This application form is for pharmacy assistants working in a London NHS Trust to register for the Medicines Optimisation Course.

Please note, you will need an Educational Supervisor within the workplace to support you with completing this programme. Discuss the course requirements with them and ensure you have your line manager's approval prior to applying.

This programme is delivered in cohorts which start every two months, choose your preferred cohort date from the drop-down list. Applications must be completed within the stated deadlines. Late applications will not be considered.

Cohort and Dates
Forename
Surname
Work Email
Telephone (work)

Please ensure you meet the entry criteria prior to applying for this programme. Please note you must be able to complete all relevant on-line learning and meet any local training requirements relevant to each module to meet course criteria.

Job Role
Job Title
Please confirm your Agenda for Change Band/Grade here
Name of Trust

If your Trust is not listed on the dropdown above, please contact us via london.pharmacy@hee.nhs.uk and we will advise if you are able to register for this programme.

Base Name

If there are any special facilities that you require (eg because of disability), please inform us at this time. We will endeavour to make reasonable adjustments to accommodate your needs.

Any reasonable adjustments required?
Yes
No
If yes, please give details

Educational Supervision & Line Manager approval

Please confirm the name and email address of your Educational Supervisor.

Educational Supervisor Forename
Educational Supervisor Surname
Educational Supervisor email
Please select Yes below to confirm agreed participation and completion of this course with your line manager.
Yes
No
Line Manager Forename
Line Manager Surname
Line Manager email
By completing this application form I confirm that the enrolled candidate meets the below entry criteria:

Is a pharmacy assistant working in an NHS trust within London.
Has completed or is working towards the Level 2 Pharmacy Services Assistant apprenticeship or equivalent GPhC approved course for pharmacy support staff.
Their mandatory training is up to date.
Their job description reflects medicines optimisation role.
They will have access to the ward environment to complete course activities.

Please refer to the NHS England privacy notice https://www.england.nhs.uk/contact-us/privacy-notice/ for information on how we manage your data.