Contractor name
Contractor number
Type of request (closure, adjusted hours)
Reason for closure/adjustment
Actions taken to limit the impact of closure/adjustment on patients and services
Actions taken to limit future risk of reoccurrence or to address the issue
Expected duration of closure/adjustment (hours, days, weeks, months)
Dates affected (from and to)
Nearest open pharmacy
Date of notification to NHS Board
Time of Notification and Point of Contact
Person Completing Notification and Role

DATE --------------->
DAY ----------------->	Mon	Tue	Wed	Thu	Fri	Sat	Sun
Normal Hours Open
Lunch
Close
Adjusted Hours Open
Lunch
Close

Copy this table if the request affects more than 1 week

Community Pharmacy Actions

Where closure is expected to be longer than 30 minutes, the following steps have been taken:

ACTION	YES/NO	If no provide a reason:
I have contacted local GP practices
I have contacted other pharmacies
Inform prescribers of any outstanding ORT doses for the day have been informed – every effort must be taken to inform patients
Instalment patients (including dosette) contacted where necessary
Sign displayed in window to signpost patients to nearest open pharmacy
I have completed this template and forwarded it to the NHS Pharmacy Team for attention of Principal Pharmacist and Director of Pharmacy

NHS Board Actions:

ACTION	COMPLETED
Gather information and discuss with Community Pharmacy requesting change
Discuss business continuity plan and arrangements
Explore impact on other services and inform as appropriate and support mitigations for patients and services
Discuss with Director of Pharmacy as soon as possible
Draft message to the public and NHS stakeholders to disseminate to the following stakeholders: Primary Care Service manager/admin for cascading CHSCP Management for information Corporate communications for public awareness
Review the previous Unplanned Closure requests and note the following: Date of last adjustment/closure Number of adjustments/closures in previous year Is this a reoccurrence of a previously known issue?
Save a copy of this, and any other correspondence (email etc.) within the Pharmacy Shared Drive under Community Pharmacy > Unplanned Closures
Email a copy of this to: nhs24providerupdates@nhs24.scot.nhs.uk