PHARMACY PRACTICES COMMITTEE MEETING Tuesday, 8 October, 2013 at 12.45pm Smithton Church, Murray Road, Smithton, Inverness, IV2 7YU Application by SANJAY MAJHU of APPLE PHARMACY GROUP for the provision of general pharmaceutical services at Unit 1C, District Centre, Milton of Leys, Inverness, IV2 6GP
PRESENT Okain McLennan (Chair) Margaret Fiddy (Lay Member) Barbara Lamb (Lay Member) Leonora Montgomery (Lay Member) Peter Mutton (APC Non Contractor Nominate) Andrew Paterson ( APC Contractor Nominate) Caroline Morgan (APC Contractor Nominate)
In Attendance Andrew J Green (Area Regulations, Contracts & Controlled Drugs Governance Pharmacist) Helen M MacDonald (Community Pharmacy Business Manager) Danielle McTaggart, Apple Pharmacy Group for Applicant Simon Wilson, Apple Pharmacy Group, Support Michael Church, Rowlands Pharmacy Stuart Scott, Rowlands Pharmacy, Support Kathleen Cowle, Boots James Higgins, Lochardil Pharmacy Gayle MacDonald, Lochardil Pharmacy, Support
Apologies Area Pharmaceutical Committee of NHS Highland Lisa Gellatly, Tesco Stores Ltd
Observers in attendance Christine McKee (NHS Western Isles) Neil Galbraith (NHS Western Isles) Tracy Beauchamp (Pharmacy Data Analyst)
1. The Chair welcomed everyone and asked all members to confirm that they had all received the papers for the hearing and had read and considered them. All members affirmed these points.
2. APPLICATION FOR INCLUSION IN THE BOARD’S PHARMACEUTICAL LIST
Case No: PPC – Milton of Leys _4, Inverness Apple Pharmacy Group, Unit 1C, District Centre, Milton of Leys, Inverness, IV2 6GP
The Chair asked each Committee member if there were any interests to declare in relation to the application being heard from Sanjay Majhu of Apple Pharmacy Group. No interests were declared.
3. The Committee was asked to consider the application submitted by Sanjay Majhu of Apple Pharmacy Group to provide general pharmaceutical services from premises sited at Unit 1C, District Centre, Milton of Leys, Inverness, IV2 6GP under Regulation 5(10) of the National Health Service (Pharmaceutical Services) (Scotland) Regulations 2009, as amended.
Apple Pharmacy Group Milton of Leys _ PPC 8 October 2013 NOTES.doc P1 The Committee had to determine whether the granting of the application was necessary or desirable to secure the adequate provision of pharmaceutical services in the neighbourhood in which the Applicant’s proposed premises were located.
The Committee, having previously been circulated with all the papers regarding the application from Sanjay Majhu of Apple Pharmacy Group, agreed that the application should be considered by oral hearing.
Prior to the hearing, the Committee had, as a group, visited the vicinity surrounding the Applicant’s proposed premises; the route followed being as laid out in advance and as directed by the Chair of the Pharmacy Practices Committee. In doing so, the Committee visited the existing pharmacies at Lochardil, Rowlands, Balloan Park, Tesco, Inshes, Boots, Inverness Retail Park and Rowlands, Culloden, all Inverness, where a full range of amenities and services were sited within them in the immediate and surrounding areas of Castle Heather/Inshes, Lochardil and Culloden.
It was particularly noticed that the siting of the pharmacy at the back of Tesco was not easily accessible in respect of disability access and, it took some time before the Committee were noticed to be waiting in the queue. A wall was noted to be between the dispensary and the public area making it impossible for the pharmacist to see who was presenting for services or gauge any special needs that they may have.
The Committee then visited the boundaries of the neighbourhood as defined by the Applicant and the residential area, noting new housing being built throughout and various walkways, footpaths and play parks. Pedestrians, cyclists and joggers were noted to be travelling around the neighbourhood and the No. 5 bus was seen travelling to the neighbourhood.
Within the neighbourhood of Milton of Leys, an extensive mix of housing development within the area – both social and private, adding to the original housing developed in the area during the late 1980s and those developed since was noted; including the site previously housing Scotland’s Housing Expo and the area of the Homes for Heroes development.
The Committee then visited the proposed premises where the Applicant, Site Manager and Developer were on hand with plans of the proposed fit out and premises plans to guide the Committee around the premises. It was noted disabled parking and access had been a consideration by the developers in their plans and the appropriate spaces and access would be sited immediately outside the proposed premises. To the left of the premises adjoined a Co-operative supermarket, due for completion in November, 2013 and which would include ATM banking facilities; to the right of the premises adjoined two other retail units which it was anticipated would form fast food outlets. Adjacent to the site was the primary school containing community facilities where various community groups met in the evenings.
The Committee then returned to the Smithton Church, Murray Road, Smithton, Inverness, IV2 7YU where the hearing was to be held.
The hearing was convened under paragraph 3(2) of Schedule 3 to the National Health Service (Pharmaceutical Services) (Scotland) Regulations 2009 as amended (“the Regulations”). In terms of this paragraph, the Pharmacy Practices Committee “shall determine an application in such a manner as it thinks fit”. In terms of Regulation 5(10) of the Regulations, the question for the Pharmacy Practices Committee is whether “the provision of pharmaceutical services at the premises named in the application is necessary or desirable to secure adequate provision of pharmaceutical service in the neighbourhood in which the premises are located by persons whose names are included in the Pharmaceutical List.”
Apple Pharmacy Group Milton of Leys _ PPC 8 October 2013 NOTES.doc P2 The start of the hearing was delayed by 15 minutes due to the late arrival of Rowlands personnel. Enquiries were made and it was found that the personnel were en route, therefore the delay was agreed to avoid unnecessary interruption of the hearing once they had arrived.
The Applicant, Support and Interested parties were invited into the meeting at around 1pm.
4. The Chair apologised to all in attendance for the late start of the hearing and welcomed:-
The Applicant, Apple Pharmacy Group represented by Danielle McTaggart, supported by Simon Wilson, the Interested Parties who had submitted written representations during the consultation period and who had chosen to attend the hearing, were Michael Church, Rowlands Pharmacy and Stuart Scott, Rowlands Pharmacy support, James Higgins, Lochardil Pharmacy and Gayle MacDonald, Lochardil Pharmacy support and Kathleen Cowle for Boots (“the interested parties”). Tesco Stores Limited submitted their apologies and a paper for reading at the appropriate point to the Health Board, as had the Area Pharmaceutical Committee.
The Chair then invited the Committee members and Board officials to introduce themselves to the Applicant and all other parties and vice versa.
The Chair asked the Applicant and the Interested Parties to confirm that they were not attending the Committee in the capacity of solicitor, counsel or paid advocate. They each confirmed that they were not.
5. The Chair reminded everyone that the meeting had been convened to hear the application from Sanjay Majhu of Apple Pharmacy Group for the provision of general pharmaceutical services Unit 1C, District Centre, Milton of Leys, Inverness, IV2 6GP. The application would be considered against the legal test contained in Regulation 5(10) of the National Health Service (Pharmaceutical Services) (Scotland) Regulations 2009, as amended.
The Chair advised Neil Galbraith and Christine McKee of NHS Western Isles were in attendance, as was Tracy Beauchamp of NHS Highland in an observation capacity for training purposes and if there were any objections to their presence for any party to declare this now. No objections to the presence of the observers being present were made.
6. Regulation 5(10) was read out:
An application shall be granted if the Board is satisfied that the provision of the pharmaceutical services at the premises is necessary or desirable in order to secure adequate provision of pharmaceutical services in the neighbourhood in which the premises are located.
7. The Chair then described the format of the hearing, reminding those attending that no new evidence could be introduced at the summing up, explaining that it would be the sole responsibility of the Lay Members to decide whether or not to grant the application. Only after the decision had been made would NHS Highland Board officials rejoin the Committee to enable the decision and reasons to be recorded.
The procedure adopted by the Committee at the hearing was that the Chair asked the Applicant to make their submission. There followed the opportunity for the Interested Parties and the Committee to ask questions. The Interested Parties would then make their submissions. There followed the opportunity for the Applicant and the Committee to ask questions of the Interested Parties in turn. The Interested parties and the Applicant were then given the opportunity to sum up.
Apple Pharmacy Group Milton of Leys _ PPC 8 October 2013 NOTES.doc P3 The Chair then asked the Applicant to give their statement.
7.1. The Applicant’s Case
Ms Danielle McTaggart of Apple Pharmacy Group stated “Thank you for the opportunity to present this application today.
Any new application must be considered in terms of the legal test: Is the application necessary or desirable in order to secure the adequate provision of pharmaceutical services in the neighbourhood in which the premises are located. I hope to satisfy you that this contract is both necessary and desirable!
Inverness is one of Europe’s fastest growing cities with a third of the Highland population living in or around the city. We have particular interest in the Milton of Leys area including Parks farm and hence define our neighbourhood as: Eastern boundary of the A9 motorway, Southern boundary being the area of Bogbain Wood, Western boundary being the extension of Old Edinburgh Road South to General Wade Military Rd and finally moving in a northerly direction taking a line from the north tip of Parks farm across to join the A9. These boundaries are accepted by the Area Pharmaceutical Committee as documented in their correspondence. In 2001 the population of Inverness was just over 40,000. The 2011 population figure was approaching 60,000 and the current 2013 figure is approximately 63,000. This is an increase of 20,000 people in ten years! No additional pharmaceutical provision has been made to compensate for this. A contract was granted in 2012 in the form of the pharmacy at Lochardil however a branch of Lloyds closed the previous year therefore the people of Inverness have had no net gain of pharmaceutical provision. With the increasing demand on all health services year on year this would appear absurd. One may question the reason a pharmacy closed if such a demand for pharmaceutical services was the case, however, the population growth seen in Inverness is not in and around the town centre where the majority of pharmacies are huddled. The growth is seen on the outer suburbs and reinforces the notion that access to services is a problem. It is generally accepted that a pharmacy is needed for every 3000 people and Milton of Leys can offer that population but a local pharmacy is absent from this community. There are 11 pharmacies in Inverness serving a population of 63,000 and growing. Ultimately each pharmacy has a captive patient base of 5727 people which is above the national average.
It can prove challenging to obtain exact population figures for particular neighbourhoods and in light of the extensive development work undertaken within our defined boundaries we consulted with the developers to obtain accurate and official population data. The statistics offered therefore are 820 units completed and occupied with 52 units under construction. If we edge on the side of caution and assume occupancy of 2.3 residents per household the figure is comfortably 1886. Apprehension to make the financial leap in light of the recession is not what these statistics show. In fact there are 206 units due to commence before the end of 2013 with a further 362 properties in the pipeline.
This would offer a population figure in excess of 3300 within our defined boundaries by the end 2014. These are the exact figures accepted by the Co-operative store when securing heads of terms for their business at the neighbourhood centre at Milton of Leys, which we are told is opening at the end of November, this year. We did not feel it was appropriate to discuss projected population figures that are too far into the future and deemed therefore inappropriate for consideration.
Can I emphasise to you that the development in housing being presented to you today is for next year!
Apple Pharmacy Group Milton of Leys _ PPC 8 October 2013 NOTES.doc P4 The expanding population of this neighbourhood justified the opening of Milton of Leys primary school which educates almost 300 children. The catchments area for this school is the exact neighbourhood described earlier. Investments in education have been made for this developing community and we believe adequate provisions for healthcare should be too. Please note that an application made by Apple Pharmacy for the exact same site was approved by Pharmacy Practices Committee in 2011 previous to a convenience store with ATM and school being available.
The Wilson review states that “A key element in local planning is ensuring equitable access to services. One of the hallmarks of community pharmacy has been its accessibility, providing rapid and flexible response to public and patients. That needs to be maintained with the increasing focus on broader clinical service in addition to dispensing of medicines. There are further opportunities for pharmacy premises to be seen as a wider community asset” and we couldn’t agree more!
Out with our defined boundary and almost two miles away is the closest pharmacy i.e. Tesco Inshes Retail Park. Primarily our concern is access to this pharmacy. Undoubtedly, if a patient is a car owner the journey from Milton of Leys to Tesco is endurable approximately ten minutes, however considering 44% of the population of Milton of Leys own one car per household with 34% having no car at all it cannot be assumed that a car is always available. Walking to Tesco is not an option. An average able bodied person takes twenty minutes to walk a mile therefore a walk from Milton of Leys to Tesco would be approximately 40 minutes each way. Given the steep gradient of the hill and the severe weather conditions known to affect all residents of Milton of Leys during winter months, consideration must be given to the elderly and disabled. Please note that Inverness lies above the snow line and winter weather conditions often restrict access further. For those patients reliant on public transport a tedious journey awaits them. The no. 4 bus operates hourly from Boswell Road which is actually outwith our defined neighbourhood. The journey time is approximately ten minutes however people are required to dismount at Raigmore Hospital and undertake a ten minute walk covering 0.5mile. The walk itself requires the use of four sets of traffic lights, three of which do not offer audio assistance and the other broken on the day I undertook the journey personally. Whilst I appreciate that a pharmacy cannot be responsible for a dangerous road or ill working traffic lights it is concerning for a visually impaired patient or person with hearing difficulties attempting to access the pharmacy.
Tesco positioned their pharmacy at the back of their store and whilst acknowledging the further distance a patient needs to walk that is not our only concern. Issues of confidentiality are frequently expressed in the responses from public consultation as are issues of stock control. Responses from the public also expressed concerns regarding the appropriate competence of staff as the same employee was witnessed working in the pharmacy and at the customer service desk. One particular response indicated that Tesco pharmacy was indeed closed when attempting to collect their prescription and this wasn’t late at night or during the pharmacists entitled break it was from 11.30 – 2pm!
The limited space for health promotion messages or health board campaigns I presume is the reason for the booklet advertising Tesco pharmacy services. Interestingly, there is no mention of a delivery service within the booklet and when attempting to telephone Tesco for clarification using the number provided proved invalid! Surely being able to telephone your pharmacy is desirable if not entirely necessary. The telephone procedure (when obtaining a number from Google) is restrictive and most certainly makes it awkward to access any member of the healthcare team let alone the pharmacist. Presented initially with five automated options, none of which mention pharmacy directly results in a further five automated options. After making a selection my call was eventually directed to the pharmacy team.
Apple Pharmacy Group Milton of Leys _ PPC 8 October 2013 NOTES.doc P5 After speaking to an assistant I could finally speak to the pharmacist. Time spent listening to options detailing the availability of the latest computer game on sale or the status of an online order of groceries before being able to communicate with the pharmacist is frustrating for a healthy, functioning adult let alone an elderly Alzheimer patient, for example.
Apple pharmacy recognises the good practice of Rowlands pharmacy and are familiar with the principles they work by through experience from our Glasgow based pharmacies. However, when assessing the merits of this application we were told by the branch directly in May that a waiting list for dosette boxes was in operation in the Culloden branch which indicates a struggle with current demand. Given the increase of 22% of people living in the Highlands aged between 65 and 79 and 32% increase in those over 80 it is surely concerning that they are at full capacity. The branch suggested I contacted the Rowlands pharmacy at Balloan Park which hesitated at whether or not they had space and actually told me whilst they were deciding that if they couldn’t accommodate me that I should try Tesco!
Having agreed with my definition of the neighbourhood the correspondence from the Area Pharmaceutical Committee acknowledged that the pharmacies closest to our proposed premises are “not ideally located for the residents within our neighbourhood”. This implies that they have identified that access to these pharmacies is restrictive which strengthens my application that a new contract is necessary and most certainly desirable! The Area Pharmaceutical Committee explains that “the delivery service offered by these pharmacies cover the neighbourhood adequately”. However, the pharmacy contract is more than simply the dispensing of prescriptions. How could a resident of Milton of Leys benefit from CMS, eMAS, smoking cessation or any health board campaigns from a delivery service. They cannot!
Our application has unanimous support from Councillors for Inverness South Ward: Carolyn Caddick, Jean Pumford (a Community Councillor), Thomas Prag and Ken Gowans. Thomas Prag, a customer of Tesco Pharmacy himself, expressed concerns regarding privacy and has personal experience of lengthy waiting times. This indicates again a struggle with demand and along with the limited space available for health promotion campaigns or advertisements Tesco is viewed by many to be an inappropriate environment to discuss ailments or medication. Mary Scanlon MSP has pledged her support for the granting of this application based on the needs of her constituents. Support from the Milton of Leys Residents Association for the opening of a pharmacy in the hope to secure the adequate provision of pharmacy services is well documented.
If this application was successful Apple pharmacy would be offering all the services of the new contract CMS, eMAS, AMS, public health as well as supply of methadone and buprenorphine supervision if required, advice to nursing homes, stoma care, compliance aids and urgent supply service. Blood pressure monitoring, cholesterol testing and access to a chiropodist would also be services on offer to any patient/customer of Apple pharmacy. Furthermore, Apple pharmacy can offer the services of a fully qualified independent prescriber which if utilised would fundamentally strengthen multidisciplinary links which is desirable given the location of this pharmacy.
As stated in the Wilson report patients want accessible pharmacy services and continuity and consistency of professional input and care from an individual pharmacist. We have a pharmacist within the company ready and willing to relocate to Inverness if the contract was granted. Furthermore, given that the pharmacist has a share in the company there are no concerns regarding inappropriate targets or, indeed, restraints being placed upon him which allows him to focus on delivering the highest level of patient care.
Apple Pharmacy Group Milton of Leys _ PPC 8 October 2013 NOTES.doc P6 I would like to conclude my application by quoting Lord Drummond Young in the Judgement case of Lloyds pharmacy Vs The National Appeal Panel:-
… “The question the decision maker must address is the adequacy of the existing provision to serve the neighbourhood in question. In addressing the question however, it is our opinion to have regard to probable future developments for two reasons. First, the standard of adequacy in a particular neighbourhood will obviously change in time. The relevant neighbourhood may change for example through construction of new housing developments or the movement of population out of inner city areas. Likewise changes inevitably occur in pharmaceutical practice and the standard of “adequate” pharmaceutical provision must accordingly develop over time….. ”
For these reasons and the evidence provided earlier we believe that this application is both necessary and desirable to secure adequate pharmaceutical services and therefore respectfully ask that this contract be granted”.
The Chair thanked Ms McTaggart for her statement on behalf of Mr Majhu of Apple Pharmacy Group and invited the Interested Parties and then members of the Committee to ask questions of him.
7.2 Questions from Mr Michael Church, Rowlands Pharmacy to the Applicant
Q. Why did you choose the northern boundary of the neighbourhood as you did?
A. There was no physical boundary as such, however, with the closeness of the vicinity of (the development of) Parks Farm, we believe that the people of Parks Farm would consider themselves to be neighbours of Milton of Leys.
Q. In the application you have written that your hours of business will be 9am to 5.30pm Monday to Friday and 9am to 1pm on a Saturday but in your advertisement in the Inverness Courier it is stated they would be 9am to 6pm Monday to Friday and 9am to 1pm on Saturdays. Can you confirm what your proposed hours of business actually are?
A. We would propose to open from 9am to 6pm, Monday to Friday and 9am to 1pm on Saturdays.
Q. Do you know when the contact referred to regarding dosette boxes was made with Rowlands Pharmacy.
A. Yes, it was Monday, 6 May 2013 around 11 am. We contacted the Culloden Pharmacy and were directed to contact Balloan Park as Culloden was at capacity. On contacting the Balloan Park Pharmacy the pharmacist advised that she would give the request some consideration but in the meantime to approach Tesco to ascertain if they were able to provide the service.
Q. Would it surprise you to know that the pharmacy in Culloden is accepting new patients for dosette boxes now?
A. No answer.
7.3 Questions from Ms Kathleen Cowle, Boots to the Applicant
Q. With reference to your comments around pharmacy business in general, moving from providing dispensing to more core services, surely, your argument demonstrates a lack of services after 5.30pm on weekdays; 1pm on Saturdays and all day Sunday when the proposed pharmacy would be closed?
Apple Pharmacy Group Milton of Leys _ PPC 8 October 2013 NOTES.doc P7 A. I take on board that Tesco is some 1.9 miles away but they are not very busy on a Saturday afternoon or Sunday. That said, if it were demonstrated that services during these times were required in our proposed neighbourhood, we would address this at that time and meet the need.
Q. Is it not true that a large part of the argument is around service delivery but at times reflect dispensing services?
A. I don’t see a great demand for this after 1pm on a Saturday or on a Sunday but as I say, we would look into this if a need were identified.
7.4 Questions from Mr James Higgins, Lochardil Pharmacy to the Applicant
Q. Was a randomised survey conducted of Milton of Leys’ residents?
A. No, primarily as we did not wish to unduly influence people which we felt would happen if we were standing next to them querying them on adequacy. People can feel under pressure and we did not have a full list of names to mail these as most of our interaction with the community has been face to face or through the Community Council.
Q. Perhaps you could have dropped one through every third letterbox. Would that not have been better?
A. Definitely, but we would need to consider if the patient base would require services on a Saturday and Sunday with Tesco open then, given the distance.
Q. Are you then saying that the distance to Tesco does not become a problem after 1pm on a Saturday or on Sunday?
A. As advised, we would address this once we had a patient base.
7.5 Questions from the Committee to the Applicant
Peter Mutton, APC Non Contractor Pharmacist
Q. You talk about the population in the area and the broad signs for supporting a pharmacy but a fair amount are going to be closer to Tesco or Rowlands. Do you have figures outlining how many would be closer?
A. If you took out current developments, you could choose to be at either Milton of Leys or Parks Farm, however, I see two neighbourhoods coming together and, as a result, more likely to choose premises within the defined neighbourhood which the premises are in.
Andrew Paterson, APC Contractor Pharmacist
Q. What are your views on the provision of dosette boxes?
A. We are open to providing the service where a need has been identified, although this is not a core element of the pharmacy contract. I mentioned it in respect of Rowlands being unable to provide the service, as I felt failure to take on new patients demonstrated that their pharmacies were at capacity. They may advise it is not an issue now but it was at one point.
Q. Would you provide a delivery service and what vehicle do you use?
A. Yes we would, using a 4X4 vehicle.
Apple Pharmacy Group Milton of Leys _ PPC 8 October 2013 NOTES.doc P8 Peter Mutton, APC Non Contractor Pharmacist
Q. I am glad you expanded on this. Would you clarify that if this is based on the existing patient levels, do you see any residents within the area who are simply unable to access any core part of the contract?
A. Public transport is an issue for some patients in accessing services as not all are car owners and not an option for all.
Q. We saw a bus today, tell us more about that?
A. Yes, the No. 5 bus stops at Balloan Park around every 20 minutes.
Q. Is that a lot better than before?
A. Yes and the bus to Tesco is hourly but you would need two buses to get to Lochardil from Milton of Leys, taking over 2 hours (one an hour).
Margaret Fiddy, Lay Member
Q. You did not make reference to the provision of a needle exchange service in the list of services you said you would provide. Why was that?
A. We have been informed by the Health Board that the demand for needle exchange in the neighbourhood was not high, however, if it were appropriate, we would not be prejudiced to taking on the provision of such a service.
8. The Interested Party’s Case – Mr Michael Church, Rowlands Pharmacy
Mr Church stated “thank you, for allowing me to represent the views of Rowlands Pharmacy today. To clarify, we at Rowlands Pharmacy believe the application for a new pharmacy at Milton of Leys is neither necessary nor desirable.
To cover the legal test, the first issue I would like to discuss is neighbourhood. I believe Rowlands disagree and that the neighbourhood is as follows:-
West Old Edinburgh Road South (General Wades Military Road), running along Sir Walter Scott Drive to meet the A9, then running south to the B9177, then back to Old Edinburgh Road South. (Mr Church demonstrated this on a map to Committee members, the applicant and interested parties).
There is one existing pharmacy in the defined neighbourhood. Our pharmacy at Balloan Park sits right on the edge of the neighbourhood I have defined and is easily accessed by residents of Milton of Leys, providing all the core services of the pharmacy contract: Minor Ailments; PHS, including smoking cessation and EHC, AMS and CMS. Supervised consumption of methadone and access to dosette boxes (blister packs) were also available. We also provide blood pressure monitoring and do so regularly. Moreover, this flu season we will be offering a private flu vaccination service. High quality customer service is central to our ethos at Rowlands and, as a result, our pharmacy here is thriving. Jen, our pharmacy manager here for several years, has developed excellent relationships with patients and local healthcare professionals alike.
Apple Pharmacy Group Milton of Leys _ PPC 8 October 2013 NOTES.doc P9 Our modern pharmacy layout is clearly attractive to our customers. Our waiting time for prescriptions is on average 10 minutes, which was demonstrated in an audit conducted in march of this year. We also offer a daily prescription delivery service and collection to all patients’ homes and to and from all Inverness GP practices. Free parking with dedicated disabled bays is abundant, meaning there are absolutely no issues here with access to the pharmacy. Of course, there will be some who have no access to a car. Bus service 5 runs from Milton of Leys to our pharmacy at Balloan Park every 20 minutes.
Residents of Milton of Leys already have to travel outwith their local area to access many day-to-day services, for example banking, post offices, libraries, GP practices etc – not to mention going to work. Speaking generally, Milton of leys has a significant privately owned houses and high car ownership. As such, residents are easily able to access existing pharmaceutical services within Inverness. As registration with a GP practice in Inverness is not limited by postcode, Milton of Leys residents could well be registered with a practice in the town centre, for example, therefore a journey made to see the GP can easily be combined with a visit to an existing pharmacy to collect any medication prescribed.
If you ask someone in the street would they like a pharmacy closer to their house, the vast majority of the time, people will answer yes, why not? It may be more convenient, however, we must make a clear distinction between convenience and necessity.
It is my belief that the residents of Milton of Leys have no difficulty in accessing existing pharmaceutical services. The granting of this contract may appeal to some on the grounds of convenience, but it is certainly not necessary or desirable. As such, it is my opinion that this application for this pharmacy contract should be rejected.
Thank you”.
The Chair thanked Mr Church for his statement and invited the Applicant, Interested Parties and then members of the Committee to ask questions of him.
8.1 Questions from the Applicant to Mr M Church, Rowlands Pharmacy
Q. You included, in the northern boundary specified by you, the area of Inshes. Do you think the people of Wester Inshes would consider themselves to be neighbours of Milton of Leys?
A. The two areas are right next to each other, however, I am not really able to answer that question.
Q. I would argue that Milton of Leys does not include Inshes. Are you representing both branches of Rowlands (i.e. Culloden and Balloan Park)?
A. I am representing the company of Rowlands.
Q. Is it not true that your Balloan Park pharmacy was advising customers to go to Tesco for dosette dispensing?
A. This is not a current issue.
Q. Well it was an issue in May – why was that?
A. Well, it is October now and is not an issue any longer. There are no capacity issues at Rowlands.
Q. Do you feel that those travelling outwith the neighbourhood of Milton of Leys to work would use their car as a means of transport?
Apple Pharmacy Group Milton of Leys _ PPC 8 October 2013 NOTES.doc P10 A. Yes they would.
Q. So you agree that with the figure presented of 44% or less owning one car that this may be an issue on occasion?
A. Perhaps.
Q. How would a disabled or elderly person either Rowlands pharmacy when the doors are not automated?
A. We would keep an eye out for patients with those needs and be on hand to offer assistance to aid them to be able to access our services.
8.2 Questions from Ms K Cowle, Boots UK Limited to Mr M Church, Rowlands Pharmacy
Q. Are there currently any complaints with NHS Highland involving Rowlands pharmacies?
A. No.
8.3 Questions from Mr J Higgins, Lochardil Pharmacy to Mr M Church, Rowlands Pharmacy
Mr Higgins had no questions for Mr Church.
8.4 Questions from the Committee to Mr M Church, Rowlands Pharmacy
Andrew Paterson, APC Contractor Pharmacist
Q. Are you aware that the Health Board has not received the complaints return from Rowlands for Quarter 4?
A. No, I am not aware of that.
Q. Do you realise that it is a legal requirement to log any complaints with the Health Board, even if that is NIL and Rowlands have not done so?
A. To my knowledge there are no outstanding issues.
Peter Mutton, APC Non Contractor Pharmacist
Q. You say there are no problems but clearly there has been concerns expressed. We have record of significant wait times with Rowlands and Tesco and we know the population is increasing. So, with the development of new core services, such as CMS, what is your strategy to ensure you can provide the increase in demand?
A. I would say starting levels are one thing but then to have reviews, which regularly take place. The Pharmacy Manager at Balloan Park can address issues to enable a quick resolution and the Area Manager is able to also take action, where necessary.
Q. If you had patients who need other aspects of the service to be provided (other than dispensing), it would occur that people would have to wait. How long might they have to wait?
A. This would happen rarely as we provide a collection and delivery service which helps manage our workload and drives down waiting times.
Apple Pharmacy Group Milton of Leys _ PPC 8 October 2013 NOTES.doc P11 Q. Have there been Issues regarding the pharmacy at Balloan Park?
A. No.
Q. Is it true there is only one pharmacist there?
A. Yes
Q. Is there an ACT (accredited checking technician)?
A. Yes there is, however, this is not a full time position.
Margaret Fiddy, Lay Member
Q. The submission letter made by Rowlands is very brief, in fact it is exactly the same letter submitted as the last time. Does this surprise you, given the extra housing and extra things which have happened since the last time the application was heard?
A. No comment made.
Q. I am surprised you did not comment on the extra people and that you still consider no change has been effected, aren’t you?
A. I wouldn’t deny there has been an increase in the population but where current provision is accessed, I don’t believe provision of services to be inadequate.
Okain McLennan, Chair
Q. We have heard and seen for ourselves, a substantial increase in houses and residents in the area. Certainly since the last application there has been significant development and an increasing number of homes being moved in to. How confident are you that your services, which were adequate before, will be able to cope without another pharmacy?
A. As I have said with reference to the statistics there is ongoing regular review. At the moment there is one pharmacist but should the number of patients increase to a point where they would need a second pharmacist to cater for their needs, then we would look at this as an option, if required. As advised, we undertake regular review and put measures in place to address any action required to be taken.
Andrew Paterson, APC Contractor Pharmacist
Q. Do you have a guide advising the trigger point when two pharmacists would be required?
A. No. This varies from pharmacy to pharmacy.
Q. Are you aware there is more than one pharmacist in some pharmacies?
A. Yes, in some pharmacies there are three.
Apple Pharmacy Group Milton of Leys _ PPC 8 October 2013 NOTES.doc P12 9. The Interested Parties’ Case – Ms Kathleen Cowle, Boots Pharmacy
Ms Kathleen Cowle, Boots UK Limited stated “Thank you for the opportunity to present today. The representation will be brief. I just want to comment on the current provision. So in identifying the neighbourhood as Milton of Leys, we found it difficult as there are currently no facilities within the boundaries of the area that would identify it as a neighbourhood other than a primary school, there are no other shops including post office, banks or bank cash lines or even churches, just houses.
The nearest pharmacies are Tesco Inshes (1.6 miles) and Rowlands (2.3 miles). I have identified the nearest services and to access these, I would have to go to Tesco so, if I were going to suggest a neighbourhood, it would have to include those services and these are outwith the area suggested by the applicant. People currently have to leave the neighbourhood for all service provision, even a pint of milk or a paper.
The site itself is adjacent to the primary school and given the layout of the housing and the streets therein would require transport to reach the proposed site from almost anywhere in the neighbourhood. That being the case, why not then access services at Inshes along with other services.
The key elements in this test are as follows:
What is the neighbourhood for the proposed premises? As I have stated we have found it difficult to identify the site highlighted as a neighbourhood due to the lack of facilities. If a neighbourhood could be identified it would have to include Tesco i.e. at Inshes.
What are the existing pharmaceutical services in the neighbourhood, or in any adjoining neighbourhood? Well, there are Tesco, Rowlands and a new contract in Lochardil. Boots at the Retail Park is a further 2 miles from Tesco.
Are these services adequate or not? As stated by the Area Pharmaceutical Committee there is no evidence to suggest otherwise either from the applicant or in feedback to the Health Board. The only suggestion of an insufficient service is around supply of medication aids which I am aware are provided by Boots and therefore make that statement incorrect. Other suggestions are anecdotal.
Boots Inverness Retail Park offers all the services required within the national contract including eMAS, PHS, CMS and AMS. Offering extended hours, great accessibility, delivery service on request and medication aids if required.
Just to reinforce, we currently have adequate pharmacist resource. We request frequent feedback from our customers and currently 77% of our customers strongly agree that they are satisfied with the care they receive from the store. I believe that this shows there is no issue with capacity within the area.
Is it necessary to grant the application in order to secure adequate provision of pharmaceutical services in the neighbourhood? We would say service is currently adequate.
Is it desirable to grant the application in order to secure adequate provision of pharmaceutical services in the neighbourhood? If asked, most people would feel that a new pharmacy in their neighbourhood is desirable, however, we feel at the moment the service is adequate and the application is, therefore, neither necessary nor desirable.
The Chair thanked Ms Cowle for her statement and invited the Applicant, Interested Parties and then members of the Committee to ask questions of her.
Apple Pharmacy Group Milton of Leys _ PPC 8 October 2013 NOTES.doc P13 9.1 Questions from the Applicant to Ms K Cowle, Boots UK Limited
Q. Did you specify a neighbourhood in your submission?
A. No, I was unable to as I don’t think there is one. In my view a neighbourhood has to include such services as shops, church, post office and other services. So, if I were to suggest anything these would need to be included within it to be subjected to the legal test.
Q. So, you are not defining an exact neighbourhood but you believe it would have to include Tesco within it to provide such services?
A. Yes.
Q. What percentage of Milton of Leys residents do Boots deliver services to?
A. I don’t have those figures.
Q. What is your opinion of Rowlands referring patients to Tesco in order to access dosette box dispensing?
A. I believe that was indicative of a moment in time but am satisfied this is now resolved.
9.2 Questions from Mr M Church, Rowlands Pharmacy to Ms K Cowle, Boots, UK Limited
Mr Church had no questions for Ms Cowle.
9.3 Questions from Mr J Higgins, Lochardil Pharmacy to Ms K Cowle, Boots UK Limited
Mr Higgins had no questions for Ms Cowle.
9.4 Questions from the Committee to Ms K Cowle, Boots UK Limited
Caroline Morgan, APC Contractor Pharmacist
Q. How would patients travel to Boots at the Retail Park from Milton of Leys?
A. It is only accessible by car.
Q. Is there a bus?
A. I don’t know but I do know that the pharmacy in this geography has no overspill of provision of services, therefore services delivered from it appear to be adequate.
10. The Interested Parties’ Case – Mr James Higgins, Lochardil Pharmacy
Mr James Higgins stated “Thank you for allowing me the opportunity to talk to you today. It is our belief that this application does not pass the legal test. We believe that it falls short in many respects and I would like to briefly outline these to you.
Firstly, the neighbourhood. As we have already indicated in our written submission, we feel that the neighbourhood is wider than that indicated.
Apple Pharmacy Group Milton of Leys _ PPC 8 October 2013 NOTES.doc P14 Whilst we would understand the temptation to define the Milton of Leys area as a neighbourhood we cannot agree that this is the case. A neighbourhood will normally be possessed of a number of local amenities which render it to some extent self contained and cohesive. The area outlined today lacks many of these amenities accepted as being standard such as a post office, petrol stations, churches, banks, supermarkets, secondary schools and Council offices, to name a few. The absence of these within Milton of Leys means it would be more accurately termed as a locality than a true neighbourhood and closer to that represented by Rowlands.
Existing pharmaceutical services are already located within this neighbourhood and offer all NHS contract services together with several private services. None of these pharmacies are operating at full capacity and several, including, our own, offer a delivery service to Milton of Leys and, indeed, across the City. In the short time that we have been trading, we have also found that patients from all areas of Inverness, including that discussed today, are accessing our services.
Significant investment on our part has added to the range of services available in Inverness and our presence as we continue to grow will ensure that capacity is not an issue at other pharmacies within the neighbourhood. I can confirm that we at Lochardil Pharmacy offer all aspects of the Scottish pharmacy contract, as well as every private service mentioned, travel and flu vaccine clinics, including the services provided by that of a pharmacist independent prescriber.
On examining the proposed neighbourhood we find that the information available from Scottish Neighbourhood Statistics for the housing data zone reveals a great deal about the population in this area and their likely need for pharmaceutical services.
The area is strikingly affluent, with just over 95% of houses privately owned and a mere 1% social rented housing. Almost half of the house (46.85%) is in the top Council tax range of F-H whilst less than half of one percent (0.29%) is in the lowest, band A.
The area is rated as being the least deprived category possible for employment and housing. It is also categorised in the top 30% nationally for education, skills and training.
As this would suggest, employment levels are high. Almost all of the employed adults will travel outwith the suggested neighbourhood to work as there are very few sources of employment within the area. Unusually, the percentage of adults claiming job seekers allowance and aged 25-49 years of age is zero. This is matched by the percentage of women smoking at maternity booking – also zero.
The profile of the population is also very youthful and healthy with a proportion of residents of pensionable age 30% lower than the local authority average and not only low rates of smoking but a rate of emergency hospital admissions 18% below local authority average. The area is defined as being the least deprived 20% of the Scottish population for health.
The physical environment is also not nearly as daunting or isolated as has been repeatedly suggested. This might be expected given that residents travel outwith the area for employment, secondary school and almost all services on a daily basis. The recent ongoing development of pathways and parkland will be a great amenity and will act to connect this healthy population more fully with bordering areas of the City. Also, the Scottish Neighbourhood Statistics data lists the drive time to GP services and supermarkets at less than 4 minutes and the public transport times to post office and shopping facilities at less than 20 minutes with that to GP services at less than 15 minutes. As recent addition of bus services to the area have show, the availability of public transport in the area is growing along with the population.
Apple Pharmacy Group Milton of Leys _ PPC 8 October 2013 NOTES.doc P15 We note that the obvious conviction and feeling in some of the supportive letters submitted during the consultation process but note also that more than one of these comes from outwith the neighbourhood as defined by the applicant. Additionally, these make a number of points which are not supported, in fact, for example the assertions that:-
“…..no pharmacy in Inverness is currently providing all services that they are supposed to be….”;
and that compliance aids are only available from a single pharmacy miles from Inverness are clearly erroneous. It has been well documented that residents in Milton of Leys have been frustrated with the slow pace of development in the area. Several have gone on record to state they were led to expect the rapid development of a wide range of amenities in the area which have been slow to materialise. This feeling has obviously been communicated to their representatives, several of whom have, in turn supported this application. In so doing, they are legitimately looking to address their constituents grievance and concerns but with a proposed solution that is wholly inappropriate to the issue.
Further, the treatment of previous applications in the press has leant a perhaps unhelpful element of the political and the emotive to people’s opinions on this matter. That some opinions on the granting of this pharmacy is not based on what is normally considered as central to the question is well illustrated by these letters. They make reference to “major disappointment” and to a pharmacy in the area providing a “fulcrum” or a “catalyst” for the area’s development but neglect to provide a strong and cohesive case for it provide a necessary or desirable pharmaceutical service to the area. Recent reports suggest that a store will open within the area satisfying this desire for a focal point for retail development much more appropriately than a pharmacy would or could. It is regrettable no survey has been conducted or available.
The Area Pharmaceutical Committee has made their views clear and is unequivocal on the questions of access and capacity at the existing pharmacies. They make the point that there has been no convincing demonstration of inadequacy of service. The case for this is built on convenience, not necessity.
Previous NHS Highland Pharmaceutical Care Services Plans have made mention of areas, chiefly remote and rural, that may benefit from an increase in pharmaceutical services but does not identify Milton of Leys as being one of these. Indeed the addition of such services to the area to serve a population with such a high level of affluence and mobility and an unusually low level of healthcare need would be extremely difficult to justify.
Taking all of this into account, we feel that the granting of this application is demonstrably neither necessary nor desirable.
Thank you”.
The Chair thanked Mr Higgins for his statement and invited the Applicant, Interested Parties and then members of the Committee to ask questions of him.
10.1 Questions from the Applicant to Mr J Higgins, Lochardil Pharmacy
Q. Can you advise how any Milton of Leys resident would access your pharmacy using public transport?
A. It is accessible by two buses which run hourly.
Apple Pharmacy Group Milton of Leys _ PPC 8 October 2013 NOTES.doc P16 Q. Would you not agree this is inadequate? I am trying to establish how they would access services from your pharmacy.
A. In the absence of a car there are other means of transport, for example, taxi, as well as bus, a lift from a neighbour, walk or cycling.
Q. Would you agree public transport is inadequate from Milton of Leys to your pharmacy?
A. No. I would advise using one of the other methods mentioned, if public transport was unsuitable.
Q. How many Milton of Leys patients do you have?
A. I am unable to fully answer this as we have only been open 3 months, however, we do have patients from Milton of Leys accessing services at our pharmacy on a regular, if not, daily basis.
Q. What has changed your perception of services offered from Rowlands since you pharmacy opened?
A. One of the previous issues was development of services and how pharmacies could serve Milton of Leys, but since the opening of our pharmacy this has been answered.
Q. Did you know that Rowlands at Culloden and Balloan Park could not help elderly patients?
A. No, I wasn’t aware.
Q. Do you agree Rowlands are struggling with demand placed on them?
A. Perhaps they were one day in the past, but I don’t think so now. Can I just clarify that 95% of housing in Milton of Leys is privately owned.
Q. Would you not agree that 25% of new developments are to include affordable housing so that those on lower income can afford them?
A. I would agree that in major developments this is the case, however, in practice they are at liberty to build and then satisfy the 25% in other areas with higher density properties. Even if 25% of new builds were built at the Milton of Leys development from now on, the proportion will never approach 25%.
10.2 Questions from Mr M Church, Rowlands Pharmacy to Mr J Higgins, Lochardil Pharmacy
Mr Church had no questions for Mr Higgins.
10.3 Questions from Ms K Cowle, Boots UK Limited to Mr J Higgins, Lochardil Pharmacy
Ms Cowle had no questions for Mr Higgins.
Apple Pharmacy Group Milton of Leys _ PPC 8 October 2013 NOTES.doc P17 10.4 Questions from the Committee to Mr J Higgins, Lochardil Pharmacy
Andrew Paterson, APC Contractor Pharmacist
Q. There has been much talk of pharmacy being at capacity. How would you define this and is there a trigger point reached where it can be identified that a second pharmacist is required?
A. We always evaluate the service we are providing in terms of staffing and already have a second pharmacist on certain days to enable Gayle (Mrs MacDonald) to carry out a prescribing clinic and flu and travel vaccine clinics. We have an ACT (accredited checking technician) and also a Technician in training. Ongoing training is part of what we do. We have designed and built the pharmacy with future requirements in mind. For now it is a massive overinvestment but we have done this for needs anticipated in the future.
11.0 The Interested Parties’ Case – Tesco Stores Limited (read by Mrs Helen MacDonald, NHS Highland Community Pharmacy Business Manager)
Mrs H MacDonald read out, in the absence of a representative from Tesco Stores Limited, their statement advising that she would be unable to take or answer questions on behalf of Tesco Stores Limited in doing so.
Mrs MacDonald read as follows:-
“Thank you for inviting us to the hearing on the 8th October, 2013. Unfortunately, we will be unable to attend but would like to provide a written submission for the Pharmacy Practices Committee to consider.
We do not feel a pharmacy at Milton of Leys is necessary.
Our Tesco Pharmacy at Inshes
We would like to take the opportunity to tell you about our Tesco Pharmacy, the range of services it offers and the excellent pharmaceutical service it offers patients and the public.
We offer all contractual services – CMS, eMAS (including all local PGDs), Unscheduled Care, EHC, NRT, supervised methadone and dosette dispensing. In addition to this we also provide our own private services; health checks (which include blood pressure, cholesterol, diabetes and body mass index), holiday health service, erectile dysfunction service, flu vaccination, Mama TENs rental and prescription collection and delivery service.
We are open seven days a week, Monday to Saturday 8am to 8pm and Sunday 10 am to 4pm, offering pharmaceutical services. Patients have access to all services during our opening hours.
Why we feel the proposed pharmacy is unnecessary?
Previous hearings for this application have come to the decision that it is neither necessary nor desirable to secure adequate pharmaceutical services and since these decisions have been made, it would be our opinion that access to pharmaceutical services has only improved to patients, including the community, residing in Milton of Leys. The reason for this being based on a number of developments
Firstly, the new pharmacy at Lochardil, opened early this summer, has meant both Rowlands at Dows and Tesco have shared the original catchment of patients with the new pharmacy and this has had the impact of patient levels falling and opening up the opportunity for growth and easier access to pharmaceutical services for patients in Milton of Leys.
Apple Pharmacy Group Milton of Leys _ PPC 8 October 2013 NOTES.doc P18 Secondly, at Tesco, we have invested in staffing hours allowing more staff to be available for our patients thereby providing a more efficient service and offering a wider range of services throughout our opening hours.
Third, the investment in the pharmacy is continuing, wiring has already been fitted for a third computer system to be installed. This again, will improve the service we offer our patients.
Finally, we offer a delivery service across Inverness, which has been in place since the end of 2012. Delivery services are also offered by many of the Boots, Rowlands and the new Lochardil Pharmacy and by some of the new pharmacies outwith Inverness, including Great Glen Pharmacy (in Drumnadrochit) all of which deliver to residents in Milton of Leys.
Since these improvements have been in place, we have had feedback from patients that they are very happy with the service they receive.
It was noted in the October, 2011 hearing that residents within Milton of Leys had expected significant development of a range of services including retail and fast food outlets when the development was being built but these developments have failed to materialise.
In light of the above, we do not see that there are any gaps in the current level of pharmaceutical service provision in Inverness. Furthermore, there are no physical barriers that prevent the public from accessing the existing doctor surgeries and the pharmacies in Inverness.
We believe the proposed pharmacy is not necessary and invite the Committee to view likewise”.
The Chair thanked Mrs MacDonald for reading the statement on behalf of and in the absence of a representative of Tesco Stores Limited and although they acknowledged she would be unable to be questioned on behalf of Tesco Stores Limited, invited the Applicant, Interested Parties and members of the Committee to make comment on the statement read.
There were no comments made.
12. The Interested Parties’ Case – Area Pharmaceutical Committee (read by Mrs Helen MacDonald, NHS Highland Community Pharmacy Business Manager)
Mrs H MacDonald read out, in the absence of a representative from the Area Pharmaceutical Committee (APC), their statement advising that she would be unable to take or answer questions on behalf of the Area Pharmaceutical Committee in doing so.
Mrs MacDonald read as follows:-
“…The APC accept the neighbourhood defined by the applicant. The boundaries are made up of major roads and a wood to the South. There is local access to daily amenities including a primary school and a local convenience store is in the process of being built.
The APC considers the application not necessary to secure adequacy. Firstly, on the basis that we do not believe the applicant has provided evidence that the current core pharmaceutical services are inadequate or would become so. Secondly, there are three pharmacies that sit just outside the applicant’s defined neighbourhood – Tesco Inshes, Rowlands Balloan Road and the pharmacy about to open at Lochardil (Mrs MacDonald advised the Committee that the pharmacy had, in fact been open since 24 June, 2013).
Apple Pharmacy Group Milton of Leys _ PPC 8 October 2013 NOTES.doc P19 Although APC acknowledge they are not ideally located for the residents within the applicant’s neighbourhood, delivery services offered by these pharmacies would cover the neighbourhood adequately. In addition to this, the APC have contacted Stagecoach (bus operator) and have been informed that the service has been actually improved in the last year and buses now run to Balloan Road, from within the neighbourhood defined in the application, approximately every 20 minutes during the daytime. Thirdly, APC believe none of the pharmacies adjacent to the neighbourhood have shown signs of being at maximum capacity.
The APC considers the application not desirable to secure adequacy. APC does not believe the applicant provided evidence to convince them the application was desirable to secure adequacy.
With the above points in mind, The Area Pharmaceutical Committee’s professional advice is the application is neither necessary nor desirable to secure pharmaceutical adequacy…”
The Chair thanked Mrs MacDonald for reading the statement on behalf of and in the absence of a representative of the Area Pharmaceutical Committee and although they acknowledged she would be unable to be questioned on behalf of the Area Pharmaceutical Committee invited the Applicant, Interested Parties and members of the Committee to make comment on the statement read.
There were no comments made.
13. Summing up
The Applicant and Interested Parties were then given the opportunity to sum up.
13.1 There was no summary statement received from the Area Pharmaceutical Committee to read.
13.2 There was no summary statement received from Tesco Stores Limited to read.
13.3 Mr J Higgins, Lochardil Pharmacy stated “thank you again for the opportunity to present our case to you today. To summarise, we feel that this application does not pass the legal test having failed to demonstrate inadequacy of current service within the neighbourhood as the applicant has chosen to define it”.
13.4 Ms K Cowle, Boots UK Limited stated “thanks for inviting me to speak today. The application is neither necessary nor desirable as inadequacy has been failed to be demonstrated therefore, the application should be refused.
13.5 Mr M Church, Rowlands Pharmacy stated “it is easy to get to Balloan Park by car and public transport and this pharmacy offers a full range of services and has no issues with capacity. Residents at Milton of Leys are able to easily access services and therefore the granting of this contract is neither necessary nor desirable.
13.6 Ms D McTaggart of Apple Pharmacy Group stated “I believe this application is necessary and desirable and it is nugatory that the interested parties were unable to define the neighbourhood. Delivery services and car ownership does nothing to demonstrate inadequacy of services. Rowlands did have problems in service delivery in May and this application had previously been approved prior to the existence of the school and convenience store by NHS Highland.
Therefore, it is necessary and desirable and I would therefore ask the committee to grant the application”.
Apple Pharmacy Group Milton of Leys _ PPC 8 October 2013 NOTES.doc P20 14. Private deliberations of the Committee
At the conclusion of the summing up, around 2.30pm, the Chair asked the Applicant, all of the interested parties, observers and Board officials if they would exit the hearing and take a seat in the waiting areas allocated and such time as they had concluded their private deliberations when they would be called back in to the meeting for a point of clarification or advised they were free to leave.
All parties were agreeable and Messrs. Wilson, Scott, Church, Higgins, Green, Galbraith and the Misses McTaggart, Cowle, MacDonald, MacDonald, Beauchamp and McKee departed to the waiting areas as requested.
The meeting then became closed with only members of the Pharmacy Practices Committee remaining.
15. Point of Clarification
At around 3.15pm all parties, including Messrs. Wilson, Scott, Church, Higgins, Green, Galbraith and the Misses McTaggart, Cowle, MacDonald, MacDonald, Beauchamp and McKee were requested to return to the meeting to enable clarification on a point to be raised and discussed openly.
The point was that, in the advert submitted to the Inverness Courier during the consultation period, prior to submission of the application to the Health Board contained opening hours which differed to that contained in the application.
The Committee sought advice from Mr Andrew Green, Area Regulations, Contracts & Controlled Drugs Governance Pharmacist.
Mr Green advised that it was the application which was the legal document as the subject for consideration today and that the opening hours therein were synonymous with those required under the terms of the NHS Highland Board Scheme.
Mr Green checked the Regulations and advised that under The National Health Service (Pharmaceutical Services) (Scotland) Regulations 2009, as amended in 2011, under paragraph 5 – Pharmaceutical List 2(a) it was advised that
the consultation must – (a) be for the purpose of assessing whether the neighbourhood to which the application relates has adequate provision, by persons on the pharmaceutical list, of some or all of the pharmaceutical services that the applicant intends to provide; (b) be completed with the period of 20 working days immediately prior to the making of the application;
(c) be advertised- …………(ii) ……..through publication in a newspaper circulating in the neighbourhood in which the applicant intends to provide services; (d) be for a continuous period of not less than 20 working days from the date of advertisement……..”.
Although it was acknowledged there was a difference between the opening hours on the advertisement and application, process under Regulation had, in fact, been adhered to as referred to above.
Apple Pharmacy Group Milton of Leys _ PPC 8 October 2013 NOTES.doc P21 Mr Green went on to advise that under paragraph 5, (2C) (g) of the Regulations referred to above in terms of Form A this must contain “…the hours in each day that the applicant intends to provide such services” which the applicant had done in making his submission.
As a result, Mr Green advised that if the application was granted, this would be on the basis of hours of business from 9am to 5.30pm Monday to Friday and 9am to 1pm on Saturdays as contained in the application, however, the applicant’s representative, Ms McTaggart had already stated that they wished to open for the hours stated in the advertisement, which they would be able to apply to extend by making an application to the Health Board at the appropriate point in time.
The Chair asked all parties present if they were happy that the point had been satisfactorily clarified to which they all replied yes (meaning that they did consider the point had been clarified to their satisfaction).
At this point the Chair asked the Applicant and all of the interested parties if they considered that they had had a fair hearing. Messrs. Wilson, Scott, Church, Higgins, and the Misses McTaggart, Cowle and MacDonald replied yes (meaning that they did consider they had had a fair hearing).
The Chair advised a written decision would be sent out within 15 working days. A letter would be included with the decision advising of the appeal process. The Chair then thanked the parties for attending.
Messrs. Wilson, Scott, Church, Higgins, Green, Galbraith and the Misses McTaggart, Cowle, MacDonald, MacDonald, Beauchamp and McKee left the meeting to enable the Committee to make their decision in private.
16. DECISION The Committee having considered the evidence presented to it, and their observations from the site visit, firstly had to decide the question of the neighbourhood in which the premises to which the application related, were located.
They considered the different neighbourhoods proposed by the Applicant, the Interested Parties and the Area Pharmaceutical Committee in relation to the application, as well as comments received during the public consultation.
The Committee took into account a number of factors in defining the neighbourhood including who resides there, neighbourhood statistics, the natural and man-made boundaries, the presence or otherwise of schools, shops, health services, land use and topography, and the distances over which and by how residents are required to travel to access existing pharmaceutical and other services.
The Committee also took into consideration its obligations in terms of the Equality Act 2010:
• the need to eliminate unlawful discrimination, harassment and victimisation and other conduct prohibited by the Act; • advance equality of opportunity between people who share a protected characteristic and those who do not; • foster good relations between people who share a protected characteristics and those who do not
Apple Pharmacy Group Milton of Leys _ PPC 8 October 2013 NOTES.doc P22 16.1 Neighbourhood: the Committee felt that although the neighbourhood as defined did lack some of the features that a neighbourhood might be expected to have such as churches or a post office it was considered that Milton of Leys was a distinct neighbourhood in its own right and disagreed with Tesco, Boots and Lochardil Pharmacy who recognised the neighbourhood as being broader than that.
The Committee considered and unanimously agreed with the Applicant and the Area Pharmaceutical Committee that the neighbourhood should be defined as follows:
North: From the General Wade’s Military Road on the west where the old farm road to Park’s Farm leaves the Wade Road in a straight line up to where the B9177 runs parallel to the A9 on the east. The Committee considered that this was a logical divide between the residents of Milton of Leys and those of Inshes who have different primary schools and residents associations and would not consider themselves to live in the same neighbourhood.
East: The A9 trunk road which acts as a man-made barrier for the length of the neighbourhood from where the B9177 runs parallel to the east of the A9 to Bogbain Wood to the west of the A9 thus separating the neighbourhood from the areas of Castlehill and Cradlehall to the East.
South: The area of natural woodland known as Bogbain Wood between General Wade’s Military Road to the west and the A9 trunk road to the east with the forest of Drummossie Muir and the countryside beyond resulting in a physical boundary which also marks the southern tip of the neighbourhood.
West: The General Wade’s Military Road from the old farm road to Park’s Farm to the south of Redwood Court at Bogbain Wood on the West up to where the B9177 passes under the A9 on the east. There is no road access to the extensive housing to the West of this road so this is a logical boundary between the neighbourhood and the Slackbuie developments. Also the residents of Slackbuie would not consider themselves to be neighbours of those resident in Milton of Leys.
16.2 Adequacy of Existing Provision of Pharmaceutical Services and Necessity or Desirability: having reached that decision, the Committee was then required having made reference to the Pharmaceutical Care Services Plan to consider the adequacy of pharmaceutical services within that neighbourhood, and whether the granting of the application was necessary or desirable to secure adequate provision of pharmaceutical services in that neighbourhood.
The Committee noted that within the neighbourhood as defined there are no community pharmacies. However there are two pharmacies within the adjacent neighbourhoods and there is now also another new pharmacy in Lochardil. The Committee were provided with data that shows that almost 50% of prescriptions for residents with a postcode from within the neighbourhood have had a prescription dispensed at Tesco at Inshes and over 35% from Rowlands in Balloan Park during the financial year 2012/13. There are also a number of other pharmacies within the city that are accessed by residents of this neighbourhood and the percentage of residents in excess of 10% who have had at least one prescription dispensed by these pharmacies is as follows: Boots, Eastfield Way 15%, Boots, Eastgate 14% & Rowlands, Culloden 13%. These pharmacies provide a comprehensive range of pharmaceutical services including NHS core and locally negotiated services and thus the Committee had to consider whether or not the neighbourhood as defined was receiving an adequate pharmaceutical service, bearing in mind that residents can choose to access any of the pharmacies throughout Inverness.
Apple Pharmacy Group Milton of Leys _ PPC 8 October 2013 NOTES.doc P23 The Committee also noted that the neighbourhood has a large primary school which opened in August 2011. The most recent data from May 2013 indicates that this school had a roll of 190 pupils in primaries 1 to 7 and 63 pupils in nursery and the school has a wider use after school hours with a multi-use games arena and an outdoor artificial sports pitch. In addition there is a community dance studio available for local and wider community use. There are also play parks, paths, walkways, recycling points and post boxes.
In addition, in considering developments which would change the pattern of local social traffic and access to services they noted that the Co-operative is opening a large convenience store (3,500 sq.ft) in November, 2013 which is to include banking facilities at the new district centre, in the retail unit next door to where the proposed pharmacy would be sited. There are another three units currently under construction one of which will be occupied by the proposed pharmacy if the application is successful, and another two which are currently designated as fast food outlets.
It is significant that the Co-operative are building a large new store within the neighbourhood in addition to an additional new store near to Inshes Primary School which would indicate that their market research has highlighted a population which is lacking services.
The Committee in considering the existing population and future housing developments took note of a master plan prepared by Graham and Sibbald, Chartered Surveyors. This plan was prepared for the Co-operative and was undertaken to demonstrate to them that there was sufficient demand and volume of houses to support their new store. Clearly the Committee cannot gauge demand for the convenience store but this plan does note as detailed by the applicant that there have been 820 homes built within the neighbourhood and a further 52 homes under construction. In addition there are 206 homes due to be commenced before the end of 2013 and there are plans for a further 362 homes thereafter.
They also considered the construction of the Homes for Heroes and it was felt that these ex- forces personnel would have increasing medical needs who would require to draw on medical services at short notice and it was felt that their pharmaceutical needs would not be met by pharmacies some miles away and without good transport links. This was a group who would need to be catered for locally.
With regard to travel patterns it was accepted that most residents would need to leave the neighbourhood to go to work and to access their GP. However it was felt that if these people were to need pharmaceutical services they would be likely to access them nearest to their home.
The primary school is approaching 300 pupils and the numbers are going to increase as more families with children move into the new houses which are currently under construction or planned for the future. The Committee are of the opinion that these children needed to be able to access pharmaceutical services locally – for instance it isn’t acceptable for a mother to have to travel out of the neighbourhood to access the minor ailment service after school, it should be available within the neighbourhood, not after a car or awkward bus journey to another neighbourhood.
They also felt that public transport was not good enough, nor frequent enough to access current pharmaceutical services. Tesco at Inshes is the nearest pharmacy but it involves a complex journey by car or a 40 minute walk. Rowlands Pharmacy at Balloan Park is even further away and parking can be difficult.
Apple Pharmacy Group Milton of Leys _ PPC 8 October 2013 NOTES.doc P24 With regard to disabled patients it is very difficult to park near the front of the Tesco store and then there is a long and awkward walk to the very rear of the store. On reaching the pharmacy the Committee noted on their visit to the pharmacy that it is difficult to be noticed and indeed the pharmacy staff within the dispensing area cannot see who is waiting at the pharmacy counter. They also noted that there are only two seats for patients who need to wait for advice or their prescription and there is a distinct lack of privacy. This observation was backed by numerous letters which highlight these points.
It was noted that a fairly large number of residents within a Milton of Leys postcode have accessed the two pharmacies in the adjacent areas Tesco, 50% and Rowlands, 35% but they have had no choice but to go out of their neighbourhood. This does not mean that the service that they are receiving is adequate.
There are no pharmaceutical services in the neighbourhood as defined and they considered that, from the latest data on prescriptions dispensed, the existing pharmacies within a reasonable travelling distance are at “fairly full stretch” and there is a large and growing population that has no pharmaceutical services within the neighbourhood. There has been a huge increase in the number of people living in this area since the last application. In addition the development plans include a care home within the neighbourhood adjacent to the district centre.
This application has received a lot of support from members of the public who have written to the applicant and the Health Board highlighting the difficulties they have accessing pharmaceutical services and all supporting the application. This message has been reinforced by strong support from Inverness South and Westhill Community Councils, Culloden Youth Forum and the Milton of Leys Residents Association. In addition supportive letters have been received from four Highland Councillors, one of whom is also the Armed Forces and Veterans Champion. These letters have raised the lack of pharmacy provision and mention the large increases in the local population and affordable housing. One letter mentions the fact that pharmacies do not just provide a dispensing service and that a delivery service although welcome does not meet all of the residents pharmaceutical needs as there should be other services available too. In addition a letter was received from Mary Scanlon MSP who pointed out that the population in Milton of Leys is ever increasing and because the nearest existing pharmacies are outwith a reasonable walking distance then a local pharmacy is needed since not everyone has a car, taxis are expensive and public transport is inadequate especially for the sick and infirm.
The Committee noted their surprise that Rowlands Pharmacy in expressing their interest had not thought to revise their comments since the last application since the population had grown considerably since then and they also disagreed that there had been no demonstration of inadequacy. They also disagreed with Tesco’s comment that there are no physical barriers preventing people accessing other pharmacies.
With regard to the response from the Area Pharmaceutical Committee (APC) although the Committee agreed with their definition of the neighbourhood they did not feel that the APC had realistically assessed the increased population in the neighbourhood neither had they properly considered future need due to the other proposed developments in this area. Considering the Equality Act it was felt that they had not fully considered the difficulty of pharmaceutical access for children, the elderly or the disabled.
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