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NATIONAL APPEAL PANEL Constituted Under the NATIONAL NATIONAL APPEAL PANEL constituted under THE NATIONAL HEALTH SERVICE (PHARMACEUTICAL SERVICES) (SCOTLAND) REGULATIONS 2009 (AS AMENDED) ("the Regulations") DECISION of the CHAIR of THE NATIONAL APPEAL PANEL in the application relating to 35 ABBEYGREEN, LESMAHAGOW, ML11 0EQ Applicant: G&S Healthcare Limited Appellant: Kirkmuirhill Pharmacy Limited Health Board: NHS Lanarkshire PPC Hearing Held: 24 April 2017 Date Decision Issued: 10 May 2017 Panel Case Number: NAP69 (2017) The Decision of the Chair of the National Appeal Panel 1. Background 1.1 This is an appeal against the decision of the Pharmacy Practices Committee of NHS Lanarkshire (“the PPC”) following upon a meeting of the PPC held on 24 April 2017. 1.2 G&S Healthcare Limited (“the Applicants”) made an application for inclusion in the pharmaceutical list of NHS Lanarkshire (“the Board”) to provide pharmaceutical services in respect of the premises at 35 Abbeygreen, Lesmahagow, ML11 0EQ (“the Premises”), said application dated 9 March 2017. 1.3 The PPC issued its decision on 10 May 2017 following upon the hearing of 24 April in which it determined that the pharmaceutical services within the neighbourhood defined by them was inadequate and that it granted the application on the basis that it was necessary to secure adequate provision of pharmaceutical services within the neighbourhood in which the premises were located by persons whose names were included in the pharmaceutical list. 1.4 Kirkmuirhill Pharmacy Limited (“the Appellants”) appealed against said decision by the PPC per their letter of appeal dated 20 May 2017 and which grounds are summarised at paragraph 2 below. 2. Grounds of Appeal 2.1 No formal complaints had been raised to the Health Board nor any regulator which was in contradiction to much of the supporting evidence. 2.2 Failure to provide timeous delivery is not the single determinate of inadequacy. 2.3 The response to the consultation analysis survey and subsequent report (“CAR”) was comparatively small at only 5% of the population and that, dependent on their responses, just over 200 people out of the neighbourhood total of 6,500 had given negative answers. A more relevant sample would have been from community GPs who were best placed to advise on the suitability of current services. This was not provided. 2.4 Boots Pharmacy, the only pharmacy within the neighbourhood, “may not be providing the best service” but met all requirements directed by the Regulations and the Board. Accordingly, the PPC erred in deeming the existing provision as being inadequate. 2.5 The population of Lesmahagow was not going to increase by any meaningful degree, indeed census figures indicate a drop in population. In any event, new homes being built in the neighbourhood were not going to be in the actual town of Lesmahagow. The PPC did not have regard to Lord Drummond Young’s decision in Lloyds Pharmacy Limited v National Appeal Panel (2004) with regard to future developments. Whilst the Appellant did not dispute the PPC’s concern for the likely demand for pharmacy services for an ageing population, the Appellant ha offered a door-to-door delivery service for 33 years and that, in any event, car ownership had increased. 2.6 The Appellants dispute the statement that dosette boxes were not available to patients in the neighbourhood, particularly those with complex drug regimes and those with poor compliance. 2.7 They questioned the adequacy of the premises, particularly in relation to its size, accessibility and ability to cope with preparing dosette boxes. 2.8 The Applicants had stated that, albeit not a core service, it was inadequate and unproductive that all 3 pharmacies in the surrounding area did not have a dispensing pharmacist to cover lunchtimes. In response, the Appellants state that their delivery service did not stop over lunchtime and that the pharmacies are generally managed throughout each lunchtime with at least one member of staff and that a pharmacist would be available to contact at short notice. 2 2.9 The Appellants had questioned the Applicants’ ability to be an independent prescriber and deal with health equality such as elderly, smoking, weight management etc and that his aim would be to provide a daily delivery service. 3. Evidence of Parties 3.1 The evidence of the Applicants and interested parties may be summarised as follows: 3.1.1 The Applicants were represented by Mr Stephen McDermott who indicated that the proposed neighbourhood for the premises was Lesmahagow, a rural village with a strong sense of community, and that following upon the CAR he had included within the boundaries of the neighbourhood Auchlochan, a retirement village which is home to several hundred elderly residents who access pharmaceutical services within Lesmahagow on a daily basis. Within the neighbourhood defined by him, there were many amenities and community facilities, including places of worship, a medical practice, a pharmacy, a dental practice, a library, banks and post office, with numerous small businesses. There were, in addition, 2 primary schools, a secondary school, a care home, sheltered housing, a housing association and the Auchlochan retirement village referred to. Lesmahagow had an active community council. He indicated that from the 2011 Scotland census that Lesmahagow had a population of 4,340. That did not include the village of Auchlochan. People would travel to Lesmahagow from Dillarburn, Hawksland, Brocketsbrae and Devonburn, Blackwood and Kirkmuirhill. Residents from these areas would access pharmaceutical services in Lesmahagow which is the heart of the community for this population. There was one GP practice, Glebe Medical Practice, which had 6,560 registered patients in January 2017. He was of the view that Lesmahagow had one pharmacy which currently served between 6,000 and 6,500 people. Patients seeking access to a pharmacy outwith Lesmahagow would require to travel to Kirkmuirhill (2.9 miles away) or Coalburn (3.5 miles away). 3.1.2 He wished to demonstrate how the people of Lesmahagow were at a disadvantage compared to other areas within NHS Lanarkshire and other health boards. These neighbourhoods had similar populations but had access to more community pharmacists. He proceeded to compare such other neighbourhoods and populations, and sought to conclude that the residents of Lesmahagow were at a comparative disadvantage. He produced statistics indicating high levels of deprivation in certain areas, including a significant percentage claiming benefits, free school meals, long term health conditions and long term or disabled, and that these were important factors to consider when determining the healthcare needs of a population. For example, 25% of the population were aged 60 or over and claiming pension credit. This was higher than the 17% in South Lanarkshire and 15% in Scotland. The average age of the residents of Auchlochan was 83 years. The population projections for Lanarkshire to 2030 indicated a 72% increase in people over age 75, thus putting a greater strain on existing pharmacy services. 3.1.3 Mr McDermott stated that future developments would put further strain on the existing pharmaceutical services, including the building of new homes and apartments, expansion of Auchlochan and planning permission granted for new plots. 3.1.4 He considered that, as the current pharmaceutical services being provided were not of a satisfactory quality, they could not accordingly be deemed to be adequate and pled in aid the 325 responses received in the CAR and the 204 signatures gathered in the Applicants’ own petitions. He reported that the number of items dispensed across Scotland had increased on an annual basis in 2004-2005 to 2004-2015 at a rate of 34.9% and continuing to rise. The average number of items dispensed per pharmacy was 81,499 items per month. Boots had dispensed 156,228 items and 91.6% more prescription items than the national average, and he argued that it had reached saturation point and which appeared to have been confirmed in the responses filed in the CAR, eg “[Boots] is struggling with too many prescriptions to fill”, “one pharmacy is not enough to cover the population in this area. They need another pharmacy”, “Boots are unable to cope with the current workload”, “…. the existing pharmacy is too busy and you have to wait for an unacceptable time to be attended to”. He referred to the Board’s pharmaceutical care services plan (“PCSP”) wherein it was stated “the timeous and 10976403v1 3 accurate dispensing of prescriptions remains a principal function of the NHS Community Pharmacy Service”. Some respondees has referred to “regular errors effected by Boots”, that “prescriptions go missing” and long waiting times. Mr McDermott had stated that there were concerns regarding the poor stock availability within Boots and that patients were having to make at least 2 journeys to pick up their medicines, and as a rural community this could mean substantial distances. He stated that the patients were also receiving an inadequate service in the provision of dosette boxes and that patients who ought to have them were being denied them. 3.1.5 Mr McDermott argued that patients ought to get the best possible outcome from their medicines, whilst avoiding harm. The current provision did not assist in that regard and that the current pharmaceutical services were falling short of the Government’s “2020 vision” of Healthcare Quality Strategy for Scotland. In addition, patients were receiving an inadequate service in relation to the Minor Ailments Service (‘MAS’) which was aimed to transfer care from the GPs and nurses to pharmacists, thereby reducing the waiting times and workloads at GP surgeries. There had been evidence in the CAR that patients had been refused treatment for minor ailments and directed to their GP as the pharmacist did not have time to discuss minor ailments.
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