PRIMARY CARE CONTRACTOR ORGANISATION

PHARMACY PRACTICES COMMITTEE

Application by Lindsay & Gilmour, Pharmacy (The Red Band Chemical Company Ltd trading as) for inclusion in the pharmaceutical list in respect of the address, 20-22 Whitehouse Road, , EH4 6AX.

The Pharmacy Practices Committee met at 11.30am on Wednesday 20 January 2010 at Pentland House, 47 Robb’s Loan, Edinburgh EH14 1TY to consider the above application in accordance with the National Health Service (Pharmaceutical Services) (Scotland) Regulations 2009.

Decision of the Pharmacy Practices Committee

The decision of the Committee was that the provision of pharmaceutical services at the premises was neither necessary nor 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 that accordingly the application should not be granted.

Pharmacy Practices Committee

Jack Aitchison, Chair Peter Jones, Non-contractor Pharmacist Mike Embrey, Contractor Pharmacist Margaret Tait, Lay member Carole Stevenson, Lay member Lynda, Campbell, NHS Lothian Administrator to the Pharmacy Practices Committee, accompanied by Susan Summers

1. The Committee convened to consider an application for inclusion in the pharmaceutical list, dated 27 November 2008, by Lindsay & Gilmour Pharmacy in respect of the address, 20-22 Whitehouse Road, Cramond, Edinburgh EH4 6HX. A copy of the application had been circulated in advance to the Committee and the parties.

2. Written representations had been received from John Sinclair, Barnton Pharmacy; Dara O’Malley, Omnicare Pharmacy; Charles Taits, Boots UK Ltd and Matthew Cox, Lloyds Pharmacy. A late representation was also received from Anne Lorimer, Lothian Pharmaceutical Committee. The applicant and interested parties were entitled to comment on the representations received, but no such comments were made. Copies of the written representations had been circulated in advance to the committee and interested parties.

3. A letter of support was received from Cramond Community Council. Additionally, unsolicited letters of support were received from The Cramond Association; Cramond Heritage Trust; Councillor Norman Work, The City of Edinburgh Council; Margaret Smith, MSP and The Rt. Honourable George Grubb, Lord Provost, The City of Edinburgh Council. Those mentioned have no statutory right to make representations on this matter. However the letters were made available to the committee for information only.

4. Two further late unsolicited letters were received, one on the 19th January 2010 from Kate Mackenzie, Councillor for Ward, City of Edinburgh Council and the other on the day of the hearing from Cramond Medical Practice via Mr Sinclair. Both these letters were made available to the committee for information only.

5. The Committee had before them maps of the area surrounding the proposed premises detailing the location of the nearest pharmacies and GP surgeries, deprivation categories and population density. They had details of the numbers of prescriptions dispensed during the months March 2009 – August 2009 by the pharmacies nearest to the proposed premises and the number of prescriptions they dispensed that were issued from the GP surgeries closest to the premises during the months July 2009 – September 2009. The Committee were also provided with “Pharmacy Profiles” of the nearest pharmacies detailing opening hours, premises facilities and services offered.

6. Under paragraph 5(10) of the Regulations the Committee was required to decide whether “the provision of pharmaceutical services at the premises named in the application is necessary or desirable in order to secure adequate provision of pharmaceutical services in the neighbourhood in which the premises are located by persons whose names are included in the pharmaceutical list.”

7. It had been confirmed prior to the meeting that the members present did not have an interest to declare.

8. The Committee agreed to invite the applicant Lindsay & Gilmour Pharmacy and those who were present who had made written representations to attend before them. They were:

Yvonne Williams, representing Lindsay & Gilmour Pharmacy & Colin Lowe, assisting in the presentation of the application Mr John Sinclair, representing Barnton Pharmacy Mr Dara O’Malley, representing Omnicare Pharmacy Mark Malone, representing Lloyds Pharmacy (as an observer only)

9. The Chairman explained the procedure that would be followed and no person present objected.

10. The procedure adopted by the Committee was that the applicant made an opening submission to the Committee, which was followed by an opportunity for the objectors and the Committee to ask questions. The objectors then made their oral representations and the applicant and the Committee then asked the objectors questions. The parties were then given an opportunity to sum up. Before the parties left the meeting the Chairman asked all parties if they felt that they had had a fair and full hearing. They confirmed that they had.

11. Prior to the meeting the Committee undertook a site visit. The Committee noted the location of the proposed premises, the pharmacies nearest to the proposed premises, the nearest GP surgeries and the neighbourhood as defined by the applicant.

12. The Committee was required to and did take account of all relevant factors concerning the issues of neighbourhood, adequacy of existing pharmaceutical services in the neighbourhood and whether the provision of pharmaceutical services at the premises named in the application was necessary or desirable to secure adequate provision of pharmaceutical services in the neighbourhood in which the premises are located.

Neighbourhood - Applicant

13. The Committee noted that the applicant, Lindsay & Gilmour Pharmacy, had defined the neighbourhood as West: the River Almond; North: the River Forth; East: the longitudinal line taken due north from the corner of Gamekeeper’s Road and Cramond Road to the River Forth and, South: Brae Park Road across to Barnton Avenue West up to Gramekeeper’s Road.

14. The applicant clarified in her oral submission that the neighbourhood can be defined by looking at the housing types which clearly change on passing Brae Park Road into Barnton where a few large estates developed in the 1970s consisting of suburban family homes have formed that community. Ms Williams contended also that the neighbourhood can be defined very clearly by its topography. Cramond is on one side of the valley and Barnton on the other side with Brae Park Road in the dip of this valley.

15. Ms Williams went on to remind the panel of Lord Nimmo Smith’s statement in relation to the definition of a neighbourhood. She went on to quote “neighbourhood is not defined in the regulations and must therefore be given the meaning which would normally be attributed to it as an ordinary word of the English Language. As the word is ordinarily understood, it has connotations of vicinity or nearness ……. The word “neighbourhood” in regulation 5 (10) of the 1995 regulations means an area which is relatively near to the premises in question, which need not have any residents, and which can be regarded as a neighbourhood for all purposes”.

16. Ms Williams advised that a neighbourhood is therefore a place where people would consider themselves neighbours. She also advised that it is not, as often misunderstood, a place with a predefined list of amenities. This is not what “a neighbourhood of all purposes” means. Ms Williams stated that the residents of Cramond considered themselves “neighbours” of their fellow residents of Cramond. She suggested that it is a village, a community.

17. Ms Williams contended that the residents of Cramond do not consider themselves neighbours of the residents of Barnton for instance. Ms Williams concluded this issue by also advising that it is important in identifying a neighbourhood to take into account the opinions of those living within this neighbourhood. She suggested that this is demonstrated in the committee’s papers by the views of the residents expressed in the letters submitted by Cramond Community Council and by the Cramond Association and Cramond Heritage Trust who regard themselves as residents and organisations of the distinct community – Cramond Village.

Neighbourhood – Interested Parties

18. Mr Sinclair from Barnton Pharmacy in his oral submission defined the neighbourhood as to the West by the River Almond – a natural barrier; to the East by Cramond Road South and the former Moray House site, to the Esplanade and up to east of Burgess Golf Club; to the North by the Firth of Forth – a natural barrier and, to the South by Queensferry Road which forms a natural barrier.

19. In his oral submission, Mr Sinclair also advised that the neighbourhood suggested is unreasonable as it omits Whitehouse Road where Barnton Pharmacy is situated. He went on to advise that Cramond Ward does not stop at Ferry Road. 58% of the ward live north of Queensferry Road, at Cramond and Barnton. On the south side of Queensferry Road, Cammo accounts for 13% of the ward and / 29%.

20. Mr O’Malley, Omnicare Pharmacy Ltd, stated in his oral submission that the NAP 2007 defined the neighbourhood clearly. In the NAP decision dated 14th January 2008 it states “The Panel considered that in light of such criteria, the neighbourhood should be designed as follows – on the west the River Almond, on the north the Firth of Forth, on the east a longitudinal line from the esplanade at the Firth of Forth running to the east of the new housing on the Moray House College site across North Cramond Road and the Links Golf Course, excluding the housing on Barnton Avenue East and running to the west of the Royal High School grounds to Queensferry Road. The boundaries on the west and north are natural boundaries. The boundaries on the east is a natural boundary marked by open ground, a golf course and the area of woodland lying between the housing at the eastern end of Barnton Park estate and the Royal High Schools grounds. Queensferry Road is a major arterial route out of Edinburgh, which forms a natural barrier. The Panel did not consider there to be any noticeable change in housing or other determining factor which would have persuaded them to draw a southern boundary at any point to the north of Queensferry Road.”

21. Mr O’Malley further suggested that to not include Barnton Pharmacy in the suggested neighbourhood of Queensferry Road (a natural boundary to the neighbourhood of Cramond, right down to the Firth of Forth and encompassing the Almond River) is impossible.

Adequacy of Existing Pharmaceutical Services and Necessity or Desirability - Applicant

22. Ms Williams commenced her representation by giving a brief history of the Cramond area covering the period before 4,000BC and up to the present day. She advised that Cramond is a very mixed community and one which still fiercely retains its identity. She suggested that with Cramond’s community of mixed house types, comes a community of mixed population – from the very affluent to those less well off.

23. Ms Williams suggested that Cramond has always been perceived as an area of wealth, however, approximately 3% of the residents are described as “income deprived” and 3% are unemployed. She also stated that whilst these figures are below the Edinburgh average, they prove that Cramond suffers from similar socio-economic problems to other areas and as such the population deserves similar access to health care.

24. Ms Williams contended that there is no pharmacy within the neighbourhood, and so pharmaceutical services are currently accessed out-with the neighbourhood. She advised that Lloyds Pharmacy, at and , Clermiston Pharmacy and Parkgrove Pharmacy are all approximately more than 2 miles away from Lindsay & Gilmour’s proposed pharmacy and Boots in Davidson’s Mains is 1.6 miles away.

25. Ms Williams contended that these pharmacies offer all the services that you would expect of a modern pharmacy. Boots has its supplementary prescribing pharmacist running an asthma/ COPD clinic at the surgery in Cramond, however, since it requires referral from a GP to access the clinic and since it is only for the a specific condition this could only be classed as pharmaceutical service benefitting patients with these specific conditions, not the majority of patients in Cramond.

26. Ms Williams suggested that due to difficulties with parking or accessing these services on foot or public transport, there is really only one pharmacy providing the majority of pharmaceutical services into the neighbourhood, as Lindsay & Gilmour define it – Barnton Pharmacy, which is 1.1. miles from the proposed site. Ms Williams added that Barnton Pharmacy offers all the core contract services and numerous in addition.

27. She stated that it should be remembered that the new pharmacy contract, which has now been in place for 4 years puts less emphasis on dispensing and is underpinned and largely financed by the 4 core services – the Minor Ailment Service, Public Health Service, Acute Medication Service, (or electronic transmission of prescriptions) and the last of the services to be introduced this coming April, is the Chronic Medication Service.

28. Ms Williams stated that she was sure the Committee’s prescription figures would demonstrate a high proportion of prescriptions issued by Cramond Surgery are dispensed at Barnton Pharmacy. Ms Williams suggested that whilst this tells little of where patients registered with this practice have their prescriptions dispensed, it tell you where the residents of Cramond have their prescriptions filled.

29. Ms Williams contented that Cramond Surgery patients and Cramond residents are not necessarily the same. In urban areas such as Edinburgh not all patients register with their local practice but will register with one that is convenient, or remain where they have perhaps previously been registered. Cramond residents will access pharmaceutical services from a very wide range of pharmacies across the entire city of Edinburgh – perhaps at work, whilst out shopping or, if registered at a GP practice other than Cramond, at a pharmacy in that vicinity. This makes sense as there is “no obvious choice” for the residents of Cramond.

30. Ms Williams went on to state that the nearest pharmacy has inadequate, difficult parking and is hard to reach on foot. If you were using your car, it would be just as easy to travel somewhere further afield where parking is more readily accessible.

31. Ms Williams suggested that the percentage of Cramond Surgery scripts dispensed at Barnton cannot be assumed to be a true reflection of where the residents of the neighbourhood go to access their pharmaceutical services, and you therefore cannot infer from this that were a pharmacy to open in Cramond, this number of prescription items would be “lost” by the nearest contractor. Ms Williams suggested that the situation is much more complex, as in all large urban areas, and the most likely scenario would be a small loss in prescription numbers spread over a large number of contractors. Ms Williams suggested again, that pharmacy is moving away from simply dispensing to focussing on more services.

32. Ms Williams stated that in terms of population, figures from Cramond Community Council for 2009 indicate that the population of Cramond and Barnton together is approximately 7,800. Even taking just 50% of this gives a population of 3,900.

33. Ms Williams further stated that from the housing development currently underway in Cramond, this population could rise by as much as another 1,000. This would bring the population of the neighbourhood to approximately 4,900.

34. Ms Williams advised that this still leaves at least 3,900 classed as Barnton. Ms Williams stated that these figures show a population more than adequately able to sustain the business of two pharmacies. Ms Williams went on to advise that it should be borne in mind that contracts have been granted on substantially smaller populations than the one being considered, eg Polbeth, with population of only 2,600. She suggested that consistency would therefore dictate that the population of Cramond is sufficient to warrant the granting of a pharmacy contract.

35. Ms Williams contended that of the residents in the Cramond neighbourhood, 22.4 % are of pensionable age and 20.1% are children i.e. 42.5% of the population is in the most important demographic for pharmacy. This demographic a) has the greatest need for pharmaceutical services and b) has least access to a car.

36. Ms Williams advised the committee that another thing to take into consideration are the thousands of visitors and tourists who visit Cramond, its shore and Cramond Island annually for walking on the beach, walking their dogs, visits to the Maltings education centre, the sailing club and large organised events such as the regattas and beach cleanings. She again quoted, Lord Nimmo Smith’s statement that a neighbourhood ‘need not have any residents’. However, Cramond has both a large number of residents and visitors and it is important that these people are considered when looking at pharmaceutical services such as NHS dispensing and minor ailment provision.

37. Ms Williams stated that whilst the residents of Cramond have higher than average car ownership this should not be a reason to discriminate against a percentage of the population simply because they have or are perceived to have money.

38. Ms Williams further contended that we are being encouraged to rely more heavily on walking, cycling, or on public transport for reasons of economy, environment and fitness. Ms Williams suggested that having access to a car should not discount reasonable access to a pharmacy. Car ownership has not necessarily been an advantage over recent weeks, as in some cases people have been unable to even get their cars out of driveways and when they have, they have been driving on roadways made dangerous by snow, gradients and lack of gritting.

39. Ms Williams advised that there are two bus services currently in Cramond. She stated that the number 64 only runs every hour and is clearly not a practical way of getting from Cramond Surgery to Barnton Pharmacy. The 41 bus has frequencies of between 10 and 15 minutes during the day. Taking into consideration the congestion along the route, a journey for the residents to and from the surgery and Barnton pharmacy/ Davidson’s Mains on the 41 bus can take upwards of 1 hour.

40. Ms Williams stated that it also has to be noted that this bus does not pass the new major housing development at Cramond Gate. The residents there will therefore have to walk to the bus route thereby increasing their overall journey time. She asked how feasible is it for someone not feeling at their best to spend this length of time travelling for a prescription. She also asked whether they going to feel like waiting and getting on a bus in the first place.

41. Ms Williams stated that we also have to remember the difficulties that anyone with a baby or young child in a pram now face since Lothian buses’ controversial introduction of their buggy & pram carriage policy. She pointed out that old style Silver Cross prams would probably be not allowed on Lothian buses at all. Some of the popular travel systems these days which are foldable are regarded as too bulky and it will be the driver’s discretion whether they are allowed on at all. The only way to guarantee you are allowed on the bus is to have one of the “umbrella” fully foldable type pushchairs. Not everyone has one of these. Ms Williams contended that while she understood there is a need to allow access to wheelchair users, there is as much need for young Mums with children and push chairs to use bus services. Ms Williams wondered how long the total travelling time would be increased if there were no room on the bus for a pram and what it would be if the next couple of buses had no room either. She suggested you could be waiting all day.

42. Ms Williams went on to suggest that on foot it is a distance of over a mile up (and down) hill from the surgery to Barnton, the nearest pharmacy at present. She contended that Davidson’s Mains is difficult to access on foot due to distance and safety concerns with the very narrow pavement on Cramond Road South. Gameskeeper’s Road is now considered a main route and very busy. Both these situations make accessing pharmacy services difficult for patients with young children in prams or buggies and also for anyone with a disability affecting their vision or their mobility. She further stated that a study of the Ordnance Survey map submitted by Cramond Community Council shows a level of exactly 25m at their premises at Whitehouse Road rising to 44.4m at Regis Court with a steep drop over a distance of 220m to 32.0m at Brae Park Road. Ms Williams stated that this is a very steep hill, with a drop of about 36 feet over a distance of 700 feet. The hill rises again at 41.8m at 173 Whitehouse Road before levelling out at 41.1m near Barnton Pharmacy. The slope of the 220m portion between Regis Court and Brae Park Road amounts to a slope of 1 in 18 and the Disability Discrimination Act would call for a rest flat at 10m intervals for a slope of this magnitude and Miss Williams suggested she was sure the committee would have seen from their site visit, there is no such resting points. Ms Williams went on to contend that walking is clearly not an easy option for anyone with physical or visual disabilities in the area that is subject to this application and the distance that is involved are not ideal for those who are able-bodied, particularly over the last few weeks when the walk has been treacherous with pavements not gritted.

43. Ms Williams made reference to the 2007 NAP decision for Lloyds pharmacy in Halfway, Cambuslang. She pointed out that the panel there, noted that a distance of 0.7 miles was “significant and challenging, particularly for those such as young mothers with pushchairs, the disabled and others without transport”. She further pointed out that this is 0.4 miles less than the minimum distance she was referring to here. Ms Williams stated that being a person who lives in the area and who regularly walks the route referred to in the decision mentioned above, she would much rather push her son’s pram up the hill that relates to this decision rather than the ones in Cramond or Barnton.

44. Ms Williams went on to state that with regard to the population’s belief in terms of adequacy it is evident in terms of the strength of lobbying that they believe the services to be inadequate. She made reference to the submissions by Cramond Community Council etc. Ms Williams contended that the population of the size in question, with access difficulties as described, does need its own local pharmacy to meet such an inadequacy.

45. Ms Williams again stated that emphasis on pharmaceutical services has increased as a direct result of the new pharmacy contract and the introduction of the Minor Ailments Service, Acute Medication Service, Public Health Service and the impending Chronic Medication Service. Ms Williams suggested that ease of access to direct contact with the pharmacist is an essential element of delivery of these services.

46. Ms Williams suggested that the GP Practice is already working at full capacity – with roughly 9,000 patients generating an average of 15.6 prescriptions per person per year. She emphasised that this is a lot of prescriptions. She further advised that there is a need for access to health care within easy reach for the people of the community. Ms Williams contended every individual in Scotland has the equal right to have access to these services irrespective of their level of deprivation or affluence and that includes the pharmacy.

47. Ms Williams contended that in order to secure adequate pharmaceutical service for their defined neighbourhood, they believe it is necessary for the application to be granted for the establishment of this pharmacy.

48. Ms Williams again stated that where an inadequacy exists it is necessary to grant a contract and further it is also desirable to do so. In concluding Ms Williams urged the panel to grant this application for inclusion in the pharmaceutical list.

49. Questions were first received from Mr John Sinclair, Barnton Pharmacy.

50. Mr Sinclair commenced by stating that he understood that Ms Williams thought that most people would be walking with young children to their pharmacy, but in his experience, most people travelled by car. Ms Williams responded by stating that she did not say that most people walked. LRT have a pram policy because of demand. She believed that a lot of people travelled by bus.

51. Mr Sinclair asked Ms Williams what had changed since the 2001 census. Ms Williams advised that demands on pharmacy services have changed. She also stated that the population has increased as approximately 500 houses have been built in the area since 2001. Mr Sinclair asked her where she got her figure of 500 houses from and he asked if she knew how many house had been built on the old Moray House campus. Ms Williams conceded that it was not 500 houses, rather 281 houses built since the 2001 census and there are more planned. (Mr Sinclair asked if he could supply evidence of numbers and the Chair said that if it was in his submission then he could give them later).

52. Mr Sinclair went on to state that in 2001 the students at Moray House campus comprised of 680. Three hundred of these students were resident and on the roll of the Cramond practice. They were factored into the population of Cramond ward. Ms Williams responded by stating that students would not be resident for a full year, perhaps only nine months. Additionally these students would be seconded to schools across Scotland and so they would not be at Moray House all the time. She continued by clarifying that her figures in relation to population i.e. 7800are 2009 figures and not the figures in 2001.

53. In answer to Mr Sinclair’s question as to whether the proposed pharmacy would offer any additional hours of service, Ms Williams answered that the proposed pharmacy would be open on Saturdays from 9.00 – 5.00 and all services would be additional as she believed there is no pharmacy in the defined neighbourhood. Mr Sinclair pointed out that his pharmacy closes at 1.00pm on Saturdays and Boots at Davidson’s Mains is open until 5.30pm. Ms Williams acknowledged this but stated that these premises are too far to be accessible to residents of Cramond.

54. In answer to questions received from Mr O’Malley, Ms Williams clarifying the boundary towards Queensferry Road as Brae Park Road across to Barnton Road West up to Greenkeeper’s Road. In answer to Mr O’Malley’s question as to whether this is the same neighbourhood as defined in the 2007 NAP appeal, Ms Williams stated it was not. She advised that this changed following their further investigations into this issue. Mr O’Malley stated that the neighbourhood must be defined as at the present day and not as historical information. Ms Williams responded that they had considered the topography and house types as boundaries. She went on to point out that the corner of Brae Park Road there is a plaque welcoming you to Cramond.

55. Mr O’Malley enquired as to whether Ms Williams was aware that a lot of the new houses are unoccupied and further building has been shelved. Ms Williams responded by pointing out that in the news that morning it had been stated that existing housing difficulties were improving and she pointed out that planning applications had been accepted. When questioned about house prices, Ms Williams stated that she could not speak to AMA’s business plan and could not speculate who was likely to buy houses at the value being sought. Ms Williams stated that based on the figures of population at present, even excluding development, the figures still show sufficient population to make a need for a pharmacy.

56. Mr O’Malley suggested that the travel time by bus of one hour is incorrect. He stated that it took him 15 minutes from Parkgrove to Cramond by bus and later 5 minutes in a car. Ms Williams responded by stating that he must consider the full time involved which would include waiting times in GP surgeries, buses and pharmacies. Mr O’Malley stated that the waiting time in a pharmacy would be the same whatever transport method had been used. Ms Williams stated that the whole period of time should be taken into consideration i.e. travel plus waiting times.

57. Mr O’Malley asked whether there had been any notification from any GP in relation to any inadequacy that was believed to exist in relation to pharmacy services. Ms Williams advised that she was not aware of any, however, she believed that some have spoken to the Community Council to give support to application. Ms Williams confirmed that the applicants have not had any direct contact with GPs.

58. In answer to Mr O’Malley’s question as to what percentage of the 3,900 people would have to get a bus to a pharmacy, Ms Williams responded that this is a personal choice. She stated she be able to eliminate every person’s difficulty in getting to a pharmacy. However, collection and delivery services are available. Mr O’Malley stated that collection and delivery services are currently available at Cramond and asked that Miss Williams would agree with that. Ms Williams responded by pointing out that collection and delivery is not a core service and the majority of pharmacies provide the service. EMAS would cut down on patients visiting pharmacies but other services would be available. Mr O’Malley referred to housebound patients and asked how the applicants would provide EMAS. Ms Williams responded by stating that EMAS is a transfer of electronic prescriptions. She stated that the applicants could do this. In the case of minor ailments she advised that if a patient could not go to a pharmacy, then the pharmacist could prescribe over the phone or a domiciliary visit could be made. Mr O’Malley asked Ms Williams if this service was provided at present and Ms Williams responded that she could not comment on that. She could only comment on Lindsay & Gilmour pharmacies.

59. Mr O’Malley referred to Ms Williams’ representations regarding visitors, regattas, sailing clubs etc and asked whether Ms Williams believed that those visiting the area could not access services from existing pharmacies in the area. Ms Williams stated that she did not know exact figures but she believed that there were thousands of visitors and sometimes this made the area very busy. Ms Williams described one particular day which been particularly busy and Mr O’Malley asked whether on that day, there had been any issue which had suggested an inadequate service. Ms Williams answered no.

60. In answer to a question from the Committee regarding parking spaces at the proposed premises, Ms Williams advised that there would be parking at the back of the site. She indicated that there would be six spaces, two disabled.

61. The Committee then asked her for further details regarding the ease of access for disabled people who would have to get from the car park at the rear of the building to enter at the front. Ms Williams was asked whether she thought it likely that an easier access point be made available for people with disabilities. Ms Williams advised that she presently only had a provisional plan for the premises and therefore could not confirm. However, it may be that a rear door with a bell could be facilitated. The Committee asked whether the pharmacist would require a parking space and Ms Williams responded that she was not sure. She went on to explain that as yet there was no exact decision made regarding dedicated spaces.

62. In answer to a question from the Committee regarding the number of pharmacists that would work at the proposed site, Ms Williams advised that there would be one full time pharmacist. She went on to state that the applicants have a good head office support system. The needs of the community would be looked at and the number of pharmacists could be increased if required.

63. In answer to the Committee’s observation that commuters are out early and home late, and their enquiry as to whether the applicants have any proposal for flexibility of opening hours, Ms Williams advised that if there was a need for flexibility in opening hours, the applicants would look at that.

64. In answer to the Committee’s enquiry as to whether the premises would be open over lunchtime, Ms Williams advised that she acknowledged that the pharmacist may be absent if domiciliary visits are required and so there may be periods where he/she may not be available.

65. In response to the Committee’s question as to where the boundaries are for population size, Ms Williams responded that the boundaries are those that were obtained from the Community Council, ie Cammo, Barnton Park View and the road through the Burgess Golf Club. The Committee enquired whether Queensferry Road was to include Brae Park Road. Ms Williams answered yes.

66. In answer to the Committee’s question of why the applicant had halved the number of population and whether there was any scientific formula to the calculation of these figures or whether it was a guess, Ms Williams responded that no scientific formula had been used, but looking at the streets, the amount of 50% looked liked a reasonable division.

67. Further, in response to the Committee’s observation that by looking at a map, in some locations within the applicants’ defined neighbourhood some residents would be nearer to Barnton, Ms Williams responded that you will find this result in any similar situation. Some residents will be closer to another pharmacy. Topography should be taken into consideration.

68. In answer to a question from the Committee, Ms Williams was asked what number of prescriptions a pharmacy would have to handle each month to make it a viable pharmacy and she responded by stating that the average patient population is 4,250. Therefore a prescription figure of 2,250 would be required to maintain viability. She went on to say that prescription figures are no longer the only thing to take into consideration as other services also have to be taken into account.

69. The Committee asked for Ms Williams’ comments on a letter that had been received from the GPs at Cramond. Ms Williams asked whether this was a solicited letter. She was informed that it was not and the letter was for information purposes only.

70. The Committee asked that Ms Williams clarify the neighbourhood at Brae Park Road. Ms Williams advised that they had taken the border as where the River Almond crosses Brae Park Road. The Committee went on to enquire whether data zones had been taken into account. Ms Williams confirmed that they had used the Community Council population figures for Cramond.

71. In answer to the Committee’s question regarding timescale for opening the proposed new premises, Ms Williams advised that they would be open within six months.

Adequacy of Existing Pharmaceutical Services and Necessity or Desirability – Interested Parties

72. Mr Sinclair commenced his oral submission by stating that there are 3 other relevant pharmacies, one at Parkgrove, one at Duart Crescent and one at East Craigs. The applicants state that their neighbourhood definition includes Queensferry Road as a boundary. Very few patients come from Cammo, Parkgrove or East Craigs as they have pharmacies in their area. Pharmacies are also located in existing shopping parades and the population can easily access pharmacy services there.

73. Mr Sinclair suggested that where a population figure is 2,500 it would not be viable to run a pharmacy from that location.

74. Mr Sinclair advised that he was not aware of any complaints from the public being made to a GP surgery or NHS Lothian other than those made by the community council and therefore he believed that a new pharmacy is not necessary.

75. Mr Sinclair contended that there are good plentiful local bus services which extend to Craigleith and the Gyle. He went on to refer to Ms Williams’ suggestion that it could take one hour to travel from Cramond to Barnton. Mr Sinclair advised that he could only ever remember one time when this had happened, and it was during a period when there were road works. He further explained that there are new traffic lights in the area which allow a much freer flow of traffic from Cramond to Barnton.

76. Mr Sinclair advised that in the last eighteen months restricted parking to 20 minutes had come into force outside his pharmacy. There is now 11 parking spaces outside Barnton pharmacy and 3 on the other side of the road. Where parking outside his premises used to be used as a “park & ride” it is now freed up and more readily accessible for patients. The restricted parking now in place is constantly monitored by traffic wardens.

77. Mr Sinclair stated that he has collection arrangements with five GP practices and he offers delivery for prescriptions collected.

78. Mr Sinclair concluded by stating there is no necessity or desirability for another pharmacy at Cramond.

79. Questions were first received from Ms Willliams, Lindsay & Gilmour.

80 In answer to Ms Williams question, Mr Sinclair stated that they deal with a few patients from the Cammo area but mostly these patients are dealt with at East Craigs. He went on to respond to Ms Williams’ suggestion that he had included this in his statistics, he advised that Cammo ward does not end at Queensferry Road, but includes 36 % of the population on the south side of the road. He further advised that his neighbourhood stops at Queensferry Road.

81. In answer to Ms Williams’ question as to why Mr Sinclair had included golf courses in his neighbourhood as these are natural boundaries, Mr Sinclair advised that he was referring to Cramond Road South, Barnton Avenue West and Gamekeepers’ Road. Ms Williams asked if he agreed that these make a natural boundary and Mr Sinclair replied yes.

82. In answer to Ms Williams’ question, Mr Sinclair advised that the services he provides are minor ailments, emergency contraception, blood pressure management, compliance aids (list still open), collection & delivery of prescriptions, smoking cessation, domiciliary visits, colostomy and incontinence supplies. He stated that he had additionally sought to provide oxygen supply but that he had been turned down due to a lack of demand.

83. In answer to a question from Ms Williams, Mr Sinclair agreed that some are core services and collection & delivery are provided by most pharmacies and they are not contracted service.

84. In answer to Ms Williams’ question in relation to the Size of the 80 houses built by AMA, Mr Sinclair stated that he believed that they were of varying sizes and he stated that some of the biggest townhouses could have a maximum of 3 to 4 bedrooms. Ms Williams asked if he agreed that that would mean that there could be up to 300 people in that development. Mr Sinclair answered yes.

85. In answer to Ms Williams’ question, Mr Sinclair confirmed that based on the figures provided by the council he did estimate that Cramond ward would be around 2,500 people. Ms Williams stated that contracts have been granted for smaller populations. She asked Mr Sinclair if he thought it unlikely that a pharmacy with these population figures would be viable. Mr Sinclair replied yes.

86. In answer to Ms Williams’ question regarding whether prescription figures are a complete representation of viability taking into account service, Mr Sinclair stated that a population of 2,500 would not be viable for Barnton. Mr Sinclair advised that he did not agree that 30% of business related income comes from prescriptions.

87. In answer to questions from Mr O’Malley Mr Sinclair advised that the viability of his business would most certainly be affected by this application being granted.

88. In answer to questions from the committee Mr Sinclair advised that he does home visits at lunch time or in the evenings as he lives locally to the pharmacy.

89. Mr Sinclair advised that his customers do not make similar comments as those contained in the letters produced by the community council. In relation to previous applications the letters supplied from patients and community councils have been standard letters produced.

90. Ms Williams stated no solicitation had been carried out in regards to the application. She suggested that it was unfair to make this allegation while a letter had today been presented by Mr Sinclair from a surgery.

91. In answer to the Committee’s question, Mr Sinclair confirmed that he could have generated letters of support of his pharmacy but he had chosen not to.

92. In answer to a question from the Committee, Mr Sinclair agreed with the earlier suggestion that people travel outside the neighbourhood and they do use pharmacy services elsewhere. However, he stated that another pharmacy opening in the area would be seriously detrimental to his pharmacy.

93. In answer to a question from the Committee Mr Sinclair confirmed that the neighbourhood includes Barnton estate, but excludes the western side of Cramond Road South where there are houses.

94. In answer to a question from the Committee, Mr Sinclair advised that his domiciliary visits are infrequent.

95. In answer to a further question from the Committee, Mr Sinclair advised that he believed that most of his customers come by car and a small percentage come by bus. He also stated that a lot of people walk from nearby flats.

96. In answer to a question from the Committee, Mr Sinclair confirmed that the five practices that he collects prescriptions from are Parkgrove, East Craigs, Davidson’s Mains, Blackhall and Cramond.

97. Mr Sinclair confirmed that previous parking issues at his premises are much better in view of the new restricted parking in place.

CHAIR - HEARING ADJOURNED

A discussion between the Chair and the Committee took place regarding the late letter from Cramond Medical Practice and Kate Mackenzie, Local Councillor. It was noted that the Committee have an open and transparent policy and all relevant helpful information should be available for consideration so that a proper conclusion can be made.

The meeting then reconvened. The Chair informed all those present that anything that is relevant to help with the conclusion should be looked at. It was confirmed that the late unsolicited representations would be looked at for information purposes only.

98. Submissions were then received from Mr O’Malley of Omnicare pharmacy Ltd. He highlighted the fact that applications for the site come up again and again.

99. He stated that there have been no complaints to the Health Board and no GP has raised concerns about pharmacy services and with that in mind, he could not understand why it would be necessary for another pharmacy contract in the area. Mr O’Malley went on to advise that his pharmacy also provides collection & delivery services in the area as well as a pharmacist going out on visits.

100. Mr O’Malley pointed out that the Minor Ailments Service etc is being provided by Barnton.

101. He made reference to earlier discussions regarding what differs now from the year 2001. The response had been a new contract. He pointed out that this was in place at the time of the last application and at the subsequent NAP decision 2007, it was decided that the proposed new pharmacy was neither necessary nor desirable. Mr O’Malley went on to suggest that whilst it would be ideal for a pharmacy to be at every patient’s front door, this was not feasible. 102. Mr O’Malley referred to his question to Mr Sinclair regarding the viability of his business being affected and he stated that he had to agree with Mr Sinclair’s response.

103. Mr O’Malley went on to state that to say that the volume of prescriptions is not important is ridiculous. At the present time the volume of prescriptions remains very important. He suggested an aim of 30% prescriptions and 70% for other services is wrong. Mr O’Malley stated that he could guarantee this.

104. Mr O’Malley concluded by saying that services in the area at present are adequate. There has been no suggestion of inadequacy. He advised that you only need one pharmacy in an area to be open on a Saturday afternoon. One pharmacy is adequate. Davidsons’ Mains is available and would provide a delivery service if necessary.

105. Questions were first received from Ms Willliams, Lindsay & Gilmour.

106. In answer to a question from Ms Williams regarding an earlier query about what had changed since the last application in November 2006, Mr O’Malley acknowledged that there had been some changes, i.e. public health, chronic medication. He pointed out however, that these are now available in the area. Ms Williams asked that Mr O’Malley agree that there have been changes and he did so.

107. In answer to Ms Williams’ question regarding negotiations that are ongoing for the new contract and that the aim is that the volume will be 30% and services 70%, Mr O’Malley acknowledged that although negotiations were ongoing there will be a time delay. He suggested that their application should be for the present and not for the future.

108. In answer to Ms Williams’ question regarding the number of pharmacists employed by Mr O’Malley and their availability to go out at any time of the day, Mr O’Malley advised that he does not have two pharmacists in each shop but they do have floating pharmacists and qualified staff who can help fill the void.

109. In answer to Ms Williams’ question regarding the neighbourhood, Mr O’Malley advised Queensferry Road to Cramond Road South.

110. In answer to Miss Williams’ questions regarding Saturday afternoon service, Mr O’Malley advised that Saturday afternoon service is minor. He believes that reasonable accessibility only is required. Davidson’s Mains provides pharmacy services to the whole area.

111. In answer to Ms Williams’ question about accessibility for patients from the other side of the area, Mr O’Malley advised that the issue of buses, cars etc had been looked at and in his opinion, there is adequate accessibility to services.

112. Mr Sinclair advised he had no questions to ask Mr O’Malley.

113. In answer to the Committee’s question regarding how many people they deal with from Cramond, Mr O’Malley advised that there are patients who have been registered at Parkgrove/East Craigs for years. Some drive and some prescriptions are delivered.

114. In answer to the Committee’s question about whether Mr O’Malley agreed with Mr Sinclair’s definition of the neighbourhood in its entirety, Mr O’Malley advised that he did. He would however extend to Quality Street junction and include more houses on the west side of Cramond Road.

115. In answer to the Committee’s question regarding whether more patients were attending at Mr O’Malley’s pharmacy due to the change in the GP contract i.e. not opening on Saturdays, Mr O’Malley advised that they had seen an increase in visits in the morning but not in the afternoon.

Summing Up

116. Mr John Sinclair of Barnton Pharmacy summed up by making the following points:  there have been no suggestion that the public find any difficulty in accessing existing pharmacy services in the neighbourhood  the proposed new pharmacy would not significantly improve access to pharmacy services fro the local population either during or outwith normal hours  the population of Cramond is very mobile and there is good, if not better than average, public transport both ways.  There has been no change in circumstance since previous applications.  There has only been a small percentage increase in the neighbourhood in the last five years and only a small number of private houses are being constructed. The existing pharmacy in the neighbourhood, Barnton Pharmacy, provides an efficient, comprehensive and readily available collection & delivery service for NHS prescriptions from 9.30am to 5.45pm. As do other adjacent pharmacies providing collection & delivery services.  The statutory bodies involved such as the area Pharmacy Committee have not supported this application.  Cramond GPs have not supported any application for any of the previous five applications. The tabled GP letter was not solicited by myself and this is similar to all other meetings.  The proposed application will bring no enhancement to pharmacy services in the area.  The refit for the new contract and by awarding this application, would seriously threaten the viability of Barnton Pharmacy. This will be apparent from my figures.  If Cramond surgery had been in support of the new application, surely any correspondence would have been included in community council’s papers.  It is clear that the application is neither necessary nor desirable and I would therefore ask the committee to refuse it.

117. Mr O’Malley of Omnicare Pharmacy Ltd summed up by making the following points:  This application is neither necessary nor desirable.  There have been no significant changes in circumstance since the last application.  If an application affects viability of another pharmacy, ie two pharmacies struggling to survive, then services and standards within these pharmacies could be affected.

118. Ms Williams of Lindsay & Gilmour summed up by making the following points:

 Every individual in Scotland has equal right to have access to health care. Cramond is a mixed community and suffers from a degree of unemployment and deprivation as do most communities. It is statistically poor in amenities / facilities and in particular has no pharmacy.  The population is approximately 3,900, not including any future development. This is significant and more than sufficient to sustain a pharmacy.  Prescription figures for Cramond surgeries suggest that there is enough to sustain three pharmacies not including additional services.  It is all too evident that there are obvious difficulties in accessing services by car (the parking is limited to 20 minutes and there is difficulty in getting out), public transport and on foot substantial distances are involved (1.1 miles) and the terrain is not user friendly especially for people with prams, or anyone who is perhaps less mobile, nor is it DDA compliant.  Local residents have expressed via their representatives, submissions of support for the application that they believe there is a clear need for a pharmaceutical service within their own community and the panel must take cognisance of these views. Reference is made to this on the back of their lobbying.  Emphasis on pharmaceutical services has increased as a direct result of the new pharmacy contract and ease of access of direct contact with the pharmacist is an essential element in delivery of this service.  Contract granted by PPC in 2004, has anything changed? Yes, there is a greater need than before to have a face to face contact with a pharmacist, something your colleagues recognised at the time. The number of services, as part of the contract, have increased.  I would urge the panel to grant this application.

Decision

Neighbourhood

119. Having considered the evidence presented to it, the Committee’s observations from the maps before it and the site visit undertaken prior to the meeting, the Committee had to decide the question of the neighbourhood in which the premises, to which the application related, were located.

120. The committee defined the neighbourhood as:  North – Firth of Forth  West – River Almond from shore to Queensferry Road  East – Queensferry Road to Barnton roundabout. Whitehouse Road to Barnton Avenue West, the boundary west which should include Riding Park.  South – Cargilfield School to Gameskeepers’ Road and Cramond Road South, and then left along the boundary of the old Moray House College to the shore. It was noted that three sides of the neighbourhood are natural boundaries, the River Almond, Firth of Forth and Queensferry Road. The bulk of the eastern boundary consists of housing, open land / golf courses, nursery and primary school, church, post office and mixed housing. The main accesses to the area are Whitehouse Road and Cramond Road South.

Adequacy of Existing Provision of Pharmaceutical Services and Necessity or Desirability

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

122. The Committee noted that the pharmacies within the local area provide comprehensive and extensive range of services to the neighbourhood of Cramond. The opening hours of the pharmacies in the local area cover the needs of the community and there was adequate provision for those patients who are unable to attend the pharmacy to request home visits.

123. The Committee considered the distance to the local pharmacy from Cramond by foot, by car and by regular public transport and found this acceptable and easily accessible.

124. The Committee felt that the population of the area has not significantly increased.

125. At this stage the contractor pharmacist left the meeting and the vote was taken.

126. The Committee agreed from the information made available that the existing pharmaceutical services in the neighbourhood were adequate and as a result the application should not be granted.

Signed ………………………………………………….. Date …………………………….. Jack Aitchison, Chair Pharmacy Practices Committee