1 September 2020 Arena Point Merrion Way Leeds LS2 8PA REF: SHA/23372 Tel: 0203 928 2000 APPEAL AGAINST NHS COMMISSIONING BOARD - Fax: 0207 821 0029 NHS ENGLAND & NHS IMPROVEMENT EAST OF Email: [email protected] ENGLAND ("NHSE&I") DECISION TO REFUSE AN APPLICATION BY KALKI HEALTH LTD, FOR INCLUSION IN THE PHARMACEUTICAL LIST OFFERING UNFORESEEN BENEFITS UNDER REGULATION 18 AT BEDFORD ROAD, BETWEEN WATSON ROAD AND FALCON FIELD, WIXAMS 1 Outcome 1.1 The Pharmacy Appeals Committee (“Committee”), appointed by NHS Resolution, quashes the decision of NHSE&I and redetermines the application. 1.2 The Committee determined that the application should be refused. NHS Resolution is the operating name of NHS Litigation Authority – we were established in 1995 as a Special Health Authority and are a not-for-profit part of the NHS. Our purpose is to provide expertise to the NHS on resolving concerns fairly, share learning for improvement and preserve resources for patient care. To find out how we use personal information, please read our privacy statement at https://resolution.nhs.uk/privacy-cookies/primary-care- appeals/ Arena Point 1 September 2020 Merrion Way Leeds REF: SHA/23372 LS2 8PA Tel: 0203 928 2000 APPEAL AGAINST NHS COMMISSIONING BOARD - Fax: 0207 821 0029 NHS ENGLAND & NHS IMPROVEMENT EAST OF Email: [email protected] ENGLAND ("NHSE&I") DECISION TO REFUSE AN APPLICATION BY KALKI HEALTH LTD, FOR INCLUSION IN THE PHARMACEUTICAL LIST OFFERING UNFORESEEN BENEFITS UNDER REGULATION 18 AT BEDFORD ROAD, BETWEEN WATSON ROAD AND FALCON FIELD, WIXAMS 1 The Application By application dated 19 July 2019, Kalki Health Ltd (“the Applicant”) applied to NHS Commissioning Board – NHS England & NHS Improvement East of England (“NHSE&I”) for inclusion in the pharmaceutical list offering unforeseen benefits under Regulation 18 at Bedford Road, between Watson Road and Falcon Field, Wixams (map provided). In support of the application it was stated: 1.1 In response to Part 5 of the application form (reference to Regulation 31) the Applicant stated: “There is no pharmacy in the same or adjacent premises to the proposed site.” Background 1.2 The location of the proposed new pharmacy is the major development near Bedford called Wixams. The Applicant intends to provide all commissioned services and will ensure that all pharmacists employed are accredited to provide these services. The premises will also be accredited. 1.3 Wixams new settlement is 3 miles (5km) south of Bedford and covers an area of approximately 384 hectares. Based upon the site of the former Elstow Storage Depot, it will eventually establish a community of around 10,000 people with potential to expand to around 15,000. It will represent the single largest development in the county and straddles the border between Bedford Borough and central Bedfordshire. 1.4 Wixams will include a town centre and several “villages” with 4,500 homes, 25% of which will be affordable homes, employment land, schools, shops and recreational spaces such as sports pitches, allotments and community buildings. The street design will prioritise safety and facilitate ease of movement using public transport, cycles and walking. PNA 1.5 Although the PNA mentions the Wixam southern extension, the PNA states “The additional pharmaceutical needs will have to be assessed with actual increase in population.” The PNA therefore has not made a statement as to a need to be provided to meet a current need for pharmaceutical services or a statement of services which would secure improvements or better access in the area and therefore the application falls to be considered under Regulation 18. When considering whether this application secures improvements or better access to pharmaceutical services, the Applicant is aware that NHSE&I has to have regard to the matter set out in Regulation 18(2)(b) and the Applicant deals with these criteria below. 1 1.6 Choice - “There being a reasonable choice with regard to obtaining pharmaceutical services in the area of the relevant HWB.” 1.7 The nearest pharmacy is 0.9 miles away, Wilstead Pharmacy, and is only open on Mondays to Fridays from 9am to 6pm and is closed on Saturday and Sunday. The Applicant’s pharmacy will be open on Saturday and Sunday. Boots Pharmacy is 1.6 miles away at Interchange Retail Park and Berkley Pharmacy is 1.9 miles away. The walking distance to the nearest pharmacy is approximately 17 minutes across the A6. The lack of any sort of healthcare provision in this developing settlement is surprising as there is already a self-contained community at the Wixams development. The current population is approximately 2,617 people. There is a primary school, secondary school, a Budgens supermarket and a fish and chip shop. There is also a community centre, a garden centre and there will shortly be a train station. The residents’ everyday requirements therefore can be satisfied within the Wixams development. There is therefore a current high need for a pharmacy to offer the population accessible pharmaceutical services and importantly, where there is no surgery, healthcare advice. 1.8 The Wixams Master plan shows that the developers plan to build a health facility with space for 4 GP’s in the town centre. There is significant pressure from the community for a new medical centre and once this is built there will be a need for support of the health centre with pharmaceutical services, in particular dispensing acute prescriptions issued by the surgery. 1.9 In summary, it is clear there is no reasonable choice for the residents for Wixams in relation to the provision of pharmaceutical services. 1.10 Services – “People who share a protected characteristic having access to services that meet specific needs for pharmaceutical services that, in the area of the HWB, are difficult for them to access, …..” 1.11 The Applicant will be providing services for the new residents of the development, particularly those who have difficulty accessing other pharmacies in other areas such as the elderly, infirm, disabled or parents of young children. There is a particularly high need for services in the following areas:- Pharmaceutical services for children 1.11.1 There are already three schools in the Wixams area; 1.11.2 Lakeview School (Primary) - 444 pupils on their roll; 1.11.3 Wixams Academy (Secondary) - pupil numbers for the year 2017/2018 are 112 . The school opened in September 2017 and they admit a new year 7 group each September. Accordingly, the number of pupils is likely to increase by 112 every year until the first intake reach the second year of sixth form; 1.11.4 Wixams Tree Primary School - as at 8 March 2019, they had 48 pupils. The school capacity is 420. Pharmaceutical services to the elderly 1.11.5 There will be a high demand for pharmaceutical services for the elderly; 1.11.6 There is a newly opened retirement village in Wixams which contains 230 homes; 1.11.7 A planning application was submitted in November 2018 to build an 80 bedroom care home in Wixams. 2 1.12 In addition, the developers have covenanted to provide 25% affordable housing in the new development and the connection between low income and ill health, and therefore need for pharmaceutical services, is well known. 1.13 As can be seen from Part 4 of the application, the Pharmacy will provide all essential services, advanced and enhanced services commissioned by the HWB. 1.14 The Pharmacy would also offer a number of free services which would include home delivery, blister pack medication, blood pressure screening, diabetes type II screening, BMI checks, as well as the more usual services that make up the package of essential services. Many of these free services would assist patients with protected characteristics and they are not currently accessible for these people. The commissioned services the Pharmacy would hope to provide would be: 1.14.1 Advanced services: 1.14.1.1 Medicines use review; 1.14.1.2 New medicine service; 1.14.1.3 NUMSAS; 1.14.1.4 Seasonal flu vaccination. 1.14.2 Enhanced services: 1.14.2.1 Minor ailments scheme; 1.14.2.2 Emergency hormonal contraception; 1.14.2.3 Palliative care; 1.14.2.4 Smoking cessation; 1.14.2.5 Supervised methadone; 1.14.2.6 Chlamydia screening; 1.14.2.7 Chlamydia treatment. 1.15 Flu vaccines could be provided at home which would make the service more accessible for patients who are unable to leave their homes and are vulnerable. Vaccination will also be offered as a walk in service. 1.16 The Pharmacy would also aim to become a health living pharmacy: it is noted that the PNA recommends that more pharmacy contractors work towards achieving health living pharmacy status. As well as proactively offering a medicines use review service, the Pharmacy would offer advisory support for carers to enable them to administer medicines. As the pharmacy is open on weekends, it will be able to offer NUMSAS as an advanced service. The pharmacy will deal with referrals from NHS111 and consequently reduce hospital visits for emergency medication. 1.17 The pharmacy would offer free delivery. 1.18 Bedfordshire-wide health concerns include targeting groups at risk of high levels of smoking. The Pharmacy would provide a stop smoking service. Alcohol dependence is also an area of concern for Bedford Council. The pharmacy would support, provide alcohol intervention and signpost patients where necessary. 3 1.19 The Pharmacy would be close to the wards in Bedford identified as teenage pregnancy hotspots and would want to provide EHC and support other sexual health services as they emerge. 1.20 The Pharmacy would be willing to provide a needle exchange service – presently only two pharmacies in the Bedford area do so.