PHARMACY PRACTICES COMMITTEE MEETING Tuesday, 10 April, 2012 at 11.30 am The Board Room, John Dewar Building, Inverness Retail & Business Park, Highlander Way, Inverness, IV2 7GE

Application by LYNNE ELIZABETH CAMPBELL for the provision of general pharmaceutical services at Units 2 & 3 Cradlehall Shopping Centre, Cradlehall Court, Inverness, IV2 5WD

PRESENT Bill Brackenridge (Chair) Maureen Thomson (Lay Member) Margaret D Thomson (Lay member) Michael Roberts (Lay member) Alison MacRobbie (APC Non Contractor Nominate) Catriona Sinclair (APC Contractor Nominate) John McNulty (APC Contractor Nominate)

In Attendance Andrew J Green (Area Regulations, Contracts & Controlled Drugs Governance Pharmacist) Helen M MacDonald (Community Pharmacy Business Manager) Lynne Elizabeth Campbell, Applicant Kenneth Lawrie, Applicant Support Alasdair Shearer, Rowlands Lisa Gellatly, Tesco Peter Mutton, Area Pharmaceutical Committee

1. The Chair welcomed everyone to Inverness. He asked all members to confirm that they had all received the papers for the hearing and had read and considered them. All members affirmed these points.

2. APPLICATION FOR INCLUSION IN THE BOARD’S PHARMACEUTICAL LIST

Case No: PPC - Cradlehall_3 Lynne Elizabeth Campbell, Units 2 & 3 Cradlehall Shopping Centre, Cradlehall Court, Inverness, IV2 5WD

The Chair asked each Committee member if there were any interests to declare in relation to the application being heard from Lynne Elizabeth Campbell. No interests were declared.

3. The Committee was asked to consider the application submitted by Lynne Elizabeth Campbell to provide general pharmaceutical services from premises situated at Units 2 & 3 Cradlehall Shopping Centre, Cradlehall Court, Inverness, IV2 5WD under Regulation 5(10) of the National Health Service (Pharmaceutical Services) (Scotland) Regulations 2009, as amended.

The Committee had to determine whether the granting of the application was necessary or desirable to secure the adequate provision of pharmaceutical services in the neighbourhood in which the Applicant’s proposed premises were located.

The Committee, having previously been circulated with all the papers regarding the application from Lynne Elizabeth Campbell, agreed that the application should be considered by oral hearing.

P1 Lynne Elizabeth Campbell Cradlehall _3 PPC 10 April 12 NOTES (2).doc Prior to the hearing, the Committee had, as a group, attended a presentation which included a site visit at the University of the Highlands and Islands Campus which was delivered by Highlands and Islands Enterprise Senior Development Manager, Mr Ian Thorburn, to ascertain factual information regarding that development, which was within the Applicant’s neighbourhood and could be considered to have been an important factor in the Applicant’s case.

The Committee then visited the proposed premises where the Applicant and Applicant Support were on hand to guide the Committee around the premises, provide advice on the proposed plans for development and answer any questions asked of them by the Committee.

The Committee then visited the vicinity surrounding the Applicant’s proposed premises, the existing pharmacies at Tesco, Inshes and Rowlands, Culloden and facilities in the immediate area and surrounding areas of Cradlehall, Castlehill, Birchwood, Westhill where social housing, a business park, primary school, nurseries, residential nursing home and the various shops, hairdressers and beauticians were pointed out. They were then driven around the boundaries of the neighbourhood as defined by the Applicant, over the railway bridge to the neighbouring areas of Smithton and Culloden, passing the Boots Pharmacy, at Inverness Retail & Business Park before returning to the John Dewar Building where the hearing was to be held. During the tour, the situation of the NHS and private dental surgeries in Castlehill, Cradlehall and Culloden and GP surgeries in Culloden were noted (the Committee were provided the opportunity to enter into all 3 pharmacies, but decided this was not required on this occasion, as all members had visited these pharmacies before and were advised by Health Board officials there had been no further changes to any of the premises since then**).

The hearing was convened under paragraph 3(2) of Schedule 3 to the National Health Service (Pharmaceutical Services) (Scotland) Regulations 2009 as amended (“the Regulations”). In terms of this paragraph, the Pharmacy Practices Committee “shall determine an application in such a manner as it thinks fit”. In terms of Regulation 5(10) of the Regulations, the question for the Pharmacy Practices Committee is whether “the provision of pharmaceutical services at the premises named in the application is necessary or desirable to secure adequate provision of pharmaceutical service in the neighbourhood in which the premises are located by persons whose names are included in the Pharmaceutical List.”

The Applicant, Support and Interested parties were invited into the meeting at around 11.40am

4. The Chair welcomed:-

The Applicant, Lynne Elizabeth Campbell, who represented herself and was supported by Kenneth Lawrie, the Interested Parties who had submitted written representations during the consultation period and who had chosen to attend the hearing, were Lisa Gellatly, Tesco Pharmacy, Alasdair Shearer, Rowlands Pharmacy and Mr Peter Mutton, Area Pharmaceutical Committee, (“the Interested parties”). The Chair then invited the Committee members to introduce themselves. Committee members introduced themselves to the Applicant and all other parties.

The Chair asked the Applicant and the Interested Parties to confirm that they were not attending the Committee in the capacity of solicitor, counsel or paid advocate. They each confirmed that they were not.

P2 Lynne Elizabeth Campbell Cradlehall _3 PPC 10 April 12 NOTES (2).doc 5. The Chair reminded everyone that the meeting had been convened to hear the application from Lynne Elizabeth Campbell for the provision of general pharmaceutical services at Units 2 & 3 Cradlehall Shopping Centre, Cradlehall Court, Inverness, IV2 5WD. The application would be considered against the legal test contained in Regulation 5(10) of the National Health Service (Pharmaceutical Services) (Scotland) Regulations 2009, as amended.

6. Regulation 5(10) was read out:

An application shall be granted if the Board is satisfied that the provision of the pharmaceutical services at the premises is necessary or desirable in order to secure adequate provision of pharmaceutical services in the neighbourhood in which the premises are located.

7. The Chair then described the format of the hearing, reminding those attending that no new evidence could be introduced at the summing up.

The procedure adopted by the Committee at the hearing was that the Chair asked the Applicant to make her submission. There followed the opportunity for the Interested Parties and the Committee to ask questions. The Interested Parties would then make their submissions. There followed the opportunity for the Applicant and the Committee to ask questions of the Interested Parties in turn. The Interested parties and the Applicant were then given the opportunity to sum up.

The Chair then asked the Applicant to give her statement.

7.1. The Applicant’s Case

Lynne Elizabeth Campbell stated “I am truly grateful to the Committee for inviting me to attend the hearing today and appreciate being able to present my evidence and put forward Lynne Campbell Pharmacy Limited’s case.

I would endeavour to keep the presentation as concise as possible, however, I have done a great deal of work that I would like to bring to the attention of both the Committee and the representatives from Tesco and Rowlands.

To date, this is the third application made in respect to providing pharmaceutical services from Units 2 & 3 Cradlehall Court. The last application was made by Assura Pharmacy which was unanimously agreed to by the Committee after having heard and discussed all the evidence. The application was subsequently overturned as indicated in the submission from the Area Pharmaceutical Committee by the National Appeal Panel in 2009.

I am aware that there has been additional interest from one of the representatives opposing this new contract as well as another company in providing pharmaceutical service from these premises.

This application relates to a similar neighbourhood and detailed evidence of a significant change that is currently undergoing within it will be discussed at a later stage within this presentation.

I am here today, not only to represent my Company, Lynne Campbell Pharmacy limited, which was formed purely for the purpose of this application, but also to represent the community within the Westhill and Cradlehall neighbourhood.

P3 Lynne Elizabeth Campbell Cradlehall _3 PPC 10 April 12 NOTES (2).doc The Chair, Bill (Brackenridge), in his introduction identified the legal test which the Committee has to discuss and focus on. This test relates to the pharmaceutical services in the neighbourhood, feedback from the local community and whether this application meets the test.

From a previous application I was made aware of helpful and legal guidance that Lord Drummond Young provided for considering an application. He identified a two stage process for considering such an application:-

1 – What is the neighbourhood; and 2 – How adequate are the services?

Until the neighbourhood has been agreed the adequacy of service cannot be identified. Once the neighbourhood has been agreed the pharmaceutical services within it can be identified and subsequently the adequacy of these services. So, what is the neighbourhood?

Neighbourhood means:-

• Community – a local community with characteristics that distinguish it from areas around it. • People living near each other – people who live near each other or in a specific neighbourhood.

There are likely to be physical aspects to boundaries within a neighbourhood which may be natural. For example, rivers or manmade such as roads or railway lines”.

The Applicant then demonstrated on a map as follows:-

“So, starting with the neighbourhood.

The proposed neighbourhood covers the area bounded by the B9006 Culloden Road, crossing the A9. From here it follows the northern edge to the right hand side of the A9 until it meets the A96 at the Raigmore interchange. It then turns 90˚ east along the A96 and meets the manmade boundary of the Inverness to Perth railway line.

The boundary is then the line of the railway along to where it goes under Tower Road. At this point the boundary turns back 90˚ to the south and runs along the edge of Culloden Woods with open ground to the left encompassing Woodlands housing to the right until it reaches the B9006 Culloden Road.

The boundary then runs down the outside of Culloden Road encompassing houses in streets off the road on both the left and right hand side (including Birchwood) and back down to where the B9006 Culloden Road meets the A9.

The information supplied within my initial application on the population within the neighbourhood was not recent data, a point which was highlighted by the Area Pharmaceutical Committee in their written submission. Previous viewing of the Scottish Neighbourhood statistics had left me really confused and unable to give a more accurate estimate on the current population within the neighbourhood.

After the initial application was presented to the Board I made contact with Mr Cameron Thomas, Research Officer at the Planning and Development Service of The Highland Council. Mr Thomas researched and sourced information based on the National Records of Scotland Small Area Population Estimates 2010, which contains the latest available data up until mid 2010. P4 Lynne Elizabeth Campbell Cradlehall _3 PPC 10 April 12 NOTES (2).doc The potential area discussed with Mr Thomas was made up of Cradlehall, Westhill and Woodside of Culloden. In mid 2010 the population of 5,271 with 21% of the population (around 1,100) were people under 16 years of age and 14% of the population (around 678) were of pensionable age. This means that 35% of the population would require more pharmaceutical services than that of the average person.

In addition to this, Mr Thomas indicated an active building site in Woodside of Culloden with 110 plots nearly completed with another site in Resaurie with a capacity for 54 houses. This gives a total of 164 houses which are expected to be completed within the next 3 years and would increase the population with this neighbourhood by 350 or so, taking the estimated population to over 5,500.

The neighbourhood is very diverse, containing well established homes, new homes, low cost housing and has 184 properties owned and rented by housing associations (Cairn and Albyn Housing Associations),with a further 29 properties owned by The Highland Council, indication that there is a social aspect of deprivation within the neighbourhood. In the neighbourhood of Woodlands there is supported social housing for patients who have recently been discharged from New Craigs Hospital.

Tesco made a comment in its written submission stating that they believed the neighbourhood to be broader than that described. If we were to look at a broader area covering Cradlehall, Westhill, Smithton, Culloden and Balloch, it is a much larger area and has a population of 13,500. This area is too large in terms of size and population to be regarded as a neighbourhood on its own and needs to be broken down into a smaller more defined neighbourhood and those people living in Culloden would not say that they were neighbours with Cradlehall. Cradlehall and Westhill are recognised areas with a growing business park, primary school, nursery, residential nursing home all within close proximity to the busy, well used focal centre of Cradlehall Court. Therefore, Cradlehall is a neighbourhood and not part of a larger area.

If I am to define the neighbourhood as being broader than initially described I would include the area of Smithton. From the Scottish Index of Multiple Deprivation (which identifies small area concentrations of multiple deprivation across all of Scotland), Smithton’s relative measure ranking is 1,399 within the 6,505 data zones identified, with one being the most deprived and 6,505 being the least deprived.

The index is relative as it shows whether an area is more or less deprived than another one but not how much more or less deprived. The least deprived area is not necessarily the most affluent, it just lacks deprivation and, not everyone living in a deprived area is deprived.

Mr Thomas also discussed the area around Stratton between Smithton and the A96 as being identified as one of the next growth areas for Inverness with planning permission granted for the first phase of 750 houses with an anticipated population of 2,500. A population of 2,100 is expected with another 350 houses still to be completed in Milton of Leys. The Planning Department have set a requirement that before planning permission is granted, the developer of a site must agree to provide 25% of these homes as low cost housing.

From The Highland Council’s area demographic fact sheet of data collated from the National Records of Scotland, the population within Highland is expected to increase by 15% compared with 10% projected for the whole of Scotland. Across the UK, and Scotland, there is a growing trend towards an ageing population and an increased amount of prescriptions.

Highland households headed by 60-70 year olds are projected to increase in numbers by 35% and those headed by the 75+ years of age are projected to increase in numbers by 106% between the years of 2008 and 2033.

P5 Lynne Elizabeth Campbell Cradlehall _3 PPC 10 April 12 NOTES (2).doc From an article in the Press & Journal Newspaper, just recently, in the Wednesday, 28 March, 2012 edition, it was printed that “since prescriptions became free in April, 2011, the number of prescriptions dispensed in Scotland has risen by 2.8 million in a year, which is a 3.1% increase from the previous year”.

Now that the neighbourhood has been defined, the next step is to consider the pharmaceutical services in the neighbourhood. There are currently no pharmaceutical services provided in the neighbourhood. If we look outside the neighbourhood for where pharmaceutical services may be accessed – Rowlands Pharmacy at Culloden is 1.9 miles away, Tesco Pharmacy is 1.4 miles away and Boots Pharmacy at the Retail Park is 2.6 miles away.

I would like to highlight some of the points included in written submissions. The Area Pharmaceutical Committee indicate that Cradlehall is an area of high car ownership with good bus links and are unaware of patients having difficulty accessing pharmacies. Rowlands Pharmacy also indicate that the area houses residents who are financially secure, have high car ownership levels and can easily access local services.

All the residents of the Cradlehall/Westhill area need the use of transport to reach a pharmacy. In relation to access of a car, not everyone will have one and since the last application in 2009, the cost of fuel has risen by 35%. With at least a 3 mile round trip to visit a pharmacy, I would suspect that the majority of individuals – even those of us who are financially secure – will consider the necessity of such journeys.

Although there is a regular bus service, Stagecoach introduced changes in the Inverness area from November, 2011. The proposed changes to the bus service were to provide improved frequencies to many areas. As a result the new service number 3 runs every 20 minutes and requires patients who live along the length of Caulfield Road to get off the bus at the top of Tower Road and wait for the new service number 2/2A which will taken them down to Rowlands Pharmacy at Culloden. This means that for a selected number of individuals who do not own a car, they must either rely on good neighbours or be physically able to hop on and off a bus four times to access pharmaceutical services at Culloden. With a population of around 5,500 the pharmaceutical services are inadequate.

In the case of all new community pharmacy applications, a public consultation must be completed before an application can be submitted to the Board. Before conducting this, advice and views from the Westhill Community Council, local community and staff at the local Co-operative store at Cradlehall Court was taken and it was decided that the newspaper of choice for most local residents would be the Inverness Courier.

The public consultation appeared in the Inverness Courier, Courier 2 supplement on Friday 18th November, 2011 and ran for a total of 20 working days, ending on Friday 16th December, 2011.

A copy of this advert was also placed in the dental surgery, nursery, bakery, hairdressers and beauticians, after consulting with the proprietors of these businesses, which are all within the busy, well used focal hub at Cradlehall Court.

In addition, a copy was placed on the notice board at the local primary school – Cradlehall Primary, and within the Cradlehall Nursing Home.

Over the 20 day consultation period a total of 14 responses were received and, after completion of this consultation, it became evident that the Inverness Courier had not assigned an address to the PO Box number. Subsequently, any letters that the local community sent via the post were never received. The Post Office was contacted to see if they would be able to source or find any letters, however, to date nothing has been obtained.

P6 Lynne Elizabeth Campbell Cradlehall _3 PPC 10 April 12 NOTES (2).doc The Inverness Courier indicated to me that they would re-run the public consultation advert free of charge as it had been their error. The incident was report to Helen MacDonald, NHS Highland Community Pharmacy Business Manager, who advised that it would be unnecessary to do this, as the requirements of completing a consultation before making an application to the Board had been fulfilled.

Due to the limited responses received during the public consultation process it was decided that a small survey would be required to collate further views from the local community on the adequacy of pharmaceutical services provided from existing pharmacies with interpretation of the neighbourhood in a question and any further comments from the local community. The survey was designed from the website www.surveymonkey.com and was based on a survey that reviewed the current service provision from a medical centre. A total of 200 surveys were handed out door to door with 122 returned to date.

The Committee received a copy of the survey results to date of the completed surveys, additional comments made on the surveys returned and the actual 122 surveys completed by the local community in and around the neighbourhood. From the surveys returned, all were included within this submission and no comments were excluded from the table supplied to the Committee.

Comments from the survey indicate that there are patients who are experiencing difficulty in accessing a pharmacy and it is the sheer inconvenience of having no other option but to use transport to reach a pharmacy that this raises the desirability for a local pharmacy at Cradlehall Court.

Looking at the result of the survey and, as the Committee has seen the results of the survey, there are four questions that I would like to bring to the attention of representatives from the APC and Tesco, who both made submissions indicating that they were not aware of any complaints or did not see any gaps within the current level of service provision within the neighbourhood (at this point the Applicant furnished the Interested Parties with a copy of the pie charts summarising the survey results referred to).

Question 1 – How adequate are the pharmaceutical services currently provided by your existing pharmacy?

From the pie chart, does this indicate that there is an inadequacy with the pharmacy provision by the existing pharmacies? With 65% of the survey respondents indicating that the pharmacy services currently provided by their existing pharmacy was moderately accurate or below, this led me to research the word “moderately” within the UK English Thesaurus – meaning fairly, reasonable, more or less, sort of. From this definition I believe that a fairly, reasonable service does not constitute an adequate service provision.

Question 2 – Overall are you satisfied with the service provision from your current pharmacy?

The pie chart indicates quite clearly that 69% of the population surveys are moderately satisfied or below with the service provision from their current pharmacy.

Question 8 – If our new pharmacy were available today, how likely would you be to use it instead of your existing pharmacy?

81% of the population said that they would use our new pharmacy if it were available today.

P7 Lynne Elizabeth Campbell Cradlehall _3 PPC 10 April 12 NOTES (2).doc Question 9 – What do you consider to be the neighbourhood that the proposed pharmacy would serve?

I was very surprised to see the results of this question with 40% of the population considering Milton of Leys to be part of the neighbourhood.

As discussed earlier, a major significant change that will be occurring within the neighbourhood is the development of the 215 acre Inverness Campus site at Beechwood Farm. Inverness Campus is one of the most exciting and important projects being developed in the Highlands and Islands over the next 20 years, playing a pivotal role in both the defined neighbourhood and in the region’s future. The Campus will create up to 6,000 jobs over the next 30 years and generate £38 million per year for the area. I am aware that the Committee had a presentation at the site earlier today so, forgive me if I go over what was already covered there.

Key to the next 5 years of development is the Scottish Government granting Enterprise Area Status for Life Sciences to the Campus. This project represents a huge boost for the local economy and will bring a significant opportunity for local businesses across a wide range of sectors, whilst bringing education, business and the community together.

Morgan Sindall started work on the infrastructure construction in January 2012, which is aimed to be completed by Spring 2013. This will allow construction of Phase I of the Inverness Campus to begin with an expectation of around 20 months to complete.

A new junction to join the existing junction between the A9 slip road and the B9006 Culloden Road has been proposed, with a secondary access point planned to connect the Campus to Caulfield Road North, which will have considerable effect on patients accessing pharmaceutical services.

Phase I on the Inverness Campus envisages a wide range of business, education and community benefits including:-

• Over 600 student residences have been planned within Phase I of the Campus. • Inverness Campus will help to create the infrastructure necessary to deliver a University for the region. • Scottish Agricultural College • A training hotel. A partnership between Albyn Housing and the Calman Trust will provide opportunities for disadvantaged young people in a real business environment. • Centre for Health Science. The Centre for Health Science plan to expand its Inverness operation onto the Inverness Campus and plans include a multi disciplinary health centre. • Also sports facilities. A high quality sports facility is planned, aspiring to create a regional venue catering for a diverse range of sports, attracting users from across the Highlands. • Community centre. A pivotal site on the Campus is earmarked for community use and the views of the local community are being sought.

At present, I am aware of 2 health centres with over 16,000 patients who are currently in discussions with Highlands and Islands Enterprise on moving their practices out to the Campus. I had hoped to be able to present to you today the practices with which this concerns. To date the press release for the public consultation with regard to this relocation will be released on or after the 17th April, 2012.

P8 Lynne Elizabeth Campbell Cradlehall _3 PPC 10 April 12 NOTES (2).doc In addition to the academic aspects of the Campus, the project includes an innovative science park for the private sector research and development and business incubation which will stimulate new employment and bring greater economic benefits to the Highlands.

In relation to core services and prescription numbers. Pharmaceutical care is changing and the new contract services which the pharmacist is required to deliver, such as the Minor Ailments Scheme, Chronic Medication Service, Public Health Service and the Unscheduled Care can be time consuming, although will help in achieving health and wellbeing but only if delivered properly. These new services can add extra strain on the pharmacies in the area and it is important to consider not just the needs now but also in the future. The neighbourhood needs a pharmacy both now and in the future.

A Freedom of Information request was made to the Information Services Division of the Common Service Agency. When reviewing the prescription numbers and the core services of all the pharmacies contracted in respect to this application and sadly, with the recent closure of Lloyds Pharmacy in Church Street, it becomes evident that the pharmacies that we see on the High Street appear to be experiencing the challenging conditions of being there.

I would like to comment on the information received, looking at the prescription numbers. I was provided with information on the number of paid items from December 2010 to December 2011and I divided these by 12 to obtain an average for each pharmacy. When you look at the number of items being dispensed you get a picture of those being dispensed from the high street, for example, Boots, Eastgate do an average of 12,500 items per month – these will not be acute prescriptions but Boots have a very high number of nursing home business, therefore, I would suggest probably only 4-5,000 are acute prescriptions.

There are similar situations at Tesco Inshes and Rowlands, with Rowlands, Culloden averaging at just over 10,000 items dispensed per month and Tesco at just over 8,500 and Rowlands Park Pharmacy with just over 8,500 items per month.

What I find interesting, when you look at Boots at the Retail Park, setting it apart from Lloyds, Church Street, whose average was just over 2,000 items dispensed per month, is that, although their monthly average dispensings are just over 4,800, they are the ones who are most effectively delivering the other core services compared to the others, with 1,224 Minor Ailment Service prescriptions dispensed on average each month, pushing them into the next bracket up for payment, Smoking Cessation Service payment being the highest for all the pharmacies and a very high rate of patient care records for the Chronic Medication Service completed.

Compared to the figures for Rowlands, Culloden and Tesco, Inshes, they are actually doubling what they are doing who I would say are not necessarily delivering as effectively all the core services, including the Minor Ailments Service. With dispensing figures of over 10,000 items per month, I would expect to see more than150 patients registered for smoking cessation services and for them to be at the top end of the payment bracket for the Minor Ailments Service. What you are seeing is that they are delivering a good dispensing service but that it is difficult for them to provide the other core services. I believe that the reason Boots at the Retail Park provide the highest proportion of core services than other pharmacies is because the number of paid items per month is lower than the rest and that they have two pharmacists on the premises during extended opening hours. This is not the case in Culloden or Tesco, insofar as I am aware and 10,000 items is a “hell of a lot” of items for one pharmacist to dispense.

P9 Lynne Elizabeth Campbell Cradlehall _3 PPC 10 April 12 NOTES (2).doc I am working in a pharmacy which fills over 8,000 items a month but this is only possible because I have a good team which allows me to provide all the services, so I would suggest for a single pharmacist to deliver all the core services and dispense 10,000 items is pretty tough going.

That said, Culloden are doing well with core services but Tesco, in its own submission indicates that it has extended hours, however, I would expect a similar proportion of core services as Boots Retail Park, but there is really not much happening there. If they were to review comments made not only within my survey but from letters received from the local community with respect to their premises they may want to take action.

I did get an opportunity to visit the Practice Manager to introduce myself within the Culloden Practice and have been asked to give a presentation on the Chronic Medication Service and the stage pharmacy is at within it. This leads me to conclude that there is not much consultation happening between the GP practice and the pharmacy at the moment.

Although not part of the core services, I am aware that the appointment of two new pharmacy contracts outwith Inverness are supplying weekly dosette boxes to patients and these pharmacies are being contacted to provide this from within Inverness. I think this indicates the inadequacy of services within and outwith the neighbourhood, resulting in a 13 mile trip for either the pharmacy or the patient to receive these in Inverness.

So, what is pharmacy about. Pharmacy is about delivering patient centred care which is respectful, compassionate and responsive to an individual’s preferences, needs and values. This application is not only about delivering a full pharmaceutical service but also providing a centre of wellbeing where all aspects of health could be addressed.

In summary, the neighbourhood has been clearly defined and the pharmaceutical services within the neighbourhood are inadequate as there is no current provision. There are services outwith this neighbourhood but these are not accessible to everyone. Although the Area Pharmaceutical Committee indicates in its submission that they believe that Rowlands Pharmacy, Culloden and Boots at the Retail Park have the capacity to provide pharmaceutical services to a growing population, with the up and coming Inverness Campus, the proposed relocation of GP surgeries into the Campus and the transient and working population who will visit the area, extra strain will be placed on these existing pharmacies – and I would suspect would not be able to provide adequate services.

As indicated in a letter of support from Mr Ian Brown, the boom in Inverness’ population over the last 10 years has not been reflected in its pharmacy provision, with the re-opening of a store at Balloan Park (a contract which previously served the Hilton area), a new contract at Boots Retail Park on the outskirts of the city and, most recently, the closure of Lloyds Pharmacy in Church Street means, with respect, there has been no increase in the number of pharmacies in the Highland capital for over 10 years.

As this community expands through future housing developments in the neighbourhood, together with the development of the Inverness Campus at Beechwood, the requirement for direct patient services under the community pharmacy contract will increase and the current lack of provision will become a more acute problem. Therefore, I feel that the present and future case for a local pharmacy within the defined neighbourhood, which would include the provision of pharmaceutical services is a strong and indeed desirable one.

The use of the term “desirable” includes the concept of improving existing pharmacy cover and, as this application will improve services to the area, the services available outwith this neighbourhood may not be easily accessible to everyone. The services are, therefore, inadequate and I would hope this application should be granted.

P10 Lynne Elizabeth Campbell Cradlehall _3 PPC 10 April 12 NOTES (2).doc The Chair thanked Miss Campbell for her statement and invited the Interested Parties and then members of the Committee to ask questions of her.

7.2 Questions from Lisa Gellatly, Tesco Pharmacy to the Applicant

Ms Gellatly advised that in relation to the survey she had carried out, 45% of respondents had said that current services were moderately adequate with only 20% combined total saying services were slightly or extremely inadequate. How did she feel these figures proved inadequacy?

Miss Campbell replied that was the reason she had tried to define the word moderately in her presentation.

Miss Gellatly commented that it could be said that 35% of the people surveyed feel that current service provision is extremely inadequate service but 35% of those think it is good enough. Did Miss Campbell think that was high enough to prove inadequacy?

Miss Campbell replied that surely the 20% would tell you if it were inadequate in that case and advised Miss Gellatly that it was identified in the response if she looked at it and clearly people were not happy with current services but advised that she had to do a survey to find that out and that the survey reflected that. It was up to Ms Gellatly to interpret the results as she wished.

7.3 Questions from Mr Alasdair Shearer, Rowlands Pharmacy to the Applicant

Mr Shearer had a few questions to ask regarding the statistics the Applicant had referred to. He stated that she had mentioned neighbourhood statistics, which he felt were based on the Scottish Neighbourhood Statistics website figures. He had accessed these figures himself and noted that the Applicant made reference that 36% of the population was of pensionable age. He asked the Applicant if she had compared that to the Scottish average.

The Applicant replied she had not.

Mr Shearer advised that this was actually 21% less than the Scottish average and asked where she had accessed her information from.

The Applicant advised that Mr Cameron Thomas of The Highland Council had accessed the information from the most accurate website available to him.

Mr Shearer asked the Applicant to confirm if 122 surveys were the total number completed and returned.

The Applicant affirmed that was the number of surveys returned to her.

Mr Shearer then enquired if the Applicant agreed that this resulted in a return for only 2.2% of a population of 5,500, whether she felt this was a true representation.

The Applicant replied that she could not say, however, she was at work, full time, five days a week and ran a busy herbal medical practice advising that she had managed to get round 200 homes but had simply not had the time to get round all the places that she would have liked. That said, she felt it was a good representation but was done on the back of, and complimented the public consultation.

Mr Shearer then asked whether the Applicant would agree that a community would always wish a pharmacy application to succeed.

P11 Lynne Elizabeth Campbell Cradlehall _3 PPC 10 April 12 NOTES (2).doc The Applicant agreed with Mr Shearer’s supposition.

Mr Shearer then enquired whether this was more so, probably, when she was standing in front of the member of public at their front door.

The Applicant advised that she had left the surveys with people and went back to collect them or they had forwarded them to her in a stamped addressed envelope she had left with them. She refuted that she stood in front of them while they completed the survey, however, advised that there were additional comments from 88 people commenting on the travel time to existing services and their provision.

Mr Shearer wanted to touch on the capacity issues the Applicant alluded to for current pharmacies and asked of her how many prescriptions she felt a pharmacy should do every month.

The Applicant replied that a very well run, efficient pharmacy could deliver fantastic service, however, to actually dispense over a certain amount of items, there would become a point where it would require to be considered if one pharmacist can actually deliver all that would be required to them. She advised that if they were processing 12-15,000 prescriptions per month, she would say they would not be able to provide all of the services expected from them as the pharmacist absolutely has to check everything, even with a dispenser or ACT (Accredited Checking Technician). In her opinion, to deliver core services, while dispensing those amount of items, you would require an extra pharmacist.

Mr Shearer acknowledged that but asked the Applicant if she agreed that any pharmacy would be able to make the necessary changes to support a busy pharmacist and recruit the relevant staff, i.e. an ACT or an extra pharmacist.

7.4 Questions from Mr P Mutton, Area Pharmaceutical Committee to the Applicant

Mr Mutton had no questions for the Applicant.

7.5 Questions from the Committee to the Applicant

Margaret Thomson advised that she was particularly interested to hear about the survey the Applicant had carried out and asked her to recap for her how she had done this, asking if she had said that she had gone out and left leaflets.

The Applicant advised that she had designed a survey through the website www.surveymonkey.com and in doing so had adapted a survey to become fit for pharmacy specifics from the site which had previously been used in the review of medical practice. She advised that as, she did not have postcodes, nor know individuals from within the proposed neighbourhood it felt right for her to go out and knock on people’s doors but that she had left a stamped addressed envelope which could be used for them to return the questionnaire to her at their convenience. She advised that she was assisted in this by her very good neighbours but had carried around 80% of this door to door herself.

Margaret Thomson asked for clarification that the survey was an actual piece of paper.

The Applicant confirmed this was the case and she had distributed this by knocking on doors and introducing herself, advising what her intentions and proposals were. She did have one individual who did not wish to participate in completion of the survey but she wanted to knock on the doors of her potential customers and let them see her, their potential pharmacist who would be working in the pharmacy and for her to see the customers she might be caring for.

P12 Lynne Elizabeth Campbell Cradlehall _3 PPC 10 April 12 NOTES (2).doc Margaret then asked for confirmation that out of the 200 surveys dispatched, was it the case 122 were returned which was around a 60% return rate and yet there was more than 60% shown on one of the pie charts?

The Applicant replied that the comments were based purely on the 122 returned so the 60% was 60% of the 122, not the 200. Unfortunately, due to work commitments, she was unable to obtain any more surveys.

Margaret Thomson asked the Applicant what her thoughts were about how to use the information received and was she happy with the response.

The Applicant replied that the results had been disappointing but acknowledged that in reality, it was not that often that people actually took the time to complete and return a survey. She advised that she had visited the Westhill Community Council, nurseries and the Senior Citizens Club – not just gone round the doors, so quite a few surveys went to them but not all responded so she then recognised she would have to give out stamped addressed envelopes if she wanted to receive responses.

Margaret Thomson then acknowledged that the Committee could be convinced that she had looked for the views in her survey from the elderly and nursery ages but, in doing so, could they assume she had missed the age group in between – those who were mobile.

The Applicant replied that she had addressed this by going about the neighbourhood on a Sunday afternoon and she had spoken to those with cars in their drive and children.

Margaret Thomson asked the Applicant if it was that population which did not return the questionnaires.

That Applicant replied that she did not know.

Maureen Thomson asked the Applicant to describe how the pharmacy would operate and how she would see it functioning in staffing levels.

The Applicant replied that it would not be just a pharmacy for her but a place for alternative treatments such as herbal medicine, massage, aromatherapy and that she would bring her current herbal experience into practice there. She advised that the Drug Information Department at Aberdeen Royal Infirmary advise they receive enquiries from affluent people looking for information with regard to herbal medicines and that often she consults with the Highland Hospice and nursing staff. She advised that she envisaged pharmacy being the centre of health and wellbeing centre and intended to look at chiropody, well men, well women and travel clinics and obtaining locally accessible services for the local community. She advised that it was a big site and that pharmacy would be the focus with one consultation and two treatment rooms but that these may not be built straight away as she wouldn’t be able to do everything immediately. She advised that she knew many individuals of high calibre willing to come and work with her but initially her staffing would comprise 2 dispensers and a part time ACT.

She further advised that if the business grew to where she hoped then she would recruit a second pharmacist and probably sooner than the multiple contractors. She would not wait until 10,000 items a month were dispensed and would seek to do so at approximately 6,000 items, to enable consistent delivery of the services that pharmacy is all about. Pharmacy is changing.

P13 Lynne Elizabeth Campbell Cradlehall _3 PPC 10 April 12 NOTES (2).doc Maureen Thomson then enquired of the Applicant how she was able to inform patients about what pharmacy is actually all about, remarking that most of the comments received about pharmacy relate purely to dispensing and how she felt it was possible to get people to understand that pharmacy is about more than that.

The Applicant advised that she had learnt so much through the experience and, quite rightly, agreed that the public have no idea about what pharmacy is all about.

Maureen Thomson then asked, in that case then, how could adequacy actually be measured.

The Applicant replied that she was not sure it could as the public don’t know what services were delivered through pharmacy and they didn’t even know about the Minor Ailments Service. She had gone back to the pharmacy in which she works after the experience and said “right girls - we need to inform the public”! She advised that from the pharmacy they could see when patients were just turning to pensionable age who did not think such services are for them but that it absolutely was. The Applicant further reported that 40% of consultations which take place within the GP surgery could be done from pharmacy and that this would be the best outcome for the patient rather than having to perhaps wait up to 3 weeks for an appointment.

John McNulty asked the Applicant to clarify her opening hours.

She replied that she had made a change to those initially applied for as she had learnt that other businesses within the Shopping Centre would be open until 6pm so made the decision that she would extend her hours to open 8.45am – 6pm, Monday to Friday and 9am-1pm on a Saturday but advised she may further extend her hours for the purposes of herbal therapy over and above that but not for pharmacy services.

John McNulty enquired if the Applicant was of the view that services would be in more demand when the GP surgery was closed at the weekend, either on a Saturday afternoon or Sunday.

The Applicant replied that, looking at the Information Services Division figures, and, in particular at Boots in the Retail Park, it can be seen that they are delivering all the services, but actually when you review this in line with the extended opening hours at Tesco Pharmacy, Inshes, these core services are not being done as well. She advised that when she had worked for Boots she had carried out a survey between 6-8 pm and they were lucky if 2% of their custom came in 6-7pm, dropping to 1% between 7-8pm. In her experience, she suspected that core service provision happens, in the main, between Monday and Friday and, although still provided at the weekend, not always the core services.

Catriona Sinclair highlighted that the Applicant had not made much mention of the Chronic Medication Service (CMS) and how did she imagine this would work through pharmacy.

The Applicant replied that it was evident that the service providers had fulfilled what is required of them, apart from 3 contractors where shortfalls were recognised in the figures. Tesco, Inshes; Superdrug, High Street and Lloyds, Church Street, both Inverness City Centre. Lloyds, Church Street is now closed.

P14 Lynne Elizabeth Campbell Cradlehall _3 PPC 10 April 12 NOTES (2).doc The Applicant thought that Superdrug was running on locums but advised that she could be wrong in saying that and that was why their figure for CMS might be low. She advised she felt that CMS was a fabulous Service for patients but, having spoken to practice managers, it would appear there was a lack of communication between pharmacists and medical practices. For Culloden, she felt that if this were improved, the practice there had advised that they have 1,500 patients they know would absolutely go on to use the Service and that was what she felt was required to be done. To go to the medical practices and tell them that we are now allowed to become more involved in patient care. She advised there were more nurse practitioners but not so many pharmacy practitioners and there was a real need to get into the medical practices to let them see what can be delivered and to then work together, hand in hand, with everyone out there.

Michael Roberts enquired where the Applicant had measured the point of distances to the other pharmacies from.

The Applicant replied that these had been measured from the actual proposed pharmacy premises.

Mr Roberts highlighted that the Applicant had talked a lot about alternative therapies and asked if a person came into the Applicant’s pharmacy with a problem, such as a rash, how likely she would be to advise that patient to use an alternative therapy rather than a traditional medicine.

The Applicant replied that she was able to gauge what was best suited to a patients needs, advising that she receives a plethora of enquiries for various conditions and that she had extended her knowledge because she had listened to patients who were asking about homeopathy, aromatherapy and herbal remedies. She advised that some patients moved towards healthcare and that some individuals have tried that and had not got what they thought and were looking for something else. She advised that she has also studied nutrition, advising that this was what pharmacists did and that they had a wealth of information and could steer people in the direction which was right and best for them. This could be nutrition, a bath in lavender or an orthodox treatment. That is when you see you have a community backing you when you have that wealth of knowledge.

Alison MacRobbie asked the Applicant what she meant when she talked about perhaps extending the boundaries of her neighbourhood into Smithton.

The Applicant advised that she had meant that residents of Smithton could easily use the services of her pharmacy in Cradlehall and that the Business Advisory Team had assisted her in deciding her neighbourhood. She advised that patients in Smithton could come through and use facilities and if she were to look at a broader neighbourhood, I would only look to Smithton, which is more deprived. In her considerations she had made contact with John Glenday of NHS Highland Harm Reduction Services, who has since retired, to see if that was a factor in the application. It was clear that the population was ageing, albeit the figures did not agree and it was apparent that now, Inverness was developed around car ownership. On the High Street there was evidence to show a slow down and not much happening there which was more apparent with the current economic climate.

Alison MacRobbie advised that one of the issues following on from that was the distances by car and although reasonable car ownership, had the Applicant viewed the ways in which people might move around the proposed neighbourhood and in what proportion.

P15 Lynne Elizabeth Campbell Cradlehall _3 PPC 10 April 12 NOTES (2).doc The Applicant replied that she could not say but she thought that this would be a high proportion as it was a very busy local hub for the local community containing a grocers, dentist, bakery, beautician, nursery and hairdressers, adding that people like to get out and about if they are able to walk and access services but, in addition, it was good to walk. In my presentation I advised that the population would increase by 106% for those 75 years and older so something like that where they can walk and see someone – which may be on their way to something, would enhance the local community.

The Chairman advised that he was very, very interested to hear about the Applicant’s conversation with Culloden Medical Practice and to hear they had requested her to do a presentation. That said he wondered if, in the opinion of the Applicant, this implied that they were not happy with the current service offered by Rowlands Pharmacy there.

The Applicant replied, no, as she advised that when she was there to introduce herself, they had said they were happy with the service they currently received, however, when she had gone to meet the Practice Manager in person, he had no awareness at all of CMS.

8. The Interested Party’s Case – Ms L Gellatly, Tesco Pharmacy

Ms L Gellatly stated “thank you for allowing me the chance to speak today.

Firstly I would like to refer to the legal test which requires a pharmacy to be necessary or desirable in order to secure adequate provision of pharmaceutical services in the neighbourhood for an application to be granted.

We do not agree that this application passes the legal test. First of all let’s discuss the neighbourhood as defined by the Applicant. While we understand why the neighbourhood was defined as such, we don’t agree with the definition. This is because in Inverness pharmaceutical services are often accessed from outwith the patient’s local neighbourhood and already several pharmacies deliver medication into the area proposed by the Applicant. Patients can be registered at any of the GP surgeries in Inverness and can, and do, access pharmaceutical services on the other side of the City. For example, we have several patients at Tesco who are registered at Kinmylies Surgery on the other side of the City.

Within the neighbourhood of Inverness there are already 11 GP surgeries whose prescriptions are already dispensed by 11 pharmacies, who have all worked hard to develop and maintain good professional relationships. There are no pharmacies currently situated in the defined neighbourhood, but neither are there any GP surgeries, therefore the residents will already be accessing such services elsewhere and the area is one of high car ownership.

We believe that the pharmaceutical services offered across these 11 pharmacies are adequate.

Much has been made in the application of the development of the Inverness Campus, however, this won’t be completed until at least 2015 and, as there are no plans for a residential component, this development will have no effect on the population of the neighbourhood. The people who work or study there will already access both medical and pharmaceutical services from the area in which they live so the impact on the neighbourhood would be negligible. In fact, many parts of the new pharmacy contract rely on patients being registered at one pharmacy, for example to use the Chronic Medication Service.

We do not believe that it is necessary nor desirable to grant the application in order to secure the adequate provision of pharmaceutical services in the neighbourhood.

P16 Lynne Elizabeth Campbell Cradlehall _3 PPC 10 April 12 NOTES (2).doc To illustrate this, I’d now like to go on to tell you a bit about our pharmacy at Tesco, Inshes and the services we offer, ranging from blood pressure, diabetes and cholesterol testing to prescribing for travel health and erectile dysfunction. We also offer health checks and flu injections. We offer all of the core NHS services including eMAS, EHC, CMS, Public Health and AMS and run a very successful nicotine replacement therapy service.

Access to our pharmaceutical services is greatly affected by our extended opening hours. We are open from 8am to 8pm six days a week and between 10am and 4pm on Sundays. Therefore, many of our services are accessed by people after their own working hours, or at weekends when other pharmacies (including the one proposed by the Applicant) will already be closed.

I would like to point out that there is 3-4 hours cross over per day allowing two pharmacists to provide all the services.

The pharmacy was recently refurbished and now has a much larger dispensary to allow our capacity for offering services like methadone supervision and dispensing of dosettes to grow. While the refurbishment was taking place, the pharmacy operated from a portakabin and it is a credit to both the service provided by the pharmacy and the loyalty of their patients that they managed to maintain 60% of their business during this period, a much greater figure than usual. Where patients choose to use other pharmacies during the refit, we have now noticed that the vast majority of them have returned to use our pharmacy which again proves the perception of great service and convenience offered at Tesco, Inshes.

The staff at Tesco, Inshes do value their patients and customers greatly and reflect on the standard of services that they offer on a regular basis. It is for this reason that we recently conducted a patient satisfaction survey, which was submitted to Helen (MacDonald, NHS Highland Community Pharmacy Business Manager). We asked a range of questions, from the convenience of the pharmacy to the friendliness and professionalism of staff, and satisfaction with services that we offered and myself, Emily (Macintyre, Tesco Inshes Pharmacy Manager) and all the staff were overwhelmed by the response we got. Out of 186 questions asked, 156 were graded as “excellent”, 29 “good” and only one as “average”.

A few examples of comments are:

“excellent staff, very caring”, “I am at the pharmacy a lot and I find that I always leave with a smile”, “I was going to get my medicines from the pharmacy beside my house but I would rather spend half and hour extra to get here”.

We are very proud of the level of excellent service that we’ve built into our business and believe it is a clear and direct result of mix of existing experienced staff and the addition to the team of newer staff who came from other pharmacies in the area.

I do hope from your visit to Tesco that you did earlier today (**) that you saw our great pharmacy and consultation room facilities and realise the potential and capacity we have to take on more services like dosettes, methadone supervisions and nicotine replacement therapy patients. We are currently investing in additional hardware for the pharmacy after listening to patient feedback about waiting times.

In conclusion, we feel that we offer a fantastic pharmaceutical service at Tesco, Inshes which is greatly appreciated by patients and the other healthcare professionals that we enjoy close relationships with.

P17 Lynne Elizabeth Campbell Cradlehall _3 PPC 10 April 12 NOTES (2).doc To refer back to the legal test, we feel that this application does not pass the legal test as it is not necessary, nor desirable for this pharmacy to be granted a contract in order to secure adequate provision of pharmaceutical services in the neighbourhood as defined.

Thank you all very much for your time”.

The Chair thanked Ms Gellatly for her statement and invited the Applicant, Interested Parties and then members of the Committee to ask questions of her.

8.1 Questions from the Applicant to Ms L Gellatly, Tesco Pharmacy

The Applicant had no questions for Ms Gellatly.

8.2 Questions from Mr A Shearer, Rowlands Pharmacy to Ms L Gellatly, Tesco Pharmacy

Mr Shearer had no questions for Ms Gellatly.

8.3 Questions from Mr P Mutton, Area Pharmaceutical Committee to Ms L Gellatly, Tesco Pharmacy

Mr Mutton had no questions for Ms Gellatly.

8.4 Questions from the Committee to Ms L Gellatly, Tesco Pharmacy

Maureen Thomson wondered if Ms Gellatly thought that the neighbourhood should be wider than had been defined by the Applicant as that was how she felt it worked in Inverness but asked, if that scenario was turned on it’s head, because people would also be able to go to the new pharmacy from other side of town so did she not feel that the point she was trying to make was negative in that respect in that people could use any GP and any pharmacy they wished seemed to point out that people can access services from wherever they want. The other point she noted from Ms Gellatly’s presentation was that did she not seem to think that it had come across that patients were having to leave the proposed neighbourhood to access medical service but that was not necessarily a factor in a pharmacy application and did she not agree that you don’t need to go to GP to access services. Therefore, did Miss Gellatly see the lack of medical provision as being a negative factor which was how Maureen Thomson had felt it had come across in what had been said.

Ms Gellatly replied that the core part of pharmacy services was still dispensing. Dispensing was the “bread and butter of what we do” and that, if people are already going to a pharmacy, then they will already use one closest to the GP practice.

Maureen Thomson enquired if Ms Gellatly had evidence to support that, to which Ms Gellatly replied she had none.

Maureen Thomson then enquired how much of making up of the prescriptions was done out of hours and at the weekend.

Ms Gellatly replied that the bulk of normal GP work was done in core hours, between 8-6 pm with a lot of walk-ins, in and out of hours because of their proximity to the Out of Hours Centre.

Maureen Thomson asked if some of the points made by Ms Gellatly could be looked at both ways.

Ms Gellatly agreed that, yes, they probably could.

P18 Lynne Elizabeth Campbell Cradlehall _3 PPC 10 April 12 NOTES (2).doc Alison MacRobbie pointed out that Ms Gellatly had stated that there was no residential accommodation planned within the UHI Campus and for her information there were plans for 400 and a social hotel. The Committee had also heard there would eventually be 6,000 employment opportunities and those people would register with a pharmacy which often is at the place most convenient to their workplace which is often now built in a large retail park. In terms of that with that level of opportunity did Ms Gellatly think there was potential for a great deal of business in the neighbourhood as defined.

Ms Gellatly replied that that depended on who this population comprised and what services they required to access and of their needs which may not be as great if it were a young population as opposed to that of an elderly one.

9. The Interested Parties’ Case – Mr Alasdair Shearer, Rowlands Pharmacy

Mr A Shearer stated “thank you, Chair and panel for allowing me to present my views on the application at Cradlehall on behalf of Rowlands Pharmacy today.

As always, I’ll first come to neighbourhood. I would like to take the neighbourhood given at previous PPC and NAP hearings, but will actually accept the slight adjustment made by the Applicant for the purposes of this hearing, which has obviously been made to incorporate the Inverness Campus. To confirm, the boundaries I would give are:- to the west, the A9 running north to where it meets the A96; to the north, the train line running east to where it meets Tower Road; to the east, running from the train line south to Culloden Road, through the open land to the west of Culloden Woods; and to the south, Culloden Road, including the housing that runs directly off the south of it.

Using this neighbourhood boundary, you can see there is no pharmacy service within this neighbourhood but, not every neighbourhood needs it’s own pharmacy. An adequate service can easily be provided by pharmacies in adjoining neighbourhoods and, on that basis, we have ourselves at Rowlands in Culloden, Tesco at Inshes and Boots at the Retail Park.

I also think it is worth noting at this point that the population of Inverness can be registered at any GP across the City, so people from this area may be registered with a GP on the other side of the City and, as a result, most people will quite often access a pharmacy outwith their “home neighbourhood” as such, anyway.

Now, looking at the population in this neighbourhood, I would class this as an affluent area, with certainly a number of new housing developments being created here at various points over the last 10+ years. It has lower than average claimants of income support, a higher than average percentage of households with cars and a lower than average percentage of pensionable residents. So, the community is mixed as always, on the whole. I believe young families with children would probably dominate this area. In fact, you just have to drive into this area first thing in the morning to see the queues of commuters driving out of the neighbourhood towards Inverness, sometimes as far back as Birchwood. This is a transient population, very used to travelling out of the neighbourhood to live and to work. I would argue if you asked these people, they have no problem accessing current pharmacy services.

Both Boots at the Retail Park and Tesco, Inshes are open extended hours on weekdays and at weekends, so any working member of the population can easily access services at a time to suit them.

P19 Lynne Elizabeth Campbell Cradlehall _3 PPC 10 April 12 NOTES (2).doc As a whole, I believe that the working families, generally young and older residents will generally have access to a car and find no problem with using existing pharmacies but we must remember that those who may not have access to a car during the day. Again, touched on, the public transport method of choice here – and there is a regular bus service every 20 minutes connecting residents with Culloden, the Retail Park at Inshes and on into Inverness. A service as often as this would be the envy of many residents in this country. These buses stop at a number of stops throughout the neighbourhood and there is a stop just outside Rowlands Pharmacy and the main surgeries in Culloden. On the whole, I can see no problem with access to pharmacies from this neighbourhood.

Again, a lot is made in the application around the development of the Inverness Campus and the changes that will bring to the area. I don’t think there is no doubt that this is a thriving development. We have to be realistic about what is being offered here. The College itself is relocating from Harbour Road and this is not due to happen until 2015, as with the Scottish Agricultural College. The Centre for Health Science is just an expansion of current services at Raigmore. Again, this isn’t due for completion until 2016. I was not aware until today that the development included living accommodation but, a Hotel is not permanent residents so that population is negligible. Obviously, workers will still use services around where they work but, let’s be honest, I don’t see many seeking out services in a small row of community shops, they are far more likely to head over – going to the Retail Parks, and there are plentiful pharmacy services there.

All 3 pharmacies around the neighbourhood are providing full pharmaceutical services. I certainly don’t see the Applicant bringing anything new, nor is there anything to say that current provision is poor. At Culloden, we have a pharmacy kitted out with a consultation room and a further room through the back used for MDS and homes. This gives us plenty of room to work in and certainly plenty of space to grow. We are constantly reviewing the service we give. We provide a full collection service from all the surgeries and a full delivery service to the surrounding area including the defined neighbourhood. Gayle MacDonald, the Pharmacy Manager, has been there for almost 3 years and has developed fantastic links with the locals and GPs alike. She currently runs an asthma clinic with Dr Kelly at Southside Road. The pharmacy comprises a full trained team and has an ACT who, as a whole team work very well, exceeding average service figures for providing eMAS, CMS and smoking cessation. To their credit, they won Community Pharmacy Team of the Year at the Scottish Pharmacist Awards this year. I would certainly like to ask what else we could do if this was not deemed adequate. This is not a pharmacy struggling to cope now and nor would I see it struggling to cope in another 10 years.

So the Applicant is bringing no new services to the area in relation to NHS pharmacy services, and the opening hours offer nothing in addition to what is already being provided. The population in this neighbourhood move freely around the city and access services where they need them. The development of the Campus area will not have a dramatic effect on this locality and their access to pharmacies and I don’t believe this application is necessary nor desirable.

The Chair thanked Mr Shearer for his statement and invited the Applicant, Interested Parties and then members of the Committee to ask questions of him.

9.1 Questions from the Applicant to Mr A Shearer, Rowlands Pharmacy

The Applicant enquired that with regard to the Inverness Campus at what stage would Mr Shearer say there would be a need to look at inadequacy of the provision of pharmaceutical services, highlighting that there would be an influx in the population through its development, although that may be transient and asked if we needed to wait to see the inadequacy prior to providing additional services.

P20 Lynne Elizabeth Campbell Cradlehall _3 PPC 10 April 12 NOTES (2).doc Mr Shearer replied that “in a sense, yes”. He felt that the existing services could handle the influx and that access to the Campus when it was fully open would probably be closest to Tesco than trying to negotiate a maze of roads, in reality.

The Applicant then enquired how the pharmacy service at Culloden would be affected if the GP practice sited there were to relocate.

Mr Shearer considered that this might have a small effect – perhaps on collections and the loss of acute prescriptions which may be lost but that that would happen in a situation where any GP relocated to new premises and, in reality, this may, or may not happen so couldn’t base a decision on it at this stage.

The Applicant advised that she was aware that the residents at Milton of Leys have just started receiving a delivery service from Rowlands since an application was made to open a new pharmacy there and that prior to that application being made was it true that there was no delivery service to that neighbourhood.

Mr Shearer replied that Rowlands had actually always covered that area between the Balloan Park and Culloden pharmacies but that this often interchanged as that area lay between the two areas.

The Applicant enquired whether then, Mr Shearer now thought that as there was now evident notice and this was making customers more aware of the services was not previously offered but now being promoted.

Mr Shearer replied that the service was always offered but that the situation had changed promotion-wise and that it was a service available which could be used but was not dedicated to this application.

9.2 Questions from Ms L Gellatly, Tesco Pharmacy to Mr A Shearer, Rowlands Pharmacy

Ms Gellatly had no questions for Mr Shearer.

9.3 Questions from Mr P Mutton, Area Pharmaceutical Committee to Mr A Shearer, Rowlands Pharmacy

Mr Mutton had no questions for Mr Shearer.

9.4 Questions from the Committee to Mr A Shearer, Rowlands Pharmacy

Alison MacRobbie enquired that, in terms of the Campus, Mr Shearer had made reference to talking about crossing busy roads but was he aware there were a number of structured walking routes integrated into planning of the site and with the promotion of healthy working lives did he not agree that this would encourage people to get out and about.

Mr Shearer replied definitely that locally this would happen but primarily not lead into a small neighbourhood.

10. The Interested Parties’ Case – Mr P Mutton, Area Pharmaceutical Committee

Mr P Mutton stated “after reviewing and discussing the application and supporting documentation the Area Pharmaceutical Committee does not feel the application to be necessary nor desirable.

P21 Lynne Elizabeth Campbell Cradlehall _3 PPC 10 April 12 NOTES (2).doc The Area Pharmaceutical Committee agrees with the Applicant’s definition of her neighbourhood, however, understands that patients access pharmaceutical and GP services from across Inverness. In addition, many pharmacies within Inverness also deliver within the Applicant’s neighbourhood and therefore the Area Pharmaceutical Committee believes it is important to consider the services of pharmacies outwith the Applicant’s neighbourhood. The Cradlehall area has several bus services and we believe a high car ownership.

The Area Pharmaceutical Committee are not aware of pharmaceutical service inadequacy within the Applicant’s neighbourhood or any complaints being made to the Board. The supporting documents provided as an outcome to the initial public consultation, in the Area Pharmaceutical Committee’s view do not highlight an “inadequacy” in pharmaceutical services but note the point of failure of the Courier to assign the PO Box may impact on that.

Some of the supporting letters for the Applicant mention supply issues of medication. There has been, and still are, national supply issues within the pharmaceutical industry, ear drops and suppositories are currently products “on quota”. These are issues affecting all community pharmacies and the Area Pharmaceutical Committee believes it is important that the Pharmacy Practices Committee are aware of these national supply issues when making their decision as this may impact on patients’ perception of services obtained through pharmacy.

An appeal for an application at this site was overturned by the National Appeal Panel in 2009. At that time the National Appeal Panel believed Rowlands, Keppoch Road were in a position to adapt to the growing population. The applicant has not provided any recent data to highlight any change in population since this appeal.

Since this decision was made by the National Appeal Panel, Boots the Chemist, Eastfield Way has had a refit, improving their facilities and capacity. Both Rowlands, Keppoch Road and Boots the Chemist, Eastfield Way, currently service the Applicant’s neighbourhood and the Area Pharmaceutical Committee believes that between them they have the capacity to provide pharmaceutical services to a growing population.

Although, on the whole, the Area Pharmaceutical Committee believe pharmaceutical services across Inverness to be adequate, Public Health reports and current HEAT targets are currently directing NHS Boards to review services in areas of deprivation; allowing individuals in these areas to improve their health in line with more affluent areas. The Area Pharmaceutical Committee would support this view and acknowledge that there are deprived areas in Inverness that would benefit from additional pharmaceutical services. NHS Highland’s Pharmaceutical Care Services Plan also highlights these areas and the Area Pharmaceutical Committee, along with the Pharmaceutical Care Services Plan, would not classify Cradlehall as an area of deprivation. The Area Pharmaceutical Committee believes there is a need to support development of pharmaceutical services within these deprived areas rather than in areas where pharmaceutical services are already adequate.

The Chair thanked Mr Mutton for his statement and invited the Applicant, Interested Parties and then members of the Committee to ask questions of him.

10.1 Questions from the Applicant to Mr P Mutton, Area Pharmaceutical Committee

The Applicant had no questions for Mr Mutton.

10.2 Questions from Ms L Gellatly, Tesco Pharmacy to Mr P Mutton, Area Pharmaceutical Committee

Ms Gellatly had no questions for Mr Mutton.

P22 Lynne Elizabeth Campbell Cradlehall _3 PPC 10 April 12 NOTES (2).doc 10.3 Questions from Mr A Shearer, Rowlands Pharmacy to Mr P Mutton, Area Pharmaceutical Committee

Mr Shearer had no questions for Mr Mutton.

10.4 Questions from the Committee to Mr P Mutton, Area Pharmaceutical Committee

The Committee had no questions for Mr Mutton.

11. Summing up

The Applicant and Interested Parties were then given the opportunity to sum up.

11.1 Mr P Mutton, Area Pharmaceutical Committee stated “to summarise I would say that the application is not about whether the application will provide a better service than is currently available, but is about whether the current services are adequate. The Area Pharmaceutical Committee believe current services are adequate and therefore are of the view that this application should not be granted”.

11.2 Mr A Shearer, Rowlands Pharmacy stated “a small cohort may have indicated that they need a pharmacy which is for convenience rather than need. There are no issues with the current pharmacy contracts already in place who can meet future provision and, as such, the application is neither necessary nor desirable”.

11.3 Ms L Gellatly, Tesco Pharmacy stated “we do not believe that this passes the legal test. Across the 11 pharmacies there is access to adequate pharmaceutical services therefore this application is not necessary nor desirable in order to secure adequacy”.

11.4 Miss Lynne Elizabeth Campbell, Applicant stated “I would like to take the opportunity to thank everyone very much for their help in my application. I have learned a lot during the process.

What is Pharmacy – pharmacy is about delivering patient centred care which is respectful, compassionate and responsive to an individual’s preferences, needs and values.

The neighbourhood has been clearly defined and the pharmaceutical services within the neighbourhood are inadequate as there is no current provision. There are services outwith the neighbourhood but these are not accessible to everyone. With the up and coming Inverness Campus the proposed relocation of GP surgeries into the Campus extra strain will be placed on these existing pharmacies.

As this community expands through future housing developments in the neighbourhood, together with the development of the Inverness Campus at Beechwood, the requirement for direct patient services under the community pharmacy contract will increase and the current lack of provision will become a more acute problem. Therefore, I feel that the present and future case for a local pharmacy within the defined neighbourhood, which would include the provision of pharmaceutical services is a strong and indeed desirable one”.

At the conclusion of the summing up, the Chair asked the Applicant and all of the interested parties if they considered that they had had a fair hearing. Miss Campbell, Mr Lawrie, Ms Gellatly, Mr Shearer and Mr Mutton replied yes, that they did consider they had had a fair hearing. . The Chair advised that a written decision would be sent out within 15 working days. A letter would be included with the decision advising of the appeal process. The Chair then thanked the parties for attending.

P23 Lynne Elizabeth Campbell Cradlehall _3 PPC 10 April 12 NOTES (2).doc Miss Campbell, Mr Lawrie, Ms Gellatly, Mr Shearer and Mr Mutton left the meeting.

12. DECISION Having considered all the evidence presented to it, and the Committee's observations from the site visits, the Committee had firstly to decide, the question of the neighbourhood in which the premises to which the application related, were located.

The Committee took into account a number of factors in defining the neighbourhood including the natural and man-made boundaries, who resides in it, neighbourhood statistics, the location of existing shops, health services and schools, land use and topography, and the distance and the means by which residents are required to travel to existing pharmacies and other services.

In addition it anticipated future developments including firm plans for the further expansion of housing estates and the Inverness Campus.

Special regard was made to the requirements of the Equality Act 2010:

• the need to eliminate unlawful discrimination, harassment and victimisation and other conduct prohibited by the Act;

• advance equality of opportunity between people who share a protected characteristic and those who do not;

• foster good relations between people who share a protected characteristic and those who do not.

The Committee considered the Applicant's definition of the neighbourhood and how this compared to those put forward by the Interested Parties as well as comments received from the public consultation, and it was unanimously agreed that it should be as that defined by the Applicant.

12.1 Neighbourhood: The Committee agreed that the neighbourhood had been clearly defined by the Applicant and supported the Applicant’s definition of the neighbourhood and considered the detail of that neighbourhood and where the boundaries would lie.

The Committee considered that the neighbourhood should be defined as follows:-

North: The northern edge of the A9 until it meets the A96 at the Raigmore Interchange and the boundary of the Inverness to Perth railway line as these mark physical boundaries to the neighbourhood. For local people there is clear definition between the Smithton area and the Cradlehall and Westhill areas defined by the route of the railway.

East: From Culloden Road along the edge of the Westfield housing development adjoining Culloden Woods until it meets the railway line at the bridge on Tower Road as this represents the extent of residential housing and the start of wooded countryside.

South: The B9006 Culloden Road and incorporating the Woodlands housing and Inshes Wood and Easter Muckovie until the Woodside development and the edge of Culloden Woods as this represents the extent of residential housing and the start of countryside.

West: The A9 from the Inshes exit below the B9006 flyover to the Raigmore Interchange as this marks a physical boundary to the neighbourhood.

P24 Lynne Elizabeth Campbell Cradlehall _3 PPC 10 April 12 NOTES (2).doc 12.2 Adequacy of Existing Provision of Pharmaceutical Services and Necessity or Desirability:

Having reached that decision, the Committee was then required to consider the adequacy of pharmaceutical services within that neighbourhood, and whether the granting of the application was necessary or desirable to secure adequate provision of pharmaceutical services in that neighbourhood.

The Committee noted the content of the 15 letters of support, some of which were in email format, received by the Applicant and submitted to the Board with the application as a result of her initial public consultation in the Inverness on Courier on 18 November, 2011. It should be noted that one of the letters of support received by the Applicant was from the Westhill Community Council in support of the application addressed “To Whom It May Concern” although a copy of this letter was not sent to the Health Board by that Community Council as a result of the letter addressed specifically to them as referred to in the next paragraph. Another of the 15 support letters, addressed directly to the Applicant, was received from the President of the Westhill Senior Citizen’s Club in support of the application but no reply was sent by them to the Health Board either in response to their consultation referred to. In any event all letters were included in the application pack and submitted to the Pharmacy Practices Committee for their consideration.

The Committee also noted that out of 34 letters sent by the Health Board to Community Councils, Senior Citizen’s Club, Highland Councillors, MPs and MSPs and the Public Notice posted on the NHS Highland Website only one response was received by e-mail. This e- mail, received from a Highland Councillor, but was written in a personal capacity and supported the application. Although this response was supportive of the staff at Tesco Pharmacy it took issue with the size and layout of the pharmacy tucked into the back of the supermarket and lack of privacy during consultations.

Whilst there was evidence submitted as a result of the consultations which indicated that access to pharmacies is not always convenient for residents in the neighbourhood, with people having to travel to access a pharmacy, the Committee felt there was not sufficient evidence submitted to judge the current service inadequate.

Unfortunately the Committee were of the opinion that the door-to-door survey undertaken, despite all the personal effort by the Applicant, could only have limited bearing on the decision making process as it represented a limited sample of the total population, may have been biased (by the nature of the applicant personally handing the form to the survey households and discussing what she was proposing as we as by the non random approach in handing them out), reporting had been against the forms returned rather than those issued and the results could not be shown to reflect the target population with any confidence. It was felt that the survey could have been conducted in a more systematic way to produce scientifically valid results. The same could be said for the survey mentioned by Tesco which showed high levels of customer satisfaction. However, that aside, the Committee considered that the Applicant’s survey did not demonstrate inadequacy in the provision of pharmaceutical services.

It was noted that the total population was more likely to be in the region of 7,000 within the neighbourhood as defined by the Applicant. This information was obtained by the Health Board from datazone information from Scottish Neighbourhood Statistics as at 2010 and, although could not be taken as completely accurate as some of the datazones overlapped into other datazone areas slightly, it was perceived that the population was significantly higher than the 5,271 intimated by the Applicant in her statement. This is not a deprived neighbourhood in fact it is quite affluent and there is a lower than average older population therefore the aging population will affect this neighbourhood less than many others. There are many families with young children.

P25 Lynne Elizabeth Campbell Cradlehall _3 PPC 10 April 12 NOTES (2).doc The Committee recognised that it was required to determine the adequacy of existing provision of pharmaceutical services in the defined neighbourhood at the time of the oral hearing and that in reaching its decision it needed to consider future developments. It was recognised that there are still new houses being built within the neighbourhood and this will result in a further population growth. The Committee also discussed the likely impact of the Phase I development of the Inverness Campus and although it was acknowledged that this could potentially lead to a transient increase in the daytime population there was currently only a small part of the development which was zoned for accommodation. In addition, the infrastructure of the Campus had clearly marked access and exit routes which would tend to lead users of the site away from the proposed neighbourhood. At the current time it was felt that any effect on the existing services was speculative, including the possible relocation of GP practices, and the Committee decided that there was insufficient evidence to suggest that the existing pharmacies would not be able to cope with the expected increase in demand for pharmaceutical services. It was felt by the majority of the Committee that any increase in the population could be managed by the existing pharmacies adjacent to the neighbourhood.

None of the 3 nearest pharmacies are particularly easy to access without transport from the defined neighbourhood. For instance a fit person walking from Cradlehall Shopping Centre to Boots would take at least 40 minutes, however, although not an NHS service, all these pharmacies offer a prescription collection service from all Inverness GP practices. This means that patients do not have to travel to their GP to collect repeat prescriptions. All 3 adjacent pharmacies also provide a delivery service to housebound patients in the defined neighbourhood. The levels of car ownership are high and the bus services are frequent. Most households were able to travel out of the neighbourhood for work or to access services to meet their daily needs. The population in this neighbourhood were generally considered to be able to move freely around the City and access services where they need them.

The Committee noted that within the neighbourhood as defined there are no pharmacies and that pharmaceutical services are currently being provided from pharmacies outwith the neighbourhood including 3 pharmacies adjacent to the boundaries of the neighbourhood, Tesco Pharmacy, Milton of Inshes, Rowlands Pharmacy, Keppoch Road, Culloden and Boots, Eastfield Way, Inverness Business & Retail Park. Consequently, the Committee recognised that they needed to consider whether an adequate pharmaceutical service was being provided from these pharmacies, bearing in mind that residents can and do choose to access pharmacies throughout Inverness.

The Committee then considered the pharmacy services provided by these 3 pharmacies adjacent to the boundaries of the neighbourhood in more detail i.e. the monthly number of prescriptions dispensed from April 2006 to December 2011 and also data related to the four core services of the Scottish Pharmacy Contract i.e. Minor Ailments Service (MAS), Chronic Medication Service (CMS), Acute Medication Service (AMS) and the Public Health Service. This data indicated engagement of varying degrees with the core services from these pharmacies. It was noted that Tesco Pharmacy had recently commenced offering NHS Emergency Hormonal Contraception (EHC) but had a lower level of Pharmacy Care Records (PCR) for CMS. It was felt that by the Committee that a pharmacy with extended hours and some double pharmacist cover might have achieved more registrations and PCRs, however, there may have been initial technical difficulties which might explain this. The evidence showed that these pharmacies were all providing the core elements of the contract.

Tesco had confirmed that they have capacity to provide monitored dosage systems to patients requiring them.

P26 Lynne Elizabeth Campbell Cradlehall _3 PPC 10 April 12 NOTES (2).doc It was recognised that Tesco Pharmacy are not currently engaging as actively with the pharmacy contract and there were some worries about the level of staffing and skill mix at Rowlands Pharmacy at Culloden where there is only one pharmacist. However the figures provided on the current provision of pharmacy services indicate that the pharmacies are delivering the required services in line with their peers.

Reference was also made to the Pharmaceutical List 2011 to establish the locally negotiated services each pharmacy offers. These were considered to offer an appropriate range for the population of the neighbourhood.

Tesco Pharmacy and Boots, Retail Park both have extended hours in the evening and on Sundays enabling them to offer pharmaceutical services beyond those expected by the NHS Highland Board Scheme and provide local access to healthcare services during the GP Out- of Hours period for this population.

There have been no complaints to NHS Highland about current pharmaceutical services within the neighbourhood. Neither has the Pharmaceutical Care Services Plan, 2012/13 identified a potential gap in pharmaceutical service provision in this neighbourhood.

The increase in the Inverness population over recent years and the increased need for pharmaceutical services had and is being met by the existing pharmacies. There can be economies of scale which allow a single larger pharmacy to efficiently manage more than twice the workload of two smaller ones.

The Committee, in determining the adequacy of existing provision of pharmaceutical services in the defined neighbourhood, took account of the evidence provided by the Applicant, and made available from other sources and concluded that the level of existing pharmaceutical services was adequate and granting the application was not necessary.

The Committee then considered whether it would be desirable to grant the application to maintain adequacy into the future and concluded that predicted increased demand could be managed by the existing pharmacies adjacent to the neighbourhood and granting the application was not desirable.

The non-voting pharmacists then left the room.

P27 Lynne Elizabeth Campbell Cradlehall _3 PPC 10 April 12 NOTES (2).doc 12.3 In accordance with the statutory procedure the Pharmacist Contractor Members of the Committee, and Board Officers were excluded from the decision process:

DECIDED/-

The Pharmacy Practices Committee (PPC) was satisfied that the provision of pharmaceutical services at the premises of the Applicant were not necessary or desirable in order to secure adequate provision of pharmaceutical services in the neighbourhood in which the premises were located by persons whose names are included in the Pharmaceutical List and in the circumstances, it was the majority decision of the PPC that the application be refused.

The non-voting pharmacists were invited back into the room and were advised that the application had been refused.

The Hearing then was closed.

Bill Brackenridge as Chair of the PPC

Date: 18 April 2012

P28 Lynne Elizabeth Campbell Cradlehall _3 PPC 10 April 12 NOTES (2).doc