22 October 2020 REF: SHA/23378 APPEAL AGAINST NHS

22 October 2020 Arena Point Merrion Way REF: SHA/23378 Leeds LS2 8PA APPEAL AGAINST NHS COMMISSIONING BOARD Tel: 0203 928 2000 ("NHS ENGLAND") DECISION TO REFUSE AN Fax: 0207 821 0029 APPLICATION BY RUSHPORT ADVISORY LLP FOR Email: [email protected] INCLUSION IN THE PHARMACEUTICAL LIST OFFERING UNFORESEEN BENEFITS UNDER REGULATION 18 AT THE NEW HEALTH CENTRE, KENT & CANTERBURY HOSPITAL, ETHELBERT ROAD, CANTERBURY, KENT, CT1 3NG 1 Outcome 1.1 The Pharmacy Appeals Committee (“Committee”), appointed by NHS Resolution, quashes the decision of NHS England and redetermines the application. 1.2 The Committee determined that the application should be refused. NHS Resolution is the operating name of NHS Litigation Authority – we were established in 1995 as a Special Health Authority and are a not-for-profit part of the NHS. Our purpose is to provide expertise to the NHS on resolving concerns fairly, share learning for improvement and preserve resources for patient care. To find out how we use personal information, please read our privacy statement at https://resolution.nhs.uk/privacy-cookies/primary-care- appeals/ 22 October 2020 REF: SHA/23378 Arena Point Merrion Way APPEAL AGAINST NHS COMMISSIONING BOARD Leeds ("NHS ENGLAND") DECISION TO REFUSE AN LS2 8PA APPLICATION BY RUSHPORT ADVISORY LLP FOR Tel: 0203 928 2000 INCLUSION IN THE PHARMACEUTICAL LIST Fax: 0207 821 0029 OFFERING UNFORESEEN BENEFITS UNDER Email: [email protected] REGULATION 18 AT THE NEW HEALTH CENTRE, KENT & CANTERBURY HOSPITAL, ETHELBERT ROAD, CANTERBURY, KENT, CT1 3NG 1 The Application By application dated 17 December 2019, Rushport Advisory LLP (“the Applicant”) applied to NHS Commissioning Board (“NHS England”) for inclusion in the pharmaceutical list offering unforeseen benefits under Regulation 18 at the New Health Centre, Kent & Canterbury Hospital, Ethelbert Road, Canterbury, Kent CT1 3NG. In support of the application it was stated: 1.1 In response to Part 5 of the application form (reference to Regulation 31) the Applicant stated: “No other pharmacy in same or adjacent premises so not applicable.” 1.2 The Applicant also stated: “We are unable to provide a floor plan of the proposed premises as the premises have not yet been identified and secured. Once the premises have been secured, they will be registered with the GPhC and will comply with all the relevant legal and ethical requirements for the operation of a retail pharmacy business.” Information in support of the application PNA points 1.3 The redevelopment and relocation of the two GP surgeries to this new site at Canterbury Hospital was not known about at the time that the last PNA was published. The Applicant believes that, had the Health and Wellbeing Board been aware of this development, it is likely that they would have considered that a pharmacy would have been included in the PNA as an identified need. However, as the development was unforeseen the Applicant has had to apply under regulation 18 as an unforeseen benefit. The Applicant would nevertheless hope that the Health and Wellbeing Board would support this proposal to bring accessible pharmaceutical services to the new development, which is a significant distance from any of the existing pharmacies in Canterbury. Proposal 1.4 The proposed scheme is to develop a new Canterbury Medical Practice premises to relocate 2 GP practice branches (Cossington House and London Road) together in a new fit for purpose building co-located on the Kent and Canterbury Hospital site. This will significantly contribute towards the Canterbury and Coastal Clinical Commissioning Group (CCCCG) Estates strategy plan by: 1.4.1 Providing a modern, purpose built, high quality premises for primary care in the area that are CQC compliant, meet minimum standards and DOA regulations; 1.4.2 Delivering purpose built accommodation for clinical services, designed to modern healthcare and environmental standards; 1 1.4.3 Taking advantage of co-location opportunities/efficiencies and supporting the implementation of integrated care; 1.4.4 Enabling a fully collaborative, shared approach to care; 1.4.5 Allowing, where possible, for the increased use of new technologies that will save time and reduce workload for staff, this will also lead to improved patient outcomes through faster response times; 1.4.6 Providing increased GP surgery provision aligned to projected population growth expectations for the local area; 1.4.7 Allowing for better space utilization and have the potential to accommodate more GP and other healthcare professional training sessions. 1.5 As part of these plans, space has been allocated for a pharmacy unit at the new site and the Applicant has agreed a lease for the pharmacy unit (picture and plan provided) with Assura, the developer. 1.6 The new facility will be built to the latest NHS standards that will provide a fit for purpose modern facility with improved accessibility for all patients and compliant with the Equality Act. 1.7 Canterbury Medical Practice currently provides GMS services in Canterbury from four sites: 1.7.1.1 Bridge Health Centre, 1.7.1.2 Cossington House Surgery, 1.7.1.3 Littlebourne Surgery, and 1.7.1.4 London Road Surgery. 1.8 Healthcare estates quality audits found the Cossington House and London Road branch buildings as failing to meet the GP practice buildings minimum standards and were unsustainable for the delivery of general practice and primary care services for the future population of Canterbury. Both premises were granted 'red-rating' status and were deemed to be non-purpose built converted surgery premises that no longer meet the standard minimum requirements. Therefore, Canterbury Medical Practice had to seek alternative accommodation to relocate the surgeries into modern, fit-for-purpose healthcare facilities. Additionally, the London Road site has a lease due to expire in March 2020 and Canterbury Medical Practice cannot look to retain the site. 1.9 Assessment of future patient demand based upon demographic trends result in the assumption that GPs will see an increase in their list size (and hence patients treated) over the coming years. The planned new housing developments across Canterbury will have an impact on new families needing to access primary care services. The current patient list size (Summer 2018 figures) from the London Road (4,744) and Cossington House (7,400) is just over 12,000 combined. Canterbury CCG estimate that the projected growth across Canterbury is likely to be 7,000 over the next 10-25 years with 5,000 across Canterbury South. It has been estimated that the impact on the two premises combining at London Road and Cossington House could be an additional 3- 4,000 patients during this timeframe and therefore has resulted in a planned Schedule of Accommodation to accommodate 15,000 patients. 1.10 The doctors and the developers see pharmacy as a key asset to the provision of joined up healthcare, not only for patients who access the new surgery, but also for those who attend or work at the hospital and may require pharmaceutical services while they are there. 2 1.11 The location of the proposed pharmacy - co-located with the medical centre and with the hospital - provides an opportunity to improve access to prescription collection using innovation. The Applicant will install a Medpoint collection machine which will allow patients to access their dispensed medication 24 hours a day and 365 days per year. The collection point will be the first that the Applicant is aware of in England that will allow for the collection of fridge lines as well as regular prescription items. As the hospital is a 24 hour environment and many staff work shifts at night, this will be particularly useful for those who rely on out of hours access to services and will provide services not only for those registered at Canterbury Medical practice, but those from any medical practice who wish to use the hospital site. 1.12 The 3 nearest pharmacies to the proposed location are all owned and operated by Boots and are all between 1,100 metres and 1,500 metres from the application site. The nearest "non-Boots" pharmacy is Superdrug which is in Canterbury town centre and a distance of 1,760 metres from the application site. 1.13 All pharmacies are beyond a reasonable walking distance from the application site and this adds weight to the submission that granting this application would secure better access to pharmaceutical services as required under regulation 18. 1.14 It is not unreasonable to suggest that the two City Centre pharmacies are out of reach of patients by reason of distance (about a mile or more), gradients and the busy heavily urbanised environment that they would need to walk through. It has been noted in the PNA that congestion in Canterbury is a concern and can cause air pollution leading to health issues. None of the other pharmacies in the retail parks or west of the City Centre could be reasonably considered in any assessment of walking from the proposal site. 1.15 Canterbury suffers from traffic congestion due to its medieval streets and heritage buildings and again, granting this application will secure better access to pharmaceutical services for those who rely on cars to travel around. 1.16 The Applicant intends to provide the following services: 1.16.1 Essential services; 1.16.2 Appliances listed in Part IX of the Drug Tariff; 1.16.3 Advanced and Enhanced Services as indicated on the application form. 1.17 In addition, the Applicant stated that it: “Intends to provide all commissioned services and will ensure that all pharmacists employed are accredited to provide these services. The premises will also be accredited. In addition the Applicant intends to provide a number of services that are not currently being commissioned and will seek to work with local GP practices to develop joint working on the provision of non-commissioned services.” 1.18 The Applicant’s proposed core opening hours are: Mon to Fri 9am to 5.30pm Sat - Sun - 1.19 The Applicant’s proposed total opening hours are: Mon to Fri 9am to 6.00pm Sat 9am to 1pm 3 Sun - 2 The Decision NHS England considered and decided to refuse the application.

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