{"text_format":"1","workbook":"xlsx","n_sheets":5,"sheets":["Amendment Form","Leaving Prescribers","Guidance Notes","Revision History","PCSE Use Only"],"not_rendered":{"charts":0,"images":2,"macros":0,"external_links":0,"defined_names":6,"comments":1,"pivot_tables":0},"unopened":[],"bounds":{"document_bytes":16777216,"sheet_cells":100000,"rows_first":2000,"rows_last":500,"rows_between":2000,"halvings":0,"cell_chars":16384,"cell_head_chars":4096},"cells_cut":0,"cells_raw":0,"read":"whole","date_system":"1900"}

{"sheet":"Amendment Form","index":0,"n_rows":93,"n_cols":9,"rows_kept":93,"cut":false,"hidden":false,"merged":[[10,1,10,5],[17,2,17,5],[58,2,59,5],[32,6,32,8],[33,1,51,1],[51,2,51,3],[51,4,51,5],[40,4,40,5],[41,4,41,5],[42,4,42,5],[37,2,37,3],[38,2,38,3],[39,2,39,3],[40,2,40,3],[41,2,41,3],[26,2,27,5],[30,2,31,5],[62,1,63,1],[58,1,59,1],[60,1,60,5],[43,2,43,3],[46,2,46,3],[49,4,49,5],[43,4,43,5],[46,4,46,5],[44,2,44,3],[44,4,44,5],[45,2,45,3],[45,4,45,5],[55,1,57,1],[57,2,57,3],[57,4,57,5],[47,2,47,3],[73,1,74,1],[66,1,67,1],[66,2,67,5],[68,1,69,1],[68,2,69,5],[70,1,70,5],[73,2,74,5],[71,1,72,5],[47,4,47,5],[48,4,48,5],[48,2,48,3],[50,4,50,5],[50,2,50,3],[38,4,38,5],[39,4,39,5],[36,4,36,5],[37,4,37,5],[32,1,32,5],[33,4,33,5],[28,2,29,5],[19,1,19,5],[34,4,34,5],[42,2,42,3],[8,1,8,5],[9,1,9,5],[20,1,21,1],[12,1,12,5],[11,2,11,3],[13,1,14,1],[13,2,14,5],[15,2,16,5],[15,1,16,1],[20,2,21,5],[22,2,23,5],[24,2,25,5],[18,2,18,5],[19,0,20,0],[64,1,65,1],[62,2,63,5],[64,2,65,5],[30,1,31,1],[28,1,29,1],[22,1,23,1],[34,2,34,3],[35,2,35,3],[36,2,36,3],[49,2,49,3],[33,2,33,3],[35,4,35,5],[24,1,25,1],[26,1,27,1],[52,6,52,8],[53,4,53,5],[53,1,53,3],[55,4,56,4],[55,2,56,3],[52,1,52,5]]}
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[null,"Closure of a GP Practice"]
[null,"Authorised signatory should complete form and send to: prescriptioninformation@nhsbsa.nhs.uk"]
[]
[null,"Parent Org name:",null,null,"Parent Org code:"]
[null,"Closing GP Practice Details"]
[null,"GP Practice Code (allocated by NHS Prescription Services):"]
[]
[null,"GP Practice name (as shown on ePACT.net, max. 40 characters including spaces):"]
[]
[null,"GP Practice Contact:"]
[null,"Reason for closure:"]
[null,"Address details (max. 25 characters per line including spaces)"]
[null,"Address line 1:"]
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[null,"Address line 2:"]
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[null,"Address line 3 (town or city only):"]
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[null,"Address line 4 (county or London only):"]
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[null,"Postcode:"]
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[null,"Telephone Number:"]
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[null,null,null,null,null,null,"PCSE USE ONLY"]
[null,"Prescribers leaving the GP Practice (including any practice employed non-medical prescribers.)","Name:",null,"Code:",null,"GMC Code","Current Role","NPL3 Form/Notes"]
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[null,null,null,null,null,null,"PCSE USE ONLY"]
[null,"Please tick to indicate use of Leaving Prescribers overspill sheet:"]
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[null,"What is happening with the patient list size?","Transferring to another GP Practice:",null,null,"Please State GP Practice Code:"]
[]
[null,null,"Dispersing within Sub-ICB:"]
[null,"Closure Date:"]
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[]
[]
[null,"Authorised signatory:"]
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[null,"Print name:"]
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[null,"Contact Number:"]
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[null,"Date:"]
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[null,"For NHS Prescription Services use only"]
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[null,"MDR input (Date and Initials)"]
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[null,null,null,null,null,"v2.9 August 2023"]
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[null,"Transferring to another GP Practice (if so state Practice Code Below)",null,"Change of Cost Centre Name",null,"Prescribing"]
[null,"Dispersing within CCG",null,"Change of Cost Centre Address",null,"Dispensing"]
[null,null,null,"Change of Cost Centre Telephone Number",null,null,"Yes (list applicable codes below)"]
[null,null,null,null,null,null,"No"]

{"sheet":"Leaving Prescribers","index":1,"n_rows":4,"n_cols":3,"rows_kept":4,"cut":false,"hidden":false,"merged":[[0,0,1048575,0],[0,1,0,2],[1,1,1,2]]}
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[null,"Prescribers leaving the GP Practice\n(including any practice employed non-medical prescribers):"]
[]
[null,"Name:","Code:"]

{"sheet":"Guidance Notes","index":2,"n_rows":16,"n_cols":2,"rows_kept":16,"cut":false,"hidden":false,"merged":[]}
[]
["Parent Org name","The name of the Sub-ICB Location that the GP Practice is attached to"]
["Parent Org code","The code of the Sub-ICB Location that the practice is attached to (three characters)"]
["GP Practice Code","The code of the GP Practice (eg A12345)"]
["GP Practice Name","as shown on ePACT.net, max. 40 characters including spaces"]
["GP Practice Contact","Name of contact at the practice"]
["Reason for Closure","Select from dropdown list"]
["Address","The address must adhere to the following format.  Each line has 25 characters including spaces"]
[null,"1st Line - address details"]
[null,"2nd Line - address details"]
[null,"3rd Line - Town/City only"]
[null,"4th Line - County/London only"]
["Telephone Number","Please state telephone number of GP Practice"]
["Prescribers leaving the GP Practice","List all prescribers leaving the GP Practice including any practice employed Non-Medical prescribers. In the case of an excess of prescribers compared to the amount of boxes given on the 'Amendment Form' sheet, please continue the list on the 'Leaving Prescribers' sheet and indicate the use of the Leaving Prescribers sheet using the tick boxes provided."]
["Closure Date","Effective date of the GP practice closure"]
["Authorised Signatory","This is the authorised signatory at the Sub-ICB Location (or an agency on their behalf) "]

{"sheet":"Revision History","index":3,"n_rows":15,"n_cols":4,"rows_kept":15,"cut":false,"hidden":true,"merged":[]}
["Version","Date","Reason for change","Editor"]
[2.1,"2022-02-01","removed 'for PCSE only' parts, amended references to CCGs","LAMAT"]
[2.2000000000000002,"2022-07-01","conditional formatting of all input cells to show white text on red background upon initial entry","MICBU"]
[2.2000000000000002,"2022-07-01","changed general text input colour to 'dark red' in line with other forms","MICBU"]
[2.2000000000000002,"2022-07-01","added 'What is happening with patient list size?' section, as missing when compared to old word form","MICBU"]
[2.2000000000000002,"2022-07-01","Added Leaving Prescribers Sheet for any overspill of prescribers on main form","MICBU"]
[2.2000000000000002,"2022-07-01","Added 'leaving prescribers' overspill check boxes on Amendment Form","MICBU"]
[2.2000000000000002,"2022-07-01","Added segment on guidance notes regarding leaver overspill sheet","MICBU"]
[2.2999999999999998,"2022-07-14","Increased all rows in 'prescribers leaving practice' section and input cells in 'leaving prescribers' overspill  from 30 to 60px, accommodating 2 lines of text per box","MICBU"]
[2.4,"2022-08-12","Increased spacing before signatory section","ALGRA"]
[2.5,"2023-05-05","added email migration information section","MICBU"]
[2.6,"2023-05-25","updated migration date to June 2023","MICBU"]
[2.7,"2023-06-27","updated email information of form header","MICBU"]
[2.8,"2023-07-03","removed migration note","ANSCU"]
[2.9,"2023-08-31","edit Objects' ticked on sheet security for image insertions","MICBU"]

{"sheet":"PCSE Use Only","index":4,"n_rows":57,"n_cols":3,"rows_kept":57,"cut":false,"hidden":true,"merged":[[10,1,10,2],[20,1,20,2],[32,1,42,1],[51,1,51,2],[52,1,52,2]]}
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[null,"SECTION - 1C","GP Patient List"]
[null,"Guidance:","Please note that it is recommended where possible that practice lists are transferred rather than dispersed, however in the event of an immediate practice lists dispersal please note that engagement from the NHS England Local Teams is required. For further information and guidance please see the Frequently Asked Questions."]
[null,"GP Patient List Transfers – Please provide details of the practice that the patient lists will transfer to"]
[null,"GP Practice Name"]
[null,"Practice Code"]
[null,"Practice Address"]
[null,"Practice Phone Number"]
[null,"Practice Contact"]
[null,"Patients Registered GP(s)"]
[null,"Confirmation of Effective Date for Practice System Closure","Xx/xx/xxxx"]
[null,"Confirmation Date of Transfer of Patient List","Xx/xx/xxxx"]
[null,"Additional Instructions:","Please enter any additional instructions into this section regarding the transfer e.g. which Registering GP patients need to transfer to (ideally by way of alphabetical allocations).  "]
[null,"GP Patient List Dispersal – Please provide instructions for practice patient list dispersals"]
[null,"Additional Instructions:","Practice patient list dispersals occur where a practice may close with no details of transfer, patients are sent a communicated letter informing them to re-register at another practice of their own choice.\n\nPlease note that engagement with your NHS England Regional Local Team will be required along with instructions, patient list dispersals on average can take 1-3months to clear on the system dependant on list sizes.\n\nPlease refer to Section 1D of this form and patient communications/letters to be sent."]
[]
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[null,"SECTION – 1D","Patient communications"]
[null,"Do you require letters to be sent out to patients","Yes / No"]
[null,"Date letters to be sent"]
[null,"Please attach a copy of the letter to be sent","Please note that letter templates are advised to be in Microsoft Word format."]
[null,"Additional Instructions"]
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[null,"SECTION – 1E","Medical Records Transfer "]
[null,"Guidance:","Where the patient list is being transferred to another practice it is assumed that the medical records will need to be collected from the closing and practice and delivered to the main surgery of the receiving practice."]
[]
[null,null,"GP Practice must ensure that each individual Medical Records are securely bagged in the individual Polylopes (which are available to order via the supplies portal). Medical Records must then be bulk bagged in sacks for courier collection (sacks are available to order via the supplier portal)."]
[null,null,"Please see FAQ Guide for further information."]
[]
[null,null,"Where the GP Practice is closed with immediate effect the medical will need to be collected from the closing practice and delivered to National Medical Records Storage Facility in Darlington."]
[]
[null,null,"GP Practice must ensure that each individual Medical Records are securely bagged in the individual Polylopes (which are available to order via the supplies portal). Medical Records must then be bulk bagged in sacks for courier collection (sacks are available to order via the supplier portal)."]
[]
[null,null,"For further guidance on medical record collections including stationary collections please refer to the FAQ Guide."]
[]
[null,"Date medical records to be collected","xx/xx/xxxx"]
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[null,"SECTION – 1F","Finance Information"]
[null,"Payments","Please note that PCSE Payments do not require a declaration of banking form to be completed for practice closures, the completion of this form will act as formal notifications to the PCSE Payments team who may contact the practice directly to confirm any further necessary details."]
[null,"Pensions","Important Information: Please note that in the event of a practice closure the completion of this form will act as formal notification to the PCSE Pensions Team, who are required to perform a mandatory update of all effected performer pension information. Due to pension certifications being generated annually, and both current and the next financial year certifications being required, the PCSE Pensions team will notify each individual performer once their records are finalised (This may take between 12-24 Calendar Months). The PCSE Pension team may contact the practice and its performers directly to confirm any further necessary details."]
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[null,"Section 4 -  For completion by the form’s submitter, if they are not the person in section 3"]
[null,"To assist NHS England please provide your contact details"]
[null,"NHS Organisation or GP Practice:"]
[null,"Contact Name:"]
[null,"Contact Number:"]
[null,"Email:"]