26 September 2019 REF: SHA/22173 APPEAL AGAINST MIDLAND AND

26 September 2019 Arena Point Merrion Way REF: SHA/22173 Leeds LS2 8PA

APPEAL AGAINST MIDLAND AND EAST (CENTRAL Tel: 0203 928 2000 MIDS) AREA TEAM, NHS COMMISSIONING BOARD Fax: 0207 821 0029 ("NHS ENGLAND") DECISION TO REFUSE AN Email: [email protected] APPLICATION BY NORTHAMPTON MEDICAL SERVICES FOR INCLUSION IN THE PHARMACEUTICAL LIST OFFERING UNFORESEEN BENEFITS UNDER REGULATION 18 AT 1 WESTERN DRIVE, HANSLOPE, MILTON KEYNES, MK19 7LA

1 Outcome

1.1 The Pharmacy Appeals Committee (“Committee”), appointed by NHS Resolution, confirms the decision of NHS England, therefore the application is refused.

NHS Resolution is the operating name of NHS Litigation Authority – we were established in 1995 as a Special Health Authority and are a not-for-profit part of the NHS. Our purpose is to provide expertise to the NHS on resolving concerns fairly, share learning for improvement and preserve resources for patient care. To find out how we use personal information, please read our privacy statement at www.nhsla.com/Pages/How-we-use-your-information-- -FHSAU.aspx

Arena Point REF: SHA/22173 Merrion Way Leeds APPEAL AGAINST MIDLAND AND EAST (CENTRAL LS2 8PA

MIDS) AREA TEAM, NHS COMMISSIONING BOARD Tel: 0203 928 2000 ("NHS ENGLAND") DECISION TO REFUSE AN Fax: 0207 821 0029 APPLICATION BY NORTHAMPTON MEDICAL Email: [email protected] SERVICES FOR INCLUSION IN THE PHARMACEUTICAL LIST OFFERING UNFORESEEN BENEFITS UNDER REGULATION 18 AT 1 WESTERN DRIVE, HANSLOPE, MILTON KEYNES, MK19 7LA

1 The Application

By application dated 12 November 2018, Northampton Medical Services (“the Applicant”) applied to NHS Commissioning Board (“NHS England”) for inclusion in the pharmaceutical list offering unforeseen benefits under Regulation 18 at 1 Western Drive, Hanslope, Milton Keynes, MK19 7LA. In support of the application it was stated:

1.1 In response to why the application should not be refused pursuant to Regulation 31, the Applicant stated:

1.1.1 The reason that this is not applicable is that there is no other pharmacy or dispensing appliance contractor premises either adjacent to or in close proximity to the location of the proposed pharmacy.

1.2 Hanslope is a village located in the Borough of Milton Keynes. The village is about 4 miles west from Newport Pagnell, about 4 miles north of Stony Stratford and 8 miles north of Central Milton Keynes. Medical services are provided by Hanslope Surgery (part of The Parks Medical Practice) to the residents of Hanslope and the surrounding villages including Hartwell, Castlethorpe and Tathall End. The total population across these village locations is 5250. The local surgery also provides dispensing services to 4709 patients which represents 99% of the patient list.

1.3 The nearest pharmacies to Hanslope Surgery are:

Roade Pharmacy NN7 2NS 4.6 miles Boots, Winchester Circle, Kingston MK10 0BN 8.2 miles Boots, Six Fields Retail Park, Northampton NN5 5DG 9.6 miles

1.4 Roade Pharmacy which is the closest community pharmacy to Hanslope is open Monday to Friday 09.00hrs to 18.00hrs with a one hour lunchtime closure between 13.00hrs and 14.00hrs. There is no Saturday opening. (Source: NHS website).

1.5 There is a bus service provided by Red Rose Travel between Milton Keynes and Northampton (Services 33 and 33A) which includes Hanslope and Roade. The service operates throughout the day. However, any resident of Hanslope who is reliant on public transport to access comprehensive pharmacy services would need to allow between 1 hour and 1½ hours to complete the return journey. 10% of households do not have access to private transport. (Source: NOMIS)

1.6 18% (national average 16.5%) of the population of Hanslope are aged over 65 and 11.6% (national average 10. 3%) of the local population provide unpaid care (Source:

Nomis). Unpaid carers as a group are frequently under pressure as a result of their caring responsibilities and their health needs can often go unnoticed thereby exacerbating the medical needs generated by the over 65's.

1.7 In the context of health and pharmaceutical services, the over 65's are a group commonly defined as sharing protected characteristics. In addition to being more susceptible to long tern conditions, this group are:

1.7.1 often prescribed medicines on a long term basis

1.7.2 are frequently prescribed multiple medicines

1.7.3 may require the support of carers

1.7.4 are more susceptible to falls and mobility issues

1.7.5 are less likely to have access to private means of transport to access services

1.8 To conclude, the current provision of comprehensive pharmaceutical services to those residing in the village of Hanslope and surrounding areas is difficult to access in terms of distance and opening times at the nearest community pharmacy to Hanslope. For those sharing protected characteristics, which in the context of Hanslope are the over 65's representing a greater proportion of the population than is the case nationally, the difficulty in accessing a full range of pharmaceutical services is much more acute.

Please explain how you intend to secure the unforeseen benefit(s).

1.9 The proposed pharmacy in Hanslope will ensure that the population will have easy access to a complete range of pharmaceutical services and advice. In addition to Essential Services and commissioned services, the Applicant will implement their own free or private services which will target the health priorities of the locality - notably those affecting older people and the management of long term conditions. Specifically the Applicant will include in their services:

1.9.1 Healthy Heart Screening

1.9.2 Weight Management Support Services

1.9.3 Healthy Eating Advice

1.9.4 Compliance Aid Service

1.10 One of the principle objectives will be to meet the criteria necessary to gain Healthy living Pharmacy (HLP) status thereby providing Enhanced Services which will seek to engage with patients at the three defined levels of engagement i.e.

1.10.1 Promotion

1.10.2 Prevention

1.10.3 Protection

1.11 HLP's generally offer at least two services from the following:

1.11.1 Smoking Cessation support

1.11.2 Alcohol Interventions

1.11.3 Emergency Hormone Contraception

1.11.4 Health Checks

1.12 The Healthy Living Pharmacy Scheme is an excellent vehicle for providing high quality pharmaceutical services working in conjunction with other health and social care professionals and will be particularly appropriate in meeting the needs of the population of Hanslope.

1.13 The Applicant is committed to providing opening hours which will meet the needs of the community - including Saturdays. Closing times will mirror those of the Surgery so that patients who have attended a late appointment with their GP and have been prescribed medicines may get these dispensed without having to make a further journey or wait until the following day.

1.14 The choice of having a pharmacy located within Hanslope Surgery will make a difference by offering immediate and convenient access to pharmaceutical services without the current difficulties associated with additional travel and access. The pharmacy will be accessible for those with mobility issues and have the added benefit of disabled parking facilities and the avoidance of an extra journey.

1.15 The co-located pharmacy will conduct its Medicines Use Review (MURs), subject to informed patient consent with patients identified by Hanslope Surgery. The Applicant will concentrate on areas where there is a need for poly-pharmacy patients to reduce medicines burden, diabetes, COPD, asthma and hypertension to optimise medicines use in line with best clinical practice.

1.16 It is intended to employ a qualified pharmacist who will be able to prescribe to help support the care of patient's long term conditions. The 'New Medicines Service' (NMS) will be used to check back with patients to clinically assess progress of new therapies, the follow up will allow informed titration of medicines, for example, respiratory inhalers, anti-hypertensives and rate control medicines.

Summary

1.17 Granting this application will ensure that the community of Hanslope have a choice of provider and improved access to comprehensive pharmaceutical services.

1.18 Northampton Medical Services Ltd wish to work with commissioners and local Health and social care professionals to ensure an appropriate range of pharmaceutical services are available to the community. This will be achieved by ensuring the pharmacy is accessible when patients need it to be, by becoming a Healthy Living Pharmacy and providing services which are targeted to the health priorities identified locally and specifically those with protected characteristics.

2 The Decision

NHS England considered and decided to refuse the application. The decision letter dated 14 June 2019 states:

2.1 NHS England has considered the above application and is writing to confirm that it has been refused. Please see the enclosed report for the full reasoning.

The Report stated:

2.2 NHS England - Midlands & East (Central Midlands) Pharmaceutical Services Regulations Committee (PSRC) has considered the above application for inclusion in the pharmaceutical list, on 31 May 2019, and this is to advise you it has been refused.

2.3 The PSRC must have regard to the NHS (Pharmaceutical & Local Pharmaceutical Services) Regulations 2013 and the initial consideration required is in regard to Regulation 31: 3

2.4 The PSRC first considered Regulation 31 of the regulations [quoted in full]

2.5 The PSRC determined that there is no requirement to refuse this application, under the provisions of this regulation, as there is no-one on a pharmaceutical list who is undertaking to provide pharmaceutical services from either the proposed premises or adjacent premises.

2.6 Application made under Regulation 18 of the NHS (Pharmaceutical & Local Pharmaceutical Services) Regulations 2013 must be assessed against Regulation 40. The PSRC then went on to consider Regulation 40.

2.7 [Regulation 40 quoted in full]

2.8 The applicant has not disputed that the site of the proposed premises, where it is seeking listing of pharmacy premises, is within a controlled locality.

2.9 The PSRC noted that there has been no refusal of an application that would impose the 5 year rule.

2.10 Regulation 40(3) is not applicable as the location of the proposed premises is known.

2.11 Based on the conclusions for Regulation 40, the PSRC went on to consider Regulation 41.

2.12 The PSRC is required to consider whether the location of the proposed pharmacy is in a reserved location as defined in Regulation 41 (3) [quoted in full]

2.13 The PSRC noted the number of NHS registered patients living within 1.6 kilometres radius of the proposed location totals 2344.

2.14 Based on the application, there was no evidence provided by the applicant to suggest that if pharmaceutical services were provided at the relevant location, the use of those services would be similar to, or greater than, the use that might be expected if the number of individuals residing in that area who are on a patient list were 2,750 or more.

2.15 The PSRC concluded that the reserved location status applies to the application site.

2.16 The PSRC noted that this was a routine application for “unforeseen benefits” and then went on to consider Regulation 18. [quoted in full]

2.17 The Milton Keynes 2018 Pharmaceutical Needs Assessment (PNA) shows an analysis of the situation as it was assessed at the date of publication (April 1st 2018) and there have been no revised assessments issued, in the form of a Supplementary Statement under Regulation 6(3), in regard to this area. The current regulations consider that any benefit is regarded as unforeseen at the time of the pharmaceutical needs assessment simply if it is not mentioned in the document and it was be noted that the benefits proposed in the applications are not mentioned.

2.18 It was noted that the PNA concludes that “Overall, the level of pharmaceutical service (as described in the regulations) currently provided across Milton Keynes meets the health needs of the population and provision of pharmaceutical services is good in our areas of deprivation.”

2.19 The applicant seeks to provide unforeseen benefits to the resident and reliant population in the area surrounding the application and in order to be satisfied in accordance with Regulation 18(1), the criteria set out in Regulation 18(2) should be considered. [quoted in full]

2.20 If the application was granted and the pharmacy was to open, the ability of NHS England to plan for the provision of services would not be significantly affected and therefore it could be concluded that the proposed pharmacy would not cause significant detriment to the proper planning of pharmaceutical services. Further that granting the application would not cause significant detriment to the arrangements currently in place for the provision of pharmaceutical services.

2.21 The PSRC noted that there are 10 pharmacies within a 5 mile radius of the proposed location covering opening hours between 08:00 – 19:00. The PSRC also noted the distance to the nearest pharmacies and that it is unlikely that residents of Hanslope would walk to the nearest pharmacy, and that there may be residents who would be unable to do so. This may indicate that there is a reasonable choice in obtaining pharmaceutical services. There was no evidence submitted to show that those who have access to private transport are currently experiencing any difficulties accessing existing pharmaceutical services in the area or that they would receive significant benefits from the granting of this application. The applicant states that any resident of Hanslope who is reliant on public transport would need to allow 1-1.5 hours for the return journey, and that 10% of households do not have access to private transport. The PSRC considered that this service is reasonable when considering access in a rural setting. There is also no bus service on a Sunday or Bank holidays, and it is noted that the applicant’s proposed opening hours do not include any hours on a Sunday, therefore it would not benefit those who are wishing to access services on a Sunday. There was no information provided by the applicant to demonstrate that those residents who did use public transport are experiencing any difficulties in accessing existing services or that they would receive significant benefits from the granting of this application.

2.22 It was noted that the applicant had proposed core opening hours of 50.5 hours in order to secure unforeseen benefits. The applicant is not proposing any core hours on a Sunday. The applicant also proposes that supplementary hours will be provided to respond to patient need and any additional GP hours.

2.23 The applicant states that current pharmaceutical provision is difficult to access in terms of distance and opening hours but has not demonstrated that the population of Hanslope are experiencing any difficulties in accessing pharmaceutical services at such times as needed. The PSRC considered that the population would be able to access pharmaceutical services in the course of their routine lives.

2.24 For those sharing protected characteristics, the applicant states the over 65’s have a more acute difficulty in accessing pharmaceutical services, and in the reply to interested parties’ responses listed patients with protected characteristics who will benefit from pharmacy services located within the community as: persons without a car either in the household or having access during the day; physically or cognitively disabled people or those who cannot drive; the elderly; mothers especially single mother with young children.

2.25 The applicant does not provide any evidence that patients in these patient groups living within the area have difficulties accessing services that meet any specific needs.

2.26 The PSRC concluded, from the evidence supplied, that any specific patient group that shares a protected characteristic, would not receive significant benefits from the granting of this application.

2.27 The PSRC had regard to the desirability of innovative approaches to the delivery of pharmaceutical services and considered whether there is something more over and above the usual delivery of pharmaceutical services that might be expected from all pharmacies, some ‘added value’ on offer at the location.

2.28 There is no information to suggest that the Applicant is proposing any innovative approaches to the delivery of pharmaceutical services, or any services that cannot be

accessed already. The PSRC was satisfied that granting the application would not give significant benefits on the population of Hanslope.

2.29 The PSRC determined that the application should be refused on the following basis:

2.29.1 there is already a reasonable choice with regard to obtaining pharmaceutical services;

2.29.2 there is no evidence of people sharing a protected characteristic having difficulty in accessing pharmaceutical services; and

2.29.3 there is no evidence that innovative approaches will be taken with regard to the delivery of pharmaceutical services.

2.30 The PSRC is not satisfied that granting the application would confer significant benefits that would secure improvements or better access to pharmaceutical services.

3 The Appeal

In a letter dated 8 July 2019 addressed to NHS Resolution, the Mr Morley on behalf of the Applicant appealed against NHS England's decision. The grounds of appeal are:

3.1 The Appellant would say that NHS England misdirected itself in its refusal determination regarding Northampton Medical Services Limited for the following reasons:

3.2 No evidence of a site report was submitted.

3.3 That NHS England failed to address Regulation 18 (2) (b) (i)

(b) whether, notwithstanding that the improvement or better access were not included in the relevant pharmaceutical needs assessment it is satisfied that, having regard in particular to the desirability of –

there being reasonable choice with regard to obtaining pharmaceutical services in the area of the relevant HWB (taking into account also the NHSCB’s duties under sections 13I and 13P of the 2006 Act (b) (duty as to patient choice and duty as respects variation in provision of health services)),

3.4 The applicant is offering better/improved access to pharmaceutical services with a significantly more accessible location and core guaranteed hours.

3.5 The applicant has proposed core opening hours of 50.5 hours in order to secure unforeseen benefits. The applicant also proposes that supplementary hours will be provided to respond to patient need and any additional GP hours. Therefore, improved better access is to be available during weekdays as again there is no provision of pharmaceutical services locally AND on a Saturday.

3.6 The unforeseen benefits:

3.6.1 Access to actual pharmaceutical services;

3.6.2 Pharmaceutical services available at the location where local retail services are accessed;

3.6.3 Securing reasonable choice in terms of distance and residents’ ability to access pharmaceutical services;

3.6.4 Better/improved access via core guaranteed hours.

3.7 PRSC report identify a substantial population of 2,344.

3.8 Whilst the PRSC stated there are ten pharmacies within a five-mile radius of the proposed location the Appellant would dispute that number and indeed believe there is only one pharmacy within five miles and that of Roade Pharmacy being 4.6 miles as the crow flies. The Appellant believes that NHS England have misdirected themselves regarding the ability for patients in Hanslope to access Pharmaceutical Services.

3.9 The PRSC failed to put any weight on the demographics of Hanslope which has a higher than average population over 65 and a lower than average car ownership.

3.10 The PRSC failed to put any weight on the poverty of public transport from Hanslope to the nearest pharmacies.

3.11 The PRSC failed to put sufficient weight on the assertions adduced in relation to persons with particular characteristics.

3.12 The Appellant is not claiming innovative services. The appeals authority will be aware that only one of the three Regulatory tests need to be satisfied.

Conclusion

3.13 The Appellant would say that on at least the balance of probabilities NHS England were incorrect to refuse consent to Northampton Medical Services Limited to join their Pharmaceutical List in Hanslope.

3.14 The Appellant therefore respectfully invites the Authority to grant consent to Northampton Medical Services.

4 Summary of Representations

This is a summary of representations received on the appeal.

4.1 LLOYDS PHARMACY

4.1.1 No evidence has been provided of groups who may share a protected characteristic having difficulty accessing pharmaceutical services. There is also no evidence of a lack of reasonable choice within the area of the Health and Wellbeing Board and no evidence of innovative services.

4.1.2 Regulation 18 has not been met and therefore the application and appeal should be refused.

4.2 BOOTS UK LTD

4.2.1 Boots stand by the comments submitted to NHS England and do not believe that the appellant has provided any evidence of people who share a protected characteristic(s) having difficulty accessing pharmaceutical provision.

4.2.2 Boots have enclosed a copy of their representations for consideration.

In a letter to NHS England dated 27 March 2019, Boots UK Ltd stated:

4.2.3 The area in which the proposed premises are located is an established one. Boots believe that the location of the proposed pharmacy to be a reserved locality. Patients who are registered with the GP Practice who live further than a mile from a pharmacy already have access to dispensing services. As the applicant has detailed, this represents 99% of their patient list.

4.2.4 Boots do not believe that the applicant has provided any evidence of people who share a protected characteristic having difficulty accessing pharmaceutical provision nor have they identified what specific health needs would be met by granting this application.

4.2.5 As with many rural locations across the country, residents are accustomed to accessing amenities beyond their immediate village. National Statistics show that 100% of residents in the Hanslope Park Ward (in which the proposed premises sits) have access to at least one car. This is a mobile population, the average age of residents in this ward is 39. Only 3.5% of residents describe themselves as having bad or very bad health.

4.2.6 The Milton Keynes 2018 Pharmaceutical Needs Assessments concludes that “There are currently a sufficient number of community pharmacies providing essential and advanced services in Milton Keynes.”

4.2.7 In conclusion Boots submit that the application should be refused as it will not confer significant benefits on persons in the area of the relevant Health and Wellbeing Board which were not foreseen when the relevant Pharmaceutical Needs Assessment was published.

4.2.8 Please be aware that Boots may wish to make further representations at a later stage and attend any oral hearing that may be held.

4.3 JARDINES (UK) LTD

4.3.1 As a preliminary matter, it is to be noted that:

4.3.1.1 Firstly, the applicant is an incorporated body of the partners of the medical practice exactly at the proposed location. This practice is a dispensing practice serving the patients living more than a mile away from any community pharmacy — effectively whole of Hanslope and nearby other villages.

4.3.1.2 Secondly, the application does not say — explicitly or implicitly — that the pharmaceutical services it intends to provide will replace the dispensing activity of the practice — which is highly relevant, given that this is a reserved location owing to the size of the population.

4.3.2 Jardines therefore fail to see motives behind this application.

4.3.3 Jardines entirely agree with the decision of NHS England Central Midlands PSRC, and their reasons for refusal.

4.3.4 The population this application seeks to serve already has a reasonable choice.

4.3.5 Hanslope Village: is an outlying village with a population around 2,300 within 'Newport Pagnell North & Hanslope' ward of Milton Keynes Local authority.

4.3.6 Hanslope is one of the affluent areas of Milton Keynes with its population enjoying well above average standards of health, education, earnings, car ownership. This, coupled with good congenial neighbourly relationships that usually prevail in any affluent village, the public transport is rarely relied upon and practically irrelevant.

4.3.7 Typically people living Hanslope are attracted to live there by an opportunity to enjoy a good balance of 'country life' — yet with easy access to all the facilities of urban life accessible by the network of trunk roads, such as A508, A5 and M1, all interconnected with well-maintained country roads. 8

4.3.8 For the reasons above, the 5-mile/20mins drive-time is the most appropriate and entirely reasonable test to apply in order to measure adequacy and choice at a location of this nature.

4.3.9 Existing Pharmacies: As the map attached with the letter shows, there are 15 pharmacies within a striking distance:

4.3.9.1 Three pharmacies in the same 'Newport Pagnell North & Hanslope' ward (with population 11,500);

4.3.9.2 Two in South Northamptonshire (one each at Roade and at Deanshanger);

4.3.9.3 And 10 more in North Milton Keynes within easy reach and vast range of service providers.

4.3.10 Jardines therefore respectfully urge the committee to refuse this application as there is already is a reasonable choice of service to the people in this part of the HWB, and it puts at risk continuation of the service provision in the neighbouring areas with proven need - such as north-west Newport Pagnell and Deanshanger.

4.3.11 Should an oral hearing is convened in order to determine this application, Jardines would like an opportunity to attend to make further representations.

4.4 LPC

4.4.1 Northamptonshire and Milton Keynes Local Pharmaceutical Committee write to thank you for advising us that the application by Northampton Medical Services Ltd for inclusion in the Pharmaceutical List offering unforeseen benefits at 1 Western Drive, Hanslope will be subject to the appeals process. In the LPC’s original response to the application they respectfully asked that the following points were considered:

4.4.2 The location for the proposed pharmacy is within a controlled locality and consequently the application must also be considered in accordance with Part 7 of the NHS (Pharmaceutical and Local Pharmaceutical Services) Regulations 2013. In this regard the LPC considered whether the location of the proposed pharmacy is in a reserved location as defined in regulation 41(3).1. The effect of a reserved location being that doctors may continue to provide pharmaceutical services to their patients living in that reserved location. Since the population is less than 2750 it is the LPC’s understanding that a prejudicial test will not be required.

4.4.3 The LPC believe that there are some ten pharmacies, three of which lie within the same ward, within a five mile radius of the proposed location of 1 Western Drive.

4.4.4 The LPC are not aware that circumstances have changed. Therefore the LPC respectfully requests that the committee take this into account in line with the conclusion of the 2018 PNA stating that ‘provision of pharmaceutical services in Milton Keynes is deemed adequate.’ The applicant specifies the essential services which could be provided. None of these are innovative and the gap analysis in the PNA states that access to existing services across Milton Keynes meets the needs of the population

4.4.5 The applicant provides no evidence that the population currently have problems accessing pharmaceutical services as part of their everyday life. This, together with the aforementioned reasons mean that the LPC respectfully

ask that the appeal is unsuccessful and the application is refused as previously.

5 Observations

5.1 MR MORLEY ON BEHALF OF NORTHAMPTON MEDICAL SERVICES

Letter received from Lloyds Pharmacy dated 30 July 2019

5.1.1 Mr Morley would dispute that the Applicant has not provided to NHS England details of groups who share a protected characteristic having difficultly accessing Pharmaceutical Services. The Applicant outlined that the disabled, elderly and mothers of young children would have particular difficulty because of the transport logistics and the distances to the nearest community pharmacy accessing Pharmaceutical Services.

5.1.2 The Applicant disputes that there is no evidence of a lack of reasonable choice.

5.1.3 The Applicant is not claiming innovative services.

Letter received 27th March 2018 (sic) Boots UK Limited

5.1.4 The Applicant would dispute that they have not provided to NHS England details of groups who share a protected characteristic having difficultly accessing Pharmaceutical Services. The Applicant outlined that the disabled, elderly and mothers of young children would have particular difficulty because of the transport logistics and the distances to the nearest community pharmacy accessing Pharmaceutical Services.

5.1.5 The Applicant would dispute that 100% of residents in Hanslope have access to at least one car from their personal knowledge.

Letter received from Pharmacy Northants and Milton Keynes LPC

5.1.6 The Applicant would dispute that there are three pharmacies within the same ward as the application site and would point out that the nearest pharmacy is even as the crow flies 3.9 miles away and circa 6 miles by road.

Letter received from Jardines (UK) Ltd dated 9th August 2019

5.1.7 The Applicant does not dispute that they are an incorporated body whose shareholders are partners at the application site. The rationale of the doctors in applying for a body corporate is to secure Pharmaceutical Services as opposed to dispensing doctor services which are of necessity inferior and less comprehensive. The applicant is also mindful that in the current turbulent political climate there may very well be a change of administration and the curtailment of dispensing doctor dispensing as per their previously published white paper.

5.1.8 The village continues to grow and has a current population in excess of 2,300.

5.1.9 The five mile/20 minute drive time test is inappropriate because as the crow flies distance is less than this the actual driving distances are circa six miles.

5.1.10 The Applicant disputes that there is no evidence of a lack of reasonable choice.

5.1.11 Because of the distances the Applicant would dispute there is any risk of the continuation of service provision in North West Newport Pagnell and

Deanshanger. Currently as is observed 99% of the prescriptions generated in Hanslope remain in Hanslope being dispensed by the dispensing practice.

Conclusion

5.1.12 The Applicant would say that NHS England misdirected itself when it refused the application. The Applicant would further state that nothing in the responses should dissuade the committee on the balance of probabilities to quash NHS England’s decision and grant the application. The Applicant respectfully invite the authority so to do. The Applicant confirms their willingness to attend an Oral Hearing if such is constituted.

6 Consideration

6.1 The Pharmacy Appeals Committee (“the Committee”), appointed by NHS Resolution, had before it the papers considered by NHS England, together with a plan of the area showing existing pharmacies and doctors’ surgeries and the location of the proposed pharmacy.

6.2 It also had before it the responses to NHS Resolution’s own statutory consultations.

6.3 On the basis of this information, the Committee considered it was not necessary to hold an Oral Hearing.

6.4 The Committee had regard to the National Health Service (Pharmaceutical and Local Pharmaceutical Services) Regulations 2013 (“the Regulations”).

6.5 Hanslope is in a controlled locality and the application was based on securing improvements or better access to pharmaceutical services in that controlled locality.

6.6 The Committee considered that the correct course was to first consider if the application must be refused pursuant to Regulation 31. The Committee will then consider if the application must be refused pursuant to Regulation 40. If the Committee is not so required to refuse the application, it will consider the issue of reserved location pursuant to Regulation 41. The Committee will then consider the application under Regulation 18. If the Committee has determined that the Applicant is seeking the listing of pharmacy premises which are in a part of a controlled locality that is not in a reserved location, it will consider the issue of prejudice under Regulation 44 last. The reason for this staged approach and in particular for dealing with prejudice last is that if the application does not meet the requirements of Regulation 18 the Committee is required to refuse it and prejudice cannot arise. The potential for prejudice only arises if the Committee has concluded that the application meets the requirements of Regulation 18 and may be granted.

Regulation 31

6.7 The Committee first considered Regulation 31 of the Regulations which states:

(1) A routine or excepted application, other than a consolidation application, must be refused where paragraph (2) applies.

(2) This paragraph applies where -

(a) a person on the pharmaceutical list (which may or may not be the applicant) is providing or has undertaken to provide pharmaceutical services ("the existing services") from -

(i) the premises to which the application relates, or

(ii) adjacent premises; and

(b) the NHSCB is satisfied that it is reasonable to treat the services that the applicant proposes to provide as part of the same service as the existing services (and so the premises to which the application relates and the existing listed chemist premises should be treated as the same site).

6.8 The Committee noted that the Applicant had stated, in their application form, that Regulation 31 was not applicable as there is no pharmacy provider or dispensing applicant contractor adjacent or in close proximity. The Committee noted that NHS England, in their decision letter, had determined that Regulation 31 was not engaged by this application. The Committee further noted that no party had provided any information to the contrary to indicate that Regulation 31 would require the refusal of this application. Given the information available to the Committee it determined that it was not required to refuse the application under the provisions of Regulation 31.

Regulation 40

6.9 In those circumstances, the application (which is made under Regulation 18 of the Regulations) must be assessed against the provisions of Part 7 of the Regulations and, in particular Regulation 40 which reads:

(1) This paragraph applies to all routine applications—

(a) for inclusion in a pharmaceutical list as an NHS pharmacist; or

(b) from an NHS pharmacist included in such a list—

(i) to relocate to different pharmacy premises in the area of the relevant HWB, or

(ii) to open, within the area of the relevant HWB, additional pharmacy premises from which to provide pharmaceutical services,

where the applicant is seeking the listing of pharmacy premises which are in a controlled locality.

(2) If the NHSCB receives an application (A1) to which paragraph (1) applies, it must refuse A1 (without needing to make any notification of that application under Part 3 of Schedule 2), where the applicant is seeking the listing of premises at a location which is—

(a) in an area in relation to which outline consent has been granted under these Regulations, the 2012 Regulations or under the 2005 Regulations within the 5 year period—

(i) starting on the date on which the proceedings relating to the grant of outline consent reached their final outcome, and

(ii) ending on the date on which A1 is made; or

(b) within 1.6 kilometres of the location of proposed pharmacy premises (other than proposed distance selling premises), in respect of which—

(i) a routine application under these Regulations or the 2012 Regulations, or

(ii) an application to which regulation 22(1) or (3) of the 2005 Regulations (relevant procedures for applications) applied,

was refused within the 5 year period starting on the date on which the proceedings relating to the refusal reached their final outcome and ending on the date on which A1 is made,

unless the NHSCB is satisfied that since the date on which the 5 year period started, there has been a substantial and relevant change of circumstances affecting the controlled locality.

(3) For the purposes of paragraphs (1) and (2), if no particular premises are proposed for listing in A1, the applicant is to be treated as seeking the listing of pharmacy premises at the location which is the best estimate that the NHSCB is able to make of where the proposed listed pharmacy premises would be, having regard to the best estimate given by the applicant under paragraph 1(7)(a)(ii) of Schedule 2.

(4) Paragraph (2)(b) does not apply where the NHSCB is satisfied that there are reasonable grounds for believing the person making the refused application was motivated (wholly or partly) by a desire for that application to be refused.

(5) The refusal of an application pursuant to paragraph (2)(b), or regulation 40(2)(b) of the 2012 Regulations (applications for new pharmacy premises in controlled localities: refusals because of preliminary matters), is to be ignored for the purposes of the calculation of a 5 year period pursuant to paragraph (2)(b).

6.10 The Committee noted that there was no information to suggest that the instant application was in respect of a location where outline consent had been granted or there had been a refusal for a previous application within the last 5 years.

Regulation 41

6.11 Based on its conclusion above, the Committee went on to consider the application in light of the remainder of Part 7 of the Regulations and, in particular, regulation 41 which reads:

(1) This paragraph applies to any routine application—

(a) for inclusion in a pharmaceutical list as an NHS pharmacist; or

(b) from an NHS pharmacist included in such a list—

(i) to relocate to different pharmacy premises in the area of the relevant HWB, or

(ii) to open, within the area of the relevant HWB, additional pharmacy premises from which to provide pharmaceutical services,

where the applicant is seeking the listing of pharmacy premises which are in a controlled locality and the NHSCB is required to notify the application under Part 3 of Schedule 2.

(2) If paragraph (1) applies to an application (referred to in this regulation and regulation 42 as “A1”), subject to paragraph (5), the NHSCB must determine whether or not the “relevant location”, that is—

(a) the location of the premises for which the applicant is seeking the listing; or

(b) if no particular premises are proposed for listing in A1, the location which is the best estimate that the NHSCB is able to make of where the proposed pharmacy premises would be, having regard to the best estimate given by the applicant under paragraph 1(7)(a)(ii) of Schedule 2, 13

is, on basis of the circumstances that pertained on the day on which A1 was received by the NHSCB, in a reserved location.

(3) Subject to regulation 43(2), the area within a 1.6 kilometre radius of a relevant location is a “reserved location” if—

(a) the number of individuals residing in that area who are on a patient list (which may be an aggregate number of patients on more than one patient list) is less than 2,750; and

(b) the NHSCB is not satisfied that if pharmaceutical services were provided at the relevant location, the use of those services would be similar to, or greater than, the use that might be expected if the number of individuals residing in that area who are on a patient list were 2,750 or more.

(4) Before making a determination under paragraph (2) (referred to in this regulation and regulation 42 as “D1”), the NHSCB must—

(a) notify the persons notified under Part 3 of Schedule 2 about A1 that the NHSCB is required to make D1 (and it may make this notification at the same time as it notifies those persons about A1); and

(b) invite them, within a specified period of not less than 30 days, to make representations to the NHSCB with regard to D1 (and the period specified must end no earlier than the date by which the person notified needs to make any representations that they have with regard to A1).

(5) The NHSCB must not make a determination under paragraph (2) in respect of A1 in circumstances where an earlier application which was in respect of the relevant premises and to which paragraph (1), regulation 44 of the 2012 Regulations (prejudice test in respect of routine applications for new pharmacy premises in a part of a controlled locality that is not a reserved location) or regulation 18ZA of the 2005 Regulations (refusal: premises which are in a controlled locality but not a reserved location) applied was refused—

(a) for the reasons relating to prejudice in—

(i) regulation 44(3),

(ii) regulation 44(3) of the 2012 Regulations, or

(iii) regulation 18ZA(2) of the 2005 Regulations; and

(b) within the 5 year period starting on the date on which the proceedings relating to the refusal reached their final outcome and ending on the date on which A1 is made, unless the NHSCB is satisfied that since the date on which the 5 year period started, there has been a substantial and relevant change of circumstances affecting the controlled locality.

(6) For the purposes of paragraph (5), the “relevant premises” are—

(a) the premises which are proposed for listing; or

(b) if no particular premises are proposed for listing in A1, premises at the location which is the best estimate that the NHSCB is able to make of where the proposed listed pharmacy premises would be, having regard to the best estimate given by the applicant under paragraph 1(7)(a)(ii) of Schedule 2.

6.12 The Committee considered the issue of reserved location for premises described in the application.

6.13 The Committee noted that the appellant had not challenged NHS England's position regarding the reserved locality status of Hanslope.

6.14 The Committee noted that NHS England had stated that the number of individuals residing within 1.6km of the location of the proposed pharmacy who are on a patient list is 2,344. The Committee noted that no party had sought to dispute this figure.

6.15 The Committee noted that NHS England had further gone on to conclude that there was no information or evidence to suggest that the use of pharmaceutical services would not be similar to, or greater than, the use that might be expect if the number of individuals residing in that area who are on a patient list were 2,750 or more. The Committee noted that this had not been disputed by any party either on appeal or in subsequent representations.

6.16 On the basis of the information before it, the Committee determined that the use of pharmaceutical services would not be similar to, or greater than, the use that might be expected if the number of individuals residing in that area who are on a patient list were 2,750 or more.

6.17 The Committee noted that as the number of individuals residing in that area who are on a patient list is less than 2,750, the area is therefore in a reserved location. The Committee noted that it would not need to go on to consider prejudice if it subsequently decided to grant the application. The Committee therefore next considered whether the application met the requirements of Regulation 18.

Regulation 18

6.18 The Committee noted that this was an application for “unforeseen benefits” and fell to be considered under the provisions of Regulation 18 which states:

"(1) If—

(a) the NHSCB receives a routine application and is required to determine whether it is satisfied that granting the application, or granting it in respect of some only of the services specified in it, would secure improvements, or better access, to pharmaceutical services, or pharmaceutical services of a specified type, in the area of the relevant HWB; and

(b) the improvements or better access that would be secured were or was not included in the relevant pharmaceutical needs assessment in accordance with paragraph 4 of Schedule 1,

in determining whether it is satisfied as mentioned in section 129(2A) of the 2006 Act (regulations as to pharmaceutical services), the NHSCB must have regard to the matters set out in paragraph (2).

(2) Those matters are—

(a) whether it is satisfied that granting the application would cause significant detriment to—

(i) proper planning in respect of the provision of pharmaceutical services in the area of the relevant HWB, or

(ii) the arrangements the NHSCB has in place for the provision of pharmaceutical services in that area;

(b) whether, notwithstanding that the improvements or better access were not included in the relevant pharmaceutical needs assessment, it is satisfied that, having regard in particular to the desirability of—

(i) there being a reasonable choice with regard to obtaining pharmaceutical services in the area of the relevant HWB (taking into account also the NHSCB’s duties under sections 13I and 13P of the 2006 Act (duty as to patient choice and duty as respects variation in provision of health services)),

(ii) people who share a protected characteristic having access to services that meet specific needs for pharmaceutical services that, in the area of the relevant HWB, are difficult for them to access (taking into account also the NHSCB’s duties under section 13G of the 2006 Act (duty as to reducing inequalities)), or

(iii) there being innovative approaches taken with regard to the delivery of pharmaceutical services (taking into account also the NHSCB’s duties under section 13K of the 2006 Act (duty to promote innovation)),

granting the application would confer significant benefits on persons in the area of the relevant HWB which were not foreseen when the relevant pharmaceutical needs assessment was published;

(c) whether it is satisfied that it would be desirable to consider, at the same time as the applicant’s application, applications from other persons offering to secure the improvements or better access that the applicant is offering to secure;

(d) whether it is satisfied that another application offering to secure the improvements or better access has been submitted to it, and it would be desirable to consider, at the same time as the applicant’s application, that other application;

(e) whether it is satisfied that an appeal relating to another application offering to secure the improvements or better access is pending, and it would be desirable to await the outcome of that appeal before considering the applicant’s application;

(f) whether the application needs to be deferred or refused by virtue of any provision of Part 5 to 7.

(g) whether it is satisfied that the application presupposes that a gap in pharmaceutical services provision has been or is to be created—

(i) by the removal of chemist premises from a pharmaceutical list as a consequence of the grant of a consolidation application, and

(ii) since the last revision of the relevant HWB's pharmaceutical needs assessment other than by way of a supplementary statement.

(3) The NHSCB need only consider whether it is satisfied in accordance with paragraphs (2)(c) to (e) if it has reached at least a preliminary view (although this may change) that it is satisfied in accordance with paragraph (2)(b)."

6.19 The Committee considered that Regulation 18(1)(a) was satisfied in that it was required to determine whether it was satisfied that granting the application, or granting it in respect of some only of the services specified in it, would secure improvements, or better access, to pharmaceutical services, or pharmaceutical services of a specified type, in the area of the relevant HWB

6.20 The Committee went on to consider whether Regulation 18(1)(b) was satisfied, i.e. whether the improvements or better access that would be secured if the application was granted were or was included in the PNA in accordance with paragraph 4 of Schedule 1 of the Regulations.

6.21 Paragraph 4 of Schedule 1 requires the PNA to include: “a statement of the pharmaceutical services that the HWB had identified (if it has) as services that are not provided in the area of the HWB but which the HWB is satisfied (a) would if they were provided….secure improvements or better access, to pharmaceutical services… (b) would if in specified future circumstances they were provided…secure future improvements or better access to pharmaceutical services…” (emphasis added).

6.22 The Committee considered the Pharmaceutical Needs Assessment ("the PNA") prepared by Milton Keynes Health and Wellbeing Board , conscious that the document provides an analysis of the situation as it was assessed at the date of publication. The Committee bears in mind that, under regulation 6(2), the body responsible for the PNA must make a revised assessment as soon as reasonably practicable (after identifying changes that have occurred that are relevant to the granting of applications) unless to do so appears to be a disproportionate response to those changes. Where it appears disproportionate, the responsible body may, but is not obliged to, issue a Supplementary Statement under regulation 6(3). Such a statement then forms part of the PNA. The Committee noted that the PNA was dated February 2018 and that no supplementary statements had been issued.

6.23 The Committee noted that the proposed site is located in Hanslope which falls within the Newport Pagnell North and Hanslope ward. The Committee noted that the PNA gave broad overviews for the area as a whole and did not look at the particular needs at ward level. The Committee noted the recommendation of the PNA at 3.3 “Key Recommendations and Findings” that “there are currently a sufficient number of community pharmacies providing essential and advanced services in Milton Keynes” and further “Based on these findings … the level of provision of pharmaceutical services in Milton Keynes is deemed to be adequate for the population”.

6.24 The PNA went on to conclude at 3.5 “Conclusion” that “Overall, the level of pharmaceutical services … currently provided across Milton Keynes meets the health needs of the population and provision of pharmaceutical services is good in our areas of deprivation”.

6.25 The Committee noted that the Applicant seeks to provide unforeseen benefits to the patients Hanslope Surgery as well as those resident in Hanslope and the surrounding villages. The Committee noted that the improvements or better access that the Applicant was claiming would be secured by its application were not included in the relevant pharmaceutical needs assessment in accordance with paragraph 4 of Schedule 1.

6.26 In order to be satisfied in accordance with Regulation 18(1), regard is to be had to those matters set out at 18(2). The Committee's consideration of the issues is set out below.

Regulation 18(2)(a)(i)

6.27 The Committee had regard to

"(a) whether it is satisfied that granting the application would cause significant detriment to—

(i) proper planning in respect of the provision of pharmaceutical services in the area of the relevant HWB"

6.28 The Committee noted that NHS England had concluded that the application, if granted, would not cause significant detriment to the proper planning of pharmaceutical services. The Committee noted that no party had sought to argue or produce any information which would support a finding that significant detriment would be caused if the application was granted.

6.29 On the basis of the information available, the Committee was not satisfied that, if the application were to be granted and the pharmacy to open, the ability of the NHS England thereafter to plan for the provision of services would be affected in a significant way.

6.30 The Committee was therefore not satisfied that significant detriment to the proper planning of pharmaceutical services would result from a grant of the application.

Regulation 18(2)(a)(ii)

6.31 The Committee had regard to

"(a) whether it is satisfied that granting the application would cause significant detriment to— …

(ii) the arrangements the NHSCB has in place for the provision of pharmaceutical services in that area"

6.32 The Committee noted that NHS England had concluded that, if the application was granted, it could not cause significant detriment to the arrangements currently in place for the provision of pharmaceutical services. The Committee noted that no party had sought to argue, or produce any information, which would support a finding that significant detriment would be caused. On the basis of the information available, the Committee was therefore not satisfied that significant detriment to the arrangements currently in place for the provision of pharmaceutical services would result from a grant of the application.

6.33 In the absence of any significant detriment as described in Regulation 18(2)(a), the Committee was not obliged to refuse the application and went on to consider Regulation 18(2)(b).

Regulation 18(2)(b)

6.34 The Committee had regard to

"(b) whether, notwithstanding that the improvements or better access were not included in the relevant pharmaceutical needs assessment, it is satisfied that, having regard in particular to the desirability of—

granting the application would confer significant benefits on persons in the area of the relevant HWB which were not foreseen when the relevant pharmaceutical needs assessment was published"

Regulation 18(2)(b)(i) to (iii)

6.35 The Committee noted the comments from the Applicant that there is currently no pharmacy within Hanslope and therefore there is no choice of pharmaceutical services for those residing in the village or the surrounding villages. The Committee was mindful that consideration needs to be given as to whether there is a reasonable choice in obtaining pharmaceutical services within the area of the relevant HWB. The Committee noted that there were 10 pharmacies located within a 5 mile radius of the proposed site and that these were operated by different contractors and were located in the vicinity of facilities and amenities within the surrounding community.

6.36 The Committee noted the distances to the nearest pharmacies as quoted by both NHS England and the Applicant. The Committee noted that there was some dispute with regard to the actual distance given and that NHS England had given the distance “as the crow flies” which the Committee did not find particularly helpful. Given the information with regard to distance and from viewing the map provided by NHS England, the Committee was of the view that it was unlikely that those in Hanslope would choose to access services outside of the village by foot, however the Committee was of the view that difficulties of access on foot did not of itself indicate that there was not reasonable choice in obtaining pharmaceutical services. The Committee went on to consider the ease of access to the nearest pharmacies by private and public transport.

6.37 With regard to access by private transport, the Committee noted the comments that the area was relatively affluent. Whilst the Committee noted the comments from the Applicant in their appeal that there was a “lower than average car ownership” the Committee noted that this contradicted the application form in which the Applicant has stated that only 10% of households do not have access to private transport. The Committee noted that this had been disputed by parties in subsequent representations who had quoted that 100% of residents in the Hanslope Ward (in which the proposed premises are located) have access to at least one car, however this figure had been disputed by the Applicant. The Committee noted that there was no dispute between parties that car ownership was very high and, irrespective of the actual figure, the Committee was of the view that this demonstrates that the area has a fairly affluent mobile population. Given the information before it, the Committee was of the view that for those who had access to their own transport there was nothing provided to demonstrate that they were experiencing any difficulties in accessing the existing pharmaceutical provision.

6.38 The Committee noted that there was limited information provided with regard to public transport in the area however the Applicant had stated that there was a bus service which ran through the village linking it to both Milton Keynes and Northampton and that those wishing to use the service should allow between 1 and 1.5 hours for a return journey however the Committee was unsure as to where this journey was from and to. The Applicant had not provided any further information with regard to public transport and how those who currently use public transport were experiencing difficulties in

access the existing pharmaceutical provision in the area. Given the limited information before it, as well as taking into account the information with regard to the high car ownership in the area, the Committee was of the view that there was nothing provided which demonstrated that those who did use public transport were currently experiencing any difficulties in accessing the existing pharmaceutical provision.

6.39 The Committee noted the comments from parties, which have not been disputed by the Applicant, with regard to facilities in the area and that residents are accustomed to leaving Hanslope on a daily basis to access facilities and amenities outside of the village. The Committee noted that no information with regard to facilities surrounding the proposed site had been provided and whilst the Committee accepted that there may be some facilities it was of the view that these would be limited. The Committee was of the view that the population was a relatively affluent mobile population that would leave Hanslope on a regular basis to go to work as well as to access a variety of services in Milton Keynes and Northampton including supermarkets in the area as well as the town centres, where there were pharmacies located, which provided choice in obtaining pharmaceutical services in the area of the HWB.

6.40 On the information available, the Committee was of the view that there is already reasonable choice with regard to obtaining pharmaceutical services in the area of the relevant HWB, such that it was not satisfied that, having regard to the desirability of there being a reasonable choice with regard to obtaining services, granting the application would confer significant benefits on persons.

6.41 In considering Regulation 18(2)(b)(ii) the Committee reminded itself that it was required to address itself to people who share a protected characteristic having access to services that meet specific needs for pharmaceutical services that are difficult for them to access. The Committee was also aware of its duties under the Equality Act 2010 which include considering the elimination of discrimination and advancement of equality between patients who share protected characteristics and those without such characteristics. The Committee noted the demographic information provided by the Applicant with regard to the elderly in the area and the statements with regard to those with mobility issues. The Committee accepted that there were always people in an area who share a protected characteristic, and was of the view that whilst a pharmacy located at the proposed site may be some benefit to some people, there was no information provided by the Applicant to indicate why this was a significant benefit or how those with a protected characteristic were currently experiencing any difficulties in accessing pharmaceutical services. In the absence of any supporting information and based on the information before it, the Committee was therefore not satisfied that, having regard to the desirability of people who share a protected characteristic having access to services that meet specific needs for pharmaceutical services that are difficult for them to access, granting the application would confer significant benefits on persons.

6.42 In considering Regulation 18(2)(b)(iii) the Committee had regard to the desirability of innovative approaches to the delivery of pharmaceutical services. In doing so, the Committee would consider whether there was something more over and above the usual delivery of pharmaceutical services that might be expected from all pharmacies, some ‘added value’ on offer at the location. The Committee noted that the Applicant did not seek to rely on innovation and had therefore not provided any information with regard to innovation in their application form or on appeal. The Committee was not satisfied that, having regard to the desirability of there being innovative approaches taken with regard to the deliverability of pharmaceutical services, granting the application would confer significant benefits on persons.

Regulation 18(2)(b) generally

6.43 The Committee noted that the Applicant was proposing to open for a total of 55.5 hours a week, 50.5 of which would be core hours. The Committee noted that the core hours were arranged so that provision would be available from 8am to 6.30pm Monday to

Friday, with a lunch break between 1pm and 2pm and from 9am to 12noon on a Saturday. The Committee noted that the Applicant proposed total opening hours from 8am until 6:30pm Monday to Friday with the additional hours being supplementary hours. The Committee noted that the Applicant was not proposing any hours, either supplementary or core, on a Saturday afternoon or a Sunday. The Committee was mindful that any core hours over the standard 40 core hours would have to be agreed with NHS England prior to the pharmacy opening The Committee was of the view that there was no information provided to support a finding that pharmaceutical services are not currently provided at such times as needed and therefore it was not satisfied that, having regard to the desirability of there being a reasonable choice with regard to obtaining services, granting the application would confer significant benefits (in relation to opening hours) on persons.

6.44 The Committee was of the view that in accordance with Regulation 18(2)(b) the granting of this application would not confer significant benefits on persons in the area of the HWB which were not foreseen when the PNA was published.

Other considerations

6.45 Having determined that Regulation 18(2)(b) had not been satisfied, the Committee did not need to have regard to Regulation 18(2)(c) to (e).

6.46 No deferral or refusal under Regulation 18(2)(f) was required in this case.

6.47 The Committee considered whether there were any further factors to be taken into account and concluded that there were not.

6.48 The Committee was not satisfied that the information provided demonstrates that there is difficulty in accessing current pharmaceutical services such that a pharmacy at the proposed site would provide better access to pharmaceutical services.

6.49 Pursuant to paragraph 9(1)(a) of Schedule 3 to the Regulations, the Committee may:

6.49.1 confirm NHS England’s decision;

6.49.2 quash NHS England’s decision and redetermine the application;

6.49.3 quash NHS England’s decision and, if it considers that there should be a further notification to the parties to make representations, remit the matter to NHS England.

7 DECISION

7.1 The Pharmacy Appeals Committee (“Committee”), appointed by NHS Resolution, confirms the decision of NHS England, therefore the application is refused.

7.2 The Committee concluded that it was not required to refuse the application under the provisions of Regulation 31.

7.3 The Committee concluded that Hanslope is in a controlled locality and that the site of the application is in a reserved location.

7.4 The Committee has considered whether the granting of the application would cause significant detriment to proper planning in respect of the provision of pharmaceutical services in the area covered by the HWB, or the arrangements in place for the provision of pharmaceutical services in that area and is not satisfied that it would;

7.5 The Committee determined that the application should be refused on the following basis:

7.5.1 In considering whether the granting of the application would confer significant benefits, the Committee determined that –

7.5.1.1 there is already a reasonable choice with regard to obtaining pharmaceutical services;

7.5.1.2 there is no evidence of people sharing a protected characteristic having difficulty in accessing pharmaceutical services; and

7.5.1.3 there is no evidence that innovative approaches would be taken with regard to the delivery of pharmaceutical services;

7.5.2 Having taken these matters into account, the Committee is not satisfied that granting the application would confer significant benefits as outlined above that would secure improvements or better access to pharmaceutical services.

Jill Jackson Case Manager Primary Care Appeals

A copy of this decision is being sent to:

Northampton Medical Services Lloyds Pharmacy Boots UK Ltd Jardines (UK) Ltd Northamptonshire and Milton Keynes LPC PCSE on behalf of NHS England – Midlands & East (Central Mids)