PRIMARY CARE CONTRACTOR ORGANISATION

PHARMACY PRACTICES COMMITTEE

Application by Elixir Pharmacy Group for inclusion in the pharmaceutical list in respect of the address, 5 Holyrood Road, , EH8 8AE.

The Pharmacy Practices Committee met at Pentland House on 8 April 2010 Room 004 to consider the above application in accordance with the National Health Service (Pharmaceutical Services) (Scotland) Regulations 1995, as amended.

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) Kaye Devlin (Contractor Pharmacist) Robbie McGregor (Contractor Pharmacist) Patricia Eason (Lay member) Ian Melville (Lay member)

Louise Hockaday (Administrator to the Pharmacy Practices Committee) (accompanied by Yvonne Shaw)

1. The Committee convened to consider an application for inclusion in the pharmaceutical list, dated 10 August 2009, by Elixir Pharmacy Group in respect of the address, 5 Holyrood Road, Edinburgh, EH8 8AE. A copy of the application had been circulated in advance to the Committee and the parties.

2. Written representations had been received from Donald Mackinnon on behalf of Mackenzie & Co Chemists, Mohammed J Iqbal on behalf of Southside Pharmacy and Peter Tinkler on behalf of Pharmacy. The applicant and the interested parties were entitled to comment on the representations received. No further comments were received within the specified time. However late comments on representations made were received outwith the specified time by the applicant and these were made available to the Committee for information only. Copies of the written representations had been circulated in advance to the Committee and the parties.

3. An unsolicited letter of support was received from Shirley-Anne Somerville, MSP, Scottish Parliament, Edinburgh on 8 December 2009. This person has no statutory right to make representations on this matter and the Board did not consult them. However the letter was made available to the Committee for information only.

4. 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 June 2009 – November 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 October 2009 – December 2009. The Committee were also provided with “Pharmacy Profiles” of the nearest pharmacies detailing opening hours, premises facilities and services offered.

5. 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.”

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

7. The Committee agreed to invite the applicant, Yaseen Yousaf and Imran Hussain of The Elixir Pharmacy Group, and those who were present who had made written representations to attend before them. They were:

Yaseen Yousaf, representing The Elixir Pharmacy Group Imran Hussain, assisting in the presentation of the application Donald Mackinnon on behalf of Mackenzie & Co Chemists, objector Mohammed J Iqbal on behalf of Southside Pharmacy, objector Peter Tinkler on behalf of Royal Mile Pharmacy, objector

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

9. 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.

10. 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.

11. 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

12. The Committee noted that the applicant had defined the neighbourhood in their written submission as Holyrood which was outlined on a map previously submitted and labelled “Appendix B”. 13. The applicant clarified in his oral submission that the neighbourhood could be defined as:

North: St Mary’s Street East: Holyrood Road West: South: Pleasance

Neighbourhood – Interested Parties

14. In his written submission, Mr Peter Tinkler of Royal Mile Pharmacy expressed his disagreement with the neighbourhood as defined by the applicant. He stated that the Dumbiedykes housing area is within the Old Town of Edinburgh which is a much larger area. He stated in his oral submission that the proposed premises are on the boundary of the City Centre neighbourhood as defined by Edinburgh Neighbourhood Partnership and that the majority of the Holyrood/Dumbiedykes housing is in the South Central Area.

15. In his oral submission, Mr Donald Mackinnon of Mackenzie & Co Chemists stated that it was his belief that the applicant had not researched the defined neighbourhood in any great depth but had drawn much of their information from Google maps and government neighbourhood statistics which had led to several inaccuracies in their application. He also stated that the applicants had used Data Zone Profiles which offer statistics down to street level which were not representative of a neighbourhood given that the profiles used only covered 1 or 2 streets covered by a postcode. He confirmed that the neighbourhood should extend to South Bridge and St Leonard’s heading towards Newington. He stated that the he found the definition of the neighbourhood as defined by the applicant confusing as the map he had provided did not cover all of Dumbiedykes and Viewcraig and that the proposed pharmacy location was right on the edge of the defined neighbourhood.

16. In his oral submission, Mr Iqbal of Southside Pharmacy agreed that the South Central area encompasses Dumbiedykes and that the proposed pharmacy location was outside the neighbourhood of Dumbiedykes.

Adequacy of Existing Pharmaceutical Services and Necessity or Desirability - Applicant

17. The applicant explained that Dumbiedykes is a housing estate of over 1100 residents in Central Edinburgh with high levels of poverty and unemployment, lack of social cohesion, poor health and widespread morbidity. This situation has worsened in the past decade.

18. The applicant stated that many surveys and reports have been carried out on the Dumbiedykes neighbourhood and one that has been carried out a number of times had been compiled by Dr Murray of Edinburgh University. Results from these had shown that complaints were common regarding the environment which included steep hills and difficult steps. He highlighted that Dumbiedykes had a higher than average number of residents over the age of 50 and that these people would have the greatest difficulties with geographical problems.

19. He stated that perceived causes of ill health included unemployment, stress, dampness, poor diet, eating habits and smoking. He also stated that drug misuse among some younger people and social isolation among elderly people were also thought to be problems as well as a lack of health education. 20. The applicant stated that amongst the most important health needs identified were for a bus route into the estate which would allow services to be accessed much easier. He explained that since the 1995 report was published and followed up in 2006, transport services had been further cut due to a lack of funding which made it increasingly difficult for residents to access services in this neglected neighbourhood.

21. He provided information from the Murray report regarding the population of Dumbiedykes in relation to age, social disadvantage, owned housing, car ownership and long term illness in relation to Lothian as a whole.

22. The applicant also stated that census data revealed high levels of HIV infection or drug misuse and single parents.

23. He highlighted that the proposed pharmacy would provide a needle exchange service which would be a boost to the community as the only other pharmacy in the area offering this service was at Boots The Chemists at Shandwick Place which was some distance away.

24. The applicant had provided copies of letters of support for a new pharmacy in Dumbiedykes from local MPs and MSPs which were circulated to the committee and objectors at the start of the meeting.

25. He stated that it was not his intention to leapfrog other pharmacies in the area but simply to enhance the services already provided which would be of benefit to the neighbourhood.

26. When asked by Mr Tinkler for the date of the Murray Report from which he had produced his date, the applicant confirmed that it was the 2006 report.

27. In answer to questions from Mr Iqbal of Southside Pharmacy, the applicant confirmed that the needle exchange service would only take place at certain agreed times which would not conflict with children coming home from school and that this should dispel any concerns which might be raised by residents.

28. Mr Mackinnon asked the applicant if he knew how to go about obtaining a contract for needle exchange services and who made the decision on that. The applicant confirmed that he was confident that he would fulfil the necessary criteria for this service.

29. Mr Mackinnon also asked the applicant if he had approached the local Community Council regarding the proposed application. The applicant confirmed he had not been in contact with anyone from the Old Town Council, only the Southside Community Council which he understood to take in a fair bit of the Old Town.

30. Mr Mackinnon asked the applicant how he intended to provide a domiciliary oxygen service when this service has already been contracted out to British Oxygen. The applicant did not reply to this question.

31. Mr Mackinnon pointed out that the applicant had not mentioned all the facilities in the area in his presentation and confirmed that a needle exchange service is already provided at the Cowgate Centre which is in a flat area only 400 yards from the proposed pharmacy site. He also pointed out that the service was also provided at the Spittal Street Centre in the City Centre.

32. In answer to questions from the Committee the applicant was asked that whilst there was no pharmacy within the defined neighbourhood, was he aware that pharmacies outwith that area could provide such services. The applicant agreed that he was aware that this was the case.

33. When asked by the Committee if an inadequacy of service can be demonstrated, the applicant stated that the continued health deterioration within the neighbourhood indicates an inadequacy. However, he confirmed that there was no evidence of inadequacy outwith the defined neighbourhood although the Salvation Army had indicated that clients had been turned away from local pharmacies in relation to substance misuse.

34. When asked by the Committee if it was the applicant’s view that the application was based on necessity and desirability rather than inadequacy of current provision of services, the applicant agreed that it was.

35. The Committee reminded the applicant that the offer of a needle exchange contract was not merely a formality. The applicant agreed that he was aware of this and confirmed that he had sought information on this from NHS Lothian many months ago but that the contract had not yet been pursued.

36. When asked by the Committee if he had had any previous experience of the needle exchange service, the applicant agreed that he had.

37. When questioned by the Committee, the applicant confirmed that the premises at the proposed site had been secured pending contract approval, that shopfitters had agreed that the plans are viable and that they would propose to open within 3 months of the contract being awarded.

38. When asked by the Committee if he had had any feedback from local residents, the applicant confirmed that he had only received this through local MPs and MSPs.

39. When asked by the Committee if he could provide any evidence of inadequacies in the current provision by way of complaints etc, the applicant agreed that he was not aware of any. However, he stated that the Salvation Army had indicated that local services for needle exchange and supervised Methadone and Buprenorphine administration were limited.

40. The Committee drew attention to the SIMD data which the applicant had provided which were drawn from outwith the defined neighbourhood. The applicant confirmed that this had been done merely for comparison purposes.

41. When asked by the Committee how the proposed delivery service would address the issue of lack of advice at the point of delivery, the applicant stated that a holistic approach would be given to this service.

42. When asked by the Committee what he had in mind for alcohol misuse, the applicant confirmed that he would set up a clinic which would liaise with the GP practices regarding advice on substance misuse.

43. When asked what he would do if contracts for needle exchange and domiciliary oxygen services were not offered, the applicant confirmed that other services such as Minor Ailments would still be offered which would help share the workload with the other local pharmacies.

44. When asked by the Committee why he had not submitted evidence of support from local residents rather than simply from MPs or MSPs, the applicant confirmed that he had received no response from preliminary contacts with Community Councils.

45. When asked if the proposed site was the only one which had been looked at, the applicant confirmed that at the time the application was made it was but that since then another larger site had been identified in the centre of the Dumbiedykes area.

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

46. Mr Peter Tinkler of Royal Mile Pharmacy stated that the list of 11 pharmacies in the current area includes 7 who are independent or small groups and that they currently offer the widest range of pharmaceutical services available.

47. He indicated that the proposed premises are located at a busy crossroads where the pavement is very narrow and sloping which would make it unsuitable for the elderly or disabled patients. He also indicated that there are extensive parking restrictions on both sides of the street and that no disabled parking area is marked. There is a high step at the entrance of the proposed premises would need to be removed to comply with disability access and there is no room for an external ramp.

48. Mr Tinkler also stated that whilst the applicant’s focus had been on road gradients, patients from St Leonards Medical Centre or Mackenzie Medical Centre could avoid walking uphill by entering the Holyrood/Dumbiedykes area via Brown Street.

49. He advised that there was no information currently available regarding the cessation of local bus services.

50. He also advised that, given the Lothian Health had not designated the need for further needle exchange services in the area, it was disingenuous of the applicant to suggest that the existing contractors were not providing the full range of services.

51. Mr Mohammed Iqbal confirmed his agreement with the points Mr Tinkler had raised and stated that the population of Dumbiedykes is fairly constant therefore the existing pharmaceutical services were adequate.

52. Mr Donald Mackinnon stated that to say that there are only 2 pharmacies close to the neighbourhood was highly misrepresentative together with the distances to the pharmacies which had been provided by the applicant. He claimed that there are 6 pharmacies within a half mile of the proposed neighbourhood which were Southside Pharmacy, Royal Mile Pharmacy, Boots at St Patrick Square, Newington Pharmacy, Edinburgh University Pharmacy at Bristo Square and Mackenzie & Co Chemists.

53. Mr Mackinnon also stated that the applicant had failed to indicate the access routes which are available by foot via Brown Street and Viewcraig Gardens where there are 4 pedestrian routes. He advised that not all residents have to walk up steep gradients to access services.

54. He pointed out that the applicant had not presented accurate numbers of local surgeries by failing to include The Access Point Cowgate Surgery. He also pointed out that patients would come from The Salvation Army Hostel, The Cowgate Crisis Centre which is 0.2 miles from Cunningham House and 0.2 miles from the Cranston Street Womens Hostel.

55. Mr Mackinnon stated that he was not aware of any pharmaceutical services which were not being provided in the area at present under the terms of the New Pharmacy Contract. He confirmed that the local health authority does not at present consider that additional needle exchange services are required.

56. He also stated that opening hours proposed by the applicant were less than many existing pharmacies offer in the neighbourhood.

57. Mr Mackinnon suggested that instead of liaising with the Dumbiedykes Environmental Group, the applicant should have contacted Braidwood Neighbourhood Centre Association as well as the South Central Neighbourhood Partnership.

58. He stated that he had spoken with Lothian Bus Group who had confirmed that they were not aware of any service being withdrawn from the area.

59. Mr Mackinnon also expressed his concern at the security risk which would arise for delivery drivers carrying controlled drugs and other medication who would have to park some distance away from the proposed pharmacy premises.

60. Mr Mackinnon confirmed that he had never turned patients away who had been seeking supervised methadone dispensing and that he was in contact with the Salvation Army and Jericho House about the needs of their residents.

61. In answer to questions from the applicant to the interested parties regarding local GP practices, Mr Tinkler explained where residents attend to access medical services.

62. The applicant stated that the intended move of Dalkeith Road Medical Practice to Lutton Place would increase business for all the pharmacies in the neighbourhood. Mr Tinkler suggested that the move to Lutton Place would also bring in pharmacies from further away which would mean sufficient current provision.

63. When asked by the applicant about a bus service which had been withdrawn the previous summer, Mr Tinkler confirmed that this had been run by a private bus company and that the service had been withdrawn through lack of use.

64. The applicant stated that concerns regarding medication deliveries will be addressed as the unit has a back entrance for such deliveries although there was no room there for parking.

65. In answer to questions from the Committee regarding current bus services, Mr Tinkler confirmed that the No. 35 bus served the area hourly as well as other buses from the South side of town where there was a 20 minute service.

66. In answer to a question from the Committee on the portion of patients they see in the area of the proposed site, Mr Tinkler confirmed that he was a high number especially with regard to the home delivery service from patients at the surgeries at St Leonards, Mackenzie Medical Centre, Boroughloch, Brunton Place and the Homeless Practice. Mr Iqbal confirmed that he sees a high number of students in the area of Mackenzie Medical Centre.

67. In answer to a question from the committee regarding their capacity for methadone patients, all 3 interested parties indicated that they have more capacity for these patients. Mr Tinkler confirmed that he has invested in equipment to provide a better service to methadone patients.

Summing Up

68. Donald Mackinnon of Mackenzie & Co Chemist summed up by making the following points:  Pharmaceutical services in the area were highly adequate;  The applicant had not addressed the points he had raised about the inaccuracies in the application;  The applicant had not done enough investigation on the neighbourhood.

69. Mohammed Iqbal of Southside Pharmacy summed up by making the following points:  The current level of pharmaceutical service is more than adequate and the applicant had not provide any firm evidence of inadequacies;  Local pharmacies have adapted over the years to the needs of the community.

70. Peter Tinkler of Royal Mile Pharmacy summed up by making the following points:  There are 3 pharmacies closed to the proposed site;  There has been no evidence of complaints regarding the current level of service;  The application is neither necessary or desirable.

71. Yaseen Yousaf of The Exilir Pharmacy Group summed up by making the following points:  Dumbiedykes is a deprived area;  Although there are other pharmacies in the area the new medical premises at Lutton Place will be within a half mile of the proposed site;  Residents have an uphill walk to the current provision of pharmaceutical services;  The company is keen to make a real difference in the area over and above the services provided to drug users and the homeless.

Decision

Neighbourhood

72. 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.

73. The committee defined the neighbourhood as: Canongate to the North down to Horsewynd, coming back up to Holyrood Road and into Dumbiedykes, up Arthur Street which joins and back down to the corner of St Mary’s Street.

74. The Committee agreed that apart from the east boundary (Horsewynd) the other borders formed 3 distinct housing populations and Holyrood Park itself.

Adequacy of Existing Provision of Pharmaceutical Services and Necessity or Desirability

75. 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.

76. The Committee agreed that current pharmaceutical services are adequate as the applicant had provided no clear evidence of inadequacies or complaints.

77. The Committee also agreed that there were 2 pharmacies within close proximity of the proposed site and that there were a total of 11 pharmacies within a one mile radius.

78. The Committee acknowledged that there had been no evidence of limitation in capacity within the existing pharmacies.

79. The Committee also acknowledged that topography was the main problem in the area.

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

81. The Committee agreed by a majority from the information made available that the existing pharmaceutical services in the neighbourhood were adequate.

82. Accordingly, the Committee agreed 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.

83. In these circumstances, it was the Committee’s majority decision that the application should not be granted.

Signed …JACK AITCHISON…………………….. Date ………13 April 2010……………………..

JACK AITCHISON, Chair Pharmacy Practices Committee