The flow chart summarises the patient journey for the Skin Flow Chart

This sheet summarises all of the Tier 1 and Tier 2a service 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

Infected Eczema PGDs cover whole Midlands Region

All pharmacists delivering the service should be familiar with and sign the PGDs.cNew 2021-2022 PGDs released.

New versions of the Infected Eczema PGDs have been released.

The new expiry date is 31.05.2022

There are new exclusions on all of the extended care PGDs and these are:

  • Immunocompromised patients are excluded
  • Patients already taking oral antibiotics should not be supplied under the extended care PGDs.

Please download the new PGDs and ensure that your pharmacists are familiar with the new version as there have been some changes to the PGDs.  

All of your pharmacists need to sign the new, current version of each PGD.

Fusidic Acid PGD infected eczema v1.2 July 2021

Flucloxacillin PGD infected eczema FINAL v1.2 July 2021

Clarithromycin PGD infected eczema FINAL v1.2 July 2021

You need to keep a copy of the signed PGDs 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 NHSE&I or the LPC.  It is to be kept in your pharmacy records.

Service Paperwork

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 2020

Anti Microbial Resistance Resources

HEE have produced info on AMR

Antimicrobial resistance | Health Education England

The Government’s five year antimicrobial resistance strategy sets out our role in improving professional education and training about antimicrobial resistance. As well as recommending that the Government campaign internationally for greater recognition of antimicrobial resistance, the strategy outlined how we have a central role in helping to improve the knowledge and understanding of antimicrobial resistance.

HEE AMR video on Primary Care Antibiotic Prescribing – click the image below.


This video supports clinical staff in primary care to make informed decisions regarding the prescription, dispensing and use of antibiotics.

HEE AMR video on Secondary Care Antibiotic Prescribing – click the image below.

This video supports clinical staff in secondary care to make informed decisions regarding the prescription, dispensing and use of antibiotics.

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 Impetigo 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 this pro forma for you to download and use Infected Eczema Proforma July 2021

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 (Shropshire & Staffordshire Area), 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 eczema. 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 simple eczema.
  • The requirements of the SLA are understood and the PGD associated with the service issigned.The pharmacist should then print their DoC and add the heading “NHSE&I Community Pharmacy Extended Care Service Tier2a”. 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.

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. (Extended Care Skin Services are 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 relevant skin conditions. 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 Tier 2a Service for infected skin conditions”. 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 simple UTIs.

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….

Q. What if you are signed up for the service but are not able to offer this service today?

A. 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