PHARMACY PRACTICES COMMITTEE MEETING Tuesday, 29 January, 2013 at 11.30am James Cameron Community Centre, Limetree Avenue, Inverness, IV3 5RH Application by CONON BRIDGE PHARMACY LIMITED for the provision of general pharmaceutical services at 30 Laurel Avenue, Dalneigh, Inverness, IV3 5RP
PRESENT Bill Brackenridge(Chair) Maureen Thomson (Lay Member) Margaret Thomson (Lay Member) Michael Roberts (Lay member) Alison MacRobbie (APC Non Contractor Nominate) Gareth Dixon ( APC Contractor Nominate) Nicola MacDonald (APC Contractor Nominate)
In Attendance Andrew J Green (Area Regulations, Contracts & Controlled Drugs Governance Pharmacist) Helen M MacDonald (Community Pharmacy Business Manager) Aileen Trappitt (Community Pharmacy Administration Assistant) Alan Horsburgh, Conon Bridge Pharmacy Limited, Applicant Alasdair Shearer, Rowlands Pharmacy Janice Robertson, Rowlands Pharmacy Support Tom Arnott, Lloydspharmacy Stuart Finnie, Lloydspharmacy Support John Ross, Kinmylies Pharmacy Carmen Harrold, Kinmylies Pharmacy Support
Apologies Area Pharmaceutical Committee of NHS Highland
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 – Dalneigh, Inverness Conon Bridge Pharmacy Limited, 30 Laurel Avenue, Dalneigh, Inverness, IV3 5RP
The Chair asked each Committee member if there were any interests to declare in relation to the application being heard from Conon Bridge Pharmacy Limited. No interests were declared.
3. The Committee was asked to consider the application submitted by Conon Bridge Pharmacy Limited to provide general pharmaceutical services from premises sited at 30 Laurel Avenue, Dalneigh, Inverness, IV3 5RP under Regulation 5(10) of the National Health Service (Pharmaceutical Services) (Scotland) Regulations 2009, as amended.
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 Conon Bridge Pharmacy Limited, agreed that the application should be considered by oral hearing.
Conon Bridge Pharmacy Limited Dalneigh _ PPC 29 January 2013 NOTES.doc P1 Prior to the hearing, the Committee had, as a group, visited the vicinity surrounding the Applicant’s proposed premises, the existing pharmacies at Lloyds, Greig Street, Lloyds, Riverside, Ballifeary Lane, Rowlands, Grant Street and Kinmylies Pharmacy, Charleston Court, all in Inverness and facilities in the immediate area and surrounding areas of Dalneigh, Kinmylies, Merkinch, Park and Ballifeary where there was much social housing, four supermarkets, many small grocers shops, seven primary schools, two secondary schools, three GP surgeries, private and NHS dental practices, residential nursing homes, Scout Inverness District Hall, charitable support organisations, community halls, including the one where the hearing took place, The Highland Council Social Work and Children Resource Centre and churches were pointed out. They were then driven around the boundaries of the neighbourhood as defined by the Applicant and throughout the residential area, noting new housing being built on the green area between St Valery Avenue and the canal and many walkways and footpaths were also highlighted.
The Committee then visited the proposed premises where the Applicant was on hand with a sketch of his proposed plans and to guide the Committee around the premises.
The Committee then returned to the James Cameron Community Centre, Limetree Avenue, Inverness, IV3 5RH 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.”
The Applicant, Support and Interested parties were invited into the meeting at around 11.45am
4. The Chair welcomed:-
The Applicant, Conon Bridge Pharmacy Limited represented by Alan Horsburgh, the Interested Parties who had submitted written representations during the consultation period and who had chosen to attend the hearing, were Alasdair Shearer, Rowlands Pharmacy and Janice Robertson, Rowlands Pharmacy support, Tom Arnott, Lloydspharmacy, Stuart Finnie, Lloydspharmacy support, John Ross, Kinmylies Pharmacy and Carmen Harrold, Kinmylies Pharmacy support, (“the Interested parties”). It was noted that the Area Pharmaceutical Committee had submitted a paper for reading out at the hearing and their apologies in advance to the Health Board. The Chair then invited the Committee members to introduce themselves. Committee members introduced themselves to the Applicant and all other parties.
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 Conon Bridge Pharmacy Limited for the provision of general pharmaceutical services at 30 Laurel Avenue, Dalneigh, Inverness, IV3 5RP. 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.
Conon Bridge Pharmacy Limited Dalneigh _ PPC 29 January 2013 NOTES.doc P2 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.
The procedure adopted by the Committee at the hearing was that the Chair asked the Applicant to make his 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.
The Chair then asked the Applicant to give his statement.
7.1. The Applicant’s Case
Alan Horsburgh, Conon Bridge Pharmacy Limited stated “I am Alan Horsburgh of Conon Bridge Pharmacy Limited and I would like to start by thanking the Committee for their time and for allowing me to present my evidence in support of the application. I have lots of evidence but will try to be as concise as possible.
The application is for premises at 30 Laurel Avenue in Dalneigh and we propose to provide a full range of pharmaceutical services from 8.30 am to 6pm, Monday to Friday and 9am to 5pm on Saturdays.
I believe the area to be considered is the neighbourhood of Dalneigh in Inverness which is bounded by the canal to the west where it runs north to its meeting with Telford Street. The boundary then runs east along Telford Street and then into and along Kenneth Street to the A82. This is the eastern boundary, running south to where it crosses the canal. This neighbourhood has a population of 5,547.
This area has all the amenities one would expect of a neighbourhood such as schooling, convenience stores and a local post office.
The population of 5,547 has remained stable and has a mixture of older residents and young families which, increasingly, are eastern European immigrants with low levels of both spoken and written English. There are small pockets of development planned such as 26 homes at St Valery Avenue for the elderly and disabled.
The percentage of the population in Dalneigh on a deprived income is 22% compared to 11% for the rest of the Highland Health Board area; 9.5% for those aged 16-24 on jobseekers allowance compared to 5.7% for the rest of the Health Board area; 6.9% of those aged between 25 to 49 on jobseekers allowance compared to 3.5% for the area; for those aged 50 to pensionable age, 4.8% of the Dalneigh population are in receipt of jobseekers allowance compared to 2.1% in the rest of the Board area. The population of the community in Dalneigh who are employment deprived is 18% compared to 9% in the rest of the Health Board area; and the total on income support is 695 which is 11% of the Dalneigh population compared to 6,370 in the rest of Highland. There is 4.5% of the total Health Board population living in Dalneigh and 22.3% of these claiming pension credits compared to 13.3% in the rest of the area with 23.5% of 16-24 years of age receiving benefits compared to 13.3% elsewhere in Highland.
Conon Bridge Pharmacy Limited Dalneigh _ PPC 29 January 2013 NOTES.doc P3 Those aged 25-49 on benefits are 25.4% of the Dalneigh population compared to 13.5% in the rest of the area and those between the age of 50 and pension age receiving benefits are 33% compared to 18.5% for the rest of the Highland Health Board area – there are a lot of facts and figures here but this paints a picture of low income and employment deprivation, creating locally an area of great inequality from the rest of Inverness. This can be expressed in terms of deprivation – income and work prospects and the associated lack of transport as well as the all important impact this has on health outcomes.
This burden placed on health services is expected to increase due to the ageing population which will increase the number of households headed by 65-75 year olds by 35% and those over 75 by 106% over the next twenty years. This increase in population age is all very well in a nice leafy area of Inverness where affluence and good health go hand-in-hand but in Dalneigh with low income and already poor health outcomes the needs are greater. Already the Highland Council acknowledges this in the local plan which states…
“it is an older core neighbourhood of considerable diversity. Initiatives are needed in Dalneigh to secure diversification of housing tenure including provision for older people and those with community care needs”.
“Given the relatively high proportion of public sector/family housing…. and an increasing requirement for adjustments to the existing stock to match needs, conversion and redevelopment schemes will be encouraged…”
“we will prepare an action plan to assess the scope for traffic/public transport…or the introduction of community services”.
The 2012/13 NHS Highland Pharmaceutical Services Plan backs up this evidence of income and health deprivation. On page 3, under inequalities and deprivation, and, I’ll paraphrase
“…found that poorer people in Scotland die earlier and have higher rates of disease than better off people. The health gap between affluent and poor has increased and the evidence is that these inequalities have worsened”.
Dalneigh is actually second only to Merkinch for having the worse life expectancy, worse mortality and worse hospital admission rates in the Highland Health Board region.
This, again, is backed up by evidence, marked G & L – where we can see how many areas of deprivation are within and surround the neighbourhood. The SIMD data demonstrates, again, that most areas in and around Dalneigh are in the worst 20 in the Highlands.
We also know from Scottish National Statistics data that between 9-10% of the neighbourhood are taking medication for anxiety, depression or psychoses.
Between 35-50% of women are smoking at first pregnancy booking and smoking rates are amongst the highest in Highland. Admission rates for drug misuse 182 per 100,000 which is comparable with some inner cities, for example, Glasgow.
Staff at Osprey House confirmed this, but were unable to provide accurate figures, that there is a large demand for harm reduction services from the Dalneigh neighbourhood, that’s including needles and methadone. They also confirmed that they periodically spend time trying to get places for clients as pharmacies in the area have filled their quota or filled there required number of spaces.
Conon Bridge Pharmacy Limited Dalneigh _ PPC 29 January 2013 NOTES.doc P4 Car ownership in Dalneigh is very low compared to the rest of Highland with 41.5% of the Dalneigh population not having a car compared to 25.1% in the rest of the area; 42.3% accessing one car in Dalneigh compared to 49.2% in the rest of Highland and 16.1% in Dalneigh having access to 2 or more cars compared to 25.7% in the rest of the Highland Health Board area.
Car ownership is very low compared to Highland and if you go along the streets you will notice there are very few cars actually out there.
Next, I wish to move onto the public consultation, where we advertised in the Inverness Courier and were expecting a large response. Normally, we would expect to get some well written cogent letters but we actually got nothing back.
So we then conducted a survey, which involved systematic random sampling of 500 letters through the door which gave us contact with just over 17% of households and we had hoped for a 25% return but instead we yielded five responses, which are included in the pack. These responses, as you can see, while supportive, are weak. So, disappointed with the results, we started looking for the reasons for this – we had a discussion with a member of the local community council and explored reasons for this. We discussed how the low levels of education, literacy, low levels of motivation and, in some households, the fact that English is not spoken were all contributory factors. It was also pointed out that the Inverness Courier is not the most commonly read newspaper in the community. We asked the newsagents which newspaper was the most commonly read and were told it was “The Sun”.
To this end, we went door to door – very aware of how this can be construed as misleading but adamant to discover the reason for poor return.
We very quickly found that most households were very elderly, some were not English speaking, some had very low levels of literacy and many we spoke to could barely write their name on the survey without being prompted where to sign.
Staff found aspects of this shocking and in particular the squalor in some of the homes. In eleven of the houses we went to we ended the survey early when the level of alcohol impairment became apparent – and this was between the hours of 11am and 1pm.
We were hoping to survey 500 homes, however, we stopped early due to safety fears due to threatening behaviour. We found that only 73 out of 194 were actually useable and did not continue with this exercise for fear of safety to the staff who were carrying it out.
In addition to the survey, we utilised new technology and ran a Facebook campaign as well as a good old fashioned petition.
In addition to this, community groups and elected officials and stakeholders were contacted. Notices were placed in local shops and on community notice boards.
The results – we found an actually overwhelming support and enthusiasm from all – the petition yielded 338 signatures. Our MP and MSP have both supplied letters supporting our endeavour and, in particular, we have a very good letter of support from the Ballifeary and Dalneigh Community Council which clearly explains their concerns about how folk access services.
The Facebook support has been very successful with, so far, a total of 764 supporting with the most likes coming from the 45-64 age group.
For us, this demonstrates fantastic support and we have provided a written summary of the responses.
Conon Bridge Pharmacy Limited Dalneigh _ PPC 29 January 2013 NOTES.doc P5 Evidence M makes for some very interesting reading – I won’t go through all the comments from the survey but, in summary:-
The majority find it hard to travel to a pharmacy by foot or bus and only half of those with a car find it an easy journey. Very few people have been made aware of the core services available from a pharmacy. 14% of people surveyed found it difficult to have a private consultation; 18% have had problems in obtaining normal medicines; 5% that had requested a service have not had it provided and many patients notice shortfalls in the items received.
In the main, the comments highlight the difficulty in physically accessing a pharmacy and the problems caused by repeat journeys.
I think at this point we should look at where and how the resident’s access services from. Ok, there are no pharmaceutical services within the neighbourhood, so one must travel to an adjacent neighbourhood. There are several pharmacies bordering the neighbourhood, which are John Ross’s Kinmylies Pharmacy which is to the west, Rowlands in Grant Street to the north, Lloyds, Greig Street to the east and Lloyds Riverside to the south east.
The nearest city centre pharmacy is Superdrug.
It has previously been widely noted in past applications in Inverness, such as at Cradlehall and Milton of Leys, that the population of Inverness is highly mobile and travel widely for services. I don’t believe that to be true for the Dalneigh area.
Due to the already demonstrated low car use, I don’t believe this to be the case for Dalneigh. The residents simply don’t have the same access to vehicles. They are suffering an inequality of access to services due to their income.
As for walking, I started from the centre of the neighbourhood, which is in Laurel Avenue at the proposed pharmacy and I walked to the surrounding pharmacies. I have done this myself and I am very fit and healthy. It was freezing last Tuesday and I walked briskly and was sweating.
It took me 27 minutes to walk the 1.4 miles to Grant Street, really ridiculously too far to expect anyone to walk. This distance is a barrier to access – that’s a 52 minute return walk.
Lloyds in Greig Street was a 22 minute return journey to walk the 0.6 miles in addition to the very busy A82 – a major trunk road – there are several busy roads to cross within Dalneigh itself – Dochfour Drive, Rangemore Road, Montague Row and Fairfield Road. Also, there are no crossing points until they get to the A82, which led to a difficult journey and must be a daunting task for those less mobile.
Also, it is an additional 10-12 minutes walk from here to Superdrug. Riverside took 14 minutes to walk the 0.9 miles and that doesn’t include the 4½ minutes it took to cross the A82. This road is a considerable barrier – the only lit pedestrian signals to enable safe crossing are outside Primark in town and the next is a zebra crossing in Drumndrochit. I actually though there might be more lights but these are for traffic and not for pedestrians to cross at.
There is no crossing point in between except for two traffic islands at the far end of Tomnahurich Street. To walk here up to a crossing point would add an extra kilometre to your return journey – that’s a return journey of 28 minutes or 35 minutes if you have to walk to the crossing point.
I didn’t actually walk to Kinmylies as it is simply too far to expect anyone to walk that distance.
Conon Bridge Pharmacy Limited Dalneigh _ PPC 29 January 2013 NOTES.doc P6 There is inequality of access due to the distance involved in accessing three of the further pharmacies. The other two pharmacies have major barriers, distance and busy roads which, again, cause inequality of access.
The bus service is not conducive for easy access either, as it takes lots of time and changing of buses. There area is services by three routes.
The No. 28 is an hourly bus service to the north of the area which passes down Fairfield Road. This service is infrequent and has received many complaints due to reliability problems. This takes approximately 12 minutes to reach its terminus in Queensgate. A 24 minute return journey, not including the hour to wait for a return bus, plus 7 minutes each way to walk to Superdrug Pharmacy is approximately 82 minutes.
The No. 3 bus, along south of neighbourhood route into town or take you to Kinmylies is approximately 10 minutes, a 20 minute return journey and, unless you feel particularly sprightly, you have a 40 minute wait for a return journey – 60 minutes in total.
The No. 4 bus is frequent at every 30 minutes, but does not pass any pharmacy and stops at Queen Street in the Town Centre. From Bruce Gardens, it can take 20 minutes to travel then you have a 7 minute walk to Superdrug, assuming they don’t keep you waiting longer than 10 minutes, you then have a 50-70 minute return journey.
For me, this demonstrates an inequality of access to pharmaceutical services, due to the levels of deprivation.
The Highland Executive Summary for the Pharmaceutical Care Services Plan states:-
“…Using travel time as a proxy measure for access, 94% of the population are within a 30 minute travel time of a community pharmacy. The remaining 6% of the population would experience difficulty in accessing pharmaceutical care services through a community pharmacy, by this definition”.
All these journeys by bus are either on or well beyond the acceptable 30 minutes.
Ok, so our residents of our neighbourhood are travelling – we have established this, whether it is by bus or foot, and in the comments that many people rely on others to collect their prescriptions for them as well. At 11 am, when I was waiting to come in to the hearing today I was speaking to a driver from City Taxis. I asked him how many runs he had done today to a pharmacy and he advised me he had done 9 and he started work at 8am.
The pharmacy in Grant Street, run by Rowlands Pharmacy, do an admirable job in the most difficult of circumstances. The facts are, Merkinch is one of the most deprived areas of Scotland with all the problems and health issues associated. High unemployment, drug and alcohol use, low income families, however, I believe that this pharmacy is running at capacity for the size of the unit they operate from.
They are restricted by space, when they receive an order for “Pharmacy Only” medicines they have to check it off in the retail area as there is no room in the dispensary to receive the stock. I think they are only just making it through the day to provide a service to their local area and do not have the ability to absorb much more and therefore are at capacity. To be quite honest, I have worked in that branch myself as a locum pharmacist and enjoyed my time working there, however, I ceased taking bookings for the store as I made several mistakes in the one day due to the huge workload and pressure of people coming in and requesting services.
Conon Bridge Pharmacy Limited Dalneigh _ PPC 29 January 2013 NOTES.doc P7 This pharmacy is not easily accessible from Dalneigh – it is too far to walk to and has no direct bus service and, while there is free parking in the surrounding area, it is often too busy during the day.
As I said, they do a very difficult job, but this pharmacy is there for the people of Merkinch and the huge problems in the area. They are not equipped to service the neighbourhood of Dalneigh too, in fact, the entire store would fit into the retail area of the proposed pharmacy.
In addressing the letter by Rowlands opposing the pharmacy, I would disagree strongly with some of the points made. They cite convenience of access. I am afraid they have confused convenience of access for equality of access – these are two different concepts, for example, it would be convenient to open a pharmacy in Milton of Leys as it would knock 3 minutes off a car trip to a pharmacy down the hill to Tesco, however, people who are income and health deprived should not be expected to have barriers put in place to travel such a distance for pharmaceutical services and every effort should be made to make the access as easy as possible in order to improve health outcomes.
The pharmacy report no increase in demand for pharmaceutical services – I find this odd as the demand for CMS (meaning Chronic Medication Service), MAS (meaning Minor Ailments Service), NRT (meaning nicotine replacement therapy) and dispensing is continually increasing year on year. If they have room for more MDS (meaning medication compliance devices) and methadone, then why did the pharmacy refuse our request for both these services on the 8th and 9th August, 2012 and then again on the 22nd and 23rd of August, 2012.
Kinmylies is a pharmacy which is 2.3 miles by road from the proposed pharmacy. It is inaccessible on foot and only by bus to those at the southern end of Dalneigh. I think you cannot possibly say that Kinmylies Pharmacy exists to service the area of Dalneigh, especially as the canal creates such a significant barrier.
When you inspect the figures obtained by a Freedom of Information request, you can see it is a busy pharmacy, it is not marginal nor is it’s viability in question. All the pharmacies in the Inverness area are busy, dispensing way more than the national average, yet Kinmylies Pharmacy, as of July, 2012 has very low levels of CMS activity with virtually no assessments done. Smoking rates are high in Inverness, yet Kinmylies Pharmacy has not offered this important service – only managing 26 patients in a year.
Looking at the MAS figures we can see they are failing to provide this essential service, as they are the third lowest providers of this service, only behind Lloyds in Greig Street and Riverside, in terms of numbers signed up and prescriptions written.
To me, this paints a picture of a pharmacy at capacity. Kinmylies is at capacity now. What is going to happen once the bridge across the river is built? Robertson Homes have 290 acres with plans for 550 homes, 25% of which are to be affordable; the first 140 homes are currently being built at Westercraigs. How is Kinmylies going to cope with this extra demand?
I understand that such a busy pharmacy currently has no qualified dispenser and that the previous Manager, Mr ** (name left blank to protect the identity of that individual), left because he could not cope with the workload, he claims it made him ill. Despite repeated requests for an increase in staff because of the workload he couldn’t cope.
Kinmylies Pharmacy state in their letter that they provide all services, yet in the Highland Pharmaceutical List, it states they are not an appliance supplier, the only pharmacy in Inverness not to (a Health Board official advised this was a clerical error and that the pharmacy were indeed an appliance supplier).
Conon Bridge Pharmacy Limited Dalneigh _ PPC 29 January 2013 NOTES.doc P8 They serviced 3 registered nursing homes for many years – Braerannock, Seorsa and MacTalla and, in that time, they have not made one visit to these homes in order to provide advice and ensure the safe administration of medicines. The homes actually came to ourselves, in Conon Bridge, as recommended by the Care Commission, to seek a new service provider and Conon Bridge were recommended as a good service provider of this service.
As well as this, we contacted the pharmacy and asked for MDS on the 8th and 22nd August, 2012 and were refused, because “we are currently not taking on more boxes”. We asked who was, they suggested the “Great Glen Pharmacy”. The service is inadequate for the needs of Kinmylies, never mind Dalneigh.
Lloyds, Greig Street, for me is essentially a city centre pharmacy, it has little to no parking and it is likely that the Council will restrict access further in the near future to improve the amenity of the riverfront.
Lloyds closed the pharmacy In Church Street, Inverness and moved business to Greig Street, in particular dosette boxes and methadone prescriptions. So, although the figures I have submitted show it to be the quietest of the pharmacies in Inverness, I believe its nature to have changed considerably. I also understand the only qualified dispenser has recently handed in her notice.
The CMS activity is very low – only Superdrug and Kinmylies have lower activity. The NRT is very poor with only 46 patients a year, they are the second worse provider of MAS in terms of registrations and prescriptions issued.
For me, this again, shows a picture of a pharmacy at capacity and the service is inadequate for the needs of Dalneigh.
Lloyds, Riverside is essentially a health centre pharmacy and, pretty much, only provides a service to those attending Riverside Surgery, therefore, this creates a barrier. People think they can’t go to Riverside Medical Practice.
Again, this is a busy pharmacy, partially restricted by size of the dispensary, for example, prescriptions are often stored on the floor. It is at capacity, again this is demonstrated by the lack of engagement with the MAS and NRT.
Both these Lloyds pharmacies have large number of people with health, income and employment deprivation in the surrounding areas. You have got to ask yourself the question why are they not matching the level of service being provided by Rowlands to the neighbourhood of Merkinch. The answer is that they are at capacity and cannot or are unwilling to do so.
I asked for the view of all the surgeries in my consultation but most would not comment, only Mr ** (name left blank to protect the identity of that individual), the now retired Practice Manager of Riverside Medical Practice would. During an informal chat he revealed that they regularly receive complaints about the service from the pharmacy and receive complaints because patients think the surgery own the pharmacy. He revealed service is that bad that it had been mooted in the practice if Lloyds could be replaced by another contractor.
Probably worth pointing out as well, we also asked these pharmacies for MDS on the 8th and 22nd August, 2012 and both refused, Greig Street had no space and Riverside couldn’t give an answer and asked us to phone back a week later. Greig Street was unable to provide anymore methadone as they have reached their limit. We understand, Riverside Pharmacy had 16 patients registered for this service which has since decreased to 6. This is a wholly inadequate level of service.
Conon Bridge Pharmacy Limited Dalneigh _ PPC 29 January 2013 NOTES.doc P9 There have been, in the lifetime of the application, several critical incidents, I think the panel may be aware of some of them. The incident that Rowlands had on the 4th and 6th June, 2012 was very serious, which jeopardised service in Culloden and Balloan and could easily have impacted on the Grant Street pharmacy and the service provided to the Dalneigh population.
Tesco, at Inshes, also have had many problems of late with no PC from the 2nd to the 6th June, 2012 – incredible! I understand there was a problem with the fridge there for 9 weeks – unbelievable, really!
Lloyds, Riverside and Greig Street had problems between May and November on 6 occasions and they had no pharmacist for one of these branches with varying degrees of disruption from a few minutes to several hours – one incident it was after lunch before a pharmacist was obtained. I asked the Health Board for details of this but it had not been reported. I believe in November, 2012 there were 2 cases of not having a pharmacist.
Rowlands, Lloyds and Kinmylies Pharmacy all state that the current service is adequate.
I strongly disagree and I feel strongly that the service available from 3 of the 4 pharmacies bordering the neighbourhood is demonstrably partial, unreliable and certainly not able to meet the needs of the Dalneigh population, the other pharmacy provides and excellent service but is severely restricted by its capacity to provide services to Dalneigh to the difficulty in access and also due to the cramped conditions within the pharmacy itself.
So, in summary, the neighbourhood has been clearly defined and not only are pharmaceutical services absent within, but those outwith have proven themselves incapable of providing an adequate level of service. There are physical barriers in accessing pharmaceutical services. The population is not mobile, has health and employment and income inequalities and this has an inequality in access to pharmaceutical services. To balance this inequality it is both necessary and desirable to grant this contract.
I, therefore, respectfully submit that this application be granted in order to secure adequate provision of pharmaceutical services within this neighbourhood.
The Chair thanked Mr Horsburgh for his statement on behalf of Conon Bridge Pharmacy Limited and invited the Interested Parties and then members of the Committee to ask questions of him.
7.2 Questions from Mr Alasdair Shearer, Rowlands Pharmacy to the Applicant
Q. Can you confirm what non medical services are in the neighbourhood?
A. There is a Post Office, grocery stores, charity shops and a hairdresser.
Q. Do you think that at some point the post office may decide to pull out?
A. I am not an expert on the Post Office business but it is next door to the proposed premises in the grocers and delivered from a desk counter.
Q. Certainly, would you not agree, with the services available, the people of Dalneigh have to leave the neighbourhood to access other services?
A. The challenge is the same for access to supermarkets for the whole of Inverness.
Conon Bridge Pharmacy Limited Dalneigh _ PPC 29 January 2013 NOTES.doc P10 Q. You mentioned your experiences of working in Grant Street, can you tell me how long ago that was?
A. 2010 was the last locum shift so, about 2 ½ years ago.
Q. I would argue that the view from 2½ years ago is no longer a reliable one, wouldn’t you?
A. I don’t think things have changed much since then.
Q. How do you know that?
A. I have been in and cannot see any changes.
Q. Are you aware of any complaints to the Health Board regarding the Grant Street pharmacy?
A. No.
Q. At what stage would you say that a pharmacist can no longer cope?
A. They have to drive things to Improve the service and if services are not being improved then I would say they are at capacity for coping.
Q. So, in theory would you say an individual pharmacy could do 20-30,000 dispensing and engage in delivering all the services?
A. I have worked in pharmacies who do more than that but 15,000 prescriptions but that does not mean that it has been easy. For example, I have worked in Tesco where the dispensing of prescriptions was quick and easy, whereas in Grant Street, prescriptions can be more complex and include instalment dispensing for individual cases.
Q. I have driven up the A82 myself and when you were referring to it I wondered if it was a different road you were referring to as I had an image of thundering lorries! I struggle to see a problem with crossing and would ask does every road need a zebra or pelican crossing?
A. I don’t think every road does but the A82 is a very busy road.
Q. You mention crossing points, where are they?
A. A third of the way down the road.
Q. If this was a significant problem would the Council not address this?
A. Yes, they should.
Q. You refer to PHS (meaning Public Health Services) in terms of current pharmacies having a lower than expected uptake in figures, may I ask where did you get this information from.
A. I applied for a Freedom of Information Request from NSS (meaning National Services Scotland) and I got them from there.
Q. What figures are you using to say we are under-performing?
A. When we applied for the contract the most up to date information available to us was for July 2012 and the dispensing figures were from the previous year.
Conon Bridge Pharmacy Limited Dalneigh _ PPC 29 January 2013 NOTES.doc P11 Q. If your application was granted and you were in your other pharmacy and the pharmacist for this one called in sick what would you do?
A. I plan to employ two pharmacists, one for each pharmacy and I would be the back up pharmacist.
Q. So if you were in your pharmacy and the other pharmacy had sickness, what would you do?
A. Currently, at the Conon Bridge pharmacy we have a contingency plan for sickness which involves another pharmacist, so if anything happens, cover is quickly put in place.
Q. Do you think it is the same for Rowlands and Lloyds?
A. I would like to think so.
Q. Can we touch on the Facebook Questionnaire. Please would you explain it as I don’t know if everyone in room is aware of how it works?
A. Sure, I never used it before but created a page with Dalneigh Pharmacy on the page, through which could be controlled age group and pop ups.
Q. And can you confirm you say that over 200 people have “Liked” this?
A. Over 700. One kind of “Like” is to like the page itself, which 264 people have but also you could like the advert which appears on the pages of people and if anyone likes the advert it likes the advert rather than the page and that is how there are over 700 in total.
Q. Does the advert say support the Dalneigh Pharmacy application? Is it correct to say that you could “Like” this then without reading the full application?
A. Yes, but most people have.
Q. Do you think you will get many customers coming from Canada or Malborough?
A. I must admit that is unusual.
Q. So would you agree that the figures are not exact in real life?
A. They are mostly accurate.
7.3 Questions from Mr Tom Arnott, Lloydspharmacy to the Applicant
Q. On your application do you believe you are demonstrating there is lower than average level of core services being available, can you expand on this?
A. I believe Lloyds are under-providing the Minor Ailments Service and the Chronic Medication Service.
Q. On your application you refer to figures that say patients are not receiving methadone. How many patients are on this waiting list for methadone?
A. I am not aware of a waiting list but we have asked for methadone availability figures and Osprey House advise that they have to phone round regularly to find places willing to dispense prescriptions for methadone.
Conon Bridge Pharmacy Limited Dalneigh _ PPC 29 January 2013 NOTES.doc P12 Q. Is there a waiting list for methadone patients?
A. I am not aware of one.
Q. You state it is difficult for patients to access the provision of dosette boxes?
A. I am not aware of this.
Q. Is the provision of dosette boxes a core service?
A. No.
Q. Has the population increased or decreased since 2001?
A. Slightly decreased.
Q. So within the neighbourhood there is a convenience store, hairdresser, church, GP services, the nearest being at Riverside and Fairfield, however, do you find that patients travel to access services as they are not restricted to where they access GP services from?
A. Yes.
Q. Where would they go to access a bank?
A. A bank – in town.
Q. Shopping?
A. I am not sure, but do know of supermarkets in town.
Q. I see in your application there is a letter from Ballifeary Community Council. Why do you think that the Dalneigh and Columba Community Council did not respond?
A. They were written to but I received no response, so don’t know why.
Q. So no response from Dalneigh?
A. No.
Q. You have gone on about dosette boxes do you just take on everyone without an assessment?
A. No, I would do an assessment.
Q. So perhaps some of the folk who didn’t get one were not suitable?
A. Perhaps.
Q. Did the APC support your application?
A. No.
Q. You have undertaken a questionnaire, but the question you asked was complex. Would that explain some of your troubles in receiving a response, as the question posed was not understood?
Conon Bridge Pharmacy Limited Dalneigh _ PPC 29 January 2013 NOTES.doc P13 A. Possibly.
Q. You brought in to your submission a lot of demographics about car ownership being less than in the rest of Highland and, as the rest of Inverness is rural would you not agree that this would reflect that?
A. Yes.
Q. A car is required as essential would you agree?
A. Yes.
Q. What times have you driven around the neighbourhood?
A. Various.
Q. I drove round at 7am and virtually every drive had a car in it. How long did you say it took you to walk to Greig Street?
A. 22 Minutes return.
7.4 Questions from Mr John Ross, Kinmylies Pharmacy to the Applicant
Mr Ross had no questions for the Applicant.
7.5 Questions from the Committee to the Applicant
Alison MacRobbie, APC Non Contractor Pharmacist
Q. Thank you for the clarity around the Facebook campaign. I noticed your advert in the newspaper was also in Polish. May I enquire why you selected the Polish language?
A. I have a family member who is married to a Pole in Dalneigh so asked her to translate for me. She feels that there are a lot of families who do not have very good English in the community.
Q. Are you aware of any other particular languages in the community?
A. There are a lot of Eastern European community languages. There are a large percentage of primary school pupils who don’t use the English language at home.
Q. In terms of understanding, how would you tackle the language issue in terms of delivering services?
A. Hopefully hire someone who can speak an eastern European language. I am aware of a website where you can hire an interpreter and can input data which is then transcribed.
Q. When you carried out the survey you mentioned behaviour and security. How would you ensure the security of your staff and premises?
A. Staff security is at the foremost of my priorities and I would install CCTV, most pharmacies now have panic buttons and a violence and aggression policy.
Conon Bridge Pharmacy Limited Dalneigh _ PPC 29 January 2013 NOTES.doc P14 Q. You talked about access to services. Are you aware how many services are accessed by receiving deliveries?
A. I don’t know, but I do know all Inverness pharmacies offer a deliver service, however, I would argue that you cannot deliver CMS or eMAS from the back of a van.
Gareth Dixon, APC Contractor Pharmacist
Q. You mentioned an open day in June, 2012 in your newspaper advert. Did it take place?
A. No, it didn’t take place.
Q. Thanks for the clarity about Facebook, as I am a bit of a habit user for my business myself! So was there 764 people who “Liked” the advert?
A. 500 “Liked” the advert and 264 “Liked” the page. In total 764 “Liked” the campaign.
Q. You also did something in the survey about people’s knowledge of pharmacy services. I was impressed about your level of knowledge. Have you done a similar survey in your current pharmacy?
A. No.
Michael Roberts, Lay Member
Q. Can I just go back to the questionnaire? You state you put an advert in the Inverness Courier and got nothing back, then received 5 response letters to the 500 posted and then you embarked on a door to door survey but cut that short, in case you got mugged, yet you put a petition into local shops? Can you explain the differences in the consultation they don’t gel?
A. The people we spoke to were very positive but nothing came back.
Q. The petition themselves came from which stores?
A. Laidlaws and the community store next to proposed pharmacy.
Q. So they were able to translate the content. Did you notice there are some duplications?
A. No.
Q. Your walk was from the centre of the area and obviously extends outwith the walking point so further away time increases do you agree with that?
A. Yes.
Q. And in a northerly direction?
A. Yes.
Margaret Thomson, Lay Member
Q. Tell me a bit more about the question you asked, in particular the question asked to someone answering the door. What exactly did you say to them?
A. It wasn’t me personally, it was my employees.
Conon Bridge Pharmacy Limited Dalneigh _ PPC 29 January 2013 NOTES.doc P15 Q. How many were there?
A. Two at a time.
Q. Was that two to each door?
A. No, one at the door and one in the car for security purposes.
Q. How did you select the houses?
A. They were randomly selected as you are supposed to do for a survey and started in the centre, working round the neighbourhood.
Q. What does that mean?
A. Every fifth door but this was sometimes more often as found folk were coming out to hear what they had to say and engaging with the survey.
Q. What did they ask?
A. They had a script which said something like on the lines of “I’m sorry to bother you but I am trying to open a pharmacy in Dalneigh and what were your thoughts on this “.
Q. Who carried out the analysis of the questionnaire?
A. I did it myself.
Q. Do you think you got any more information from it than from other sources?
A. Quite a lot, yes.
Q. What were the key things learned?
A. About the difficulty in accessing services. I had not realised it was such an elderly population.
Q. What was the question that prompted the issue of access - can you remember?
A. They were asked if they agreed it was difficult to access by foot, by car or by bus.
Q. Did you select a particular street or age group?
A. It was made very very clear to the girls that it was a random survey but there was no-one home in some of the streets.
Q. So it was basically signed and they said “yes, they wanted a pharmacy”, but there is no actual evidence. What do you see as the most important piece of evidence from that?
A. That no-one could get to the pharmacy.
Maureen Thomson, Lay Member
Q. Can I slightly expand on this and ask, that if you were to look at the legal test, it is about adequacy of services while a lot of your case is about access to services. How does access come into the legal test?
Conon Bridge Pharmacy Limited Dalneigh _ PPC 29 January 2013 NOTES.doc P16 A. I would relate this to adequate and desirable. What I feel is that the pharmacies are not providing all the core services and therefore they are not adequate. They would argue to the alternative but, in my view, they are not providing adequate levels of service. For me, also adequacy is also about how people get to a pharmacy and localised access restricts access. This population cannot easily access them so are at a disadvantage.
Q. Did you ever consider trying to ascertain how many folk receive their services through a delivery?
A. No, I didn’t.
Q. We sometimes see access as being a big issue but what did you do to try to understand how the population access their current services? I wondered how you had thought through this?
A. Obviously, I haven’t in any way at all.
Q. If you won the contract you would provide the core services but I note in your application that you have listed a number of private services. You have indicated that this is a deprived community, so how many of these additional private services would you expect would realistically be accessed?
A. In my pharmacy in Conon Bridge people travel to access them from as far as Inverness. And we feel that they would travel to within the area of Inverness if they were available there.
Q. So would you see this as attracting people from outwith your area?
A. Yes, and as chiropody is a service no longer available through the Health Board and people at most need of this i.e. the elderly would be willing to pay for this even from within a less affluent area.
8. The Interested Party’s Case – Mr Alasdair Shearer, Rowlands Pharmacy
Mr Shearer stated “thank you, Chair and Panel for allowing me to present my views from Rowlands Pharmacy as to why we believe the application for a new pharmacy in Dalneigh in Inverness is neither necessary, nor desirable. Again, in order to cover the legal test, I’ll first address the issue of the neighbourhood.
For the purpose of this hearing, I would actually tweak the applicants neighbourhood ever so slightly.
To the north – Telford Street, running along to Kenneth Street across to the water at the river; To the east – down the river to Bught Road; To the south – across to the canal; and To the west – the canal, taking in the area known as Ballifeary.
So, looking at the neighbourhood, is it a neighbourhood in its own right? Does it have all facilities required for day to day living – banks, post offices, libraries, schools, GPs, supermarkets and, of course, pharmaceutical services? I believe that most people will still have to come out of this neighbourhood to get to their GP practice, or for shopping, or for any other day to day business. Therefore, these residents are used to crossing the neighbourhood boundaries. Indeed, again, in Inverness it should be noted that residents can be registered with any GP across the city and are not confined to their individual neighbourhoods.
Conon Bridge Pharmacy Limited Dalneigh _ PPC 29 January 2013 NOTES.doc P17 The legal test states that consideration must be given to pharmaceutical services in adjoining neighbourhoods. The nearest pharmacies for residents around this area, and who are represented here today, are Rowlands, Grant Street, Lloyds, Greig Street and at Riverside Medical Practice and at Kinmylies Pharmacy. That is 4 pharmacies in total, all just outwith the defined neighbourhood. In reality, these are well within easy reach, by car, foot or public transport. Furthermore, there is a frequent bus service, up to every 20 minutes for those who need it to get about their daily business and, again, if patients travel a little further, they have the choice of 11 pharmacies within Inverness, all providing the core pharmaceutical services and additional delivery services too. Is access to pharmaceutical services, as they stand, really a problem? I would suggest the answer is no. Rowland’s, Grant Street provides all the core services of the pharmaceutical contract to a high level, plus additional services such as blood pressure measuring. Waiting times are low, we provide a delivery service to those that need it, and despite what the applicant has alluded to in his application, we have no capacity restrictions for methadone or MDS trays. In fact, contrary to what the applicant says, space is no longer a problem with extended working areas upstairs.
Our pharmacist and experienced teams of dispensers and counter assistants have built up good relationships with the local GPs, nurses and patients. There is nothing to suggest our pharmacies, or indeed others in the neighbourhood are offering poor or inadequate service. Personally, I would be pleased to hear what we are missing if our pharmacy is anything but adequate.
Does anyone within the Dalneigh neighbourhood have any problems whatsoever in accessing existing pharmacy services? Not at all. Are the current services adequate? Without a doubt. I cannot see the need for another pharmacy contract to be granted in this neighbourhood. Thank you.
The Chair thanked Mr Shearer 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 A Shearer, Rowlands Pharmacy
Q. May I ask why services, such as methadone, have been refused?
A. There is no capacity restriction but it may be that there may have been instances where the pharmacy has had to bar a patient as a result of an incident. I can say, however, that if Osprey House is asking for the service, we have no reasons to not provide the service.
Q. Can the pharmacist now work upstairs?
A. They can do. It is mainly the MDS dispensing process that takes place there.
Q. Would you agree the A82 is a trunk road?
A. I would say that it is more of a main road, as traffic can be diverted through the Kinmylies area.
Q. Would you then say it was an A road?
A. Yes, although it has residential housing on it.
Conon Bridge Pharmacy Limited Dalneigh _ PPC 29 January 2013 NOTES.doc P18 8.2 Questions from Mr T Arnott, Lloydspharmacy to Mr A Shearer, Rowlands Pharmacy
Q. Could you confirm if there are capacity issues with the provision of CDS and methadone and do you provide a collection and delivery service.
A. There are no capacity issues and yes, we do provide a collection and delivery service.
8.3 Questions from Mr J Ross, Kinmylies Pharmacy to Mr A Shearer, Rowlands Pharmacy
Mr Ross had no questions for Mr Shearer.
8.4 Questions from the Committee to Mr A Shearer, Rowlands Pharmacy
Alison MacRobbie, APC Non Contractor Pharmacist
Q. We have heard about pockets of communities with language barriers. Is this an issue in your pharmacy?
A. There has never been a situation in the pharmacy where it has been a problem and issues cannot be effectively addressed through the current staff.
Nicola MacDonald, APC Contractor Pharmacist
Q. We have discussed the needs of housebound patients. How do you deal with one on one pharmacist time for these patients?
A. Okay, we are always going to be limited when providing services to those who are housebound. One of the benefits is that we have a few pharmacies and some of the pharmacists are out and about providing clinics, so this frees up time for when a second pharmacist can address this issue. I have personally gone out to assess a patient if they have been struggling with their medication or need an assessment for MDS.
Maureen Thomson, Lay Member
Q. Can you remind me of your proposed neighbourhood?
A. To the north - Telford Street running along to Kenneth Street across to the water; to the east, down the river to Bught Road; to the south, across the canal and to the west the canal
Q. Why do you think that is the neighbourhood?
A. For one, I didn’t feel Ballifeary could be its own neighbourhood, as I don’t see the A82 as a barrier and in terms of such the river then causes a natural boundary.
Q. If you were a resident in Bught or Torvean do you think they would consider themselves a resident of Dalneigh?
A. No, but the neighbourhood wouldn’t have to be called Dalneigh or Ballifeary and this is reflected in the Community Council names.
Q. Is it convenient that in your neighbourhood there is not a pharmacy?
A. Perhaps it was convenient for the applicant there was none in his.
Conon Bridge Pharmacy Limited Dalneigh _ PPC 29 January 2013 NOTES.doc P19 Q. How many patients from the applicant’s neighbourhood in Dalneigh access services in your pharmacy?
A. Our largest proportion of patients come from the Riverside Surgery so 50% of the majority of our prescribing is from that area.
Q. As you have alluded to yourself, can patients not come to pharmacy from any GP surgery?
A. Absolutely, but they would be more likely use our pharmacy if they were registered at Riverside.
Q. You made a point about capacity and almost that a pharmacy could never get to capacity but don’t you think that premises and staffing levels eventually affect the capacity of a pharmacy?
A. Perhaps, however, you can address this by putting in more staff and a second pharmacist if that what is required and if the premises were an issue you can extend upwards, outwards or even relocate. Capacity can be well managed if the right manager is in a busy pharmacy.
9. The Interested Parties’ Case – Mr Tom Arnott, Lloydspharmacy
Mr Tom Arnott thanked the Panel for allowing him to speak today on behalf of Lloydspharmacy and stated “Can I just clarify the Post Office issue, Mr Finnie and I went into the convenience store which had a sign up above it for the Post Office and were told there was no Post Office. In respect of the neighbourhood, the applicant has chosen to choose the Caledonian Canal as his western boundary and yet has chosen to ignore the River Ness as the most appropriate eastern boundary. His northern boundary is Telford Street running into Kenneth Street. His eastern boundary is Glenurquhart Road and south to the Caledonian Canal. This has been done deliberately to exclude the 3 pharmacies that would be included if the neighbourhood was based on the natural geographical boundaries.
I would suggest the most logical definition would be the Caledonian Canal to the west; the River Ness to the east and south and, to the north, the Beauly Firth.
The population of this neighbourhood being approximately 9,000 and within this neighbourhood there are three pharmacies providing all the core services and opening hours are within the guidelines and all meet the service provision requirements. Even if the Panel were to accept the applicant’s definition of the neighbourhood, the fact is, that it is possible and it has been accepted at numerous Health Board Panels and National Appeal Panels, that a neighbourhood can be adequately serviced by pharmacies outwith the neighbourhood. Note, there are 4 pharmacies currently within one mile of the applicant’s proposed pharmacy. I note the application is not supported by the Area Pharmaceutical Committee and would also point out that in the applicant’s own application he states that public transport is frequent.
In his application, the applicant has stated that the current pharmacies have no capacity for CDS (MDS), which I would point out is not a core service and also that there are no places for substance misuse, I can categorically deny this. Both Lloyds pharmacies have capacity and will continue to have capacity for both substance misuse and CDS. Indeed, in the last 3 months, Greig Street have taken on 10 new CDS patients.
I think the applicant’s statement that patients are turning to pharmacies in Conon Bridge, I believe the applicant owns this pharmacy, is more to do with the applicant pursuing business in his pharmacy than any need.
Conon Bridge Pharmacy Limited Dalneigh _ PPC 29 January 2013 NOTES.doc P20 The applicant has provided a petition. I must admit, I find this confusing. On one page, it stated 338 signatures. Facebook results state total “Likes” 764, however, it appears only 259 are from the UK and 228 are from Inverness. Even then it does not detail how many of these are from the applicant’s proposed neighbourhood. I have not had sight of the questionnaire until now where there are 194 forms of which only 73 are useable. Looking at the comments, it could be construed many are housebound, therefore, they would not benefit from a new pharmacy. (Mr Arnott repeated some of the comments to the Panel from the survey). There are a lot of non specific comments regarding medication not being in stock and a lot of comments around difficulties in parking, although no specific examples. The fact that these respondents drive mean they are mobile.
The Chair thanked Mr Arnott for his statement and invited the Applicant, Interested Parties and then members of the Committee to ask questions of him.
9.1 Questions from the Applicant to Mr T Arnott, Lloydspharmacy
Q. Can you explain why you have not matched level of targets for the Chronic Medication Service?
A. We are on target. Your figures are out of date.
Q. What about matching the level of targets for the Minor Ailments Service?
A. Funnily enough I was in Riverside yesterday and they were moving into the next banding.
Q. Can you explain why the lowest number of CP2s (meaning MAS prescriptions) are written in the most deprived areas of Inverness?
A. No, I cannot explain it.
Q. Do you agree the A82 is a trunk road?
A. I believe it is a main road and an A road but if the Council felt that crossing it was a problem they would address this.
Q. Do you agree it’s a barrier?
A. No I don’t.
9.2 Questions from Mr A Shearer, Rowlands Pharmacy to Mr T Arnott, Lloydspharmacy
Q. Will the pharmacist be giving out PHS advice?
A. Yes.
Q. Do you think they would encourage patients to make a 10-15 minute walk to address the issue of cardiovascular disease?
A. Certainly.
9.3 Questions from Mr J Ross, Kinmylies Pharmacy to Mr T Arnott, Lloydspharmacy
Mr Ross had no questions for Mr Arnott.
Conon Bridge Pharmacy Limited Dalneigh _ PPC 29 January 2013 NOTES.doc P21 9.4 Questions from the Committee to Mr T Arnott, Lloydspharmacy
Alison MacRobbie – APC Non Contractor Pharmacist
Q. Again, we have heard about language barriers. How are Lloyds dealing with these?
A. One of our relief pharmacists is Polish.
Nicola MacDonald, APC Contractor Pharmacist
Q. How do your pharmacists access housebound patients in order to deliver the core services?
A. Certainly with regards collection and delivery, all our pharmacies have that in place for those who are housebound and some folk ask for it now, who simply cannot be bothered. We can provide CMS consultations over the telephone, although I recognise that this is not ideal.
Gareth Dixon, APC Contractor Pharmacist
Q. How long have your Managers been in post in both pharmacies and have there been any disruptions to service?
A. Jamie at Riverside has been in post now for 12 months and Calum in Greig street for 10 months. There has been no service disruption.
Margaret Thomson, Lay Member
Q. Did you deliberately recruit a Polish pharmacist?
A. No, it was more of a lucky coincidence as she had successfully applied for the post.
Q. How effective has this been?
A. Most effective. Stuart was telling me she works in Aberdeen as well as in Inverness.
Q. If you consider the applicant’s neighbourhood, do you know how many people receive services from your pharmacies?
A. It could be that as much as 70% of prescriptions dispensed come from round about.
Q. How many patients get a delivery?
A. 60 patients per day.
Q. For patients who receive this how often do they receive a pharmacy interaction?
A. When they need it. This is done by telephone and some will receive a pharmacist interaction in the evening after the pharmacist has finished work.
Maureen Thomson, Lay Member
Q. Can I just pick up a wee bit again in terms of both pharmacies in Ballifeary and Greig Street? From the figures we have available, these pharmacies figures are well below the Highland average, for example for MAS. I wonder why this is the case?
A. The pharmacist was telling me they are moving on to the next band so levels are improving.
Conon Bridge Pharmacy Limited Dalneigh _ PPC 29 January 2013 NOTES.doc P22 Q. I suppose one of your pharmacies is immediately adjacent to a GP practice so it might be difficult for patients to understand a pharmacies role in minor ailments. How do you try to promote MAS?
A. It can be difficult but still, the service is designed to be delivered to take away appointments from GP practices for minor ailment consultations.
10. The Interested Parties’ Case – Mr John Ross, Kinmylies Pharmacy
Mr J Ross stated “The location where the pharmacy is planned was previously used by the post office and, interestingly, they closed it down due to lack of support from the local community! Surely this says it all as if the people living in the area could not support the Post Office , which I am sure they would use on a more regular basis, then why does anyone think they would use provision of a pharmacy.
There is adequate fact based information from genuine sources to support the surrounding pharmacies offer more than enough pharmacy provision to the surrounding area and beyond.
We have extensively redesigned our pharmacy so that we could fully implement the pharmacy contract and increased the range of services to our client base.
We feel that there is adequate pharmacy provision in this area and a new pharmacy would jeopardise the service provided by the currently established pharmacies, especially in the current economic climate. As everyone will be aware there has been an increased pressure on pharmacies with margin being squeezed to such an extent most existing pharmacies are under a lot of pressure to continue. We would also like to point out that only a few months ago one pharmacy located in Church Street closed down as it was found to be unviable, so we would question the need for another pharmacy to be granted a new contract.
In regards to the information we were sent in relation to this new pharmacy we have some concerns which I have listed below:-
It states that at present the surrounding pharmacies do not provide adequate service provision in relation to substance misuse. We would not accept this as accurate as our manager has spoken on numerous occasions to Osprey House to inform them we have the capacity to take on more substance misuse clients. On that basis we would argue that the current pharmacies provide more than an adequate service facility.
He has indicated that he will be open all day on a Saturday where we are open half day. When the out of hours service was introduced the requirement for pharmacy provision was then decreased to such an extent that the provision to open all day was found to be not viable. We would have to question why, if someone had done their research into pharmacy provision that they would see opening all day would be a viable option when others that have years of experience found it not to be the case.
We provide a free delivery service to clients which covers a large area over Inverness collecting prescriptions from various surgeries, taking back to Kinmylies to be dispensed. Prescriptions would then be delivered to the client. At no time would anyone be compromised by a lack of transport facility as stated in the application. Also the other surrounding pharmacies also provide a collection and delivery service so, again, the provision would be more than adequately provided.
Conon Bridge Pharmacy Limited Dalneigh _ PPC 29 January 2013 NOTES.doc P23 He indicated that clients had to access pharmacies outwith the area to provide a dosette box service. Kinmylies, at present, provide approximately 150 boxes to our client base and have the capability to handle more due to our expansion in the dispensary. It would be the client’s choice to obtain their box from another pharmacy – not through a lack of provision as he states. We would promote the client’s right to choice and not see this as a lack of service we provide.
At Kinmylies, we provide all core services but in the application, the applicant states that the surrounding pharmacies do not. We, again, would have to question this information as I am sure the other surrounding pharmacies also provide core services which between us would be more than adequate.
We have found in previous research that clients attending their surgery will then access the pharmacy nearest the surgery and not necessarily the one closest to their home. This, again, would lead to question the viability of another pharmacy when, at present, there are ample pharmacies to provide the service including in the area where the new pharmacy has been requested.
Over the years, when we have looked into opening other pharmacies we first test the adequacy then necessity and desirability. If the first test is okay then is it taken no further. On looking at the information in the application and researching the viability we really would question why someone would think it would be a viable proposition. I would be extremely concerned if this was granted, that due to the lack of viability it could potentially close, as the one in Church Street did, and what would this reflect to the client base and the public in general in the confidence of pharmacy provision.
There has been no significant increases in the population I the area now or planned in the future so, again, why would the necessity for another pharmacy be required.
The granting of another pharmacy contract would have an adverse effect on current pharmaceutical services, their development and investment. Therefore, we would ask the panel to reject the application.
The Chair thanked Mr Ross for his statement and invited the Applicant, Interested Parties and then members of the Committee to ask questions of her.
10.1 Questions from the Applicant to Mr J Ross, Kinmylies Pharmacy
Q. What would you say about the low engagement by your pharmacy of CMS?
A. This has been developed to quite an extent in the last few weeks.
Q. How many dosette boxes did you say you do?
A. About 150.
Q. Isn’t there a lot of work involved in that?
A. Yes.
Q. Was this reason why MAS not being provided?
A. No, it has just not been a focus.
Conon Bridge Pharmacy Limited Dalneigh _ PPC 29 January 2013 NOTES.doc P24 Q. Why did someone not get MDS?
A. Whoever said that should be challenged. This is not a problem for us.
10.2 Questions from Mr A Shearer, Rowlands Pharmacy to Mr J Ross, Kinmylies Pharmacy
Mr Shearer had no questions for Mr Ross.
10.3 Questions from Mr T Arnott, Lloydspharmacy to Mr J Ross, Kinmylies Pharmacy
Mr Arnott had no questions for Mr Ross.
10.4 Questions from the Committee to Mr J Ross, Kinmylies Pharmacy
Alison MacRobbie, APC Non Contractor
Q. Again, we have heard about language barriers, how have your pharmacies addressed this issue?
A. There is a member of staff in Aberdeen who speaks the language so if ever an issue would arise, we would just network within our group and solve any problems very quickly.
Nicola MacDonald, APC Contractor
Q. How do you ensure that those receiving deliveries receive access to the core services?
A. We ask the driver to pass the information on. We have a group of relief pharmacists and today there are two pharmacists in Kinmylies so we can release a pharmacist to provide domiciliary access to services. We are quite happy to do that.
Margaret Thomson, Lay Member
Q. John, you spoke a bit about the neighbourhood. How much, if at all, do you see that affecting your business?
A. Well it is bound to affect our business as we service this area and beyond but I couldn’t put any numbers on it.
Q. I am asking as it seems to me almost inconceivable I would bother to get along to Kinmylies if I lived in Dalneigh?
A. Well, we could come to you!
Q. That, combined with a lot of the folk who did respond to the survey, say they don’t drive. I know you deliver a lot of boxes and do you think that would increase or decrease. I am trying to get a picture that if lots of people want a pharmacy in Dalneigh, don’t drive and are elderly, then Kinmylies has got to be one you would not walk to?
A. We would take the pharmaceutical service to the patient.
Q. I am delighted to hear it, and for young mums with sick babies also - not solely the elderly?
A. Yes, it is not a service supported by the NHS but part of the service we like to give to our customers.
Conon Bridge Pharmacy Limited Dalneigh _ PPC 29 January 2013 NOTES.doc P25 Maureen Thomson, Lay Member
Q. I take it from what you have said to Margaret (meaningThomson) you cannot tell what numbers of patients coming to your pharmacy are resident in Dalneigh?
A. We would need to pull that information out from our database but I don’t have it with me.
Q. Your proximity to a GP practice is fairly close. I note that the last 3 months figures are fairly low for MAS. How do you promote services?
A. Well we appointed a new Pharmacy Manager in April last year and he has been promoting this.
Q. What about smoking cessation services?
A. Exactly the same – this is being driven forward.
Q. I notice in your written response you say research suggests people would access pharmaceutical services to near where there GP practice is. I thought the new contact was trying to promote pharmaceutical services as a new service in its own rights so what do you mean by that?
A. From our point of view it would indicate that people would access services closest to them.
Q. I would question that, as an individual, in an urban environment would people not access a pharmacy closer to their home.
A. It would tend to say they access those closest to the GP practice.
11.0 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, 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 Area Pharmaceutical Committee is unable to be represented in person at the Hearing due to lack of availability of its membership. This statement will present the views and opinions of the Area Pharmaceutical Committee. The Area Pharmaceutical Committee agrees with the applicant’s proposed boundaries and definition of the neighbourhood as these appeared to be reasonable. The Area Pharmaceutical Committee also acknowledges that this neighbourhood is within an area NHS Highland would deem as ‘deprived’ and notes there are advantages to locating pharmacies within such areas.
However, The Area Pharmaceutical Committee believes that the applicant has not provided sufficient evidence to demonstrate an inadequacy with the current pharmaceutical service provision for the neighbourhood. It is the Area Pharmaceutical Committee’s view that the application is neither necessary nor desirable to secure adequacy of pharmaceutical services in the proposed neighbourhood. Dispensing and other pharmaceutical services are currently provided by three pharmacies just outside the boundaries of the applicant’s defined neighbourhood. The Area Pharmaceutical Committee agreed that patients in this neighbourhood have access to the additional pharmaceutical services offered by a community pharmacy without the need to travel considerable distances to access them.
Conon Bridge Pharmacy Limited Dalneigh _ PPC 29 January 2013 NOTES.doc P26 The Area Pharmaceutical Committee is unaware of any complaints regarding the current service and believe that none of the pharmacies adjacent to the applicant’s defined neighbourhood show any signs of maximum capacity. After reviewing and discussing the application and supporting documentation the professional advice from The Area Pharmaceutical Committee to the Pharmacy Practices Committee is to recommend that the application is not granted.
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 then members of the Committee to make comment on the statement read.
11.1 Statement from the Applicant to the Pharmacy Practices Committee for noting in respect of the statement read by Mrs H MacDonald, in the absence of and behalf of a representative of the Area Pharmaceutical Committee
Mr Horsburgh asked for it to be noted that, in the absence of a representative from the Area Pharmaceutical Committee, the statement made was in advance of that Committee hearing any further facts today by the applicant and, therefore, should be carefully taken.
12. Summing up
The Applicant and Interested Parties were then given the opportunity to sum up.
12.1 Mrs H MacDonald, in the absence of an on behalf of a representative present from the Area Pharmaceutical Committee asked “the Committee and Interested Parties to note that the summary was as per the last sentence read from the statement provided to her by to read on behalf of the Area Pharmaceutical Committee:- “After reviewing and discussing the application and supporting documentation the professional advice from The Area Pharmaceutical Committee to the Pharmacy Practices Committee is to recommend that the application is not granted”.
12.2 Mr J Ross, Kinmylies Pharmacy stated “basically, I’d like to say thanks for your time and to finally say that granting another contract would have an adverse impact on the other pharmacies currently in place and is not necessary or desirable.
The applicant has shown no inadequacy in core services and adequate services are supplied to those from within one mile of the applicant’s premises, therefore, the application is neither necessary nor desirable in order to secure adequacy”.
12.3 Mr T Arnott, Lloydspharmacy stated “in summary, I do not agree with the applicant’s defined neighbourhood, which has been chosen ignoring the natural boundaries only in order to exclude the three existing pharmacies. Regardless of this, the applicant has shown no inadequacy in current provision of core services and it is the fact that adequate pharmaceutical services are provided to the applicant’s proposed neighbourhood from pharmacies situated outside this neighbourhood. Note there are four pharmacies within one mile of the applicant’s proposed pharmacy.
In view of this, the applicant has shown no inadequacy in the current service provision and therefore it is neither desirable nor necessary to grant this application in order to secure the adequate provision of pharmaceutical services to the neighbourhood in which the premises are located”.
Conon Bridge Pharmacy Limited Dalneigh _ PPC 29 January 2013 NOTES.doc P27 12.4 Mr A Shearer, Rowlands Pharmacy stated “again in today’s presentation, the applicant has refused to show an inadequacy in current pharmacy services. Patients will and do travel outwith Dalneigh, to access numerous services – medical and non medical. Patients have a choice of numerous pharmacies providing all the core services and many additional ones.
I believe there is a lack of weight to the applicant’s public feedback with no response to the local paper advert, a door to door questionnaire that perhaps did not give a full demographic, a Facebook campaign is not a reliable source of information. If this was required surely there would be loads of locals would be crying out for it.
I do not believe the applicant has provided evidence that the application is desirable to secure adequacy. Again, I ask that the application is refused.
12.5 Mr A Horsburgh, Conon Bridge Pharmacy Limited stated “in summary we have clearly defined a neighbourhood and explained the health of the populace in terms of health needs and multiple deprivations.
Our application has support from MP Danny Alexander and MSP Mary Scanlon. The local Community Council has given a fantastic supporting letter clearly laying out the barrier caused by the main A82 trunk road. The local populace have engaged with the evidence gathering process and have supplied many pieces of evidence regarding the quality of services provided, in particular to the Chronic Medication, Minor Ailments and Public Health Services.
We have clearly demonstrated that there is a clear inadequacy and capacity issues at three of the adjoining pharmacies and the fourth is separated by distance and is at physical capacity.
It is necessary and desirable to grant this application in order to provide adequacy in pharmaceutical services and equality of access for the neighbourhood.
At the conclusion of the summing up, the Chair asked the Applicant and all of the interested parties if they considered that they had had a fair hearing. Messrs. Horsburgh, Shearer, Arnott, Finnie, Ross and the Misses Harrold and Robertson replied yes, that they did consider they had had a fair hearing.
The Chair advised that 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.
Messers. Horsburgh, Shearer, Arnott, Finnie Ross and Green, (Area Regulations, Contracts & Controlled Drugs Governance Pharmacist) and the Misses Harrold, Robertson, Trappitt (Community Pharmacy Administration Assistant) and MacDonald (Community Pharmacy Business Manager) left the meeting.
13. DECISION
Having considered all the evidence presented to it, and the Committee’s observations from the site visits, the Committee had firstly to decide, the question of the neighbourhood in which the premises to which the application related, were located.
The Committee considered the different neighbourhoods put forward 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.
Conon Bridge Pharmacy Limited Dalneigh _ PPC 29 January 2013 NOTES.doc P28 The Committee took into account a number of factors in defining the neighbourhood including the natural and man-made boundaries, who resides there, neighbourhood statistics, the location of existing shops and services, health services and schools, land use and topography, and the distance, means and travel times by which residents have to travel to access existing pharmaceutical services and other services.
The Committee also took into consideration it’s 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 characteristic and those who do not.
13.1 Neighbourhood: The Committee unanimously agreed that the neighbourhood was the same as indicated by the Applicant and should be defined as follows:
North: The A862 Telford Street starting at the Muirtown Bridge at the Caledonian Canal along to the Telford Street roundabout of the A82 at Kenneth Street. It was considered by the Committee that this clearly marks the northern boundary since north of Telford Street is clearly within the Merkinch area and local people would consider themselves within another neighbourhood and the natural flow would be towards Grant Street to access pharmaceutical services. They could not agree with Lloyds definition that the northern boundary was the Beauly Firth since the residents of Merkinch would not consider themselves to be in the same neighbourhood as those of Dalneigh.
East: The A82 from Telford Street roundabout along Kenneth Street, Tomnahurich Street and Glenurquhart Road down to Tomnahurich Bridge at the Caledonian Canal. The Committee was of the opinion that the A82 was a perfect boundary to the neighbourhood not only because it is a busy trunk road but also because crossing it takes you into different neighbourhoods. From Kenneth Street and Tomnahurich Street to the river is considered as living “in town” and the residents of Ballifeary, to the east of Glenurquhart Road, would not consider themselves as living in the same neighbourhood as those of Dalneigh. Walking across Glenurquhart Road feels immediately like crossing from one neighbourhood to another and the Committee could not agree with Rowlands and Lloyds that the east boundary should be to the River Ness.
South: Where the A82 meets the physical boundary of the Caledonian Canal at Tomnahurich Bridge and the natural boundary of the hill and trees bounded by the fence around Tomnahurich Cemetery. To the south of this lies a golf course and open countryside.
West: The Caledonian Canal which results not only in a physical boundary but marks the edge of a different neighbourhood at Kinmylies area to the West.
13.2 Adequacy of Existing Provision of Pharmaceutical Services and Necessity or Desirability: Having reached that decision, the Committee was then required 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.
Conon Bridge Pharmacy Limited Dalneigh _ PPC 29 January 2013 NOTES.doc P29 The Committee noted that within the neighbourhood as defined there are no community pharmacies. However there are four pharmacies within the adjacent neighbourhoods and these (or other pharmacies in the town) pharmacies provide a comprehensive range of pharmaceutical services including NHS core and locally negotiated services to the neighbourhood. Consequently, the Committee recognised that they needed to consider whether an adequate pharmaceutical service was being provided from these pharmacies, bearing in mind that residents can choose to access pharmacies throughout Inverness.
The Committee acknowledged the deprivation levels in the neighbourhood and the fact that it has a community centre, convenience stores, social work units, a primary and a secondary school amongst other services and these helped to provide a sense of community but it was recognised that residents would have to leave the neighbourhood to consult a general practitioner, other primary care services, and for their main shopping provisions. At the present time post office services also have to be accessed out with the neighbourhood. A small number of additional housing units are being built, but there was little capacity for further growth and the population has remained relatively stable.
The Committee did consider the evidence submitted by the Applicant both within his application and during the oral hearing but was of the opinion that no robust evidence had been presented to support the claim that there was an inadequacy of pharmaceutical services within the neighbourhood. It was recognised that there was evidence submitted that indicated that access to pharmacies isn’t always convenient with people travelling to access a pharmacy or in some cases having their prescriptions delivered but there wasn’t sufficient evidence submitted to judge the current service inadequate and bus services to and from the neighbourhood are frequent.
The public consultation that was advertised in the Inverness Courier had no responses to the applicant’s request for the community’s views on the proposed pharmacy and adequacy of pharmaceutical services.
Unfortunately the postal survey, door-to-door survey and Facebook campaign also did not provide real evidence to support the applicant’s claims of inadequacy and, in addition, were poorly conducted. The Committee noted the issues of literacy and that residents may not have understood the questions asked. This consequently had resulted in the survey staff filling in some answers.
It was noted that the petition had yielded 338 signatures indicating support for the pharmacy but again this did not highlight any inadequacies and there was some duplication in the signatures and some entries appeared to be in the same handwriting.
The Committee did note that the Lloyds pharmacies in Greig Street and Riverside and Kinmylies Pharmacy were not engaging as well as they might with all four core services of the Scottish Pharmacy Contract. While all the services appeared to be available, statistics showed that engagement in some core services was well below the Highland average. This, however, does not necessarily indicate an inadequacy of pharmaceutical services in the neighbourhood since the residents may be accessing these services such as the Minor Ailment Service (MAS) from other pharmacies. The Committee also noted that there is additional capacity in the existing pharmacies. They also disagreed that Rowlands in Grant Street was at capacity due to the size of its premises and also noted that it had a high engagement with all the core services.
The Committee did acknowledge that there are some patients who rely on prescription collection and delivery services to the neighbourhood and that this creates some difficulties in offering the core services of the new contract particularly the Chronic Medication Service (CMS).
Conon Bridge Pharmacy Limited Dalneigh _ PPC 29 January 2013 NOTES.doc P30 During the NHS Highland Public Consultation as well as the public notice on the website, Facebook and Twitter, 27 letters were sent out to the local MP, the Constituency MSP and all the Regional MSPs, Highland Councillors and Community Councils but only one supportive letter was received from Ballifeary Community Council and the Committee noted surprise that there was nothing from the Dalneigh and Columba Community Council.
The Applicant did receive letters of support directly from Mary Scanlon, MSP, Danny Alexander MP offering their support but didn’t highlight any inadequacies, and also again from Ballifeary Community Council who again expressed the view that the residents of Dalneigh were currently not well served with regard to pharmaceutical services and that a pharmacy would be of considerable benefit. There were also 5 letters of support from members of the public.
There have been no complaints to NHS Highland about current pharmaceutical services within the neighbourhood.
The Committee, in determining adequacy of existing provision of pharmaceutical services in the defined neighbourhood took account of the evidence provided by the Applicant, and made available from other sources and concluded that the level of existing pharmaceutical services was adequate and that granting the application was not necessary or desirable.
The non-voting pharmacists then left the room.
13.3 In accordance with the statutory procedure the Pharmacist Contractor Members of the Committee were excluded from the decision process:
DECIDED/-
The Pharmacy Practices Committee (PPC) was satisfied that the provision of pharmaceutical services at the premises of the Applicant were not necessary or 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 in the circumstances, it was the majority decision of the PPC that the application be refused.
The non-voting pharmacists and the Board Officers were then invited back into the room and were advised that the application had been refused and the decision of the Committee was recorded.
The Hearing was then closed.
Bill Brackenridge as Chair of the PPC
Date: 5 February 2013
Conon Bridge Pharmacy Limited Dalneigh _ PPC 29 January 2013 NOTES.doc P31