Sha/24542 Appeal Against East of England Area Team, Nhs

11 June 2021 Arena Point Merrion Way REF: SHA/24542 Leeds LS2 8PA

APPEAL AGAINST EAST OF ENGLAND AREA TEAM, Tel: 0203 928 2000 NHS COMMISSIONING BOARD ("NHS ENGLAND") Fax: 0207 821 0029 DECISION TO REFUSE AN APPLICATION BY LNG & Email: [email protected] NTH-STW PHARMA LTD FOR INCLUSION IN THE PHARMACEUTICAL LIST OFFERING UNFORESEEN BENEFITS UNDER REGULATION 18 AT BEST ESTIMATE FROM 10 TO 101 HIGH STREET AND THE PREMISES OCCUPIED BY LONGSTANTON SURGERY AND 2524 SQUADRON AIR TRAINING CORP ON MAGDELENE CLOSE, LONGSTANTON, CAMBRIDGE, CB24

1 Outcome

1.1 The Pharmacy Appeals Committee (“Committee”), appointed by NHS Resolution, confirms the decision of NHS England, therefore the application is refused.

A copy of this decision is being sent to:

Rushport Advisory LLP on behalf of LNG & NTH-STW Pharma Ltd L Rowland & Co (Retail) Ltd Gordons on behalf of Willingham Pharmacy Cambridgeshire & Peterborough LPC PCSE on behalf of NHS England

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 REF: SHA/24542 Merrion Way Leeds APPEAL AGAINST EAST OF ENGLAND AREA TEAM, LS2 8PA

NHS COMMISSIONING BOARD ("NHS ENGLAND") Tel: 0203 928 2000 DECISION TO REFUSE AN APPLICATION BY LNG & Fax: 0207 821 0029 NTH-STW PHARMA LTD FOR INCLUSION IN THE Email: [email protected] PHARMACEUTICAL LIST OFFERING UNFORESEEN BENEFITS UNDER REGULATION 18 AT BEST ESTIMATE FROM 10 TO 101 HIGH STREET AND THE PREMISES OCCUPIED BY LONGSTANTON SURGERY AND 2524 SQUADRON AIR TRAINING CORP ON MAGDELENE CLOSE, LONGSTANTON, CAMBRIDGE, CB24

1 The Application

By application dated 31 March 2020, LNG & NTH-STW Pharma Ltd (“the Applicant”) applied to NHS Commissioning Board (“NHS England”) for inclusion in the pharmaceutical list offering unforeseen benefits under Regulation 18 at a best estimate address from 10 to 101 High Street and the premises occupied by Longstanton Surgery and 2524 Squadron Air Training Corp on Magdelene Close, Longstanton, Cambridge, CB24. In support of the application it was stated:

1.1 In the Applicant’s view this application should not be refused pursuant to Regulation 31 as there is no other pharmacy in same or adjacent premises so it is not applicable.

1.2 Northstowe is a new town development with up to 10,000 new homes to be built in the town.

1.3 Northstowe will have its own unique community with all the amenities and facilities that are required including Schools (nursery and pre-school), recreation, community facilities and shops are all included. As a new town some of these facilities will also provide services for other nearby communities allowing Northstowe to become an ideal hub and a destination for the wider community to enjoy. A GP surgery and pharmacy form part of the overall masterplan subject to NHS approval.

1.4 The overall development site is shown [at Appendix A] and it wraps around the existing settlement of Longstanton, which will serve as the main service provision area until the new retail development is available in Northstowe. The two communities will essentially merge into a larger development.

1.5 The first residents moved in during early 2017. As at December 2019 over 500 homes, a primary school and the community wing of the school are all constructed and the secondary college has already opened its doors. At least a further 400 homes will be completed during 2020. A further 400 homes, 2 primary schools and a local centre are to be constructed in phase 3. These are in addition to the approximately 2,300 people already living in Longstanton at the time of the 2011 census and before any of the new homes were completed.

1.6 The attached development masterplan shows the scale of development and the integration with Longstanton.

1.7 The nearest pharmacies to Longstanton are between 2.5 miles and 3 miles away and access by foot is therefore not a realistic option. There is a limited bus route which runs approximately once per hour to Willingham in the north or Tesco to the south, but these

cannot be considered to provide proper and sufficient services for an area which is growing to become a new town in its own right.

1.8 Longstanton has benefitted from some additional retail development already, with the new Co-op store and associated shops developed in 2014 as part of the significant housing development at Nelson’s Close (off the High Street). These new shops are in addition to the shops and services that already existed along High Street prior to the Nelson’s Close development.

1.9 The steady increase in facilities as additional housing development has taken place is indicative of an area which is becoming increasingly reliant on having its own provision and not having to look outside for main services. As the housing development continues, demand for pharmaceutical services will only increase and should be properly catered for.

1.10 By opening a pharmacy at the proposed location the Applicant is intending to secure the unforeseen benefit.

2 The Decision

NHS England considered and decided to refuse the application. The decision letter dated 15 February 2021 states:

2.1 NHS England has considered the above application and are writing to confirm that it has been refused. Please see the enclosed report for the full reasoning.

Extract from PSRC

2.2 The Pharmaceutical Services Regulations Committee (hereafter referred to as “the Committee”) considers all pharmaceutical services applications on behalf of NHS England and NHS Improvement East of England in accordance with the National Health Service (Pharmaceutical and Local Pharmaceutical Services) Regulations 2013 as amended (hereafter referred to as “the Regulations”).

2.3 The Committee considered this unforeseen benefits application which is determined under Regulation 18.

2.4 The Committee noted the following;

Background

2.5 Longstanton is a village and civil parish in South Cambridgeshire, 6 miles (9.7 km) northwest of Cambridge city centre. Currently it is classified as a controlled locality.

2.6 Longstanton has a small number of shops and businesses, including a public house, local supermarket that was opened in 2014 and a post office. There is a medical practice, dental practice and two veterinary practices.

2.7 The village has a primary school and is in the catchment area for Northstowe Secondary College and Swavesey Village College.

2.8 The route of a decommissioned railway in Longstanton was developed as the Cambridgeshire Guided Busway, the world's longest guided busway. The busway opened in August 2011 and there is a stop with a park-and-ride car park at Longstanton, close to the site of the old railway station. There are frequent daily services from Longstanton to Cambridge and St Ives along the busway. A bus service links Longstanton and surrounding villages with Cambridge.

2.9 The Applicant has stated in their application, a new town called Northstowe. Northstowe is a new town that will eventually have up to 10,000 homes, with an anticipated population of 24,400 in Cambridgeshire. The new town currently falls mainly within the Longstanton ward of South Cambridgeshire District Council.

2.10 There are 8 pharmacies and 10 GP surgeries within a 5-mile radius of the centre of the best estimate area as per the NHS website. The post code used for this search was CB24 3BP, this being the Post Office premises in Longstanton. 3 of these pharmacies and 5 GP surgeries are within 3 miles.

2.11 The Committee had sight of a report detailing the nearest pharmacy and surgery opening hours which was disseminated to all members and attendees prior to the meeting.

2.12 The Committee noted that a site visit is unable to be conducted due to the pandemic and travel restrictions in force at this time. All details above have been researched from the internet.

Consideration

2.13 The Committee first considered the unforeseen benefits application under Regulation 31 of the Regulations. [quoted in full]

2.14 The Committee agreed that this condition is not met as there are no existing services from the best estimate of the proposed pharmacy premises or at adjacent premises. There are no existing pharmacies operating from the proposed area and therefore, under this provision, Regulation 31 does not cause the application to be refused.

2.15 The Committee moved on to consider Regulation 40 of the Regulations.

Regulation 40.—(1) This paragraph applies to all routine applications—

(a) for inclusion in a pharmaceutical list as an NHS pharmacist; or

(b) from an NHS pharmacist included in such a list—

(i) to relocate to different pharmacy premises in the area of the relevant HWB, or

(ii) to open, within the area of the relevant HWB, additional pharmacy premises from which to provide pharmaceutical services, where the applicant is seeking the listing of pharmacy premises which are in a controlled locality.

2.16 The Committee noted that the Applicant has not disputed that the area of the best estimate of the proposed premises, where they are seeking listing of pharmacy premises, is within a controlled locality.

2.17 The Committee agreed that Regulation 40(2) is not applicable as there has been no refusal of an application that would impose the 5 year rule.

Regulation 40 (3) For the purposes of paragraphs (1) and (2), if no particular premises are proposed for listing in A1, the applicant is to be treated as seeking the listing of pharmacy premises at the location which is the best estimate that the NHSCB is able to make of where the proposed listed pharmacy premises would be, having regard to the best estimate given by the applicant under paragraph 1(7)(a)(ii) of Schedule 2.

2.18 The Committee noted that for the purposes of this regulation NHS England and NHS Improvement determined the best estimate postcode as CB24 3BP, being the post code of the Post Office in Longstanton.

2.19 The Committee considered whether the location of the proposed pharmacies is in a reserved location as defined in Regulation 41(3)

Regulation 41(3)

Subject to regulation 43(2), the area within a 1.6 kilometre radius of a relevant location is a “reserved location” if—

(a) the number of individuals residing in that area who are on a patient list (which may be an aggregate number of patients on more than one patient list) is less than 2,750; and

(b) the NHSCB is not satisfied that if pharmaceutical services were provided at the relevant location, the use of those services would be similar to, or greater than, the use that might be expected if the number of individuals residing in that area who are on a patient list were 2,750 or more.

2.20 The Committee noted that on the date the application was received, the number of NHS registered patients living within a 1.6 kilometre radius of CB24 3BP was 4,821.

2.21 The Committee agreed that the reserved location status does not apply as the patient figures exceed 2,750.

2.22 The Committee moved on to consider Regulation 44 of the Regulations.

Prejudice test in respect of routine applications for new pharmacy premises in a part of a controlled locality that is not a reserved location

Regulation 44.—(1) This paragraph applies to all routine applications—

(a) for inclusion in a pharmaceutical list as an NHS pharmacist; or

(b) from an NHS pharmacist included in such a list—

(i) to relocate to different pharmacy premises in the area of the relevant HWB, or

(ii) to open, within the area of the relevant HWB, additional pharmacy premises from which to provide pharmaceutical services.

(2) As regards any application to which paragraph (1) applies, the NHSCB must have regard to whether or not the applicant is seeking the listing of pharmacy premises which are in a part of a controlled locality that is not a reserved location.

2.23 The Committee noted that the Applicant is seeking the listing of a pharmacy premises which are in a controlled locality that is not a reserved location.

(3) If the applicant is seeking the listing of pharmacy premises which are in a part of a controlled locality that is not in a reserved location, the NHSCB must refuse the application if granting it would, in the opinion of the NHSCB, prejudice the proper provision of relevant NHS services in the area of—

(a) the relevant HWB; or

(b) a neighbouring HWB of the relevant HWB.

(4) For the purposes of paragraphs (2) and (3), if no particular premises are proposed for listing in the application, the applicant is to be treated as seeking the listing of pharmacy premises which are in a controlled locality if the best estimate that the

NHSCB is able to make of where the proposed pharmacy premises would be is at a location which is in a controlled locality, having regard to the best estimate given by the applicant under paragraph 1(7)(a)(ii) of Schedule 2.

2.24 The Committee agreed that no evidence has been submitted to suggest that granting the application would prejudice the proper provision of relevant NHS services in the HWB or a neighbouring HWB.

2.25 The Committee were satisfied they would not refuse under this regulatory test.

2.26 The Committee moved on to consider Regulation 18 of the Regulations.

Regulation 18.—

(1) If—

(a) the NHSCB receives a routine application and is required to determine whether it is satisfied that granting the application, or granting it in respect of some only of the services specified in it, would secure improvements, or better access, to pharmaceutical services, or pharmaceutical services of a specified type, in the area of the relevant HWB; and

(b) the improvements or better access that would be secured were or was not included in the relevant pharmaceutical needs assessment in accordance with paragraph 4 of Schedule 1,

(c) in determining whether it is satisfied as mentioned in section 129(2A) of the 2006 Act (regulations as to pharmaceutical services), the NHSCB must have regard to the matters set out in paragraph (2).

2.27 The Committee noted that representations were made during the 45-day consultation by the following: -

2.27.1 Willingham Medical Practice

2.27.2 Gordons Partnership LLP on behalf of Willingham Healthcare Limited

2.27.3 Swavesey Surgery

2.27.4 Rowlands Pharmacy

2.27.5 Over Surgery

2.27.6 Cambridgeshire and Peterborough Local Pharmaceutical Committee (LPC)

2.27.7 Boots UK Limited

2.28 The Committee noted that all the above with the exception of the LPC, object to the application.

2.29 The Committee noted that Longstanton is not mentioned in the Cambridgeshire Pharmaceutical Needs Assessment 2017 (PNA), however Northstowe is.

2.30 The PNA states in regard to Northstowe, the following: -

“The new town of Northstowe is an NHS Healthy New Town Vanguard and the project is looking to provide new residents with the spectrum of health services from pharmacy and primary care in a new model of care. Residents will be advised when they move in on the most appropriate health service to access for their needs.

The HWB has considered ways of monitoring the progress of planned housing developments in relation to need for pharmaceutical services.”

2.31 It goes on to detail how the HWB will monitor the need for pharmaceutical services as follows: -

“Cambridgeshire Research Group publish a quarterly update on the status of major housing developments in Cambridgeshire. This information will be used to inform monitoring of need for pharmaceutical services before the next PNA is published.”

2.32 The Committee noted the following statement extracted from the PNA: -

“The Committee is aware of the new developments that are planned across the county and how this could impact on GP services. We agree that the Senior Public Health Manager for Environment and Planning should monitor and assess pharmaceutical need in these areas regularly with a view to publishing a supplementary statement to the PNA if necessary. The Committee would be happy to assist in any way with these reviews.”

2.33 The Committee noted the PNA shows an analysis of the situation as it was assessed at the date of publication and there have been no revised assessments issued, in the form of a Supplementary Statement under Regulation 6(3), in regard to this area.

2.34 In the PNA, the conclusion states:

“Key finding: There is currently sufficient pharmaceutical service provision across Cambridgeshire. No need for additional pharmaceutical service providers was identified in this PNA.”

2.35 The Committee noted the applicant seeks to provide unforeseen benefits to the resident and reliant population in the area surrounding the application and in order to be satisfied in accordance with Regulation 18(1), the criteria set out in Regulation 18(2) should be considered.

(2) Those matters are—

(a) whether it is satisfied that granting the application would cause significant detriment to—

(i)proper planning in respect of the provision of pharmaceutical services in the area of the relevant HWB, or

(ii) the arrangements the NHSCB has in place for the provision of pharmaceutical services in that area;

2.36 The Committee agreed that if the application was granted and a pharmacy was to open, the ability of NHS England and NHS Improvement to plan for the provision of services would not be significantly affected and therefore it could be concluded that the proposed pharmacy would not cause significant detriment to the proper planning of pharmaceutical services.

2.37 Further, that granting the application would not cause significant detriment to the arrangements currently in place for the provision of pharmaceutical services.

(b) whether, notwithstanding that the improvements or better access were not included in the relevant pharmaceutical needs assessment, it is satisfied that, having regard in particular to the desirability of—

(i) there being a reasonable choice with regard to obtaining pharmaceutical services in the area of the relevant HWB (taking into account also the NHSCB’s duties under sections 13I and 13P of the 2006 Act (duty as to patient choice and duty as respects variation in provision of health services)),

2.38 The Committee noted there are 8 pharmacies within a 5-mile radius of the centre of the best estimate area as per the NHS website, covering 08:00 – 20:00, Monday to Saturday and 10:00 – 16:00 on Sunday.

2.39 The applicant has proposed 40 core opening hours in order to secure unforeseen benefits.

2.40 The applicant is not proposing any core hours on Saturday and Sunday but will provide supplementary hours on Saturday only. The total number of hours is 46.5.

2.41 The Committee considered the full supportive text in the application and the response in relation to comments made by interested parties during the 45 day consultation period. The following is a short summary of the base points: -

2.41.1 Northstowe is a new town development with up to 10,000 new homes to be built.

2.41.2 A GP surgery and pharmacy form part of the overall masterplan subject to NHS approval.

2.41.3 The two communities (Longstanton & Northstowe) will essentially merge into a larger development.

2.41.4 The applicant has provided a development masterplan which shows the scale of development and the integration with Longstanton.

2.41.5 The nearest pharmacies to Longstanton are between 2.5 miles and 3 miles away and access by foot is therefore not a realistic option.

2.41.6 There is a limited bus route which runs approximately once per hour to Willingham in the north or Tesco to the south, but these cannot be considered to provide proper and sufficient services for an area which is growing to become a new town in its own right.

2.41.7 The steady increase in facilities as additional housing development has taken place is indicative of an area which is becoming increasingly reliant on having its own provision and not having to look outside for main services.

2.41.8 As the housing development continues, demand for pharmaceutical services will only increase and should be properly catered for.

2.41.9 There are no other pharmacies that are reasonably accessible to the population of Longstanton.

2.41.10 There are no pharmacies that offer the population of Longstanton a reasonable choice of pharmaceutical services.

2.41.11 There are groups that share protected characteristics that will benefit from this proposal as set out in this document.

2.41.12 Dispensing practices can only provide a single pharmaceutical service, which is dispensing. Even this is limited, with some patients ineligible for the service. Opening a pharmacy would provide all patients with a full range of locally

accessible pharmaceutical services and the significant benefit this would secure should be acknowledged.

2.42 The Committee noted that there is no evidence submitted to show that residents of Longstanton and beyond are currently experiencing any difficulties accessing existing pharmaceutical services in the course of their routine lives or would receive significant benefits from the granting of the application.

(ii) people who share a protected characteristic having access to services that meet specific needs for pharmaceutical services that, in the area of the relevant HWB, are difficult for them to access (taking into account also the NHSCB’s duties under section 13G of the 2006 Act (duty as to reducing inequalities)), or

2.43 The Committee noted the application does not provide any evidence that patients in these groups living within the area have difficulties in accessing services that meet any specific needs.

2.44 The Committee agreed, on considering the evidence supplied, that any specific patient group, that shares a protected characteristic, would not receive significant benefits from the granting of this application.

(iii) there being innovative approaches taken with regard to the delivery of pharmaceutical services (taking into account also the NHSCB’s duties under section 13K of the 2006 Act (duty to promote innovation)),

granting the application would confer significant benefits on persons in the area of the relevant HWB which were not foreseen when the relevant pharmaceutical needs assessment was published;

2.45 The Committee agreed that no evidence has been submitted to support there being innovative approaches taken with regard to the delivery of pharmaceutical services. The Committee agreed that granting the application would not confer significant benefits on persons in the area of the relevant HWB which were not foreseen when the relevant pharmaceutical needs assessment was published;

2.46 Paragraph 31, (Schedule2)

Conditional grant of applications where the address of the premises is unknown

31.—(1) As regards any routine application, sub-paragraph (2) applies where—

(a) the applicant (A) is seeking the listing of premises not already listed in relation to A (whether or not A is already included in the pharmaceutical list); and (b) prior to the determination of the application, A was only able to provide a best estimate of where the proposed listed chemist premises would be (not the address of those premises).

(2) Where this sub-paragraph applies, it is a condition of the grant of that application that A notifies to the NHSCB the address of the premises to be listed within 6 months of—

(a) the date on which A was sent the notice of decision under paragraph 28 (having regard also to paragraph 10(2) of Schedule 3);

(b) if the grant of the application is appealed to the Secretary of State by a person with third party appeal rights, the date on which the appeal is determined by the Secretary of State; or

(c) in a case of an application which is subject to a condition imposed by virtue of paragraph 33(2), the date on which that condition becomes spent, whichever is the latest. 8

(3) A notification under sub-paragraph (2) is only valid if the NHSCB is satisfied that the premises are at a location that is within the range of possible locations covered by the estimate referred to in sub-paragraph (1)(b).

(4) If the NHSCB receives a purported notification under sub-paragraph (2), it must, within 14 days of receiving that purported notification—

(a)notify A of whether or not it is satisfied that it is a valid notification;

(b)if it is satisfied that it is a valid notification, notify the address to the persons notified of the decision to grant the application; and

(c)if the NHSCB is not satisfied that it is a valid notification, it must include with that notification—

(i)the reasons for its decision, and

(ii)an explanation of how A’s rights of appeal under paragraph 36(1)(b) may be exercised.

(5) The NHSCB may not vary or remove a condition imposed by virtue of this paragraph.

(6) If A breaches a condition imposed by virtue of this paragraph, the grant of the application lapses.

2.47 The Committee noted that NHS England and NHS Improvement would need to have regard to Paragraph 31, (Schedule 2) above as the proposed location for the application is for a best estimate and, if approved, the body corporate would be required to notify the address of the premises within 6 months of the date of any determination.

Decision

2.48 After careful consideration, the Committee refused the application on the following basis:

2.48.1 Cambridgeshire PNA published in 2017 did not identify a need for additional pharmaceutical services in the area.

2.48.2 There is already a reasonable choice with regard to obtaining pharmaceutical services;

2.48.3 There is no evidence of people sharing a protected characteristic having difficulty in accessing pharmaceutical services;

2.48.4 There is no evidence that innovative approaches will be taken with regard to the delivery of innovative pharmaceutical services.

2.48.5 Patients can access an array of Distance Selling pharmacies.

2.49 The Committee agreed that as the application has been refused, Regulation 50 – ‘Discontinuation of arrangements for the provision of pharmaceutical services by doctors’, would not apply.

2.50 The Committee agreed that the refusal would set a 5-year bar.

2.51 The Committee agreed that appeal rights be granted to the applicant.

3 The Appeal

In a letter dated 1 March 2021 addressed to NHS Resolution, Rushport Advisory LLP on behalf of the Applicant appealed against NHS England's decision. The grounds of appeal are:

3.1 The main points of the appeal and application are set out in the attached “Longstanton Pharmacy Appeal Report”. In addition the Applicant highlights the following points on the NHSE&I decision report.

3.2 It is clear from the tone of the NHSE&I decision report that it set out to find reasons to refuse the application. Services are described as “small” when they are significant and growing. Pharmacies and GP surgeries are listed if they are within a 5 mile radius without any justification for such a radius and the Committee feels comfortable with this analysis even though no site visit was carried out.

3.3 The Committee then considers the number of patients living within 1.6km of the application site and notes that it is already 4,821. This is a very sizeable population to have no pharmacy either within in or nearby. NHSE&I makes no comment on this and just notes the population figure and (unlike with consideration of shopping or services) does not use any adjectives or consider what the needs of those patients may be.

3.4 NHSE&I then quotes from the PNA and appears to accept the quotes at face value and fails to interrogate them in any way. For example, the PNA states that;

The HWB has considered ways of monitoring the progress of planned housing developments in relation to need for pharmaceutical services.

3.5 This comment is simply quoted by NHSE and appears to rely on it. However, the Applicant can find no evidence of any such monitoring of need for pharmaceutical services having been carried out.

3.6 The Applicant refers the Committee to the attached report in respect of the rest of our client’s evidence and look forward to hearing from you in due course.

Pharmacy needs Report – High Street/Magdelene Close, Longstanton, Cambridge

Introduction

3.7 This Pharmacy Needs Report considers an application for a new pharmacy located between 10 and 101 High Street and the premises occupied by Longstanton Surgery and 2524 Squadron Air Training Corp on Magdelene Close, Longstanton, Cambridge CB241.

3.8 For the benefit of the reader the location site used to take measurements in this report is taken as the junction of High Street and Thornhill Place.

3.9 This Report is submitted on behalf of the Applicant LNG & NTH-STW Pharma Ltd.

3.10 This Report provides:

3.10.1 Structure of the Report

3.10.2 a brief description of the Application at Section 2;

3.10.3 description of Longstanton, Northstowe and Oakington at Section 3;

3.10.4 comments on the Statutory Tests at Section 4;

3.10.5 comments on the Cambridgeshire Pharmaceutical Needs Assessment at Section 5;

3.10.6 details of the Healthcare Provision in the Area at Section 6;

3.10.7 the Key Factors of the Case in Section 7;

3.10.8 a Consideration of Key Issues in Section 8;

3.10.9 the Conclusion in Section 9.

The Application

3.11 Details of the proposal are set out in the application forms. The proposal is for a pharmacy in Longstanton. The pharmacy is proposed to cater for:

3.11.1 The local population of Longstanton;

3.11.2 The growing population of Northstowe that do not have any community facilities also with the many workers in this area; and

3.11.3 The local community of Oakington that will have improved access to Longstanton and will increasingly look to it for its daily needs.

3.12 The pharmacy will open between 9am to 5:30pm Monday to Friday and from 9am to 1pm on Saturday. Its core hours will be 9am to 5pm Monday to Friday.

3.13 The pharmacy will provide full NHS services and will sell pharmacy only medicines and provide the local population with access to health care 6 days a week. It increases the hours of healthcare available at present provided in the surgery and its dispensary which is limited.

Longstanton, Northstowe & Oakington

3.14 There are three key settlements associated with this application. The primary area of consideration is Longstanton. In addition the growing New Town of Northstowe is increasingly relevant to the application given the demands these new residents are placing on Longstanton. Oakington is an isolated village to the south of Longstanton that will look to Longstanton for some of its needs.

Longstanton

3.15 Longstanton is a town in South Cambridgeshire located about 6 miles northwest of Cambridge. It is located about 2 miles northeast of the A14 dual carriageway at junction 29. The A14 runs east-west between Cambridge and Ruby and links the M11 to the A1, the M1 and the M6.

3.16 Longstanton is bounded to the north and east by the new town of Northstowe and a Guided Busway that links Cambridge to St Ives and Huntington. South of the town is the lands of former Oakington RAF base and settlement of Oakington and to the west across the A14 is Bar Hill.

3.17 Longstanton is a well-established town in south Cambridgeshire with a population in 2011 of just under 2,700, however due to the significant recent housing developments on the edge of the village this figure has increased significantly and now stands at about 3,500.

3.18 Longstanton is an attractive village. It has historical significance with the village dating from the middle ages. It has a number of listed buildings and an attractive village

setting. Its connections with the former RAF base at Oakington adds to the character and history of the village.

3.19 Longstanton is within commuting distance of Cambridge, Bedford, Peterborough and Corby. It is a civic parish with an active local parish council. It is a tranquil and pleasant place for people to live to raise families or retire. The village is surrounded by low lying countryside.

3.20 On its own Longstanton is a settlement of its own identity and history, however, in the last decade or so the lands that wrap around the south, east and north of the village have been identified and developed as one of England’s newest and largest new towns. The former Oakington airfield and army barracks located north of the airfield are being developed as the new town of Northstowe.

Settlement Pattern of Longstanton

3.21 Longstanton is a linear settlement that runs either side of the roads of St Michael’s, Woodside and High Street which run in a southeast to northwest direction for about 1.1miles (1.84km).

3.22 Housing estates are located either side of these roads to provide residential areas off Mills Lane, Thatchers Wood, Haddows Close, Thornhill Place, Hattons Road, Prentice Close and Lady Walk. On the edge of Longstanton are caravan parks at Wilson Road and at Toad Acres Park Home Estate which is a development of park homes used by semi-retired and retired people. It also has static caravans for hire by tourists and visitors to Cambridge and the wider area. The Manor Longstanton is a guest house providing accommodation to visitors in the area.

3.23 Longstanton has a number of public services including historic churches, post offices and shop, village vet, dentist, bicycle business, the Pavilion, Village Institute, the Black Bull restaurant and take away, car sales, Longstanton bowls club, park and outdoor recreation area.

3.24 As a vibrant community Longstanton has a wide variety of community activities including bowls, tennis, women’s institute, fitness boot camp, ballroom dancing, football club, army and air force cadets, children’s and elderly social clubs.

3.25 In recent years a new Neighbourhood Centre has been developed at High Street anchored by a 255 sq m (2747 sq ft) Co-op and also providing an estate agents, chip shop and Bellaclaire Childcare.

3.26 There is Mad Hatters Pre School and Hatton Park Primary located in the centre of Longstanton. This Primary School has about 180 pupils.

Longstanton Branch Surgery

3.27 Longstanton Branch Surgery, Magdalene Close is a branch of the Willingham Medical Practice based in Willingham north of Longstanton. The surgery is registered as opening between 08:30-13:00 Monday to Friday. The branch surgery provides a dispensary which is open between 08:30-13:00 Monday to Friday. It is open for telephone repeat prescriptions between 14:30 – 17:00 Monday, Tuesday, Wednesday and Friday. It is closed on Thursday afternoon. It is not open on Saturday.

3.28 The branch surgery essentially has a captive audience and limits access to its dispensary accordingly. Allowing a pharmacy to open to serve all those in the area would be a significant benefit to local patients and also to visitors.

3.29 In October 2000 planning permission was granted for development of a bypass and 21ha of housing and a 7.2ha Business Park and an extension to the village recreation

area (2.8ha) a village green including land for a local shop and surgery at lands west of Longstanton. This permission granted planning permission for 546 dwellings.

3.30 This development has largely been completed as shown in the images (see Appendix B).

3.31 It can be seen that the development of Home Farm has delivered the circa 546 dwellings approved and this will have significantly increased the population. About half of these homes were built after 2011, and as such the 2011 population will have been increased by 273 dwelling and an increase in population of about 765 people. This suggests that the Longstanton population is probably in the region of 3,500. This excludes the population at Northstowe.

Northstowe

3.32 In 2007 South Cambridgeshire District Council published the Northstowe Action Area Plan that confirmed that Northstowe would be developed as a new town adjacent to Longstanton and Oakington with 10,000 dwellings creating a population of about 25,000 people and associated developments of new roads and streets, schools, health care and other social and civic uses, open space and a town centre providing shops and services.

3.33 The area covered by Northstowe is illustrated at Appendix B.

3.34 The Masterplan for Northstowe is illustrated at Appendix B which highlights areas of a wildlife corridor, local centre, primary school, sports hub/community building, secondary school, town centre, Cambridgeshire Guided Busway, new links to the A14 and areas of green buffers.

3.35 Multiple planning applications and permissions have been submitted and approved for Northstowe. An application for phase 1 was granted in April 2014 which permitted up to 1,500 dwellings, a primary school, a mixed use local centre, leisure, community, health and employment uses, a household recycling centre, recreational space and infrastructure works.

3.36 Significant infrastructure developments have commenced with the development of the Emmanuel Church and the development of the southern relief road. Overall the town is planning to have eight schools including a pre-school and nursery, primary, secondary, sixth form and special needs education. The first primary school (the Pathfinder Church of England Primary) opened in 2017 and provides 630 places and 52 pre-school places. Northstowe Secondary College also recently opened. This has an initial 600 places and will grow to 1800 places. It will also provide 400 place sixth form education.

3.37 To date about 650 new homes have been built in phase 1 and the Council are predicting a build rate of about 200 - 250 dwellings per year in the coming years. NHS England has provided funding for a Healthy New Town programme in Northstowe. Residents in Northstowe are given health advice on where to seek medical care. The NHS advises new residents that the nearest pharmacy is located in Willingham, Over and Bar Hill.

3.38 To place Northstowe in context, it is being developed by 5 separate house builders (Bloor Homes, Taylor Wimpey, Linden Homes, Barrat Homes, Bovis Homes), and is being supported and co-ordinated by Homes England – the Government’s housing accelerator who are responsible for releasing public land and speeding up the rate it can be built on. Phase 1 will provide 300 affordable homes.

3.39 Planning permission was granted in February 2020 for Phase 2. This is a higher density area that will comprise 78,700 sq m of floor space in a new town centre and 3,500 new homes. 50% of these will be affordable homes (40% starter homes and 10% affordable rental homes).

3.40 In April 2020 England Homes submitted outline applications to South Cambridgeshire District Council for Phases 3a and 3b Northstowe. Phase 3 a (north of Phase 1) is for 4,000 new homes, a local centre and two primary schools and Phase 3b (on the former RAF airfield) is for 1,000 new homes and a primary school.

3.41 The Googlearth image (see appendix B) shows the scale of works that have taken place at Northstowe. It can be noted that significant infrastructure works are on-going across the site. The image shows the new roads and guided bus route, the new housing in Longstanton at Home Farm and the various phases of Northstowe. It also shows the close proximity of Oakington.

Oakington

3.42 Oakington is a village in its own right, however, the inevitable consequence of the scale of construction at Northstowe Phase 3b will be that Longstanton, Northstowe and Oakington will essentially coalesce. While there is a current road link between the two settlements via Longstanton Road, the design of Phase 3b Northstowe has been to reinstate a previous transport route known as Mill Road linking Oakington and Longstanton. This was a request from the local community. It will eventually provide a pedestrian and cycle path directly between the two villages which are separated by about 1 mile.

3.43 It is notable therefore that Oakington also has a population of over 1500 in 2011 and has local shops and a post office, a pub, a primary school (130 pupils) and a variety of businesses. The village population do not have reasonable access to a pharmacy.

3.44 Oakington has seen new housing growth in the mid 2000’s at Saxon Close and Day’s Meadows.

3.45 Overall combining population of Longstanton, the new residents at Northstowe and the residents at Oakington the resident population of this area could be around 6,800, and is growing exponentially every year given the significant housing growth taking place.

3.46 It is noted that the NHSE Decision Report states that there are already 4,821 patients living within a 1.6km radius of the proposed pharmacy location – this is a sizeable population.

3.47 There is no pharmacy in the 1.6km area used by NHSE to calculate the relevant patient population for the purposes of regulation 41(3) or the wider area we describe above with an estimated population of 6,800 currently.

Statutory Tests

3.48 The statutory tests are set out under “The National Health Service (Pharmaceutical and Local Pharmaceutical Services) Regulations 2013” (the “Regulations”). In particular the application should be assessed under Regulation 18.

3.49 The first test is whether the need for a pharmacy has been identified in the required manner within the Pharmaceutical Needs Assessment for Cambridgeshire (the “PNA”). A review of the PNA confirms that the benefits of a pharmacy at Longstanton are not considered in the manner set out in the Regulation. As such this application is an ‘unforeseen’ application and Regulation 18 applies to its assessment. We discuss the PNA further below.

3.50 Other aspects of the Regulations are Regulation 18 (2)(a)(i) whether significant detriment to proper planning in respect of the provision of pharmaceutical services in the area of the relevant HWB would occur and Regulation 18(2)(a)(ii) whether significant detriment to the arrangements the NHSCB has in place for the provision of pharmaceutical services in that area would occur. There is no evidence that granting the application would cause significant detriment to proper planning or the

arrangements for provision of pharmaceutical services. As such neither grounds arise in this application.

3.51 The other aspects that an applicant can ground their application on includes Regulation 18 (2)(b) (ii) and (iii) being that a proposal will support the needs of people who share a protected characteristic and innovative approaches are being taken.

3.52 Access for those who share Protected characteristics (which includes every single person) is justification for this application as shown later, where it is shown that the local community of Longstanton, Oakfield and Northstowe includes elderly people and high levels of young people that have no access to a pharmacy in their area.

3.53 The Regulations have been in place for 7 years and are well understood. They have been distilled into the central issue of whether a proposal will provide better access to pharmaceutical services (Regulation 18(1)(a)) and whether there is reasonable choice of pharmaceutical services (Regulation 18(2)(b)(i). The Regulations provide no guidance as to what is “better access” or “reasonable choice”, such matters are determined by the facts of the case.

3.54 Better access and reasonable choice is clearly relevant in this case where a substantial population lives in an area that is remote from any pharmacy and there is a clear need for the residents in both the established settlements and the new settlement to have access to a pharmacy. Even some of those who have objected to the application accept that there is a need for a pharmacy but wish to delay the opening for some years.

Cambridgeshire Pharmaceutical Needs Assessment

3.55 The Cambridgeshire PNA 2017 (the PNA) considers pharmacy provision across the Health and Wellbeing Area. Section 6 of the PNA looks at population growth across the various Districts in Cambridgeshire. The following are the most notable comments:-

3.56 The PNA acknowledges that Cambridgeshire is the fastest growing county in England in terms of population between 2001 and 2011.

3.57 In terms of young people south and east Cambridgeshire will have the highest growth between 2016-2026 as shown below with a growth of 3,950 children between 2016 and 2021 and 2,850 children between 2021 and 2026. This is an increase of 6,800 over the decade.

The population of 0 to 19 year olds in Cambridgeshire is expected to increase by 9.4% overall between 2016 and 2021 (see Table 14). East and south Cambridgeshire are forecast to have the largest increases of 14% and 11% respectively. Table 14. Current and Forecast Population aged 0-19 years Local authority 2016 2021 2028 % change % change 2016- 2016- 2021 2026 Cambridge 35,000 37,800 38,900 8.0% 11.1% East Cambridgeshire 20,350 23,200 24,150 14% 18.7% Fenland 21,100 22,200 23,000 5.2% 9.0% Huntingdonshire 40,400 44,100 45,750 9.2% 13.2% South Cambridgeshire 36,100 40,050 42,900 10.9% 18.8% Cambridgeshire 152,950 167,350 174,700 9.4% 14.2% Source: Cambridgeshire Research Group 2013 base population forecasts

3.58 In terms of adult working population, east Cambridgeshire is expected to have the largest increase. However it can be noted that south Cambridgeshire has a very similar level of growth as east Cambridgeshire between 2016-2026. This is shown below where the population grows by 7,650 people between 2016 to 2021 and by 5,750 people between 2021 and 2026. The total growth in adults is 13,400 over the decade.

The adult working age population (age 20 to 64) in Cambridgeshire is expected to increase by some 7.6% between 2016 and 2021 (see Table 15). East Cambridgeshire is expected to have the largest increase at 11.6%. Table 15. Current and Forecast Population aged 20-64 years Local authority 2016 2021 2028 % change % change 2016- 2016- 2021 2026 Cambridge 84,900 92,100 94,000 8.5% 10.7% East Cambridgeshire 49,750 55,500 57,350 11.5% 15.3% Fenland 55,100 56,900 58,700 3.3% 6.5% Huntingdonshire 103,500 109,900 111,650 6.2% 7.9% South Cambridgeshire 88,200 95,850 101,600 8.7% 15.2% Cambridgeshire 381,450 410,250 423,300 7.6% 11.0% Source: Cambridgeshire Research Group 2013 base population forecasts

3.59 The over 65 age group in Cambridgeshire is also growing significant as shown below. In south Cambridgeshire this age group will grow by 4,300 between 2016 and 2021 and by 4,800 between 2021 and 2026. Over the decade it will increase by 9,100 people (+30.7%).

The number of people in Cambridgeshire aged over 65 years is expected to increase by 14.8% between 2016 and 2021 (see Table 16). The highest growth in the older population is expected to be in East Cambridgeshire (16.6%) and in Huntingdonshire (16.6%). Table 16. Current and Forecast Population aged 65 years and over Local authority 2016 2021 2028 % change % change 2016- 2016- 2021 2026 Cambridge 16,200 18,500 20,900 14.2% 29.0% East Cambridgeshire 16,900 19,700 22,300 16.6% 32.0% Fenland 22,200 24,800 27,800 11.7% 25.2% Huntingdonshire 33,800 39,400 45,200 16.6% 33.7% South Cambridgeshire 29,600 33,900 38,700 14.5% 30.7% Cambridgeshire 118,700 136,300 154,900 14.8% 30.5% Source: Cambridgeshire Research Group 2013 base population forecasts

3.60 The population of south Cambridgeshire will grow from 153,900 people in 2016 to 169,800 people in 2021 (+15,900) and to 183,200 people in 2026 (+29,300). That is a growth of 19% over the decade.

3.61 To accommodate this scale of population growth significant new housing is required. Northstowe is identified as the largest housing development to occur across Cambridgeshire with 10,000 dwellings. In addition to being the largest housing site it is notable that Northstowe is one of the sites acknowledged as having started in 2017 as shown below.

Table 19. Major Developments in Cambridgeshire 2017 to 2020 Site Area Total units at Estimate start completion date Northstowe South Cambridgeshire 10000 Started Bourn Airfield South Cambridgeshire 3000 TBC Cambourne West South Cambridgeshire 2350 TBC Waterbeach South Cambridgeshire 10000 TBC Cottenham (various sites) South Cambridgeshire 530-625 TBC Alconbury Weald Huntingdonshire 5000 2015 Wyton Huntingdonshire 4500 TBC RAF Brampton Huntingdonshire 587 TBC West March Fenland 2000 TBC Chatteris Fenland 1000 TBC

St Neots East St Neots 3700* 2014 Ely North Ely 3000 2014 Cambridge North West Cambridge fringe 3000 2014 Darwin Green 1 & 2 Cambridge fringe 2700 2014 Clay Farm Cambridge fringe 2300 Started Trumptingon Meadows Cambridge fringe 1200 Started Wing Cambridge fringe 1500 2015 *St Neot’s east includes two separate sites, Wintingham Park (2,800 units) an Lives Farm East (900 units with a possible potential for 1200 units) Source: Cambridgeshire Research Group

3.62 Northstowe is recognised in the PNA as a new town as shown below:

“The new town of Northstowe is an NHS Health New Town Vanguard and the project is looking to provide new residents with the spectrum of health services from pharmacy and primacy care in a new model of care. Residents will be advised when they move in on the most appropriate health service to access for their needs.

3.63 The PNA notes that Cambridgeshire Research Group publish a quarterly update on the status of major housing developments in Cambridgeshire and this will be used to inform monitoring of need for pharmaceutical services before the next PNA is published.

3.64 It also notes that the average household size in new developments in Cambridgeshire is 2.8. This is above the normally used average of 2.5 residents per new dwelling.

According to the 2011 census the average number of people per household in East of England is 2.3-2.4 (the average for England is 2.3). However an analysis undertaken by Cambridgeshire Research Group, to forecast the population of new developments in Cambridgeshire, suggested that it is reasonable to assume an average household size of 2.5 people. Note that the average household size in the new developments tends to be larger than the standard multiple used of 2.5 with Cambourne, Cromwell Park and Orchard Park seeing average household sizes of 2.7 (see table 20). This has implications for service delivery in new developments (i.e. coping with an increase in population compared to predicted populations). The average household size was expected to be relatively consistent in different housing mix scenarios, so that the average would be 2.25 and 2.75 people for most scenarios.

Table 20 Average household size of recent new developments

Development Average Household size Bar Hill 2.3 Cambourne 2.8 Cromwell Park 2.8 Hampton 2.7 Loves Farm 2.6 Orchard Park 2.8 Stukeley Meadows 2.6 Source: Cambridgeshire Research Group

3.65 The PNA does not make any analysis of whether or not and when a new pharmacy might be needed in Northstowe. The PNA states that:-

The HWB is not aware of any robust evidence to suggest a generic ‘population trigger point’ for when a housing development in a location might need a pharmaceutical service provider. The HWB is also not aware of any measure of the extent to which existing local pharmaceutical service providers can accommodate the increase in need for pharmaceutical services created by an increase in local population size.

An increase in population size is likely to generate an increased need for pharmaceutical services, but, on a local level, changes in population size may not necessarily be directly proportionate to changes in the number of pharmaceutical service providers required to meet local pharmaceutical needs, due to the range of other factors including such needs.

3.66 The PNA highlights (as shown in Appendix B) the large housing development at Northstowe and the fact that it is located in a rural area. It also highlights the nearest dispensing GPs and pharmacies. Note this Map does not appear to acknowledge that the Longstanton Branch Surgery has a dispensary.

3.67 The PNA’s conclusion is as follows:

In conclusion, over the coming years, the population in Cambridgeshire is expected to both age and grow substantially in numbers. Several large scale housing developments are in progress. The Cambridgeshire HWB will monitor the development of major housing sites and produce supplementary statements to the PNA if deemed necessary, to ensure that appropriate information is available to determine whether additional pharmaceutical services provision might be required,

3.68 The PNA does not consider the need for a pharmacy in Longstanton. It makes no reference to Longstanton at all. Whilst the PNA notes the need to monitor the development of major housing sites we are not aware of any such monitoring or review having been carried out in the lifetime of the PNA.

3.69 Moreover, the PNA does not assess the need for a new pharmacy for the area of Northstowe. This is likely to be because it was published in 2017 and as such was published before the housing growth at Northstowe gained the volume of units and build rate momentum it has now.

3.70 Further the PNA does not identify the need to cater for the Oakington population who also do not have reasonable access to a pharmacy.

3.71 The PNA has not foreseen a pharmacy at Longstanton or the benefits this will have for the significant and growing population of the surrounding area given the inaccessibility of existing pharmacies. With a new PNA further delayed due to the COVID pandemic, there is no justifiable reason to further delay the provision of pharmaceutical services just to allow the PNA to “catch up” with circumstances on the ground.

Healthcare Provision in the Area

Pharmacies in Longstanton

3.72 There are no pharmacies in the area of Longstanton.

Surgery and Dispensary in Longstanton

3.73 Longstanton Branch Surgery, Magdalene Close, Longstanton is the only surgery in Longstanton or in the wider Northstowe and Oakington area. It is a branch surgery of the Willingham Medical Practice. Combined the Willingham Medical Practice and Longstanton Branch Surgery has 9,541 registered patients. The practice area is located north of the A14. The surgeries website advises that it no longer accepts patients from Bar Hill because this area is outside the practice boundary and they have suspended applications due to capacity and the increasing demands on GP time. Applications from the towns within the practice area are still being accepted.

3.74 The prescriptions issued by Willingham Medical Practice are predominantly either dispensed by Willingham Pharmacy (7,763 items/66% of items prescribed) which is co- located with the Willingham Medical Practice or self-administered (3,335 items/28.37%

of items prescribed). Self-administered prescriptions are dispensed from the dispensary in Longstanton or Willingham and these are not further broken down.

3.75 Given the Willingham Medical Practice operates a branch surgery and a dispensary in Longstanton, it is clear that the Medical Practice in Willingham and the pharmacy co- located with it is not capable of meeting the demand for pharmaceutical services from the Longstanton area (at least as far as the doctors are concerned). The requirement to provide a dispensary is evidence that there is demand for pharmaceutical services in Longstanton. In our submission, the provision of a branch surgery dispensary alone cannot and does not meet this growing demand.

3.76 The dispensary within the branch surgery is not a substitute for a full pharmacy which would be open longer hours and have a fully trained pharmacist and associated staff available to patients whether seeking to have a prescription dispensed or to seek immediate care.

3.77 There is no other health care service within nearly 3 miles of the application site.

3.78 It is notable that the NHSE decision report refers simply to their being 8 pharmacies within a 5 mile radius. This may be correct, but is entirely unhelpful in considering the issues of access and choice. We provide a proper analysis of the location of the closest of these pharmacies below to demonstrate that they cannot be considered to provide accessible services.

Pharmacies over 2 miles away

3.79 Willingham Pharmacy, 52 Long Lane, Willingham is located at the same address as a Willingham Medical Practice and is 2.8 miles north of Longstanton. This pharmacy dispenses about 8,000 items per month from 3,791 forms, and as mentioned above the majority of this is from the Willingham Medical Practice. This pharmacy has provided a monthly average of 22 MURs, 15 NMS and 78% EPS take up in the last 12 months.

3.80 Tesco, 15-18 Viking Way, Bar Hill is located about 2.4 miles southwest of Longstanton. This has a 100 hour pharmacy. It dispenses about 6,117 items per month from 3,195 forms. 94% of the items dispensed in this pharmacy are prescribed at Maple Surgery Bar Hill Health Centre. Only 1.7% of items dispensed in this pharmacy are prescribed by Willingham Medical Practice. On this evidence this pharmacy is not catering for the population of Longstanton, Northstowe or Oakington.

3.81 The proposal will provide a new pharmaceutical service in the growing area of Longstanton/Northstowe and Oakington and give the people that reside in, and resort to, this area a full pharmacy service for the first time.

Key Factors of the case

3.82 The Regulations seek to understand whether a proposal will deliver improved access and choice of pharmaceutical services to an area. In order to assess this it is necessary to understand the scale of the resident and resorting population in an area, along with the scale of demand for health care services in that area.

3.83 It is also material to consider the current provision and accessibility of pharmacy services in the area. This section sets out the significant and growing resident and resorting population in this case before setting out where the nearest pharmacies are located and the propensity of local people using them.

3.84 Looking at the population this can be considered in the context of the resident and resorting population.

Population of Longstanton and surrounding area

3.85 As shown earlier the population of Longstanton has grown in recent years. The population of the area of Longstanton and Oakington/Northstowe in 2011 was 4,241. This is shown in the map in Appendix B. It is estimated to have grown to 5,290 in 2018.

3.86 With ongoing housing development in the area as shown earlier the population has will quickly grown. The housing growth at Northstowe is likely to be around 250 dwelling per annum. Between 2018-2019 the build rate for Northstowe was 278 units. As shown in the PNA, average household size is above the 2.5 and is at 2.8. As such there is a potential increase in population of 1,480. This creates a total population of about 6,800.

3.87 Looking forward, by the time this application is determined and opened the population in the area is likely to exceed 7,500.

Socio Economic Characteristics of the Longstanton Population Generally

3.88 Given the rapidly growing nature of this area, and the fact that there has not been a Census of the area since 2011, it is not possible to accurately reflect the full character of the Longstanton population. However the following Tables set out notable characteristics of the area.

3.89 The Tables in Appendix A shows that 12.1% of people in Longstanton and 13.1% of people in Oakington suffer from an illness that limits their daily activity.

3.90 The household tenure in the area is set out in Appendix B which shows home ownership in Longstanton of 74.6% and 73.9% in Oakington.

3.91 Car ownership in Longstanton is shown in Appendix B. It can be seen that 6.8% of people have no access to a car and 41% (450) of households have only access to one car. This means that during the day almost half of households have no car at home if it is being used to commute to work. Note this figure also excludes the people that live in Oakington and Northstowe that have no car or only one car per household.

Affordable housing provision in Northstowe

3.92 It can also be noted is that urban extensions are designed to provide a complete local community, with a mix of house types providing for all groups of people. It will have family homes, apartments and homes for elderly people.

3.93 In addition there will be a requirement to provide affordable housing. The Council are seeking that the developers of Northstowe provides 2000 affordable homes among the first 5,000 homes built. 300 affordable homes are built in the first phase. This will provide accommodate [sic] for about 840 people now, rising to 5,600 people.

Resorting Population to Longstanton

3.94 Northstowe is a major construction site and will continue to be for many years to come. The works on the site and the infrastructure works associated with it attract workers into the area on a weekly and daily basis. It is estimated on the Northstowe website that 12,000 construction jobs will be created in Northstowe over the period of the construction of the new town.

3.95 While it is not possible to be specific about the volume of workers resorting to the area, it is notable that high volumes of construction workers are in the area daily and they will not be aware of the location of the dispensary and would not seek it out if they feel unwell whilst at work. Even if they did, the dispensary cannot assist them with their day to day needs. These workers would typically seek out a local pharmacy in the High Street area to obtain healthcare either through consultation with the pharmacist, make use of the minor ailments scheme or obtain over the counter medication. Others may have a prescription with them and seek to have this dispensed during the day whilst at

work due to the long commute. These workers have nowhere in Longstanton to do this. A new pharmacy will support these workers.

3.96 In addition is can be noted that the opening of the neighbourhood centre in Longstanton, the schools, community services and clubs provided in the local community facilities will draw people into Longstanton from the wider rural catchment.

3.97 As shown in Appendix B, there are holiday homes in Longstanton at Toads Acres Park Homes where retired people and tourists to the surrounding area and Cambridge stay. The proposal will be well placed to cater for any emergency pharmaceutical services these people require.

Proximity and Accessibility of Existing Pharmacies

Walking

3.98 As shown in Section 5 there is no pharmacy in Longstanton. The only provision is a dispensary at the Longstanton Branch Surgery. A streetview image of the surgery is shown in Appendix B.

3.99 As shown in Appendix B Tesco, Bar Hill is 2.4 miles to the southwest. It is a 49 minute walk from Longstanton and is well beyond what can be considered as a reasonable walking distance.

3.100 Willingham Pharmacy is co-located with the Willingham Medical Practice about 2.8 miles north of Longstanton as shown below. This a walk of 54 minutes and is beyond what can be considered a reasonable walking distance.

Public Transport

3.101 In terms of public transport from Longstanton bus route 5 runs between Fenstanton and Cambridge via Longstanton. This services runs hourly.

3.102 There are bus stops along High Street. People in Longstanton need to walk to High Street from the surrounding housing areas to reach the bus stop. The proposal will facilitate these same people by having a pharmacy in or close to High Street, rather than them having to wait an hour for a bus to take them to Bar Hill or Willingham. The route is shown in Appendix B. It is clear from the dispensing data for Tesco that very few residents from Longstanton that are registered with the Willingham Medical Practice are actually using Tesco. As such the inadequacies of the bus service are borne out by the dispensing statistics.

3.103 For completeness, it is noted that the guided busway provides access from Longstanton to Cambridge. However this is principally a commuter service. The station is located about a mile north of High Street.

Private Car

3.104 While it is accepted that Tesco would be accessible by private car, many people will not have access to a private car during the day.

3.105 This application seeks to open a pharmacy in the heart of Longstanton. It will be at the heart of the area. It is the hub of daily activity where people bring their children to school, attend community buildings for the social activity, have a coffee or buy lunch in the local restaurant and where they do their daily shopping or use childcare. If this application is refused the Committee will be essential requiring the large and growing population of Longstanton continue to rely on the dispensary for a very limited service or to bypass its own town in favour of the out of town centre retail developments at Tesco or to visit the separate town of Willingham. This would be inconsistent with the

wider Council decision to make Longstanton the location of significant growth with the development of Home Farm and Northstowe.

3.106 While the bus route may be available, it adds financial burden and takes time out of a patients day to make what is likely to be three hour journey to visit their nearest pharmacy. Given the size of Longstanton and the growth occurring in Northstowe, these people look to Longstanton for their needs in the absence of any pharmacy or health care in the new town. It is unreasonable for these people to have to travel to outside of Longstanton for a pharmacy. Opening a pharmacy in Longstanton would secure better access to pharmaceutical services for those who live in the area.

3.107 The fact that the Tesco is located in a retail park and separated from Longstanton by the A14 which has undergone significant works in recent years reinforces the perception that the towns are distinct and separate areas. The Bar Hill shopping centre has a specific use, catering for long distance car borne shoppers. While Tesco provides pharmaceutical services, the evidence of prescription dispensing patterns shows it is not catering for the patients registered at Willingham Surgery or the Longstanton Branch Surgery. As such, Tesco is clearly not meeting the needs of the area. Willingham is a settlement in its own right with its own population and catering for its own community needs. Willingham and Bar Hill each had a 2011 population of 4,000. They each have their own pharmacy. These towns cannot be expected to meet the needs of the additional 6,800-7,500 people that live in the Longstanton/Northstowe and Oakington area.

3.108 Accessibility to pharmacies in this area is therefore limited. Indeed the proximity to pharmaceutical services is below any reasonable standard, which is made worse given :-

3.108.1 the substantial scale of population growth in Longstanton and Northstowe; and

3.108.2 the fact that the High Street will be increasingly important to the growing New Town population before any new local community facilities are opened. High Street will become under increasing demands from growing families and people living in affordable homes and the elderly in the Northstowe area.

Locally Provided Services

3.109 A local pharmacy can have a significant positive impact on community spirit and community identity. It provides a local meeting place for people to stop and meet their neighbours. While there is a dispensary in the Longstanton Branch Surgery it is not a substitute for the provision of a full pharmacy.

3.110 It is contrary to the aims of good planning and sustainable living to require the entire population of a settlement the size of Longstanton to leave the area to and travel unnecessarily to a large retail park or other town to access a pharmacy. Such an approach undermines the viability of the local shops and services in Longstanton, undermines the efforts to foster a sense of community spirit in Longstanton and places an unnecessary burden on people to make long journeys elsewhere rather than visit their local pharmacist. For those that have access to cars it increases traffic congestion on roads. In planning terms there are no good grounds to require the population of Longstanton to leave their community to travel elsewhere for a pharmacy.

3.111 On the contrary, good planning would actively encourage a pharmacy in Longstanton as it would reinforce the services in the village, support the needs of the local community, make access to a pharmacy easier and more sustainable encouraging people to walk to local shops, and combining a visit to the pharmacy as part of their day to day activity.

Benefits of Locally Accessible Healthcare in Longstanton

3.112 The Department for Health has the objective of pharmacies providing a wider range of services and to have a stronger role in the local community. It would encourage the provision of NHS services from a pharmacy to complement peoples current lifestyles and needs, where prevention of medical conditions can be achieved and where people can become educated in medical conditions so that they are better engaged in taking care of their own health and well-being.

3.113 With the closest pharmacy located outside Longstanton, and a 5 mile return trip away from many living in this area, a material consideration is the benefits of having a pharmacy in Longstanton. A pharmacy can provide a private consultation room and provide immediate access to a pharmacist without an appointment who can help diagnose health conditions, prescribe medication and sign post patients to GP and other health services. It is a fundamental aspect of the health services provided throughout the UK. It is the frontline of health care and has the clear benefits of relieving pressure on GPs.

3.114 The proximity of the proposal site close to the local new Co-op store, the primary school, and the Community Centre will encourage people to call in with the pharmacist rather than delay seeking treatment because existing pharmacies are beyond reasonable walking distance, are awkward to get to by public transport and are outside the daily travel patterns of the population. The very fact that this proposal site is in the heart of the community means for many people, a pharmacy will be located as part of their daily patterns of movement.

Protected Characteristics

3.115 The proposal will cater for people of protected characteristics, namely those people of a particular age, disability and as well as expectant mothers and mothers with very young children.

3.116 The population of Longstanton, Northstowe and Oakington will be a fully mixed community and will have all cohorts of the population. The child population is growing in this area and there are currently over 1500 school places available in this area to cater for the growing population as well as nurseries and childcare services in the area which are a group with protected characteristics. These people have no access to a pharmacy within the Longstanton area. The provision of pharmacy services in this area ensures the needs and rights of this groups are protected. The elderly people that live in the area including those living in the Park Homes are a group with protected characteristics also. These people have no access to pharmacy services in their local area.

Consideration Of Key Issues

3.117 This is a relatively straight forward application. The key issues that this proposal raises are:

3.117.1 What level of demand is there for new pharmacy?

3.117.2 How is that demand being met at present?

3.117.3 Is there a need for improved accessibility and choice in pharmaceutical services?

3.118 As shown above in response to the first, the demand in the area of Longstanton is substantial. Longstanton has become the dominant settlement in this part of south Cambridge. The development of Home Farm has significantly increased the immediate resident population, which has introduced new shops and services. This on its own places increased demand on services in Longstanton.

3.119 Added to this the growth of Northstowe, both in terms of the resident population, but also the resorting population that are coming into the area daily for work has increased demands for pharmaceutical services. The resident population is growing quickly and daily. These people have no health care provided at present within Northstowe and as such are reliant on the services in Longstanton. Many new residents are likely to not even be registered with their GP. As such the proposal will help meet the needs of these people, particularly those that are unwell before registering with a local GP and in the period of time between the development of housing in Northstowe and the provision of any future surgeries and pharmacies in the new town.

3.120 Added to this the merging of Longstanton, Northstowe and Oakington means that people for Oakington will look to Longstanton for its needs. Oakington residents have no pharmacy at present.

3.121 In regard to the second, the demand from these core groups of people it being met by the sole dispensary located within the Longstanton Branch Surgery. Dispensaries are an important part of the healthcare service especially in remote areas, however they are not a substitute for a full pharmacy offer, nor have they even been intended to act in such a way. The key consideration in this case therefore is whether the dispensary is capable of meeting the needs of the 6,800-7,500 residents of the area and the significant levels of construction workers coming to Northstowe daily. Unfortunately the limited size of the dispensary and the constrained level of pharmaceutical services it can offer alongside the limited hours it opens means that the demands of the resident and reliant population cannot and are not being met by the dispensary. The dispensary is not available to patients who require any sort of pharmaceutical service in the afternoon or on Saturday. The proposal will be open from 9am to 5:30pm Monday to Friday and from 9am to 1pm on Saturday. It broadens significantly the accessibility of pharmacy services to the population of the area and improves the services available to patients. The dispensary is also not available to any patient who is not registered with the practice. It is therefore a limited service at best.

3.122 The alternatives to the dispensary is the provision of pharmacies in towns that are over 2.4 miles away. These pharmacies are not accessible on foot and would not be considered to be reasonably accessible by public transport given the limited time table operated in the single bus service that links these towns. Certainly there is no way a worker in Longstanton could access a pharmacy in their lunch break for example. Similarly for those residents without a car at home during the day the pharmacies would not be considered to be reasonably accessible.

3.123 In regard to the third, there is a clear need for the growing population of Longstanton and the wider Northstowe and Oakington populations to have access to a new full service pharmacy.

Need for a new pharmacy

3.124 This application is needed because:

3.124.1 Longstanton is an established town with a significant population in its own right;

3.124.2 Longstanton provides all community facilities of shops, services and schools and places of worship and employment. It is missing a full pharmacy offer;

3.124.3 The town has strong links with an established town of Oakington and increasingly strong links with the large New Town of Northstowe;

3.124.4 Recent growth in the Longstanton has increased demand for a new pharmacy;

3.124.5 On its own the demands of the current population support the case of a new pharmacy contract;

3.124.6 The short term growth in the area at Northstowe has augmented the demands for a new pharmacy contract;

3.124.7 The isolated nature of the towns in this area means that there is no close by pharmacy meeting the needs of this substantial population.

3.124.8 The key consideration is therefore whether the existing dispensary in the branch surgery is adequate to meet the established and growing needs of the area. The answer to the question is clearly no. Furthermore, the dispensary is therefore operating from what is a branch surgery. This implies the service is a secondary consideration, and while that is not a reflection on the quality of the care that is being given by the staff in the dispensary it is a simple reflection on the fact that it cannot compare to the services provided by a pharmacy whether that be in terms of hours of opening, the services provided or the fact that the pharmacy will have a fully qualified pharmacist on site daily.

3.125 The need for a new pharmacy arises therefore because:

3.125.1 There are no other pharmacies that are reasonably accessible to the population of Longstanton;

3.125.2 There are no pharmacies that offer the population of Longstanton a reasonable choice of pharmaceutical services;

3.125.3 There are groups that share protected characteristics that will benefit from this proposal as set out in this document.

3.126 To contend that the 6,800-7,500 residents of area of Longstanton, Northstowe and Oakington have reasonable access to a pharmacy because there is a dispensary in the Branch Surgery and there is a pharmacy located in another town over 2.5 miles away is to take an overly optimistic view of this area and ignore reality. It would pay no attention to the requirements of proximity that are inherent in the concept of reasonable choice and better access.

3.127 The need to provide choice to the residents is equally clear.

3.128 The opportunity to satisfy the need for better access and choice is matched by the accessibility of the High Street (or Magdelene Close) which is the heart of Longstanton. The better accessibility to, and choice of, pharmacy services that a pharmacy located at High Street or Magdelene Close will provide is unquestionable.

Conclusion

3.129 Longstanton is an area that does not have a reasonable choice of pharmacy services and is clearly in need of better access to pharmacy services. Following a critical assessment of the circumstances of Longstanton the applicant contends that the application is an unforeseen proposal that will satisfy the requirements of Regulation 18.

4 Summary of Representations

This is a summary of representations received on the appeal.

4.1 L ROWLAND & CO (RETAIL) LTD

4.1.1 Thank-you for the opportunity to comment on the above appeal. If NHS Resolution decide to convene an oral hearing L Rowland & Co (Retail) Ltd are willing to attend under the provisions of Paragraph 8 of schedule 3 of the regulations.

4.1.2 L Rowland & Co (Retail) Ltd have no further comments to make at this stage.

4.1.3 L Rowland & Co (Retail) Ltd respectfully request that NHS Resolution inform them of the outcome in due course.

In a letter to NHS England dated 13 November 2020, L Rowland & Co(Retail) Ltd stated:

4.1.4 Thank you for informing L Rowland & Co (Retail) Ltd of the above application.

4.1.5 L Rowland & Co (Retail) Ltd note this is a Routine Unforeseen Benefits application and should one be required would be willing to attend any oral hearing should the NHS CB deem it necessary to hold one.

4.1.6 By their very nature, unforeseen benefits applications must be responding to a need not detailed in the PNA for the HWB. However, with most PNA being very detailed and considering issues such as new housing and retail developments we respectfully request NHSCB to consider whether the 'unforeseen need' is actually relevant. Regulation 18 provides several criteria which must be considered as part of the determination process and we trust that those requirements will be applied to this application.

4.1.7 L Rowland & Co (Retail) Ltd respectfully ask the Market Entry keeps us informed of the determination of the above application.

4.2 CAMBRIDGESHIRE AND PETERBOROUGH LPC

4.2.1 The LPC contracts group has discussed this appeal and appropriate declarations of interest have been made.

4.2.2 The LPC has nothing further to add to our original representations, which are attached for reference.

4.2.3 The LPC would like to be kept informed of the progress of this appeal and would be willing to attend an Oral Hearing if necessary

In a letter to NHS England dated 3 December 2020, Cambridgeshire & Peterborough LPC stated:

4.2.4 Thank you for your letter of 19th October 2020 giving details of the above application.

4.2.5 The LPC has discussed this application and appropriate declarations of interest have been made.

4.2.6 The LPC notes that the application form includes the GPhC registration number of the Superintendent but not the name. The LPC also notes that Fitness to Practice [sic] information was supplied with this application and asks the committee to ensure this is acceptable.

4.2.7 Using information available on www.nhs.uk the LPC is aware that there is a branch GP surgery in Longstanton which operates part time hours. The surgery website states that dispensing services are available from this site.

4.2.8 The LPC is aware than in addition to the bus service mentioned in the application there is also a stop on the outskirts of Longstanton for the Guided Busway. This offers services up to every ten minutes in to Cambridge and up to every twenty minutes to St Ives and then Huntingdon. The LPC agrees with

the applicant’s statement that accessing the nearest pharmacies to Longstanton on foot is not a realistic option.

4.2.9 The LPC asks that you ensure this application meets all the requirements of Regulation 18.

4.2.10 We would like to be kept informed of the progress of this application and would be willing to attend an Oral Hearing if necessary.

5 Observations

5.1 NHS ENGLAND

5.1.1 Further to correspondence dated 12th April 2021 regarding the above appeal, I am writing to confirm that NHS England and NHS Improvement has nothing further to add in respect of the application.

5.1.2 The matter was considered by the Pharmaceutical Services Regulations Committee (PSRC) at its meeting on the 27th January 2021. NHS England and NHS Improvement stands by the decision made by the PSRC on 27th January 2021 to refuse the application. The decision made was based on the information in the application and the representations of interested parties received at the time.

5.2 L ROWLAND & CO (RETAIL) LTD

5.2.1 Thank-you for the opportunity to comment on the above appeal. If the NHSR decide to convene an oral hearing we are willing to attend under the provisions of Paragraph 8 of schedule 3 of the regulations.

5.2.2 L Rowland & Co (Retail) Ltd write further to their letter of 23 March 2021. L Rowland & Co (Retail) Ltd have now received the representations on the appeal, and it appears that there have been no comments on the Pharmacy Needs Report enclosed by the appellant.

5.2.3 L Rowland & Co (Retail) Ltd do not accept the accuracy of the report. The main areas of contention appear to be as follows:

Section 3

5.2.4 3.4 - the 2011 population figure for Longstanton is given as 2,700 but an increased figure of 3,500 is offered with no supporting evidence except speculation about the Home Farm development.

5.2.5 3.14 - L Rowland & Co (Retail) Ltd believe the dispensary in Longstanton is open for longer hours than the times stated in the report; until 4pm rather than 1pm.

5.2.6 3.25 - There is considerable comment about Northstowe but most of the development will take place in the future. There is a slow build rate and the later phases of the development are subject to objections and do not appear to have detailed planning permission.

5.2.7 3.30 - Oakington should be disregarded as the population here would not look to Longstanton for their pharmaceutical services. The Tesco at Bar Hill would be closer and more convenient for much of the population of Oakington than the proposed pharmacy in Longstanton.

Section 6

5.2.8 6.8 There is no mention of the healthcare provision offered by pharmacies other than Willingham Pharmacy and Tesco although paragraph 2.6 of the report characterises Longstanton as within commuting distance of Cambridge, Bedford, Peterborough and Corby. Rowlands Pharmacies are located on the Longstanton side of Cambridge (14 minutes' drive from Longstanton surgery), Central Cambridge and Peterborough.

Section 7

5.2.9 7.4 and on - The population figures are not referenced to sources and are inconsistent with figures given at paragraph 3.4. The figures for growth are not linked to a timeline and are speculative. The household size figure used is 2.8 which is inconsistent with the comment in the report at paragraph 5.10 which indicates the average would be between 2.25 and 2.75.

5.2.10 7.20 - The report lacks detail on the public transport options. It is not possible to determine how convenient the options would be until the location of the proposed pharmacy is identified in greater detail.

Section 8

5.2.11 It remains unclear where the proposed pharmacy would be located and the extent of the population it will serve.

5.2.12 In summary, L Rowland & Co (Retail) Ltd would respectfully suggest the report does not establish that the proposed pharmacy would offer an unforeseen benefit at the Longstanton location.

5.2.13 L Rowland & Co (Retail) Ltd respectfully request that NHSR inform us of the outcome in due course.

5.3 GORDONS ON BEHALF OF WILLINGHAM PHARMACY

5.3.1 Gordons act on behalf of Willingham Health Care Limited trading as Willingham Pharmacy and are instructed to make representations against the appeal of the refusal of the application made by LNG & NTH-STW Pharma Ltd (“LNG Pharma”).

Background

5.3.2 There have been two applications for inclusion in the pharmaceutical list in Longstanton. The first application is the subject of this appeal. The second application is an application offering unforeseen benefits at Longstanton Branch Surgery, Magdalene Close, Longstanton, Cambridge, CB24 3EG by Longstanton and Northstowe Healthcare Ltd (“LNH”). The location of the LNH application is the same as part of the best estimate location of the LNG Pharma application. The LNH application was made in November 2020, it has been circulated and final comments have been made (in February 2021) but no decision has been made.

Procedural errors

5.3.3 Gordons agree with the appellant that the NHS England decision is flawed. It is flawed for the following reasons:-

5.3.4 NHS England failed to consider regulation 18(1) and 18(2)(d) of the NHS (Pharmaceutical and Local Pharmaceutical Services) Regulations 2013 (“the Regulations”) which states:

Regulation 18(1) ”…the NHSCB must have regard to the matters set out in paragraph(2).”

Regulation 18(2)(d) “The matters are… whether it is satisfied that another application offering to secure the improvements or better access has been submitted to it, and it would be desirable to consider, at the same time as the applicants application, that other application…”

5.3.5 NHS England did receive another application for the same location as part of the best estimate location of the application by LNG Pharma but failed to consider whether that application should be considered with the LNG Pharma application.

5.3.6 The consequences of this failure for the population are considerable as the alternative application offered longer hours and more extensive services. The alternative application had secured premises in the surgery. There appears to be no other premises available in Longstanton. As the site is in a controlled locality should the application by LNG Pharma be refused no further applications will be granted for five years. (Regulation 40(2)(b) of the Regulations).

5.3.7 Other procedural irregularities were:

5.3.8 The best estimate given in the application is not one on which NHS England should have been able to make a determination. The best estimate is very extensive and is in two separate locations. It covers a retail area and a position next to a GP surgery. The distance between the furthest two points of the first best estimate along High St is almost a kilometre. The reliant population would have different transport arrangements within the best estimate depending on the location of any potential pharmacy.

5.3.9 Accordingly, the application does not give a valid best estimate for the purpose of schedule 2 paragraph 1 (7)(a) (ii) and (10) of the NHS (Pharmaceutical and Local Pharmaceutical Services) Regulations 2013 (“the regulations”). For this reason, NHS England should have clarified the position. However rather than doing this NHS England took an arbitrary location upon which was meaningless for the reliant population.

5.3.10 The name of the superintendent pharmacist is not given – this is a breach of schedule 2, paragraph 1(6) of the regulations.

5.3.11 The first procedural error is not capable of remedy by Primary Care Appeals so we would ask that the matter is remitted back to NHS England for renotification.

Willingham Pharmacy

5.3.12 Willingham Pharmacy supports local and appropriate plans to develop pharmaceutical services in the area, such as the application by LNH referred to above. However, the application by LNG Phama offers no improvement or better access to pharmaceutical services. In terms of services and hours Willingham Pharmacy is open from Monday to Friday from 8:30am to 6pm with extended opening on Tuesday until 7pm. The weekday opening hours are longer than those offered by the applicant.

5.3.13 The NHS services Willingham Pharmacy offers are comprehensive:

5.3.13.1 Appliance dispensing

5.3.13.2 Medicines use review (MUR) 29

5.3.13.3 New medicine service

5.3.13.4 Community Care Home services

5.3.13.5 Emergency contraception

5.3.13.6 Stop smoking service

5.3.13.7 Supervised consumption of medicines

5.3.13.8 Blood pressure monitoring

5.3.13.9 Travel advice and private travel vaccination

5.3.13.10 Emergency contraception –commissioned

5.3.13.11 Inhaler technique service

5.3.13.12 NHS Advanced Seasonal Flu Vaccination service

5.3.13.13 CPCS (NHS 111 Minor illness service, Urgent supply service, GP Minor illness service)

5.3.13.14 Palliative Care

5.3.13.15 Free delivery service of OTC and prescription items

5.3.14 Therefore, the services offered by the appellant are already offered by Willingham Pharmacy, are offered in the local area or are not in fact commissioned.

5.3.15 In relation to location, Primary Care Appeals will be aware that Longstanton is still a rural area, with the expectations about travel distances that involves.

5.3.16 The list size for the Longstanton Branch Surgery is approximately 4,500 patients and, of these, the majority receive dispensing services on-site from the GP practice, although Willingham Pharmacy dispenses to a significant minority of these patients.

The appeal report by the appellant

5.3.17 The appeal report contains a great many factual inaccuracies and misleading statements and Gordons comment on them below using the numbering of the report:

5.3.18 2.3 - in relation to the appellants hours; it cannot be said the proposed pharmacy will provide the local population with access to services 6 days a week. Its core hours are limited to Monday to Friday 9 to 5.

5.3.19 There is a 100-hour pharmacy under two miles away, Willingham Pharmacy’s hours are extensive and the dispensary is open only half an hour less than the applicants proposed hours.

5.3.20 3.14 – the Longstanton Branch Surgery and the Longstanton dispensary hours are incorrectly stated. The Surgery is open from 8:30 to 5pm. It has appointments until 1pm but takes telephone calls until 5pm. The dispensary is open from 8:30am to 4pm for repeat prescriptions and collection of medication.

5.3.21 3.15 – the access to the branch surgery is not limited. There is no other doctor in the vicinity so the local population will be registered with this surgery with the exception of the Oakington population which is dealt with below. In relation to access more generally; the surgery is extremely accessible to the population as it is adjacent to a bus stop and has a large car park. This location is not available to the applicant as there are no vacant premises.

5.3.22 3.18 - Population numbers for Longstanton ward were 2,294 in the 2011 census. The extrapolation from that figure is speculative as it is not confirmed by official data.

5.3.23 3.24 – much of the discussion of the development of Northstowe is about future plans that will be implemented after the next PNA cycle.

5.3.24 3.25 – at a build rate of 200 to 250 dwellings per year, at a rough estimate it would take 20 to 25 years to get to a population figure of 6,800 to 7,500 as quoted at 8.10.

5.3.25 3:30 – In relation to Oakington, the Tesco Pharmacy at Barhill is closer to Oakington than the proposed pharmacy so that population is provided with pharmaceutical services. In addition, we are instructed the Oakington population will be registered with surgeries at Girton and Huntingdon Road, which has a dispensary, Histon or at the Maple Surgery. No patients from Oakington are registered with the Longstanton Surgery.

5.3.26 4.6 – there is still no detail in this application where the pharmacy will be located.

5.3.27 6.3 – Gordons are instructed that of the 3,335 items dispensed by the Longstanton Dispensary only 1,800 to 2,000 are from patients in Longstanton or Northstowe.

5.3.28 6.4 – The statement is not correct. Willingham Surgery and the Willingham pharmacy are working in a co-ordinated manner to providing excellent services in the area with new innovative services; for example the use of a Pharmacy App. Willingham pharmacy and staff are efficient and patient focused and are well regarded in the area. It has a high staffing level and has capacity to dispense many more prescriptions and to provide any new pharmaceutical services. Our client estimates the pharmacy could double the number of items it is currently dispensing per month with the existing staff levels and infrastructure.

5.3.29 6.7 – the statistic demonstrates that the majority of the population have access to cars so will be able to get to any of the eight pharmacies within the 5 mile radius and the minority with no car access are already using free delivery service offered by Willingham Pharmacy or one of the transport options available. There have been no complaints about the level of pharmaceutical services in the area.

5.3.30 6.8 – The figures are incorrect. The pharmacy dispenses an average of 8,800 items. 92% are received by EPS. It operates a free delivery service to all customers and delivers GSL and P medicines as well as dispensed items.

5.3.31 6.9 – the pharmacies listed will still be the only option for residents in the evenings and at weekends due to the proposed pharmacy’s limited opening hours. The correction at 3.30 shows why the comment that Tesco is not serving Oakington residents is misleading. The Tesco does serve Oakington residents, but they are not registered with Longstanton surgery.

5.3.32 7.10 - the statistics in relation to car ownership demonstrate the limited number of households the pharmacy will potentially serve

5.3.33 7.14 - workers in the area are likely to have travelled to sites by car and have access to pharmacies where they live or as they travel to work

5.3.34 7.26 - the figure of 6,800 is based on speculative underlying material and is a future prediction.

5.3.35 7.33 – the application mentions its reliance on its proximity to the co-op store but given the extent of the best estimate the pharmacy could be almost a kilometre away from this location. There is no indication of the progress in obtaining premises and there are no vacant premises in Longstanton.

5.3.36 In summary the application does not meet the regulatory test as the population of the HWB already have reasonable choice with regard to obtaining pharmaceutical services (Regulation 18(2)(b)(i)). The applicant has provided no evidence to suggest that the people who share a protected characteristic have any difficulty in having access to services that meet their specific needs for pharmaceutical services (regulation 18(2)(b)(ii)). There is no suggestion that there is an innovative approach to the delivery of pharmaceutical services.

5.3.37 In all the circumstances, it appears that if PCA is minded to quash the decision of NHS England in order to rectify the procedural errors that have arisen, rather than to redetermine the application in the applicants favour the only lawful step available is for the application to be remitted back to NHS England for redetermination with the application by LNH. However, the application by LNG Pharma is flawed, and the lengthy report disguises the minimal information the applicant has given about the improvements or better access that would be offered. What is set out in the application is already provided by exemplary services in the area and NHS England was correct in concluding this application does not meet the regulatory test. If there is an oral hearing, our client would want to attend and be represented.

6 Further observations

6.1 Thank you for your letter of 6 May 2021. Rushport Advisory LLP act for LNG & NTH- STW Pharma Limited in the above application and have been instructed by the Applicant to submit this reply to the comments received on the Applicant’s appeal referenced above.

Gordons Partnership on behalf of Willingham Pharmacy

Background

6.2 Gordons refers to a second application being submitted in the same area. The Applicant was not aware of this application. Any competing application should have been notified to the Applicant and no such notification has been received. In any event, there is no good reason to defer the consideration of the Applicant’s application and any competing application is very significantly behind in terms of time. Having contacted PCSE about this second application they have stated by email of 7 May 2021 that;

I can confirm however that the application by Longstanton and Northstowe Healthcare Ltd is currently on hold pending the outcome of the appeal into your clients application.

6.3 This confirms that there is no value in attempting to consider both applications together as they will not get to the same stage in proceedings.

6.4 The Committee is asked to note that, having objected to this application, the doctors from the medical practice appear to have submitted their own application to open a pharmacy in Longstanton and therefore clearly recognise the need for a pharmacy at this location.

Procedural Errors

6.5 The procedural errors alleged by Gordons do not exist. It would have been a matter for NHSE&I to determine whether to hear applications together and whether the proposed address was a reasonable “best estimate”. In previous appeals a best estimate has been accepted as covering more than one area (e.g. SHA/19882) and in any event, the best estimate has been properly accepted by NHSE&I.

6.6 In relation to the name of the superintendent pharmacist, Gordons appears to be unaware that PCSE redacts this information from applications prior to circulation to interested parties. The name of the superintendent pharmacist was properly provided in the application.

Willingham Pharmacy

6.7 The Applicant notes that Willingham Pharmacy (in a similar way to Willingham Medical Practice which operates Longstanton Surgery) now accepts that there is a need for a new pharmacy to be opened in Longstanton. Gordons are clear that their client supports the application which has been made by another party, but has chosen not to support this application. The Applicant is grateful to Willingham Pharmacy for acknowledging the need for additional pharmaceutical services.

6.8 Having accepted the need for a new pharmacy in Longstanton, Gordons then makes comments which suggest that the need does not exist. These comments simply fail to address the difficulties in accessing existing pharmacies and are contradictory.

6.9 Gordons comments on the Appeal Report submitted by the Applicant are little more than argumentative. Nevertheless the Applicant replies using the same reference numbers used by Gordons in their letter.

6.10 [2.3] Gordons ignores the supplementary hours offered by my client even though they are happy to quote and rely on their own client’s supplementary hours.

6.11 [3.14] Gordons states that the surgery opening hours quoted in the appeal report are incorrect. The opening hours appear to have changed and are now listed on the surgery website as follows;

Longstanton Branch Surgery Morning Afternoon Monday – Friday 08:30 – 13:00 Closed Appointments 08:30 – 11:00 Closed Wednesday Antenatal Clinic 8:30 – 13:00

Longstanton Dispensary Morning Afternoon Monday 08:30 – 13:00 14:30 – 16:00 Tuesday 08:30 – 13:00 14:30 – 16:00 Wednesday 08:30 – 13:00 14:30 – 16:00 Thursday 08:30 – 13:00 Closed Friday 08:30 – 13:00 14:30 – 16:00

6.12 The hours stated by Gordons are therefore incorrect, with the correct hours shown above.

6.13 [3.15] Given the above hours it is perfectly clear how access to the surgery and dispensary is “limited”.

6.14 [3.18] Gordons then suggests that the Committee should rely solely on the 2011 census data, which is now 10 years out of date, and blind itself to the reality of the extensive commercial and residential development that has taken place (and which is acknowledged by Gordons) simply because “it is not confirmed by official data”. Such an approach would require the Committee to fail to take into account relevant considerations and would be irrational.

6.15 [3.24] – requires no response.

6.16 [3.25] – Gordons calculations are incorrect. It can be seen that the development of Home Farm has delivered the circa 546 dwellings and this will have significantly increased the population. About half of these homes were built after 2011, and as such the 2011 population will have been increased by 273 dwellings and an increase in population of about 765 people. This suggests that the Longstanton population is probably in the region of 3,500. This excludes the population at Northstowe. Multiple planning applications and permissions have been submitted and approved for Northstowe. An application for phase 1 was granted in April 2014 which permitted up to 1,500 dwellings, a primary school, a mixed use local centre, leisure, community, health and employment uses, a household recycling centre, recreational space and infrastructure works. To date about 650 new homes have been built in phase 1 (approximately 1,500 residents) and the Council are predicting a build rate of about 200 - 250 dwellings per year in the coming years.

6.17 200-250 dwellings per year represents an increase in population of approximately 400 to 600 persons.

6.18 It would therefore take 2 years from now to reach the population figure quoted in the report, which if anything is an underestimate. It is unclear how Gordons came up with a figure of “20 to 25 years”.

6.19 [3.30] In relation to Oakington, Gordons are again incorrect. Tesco is 3.1 miles from Oakington. Longstanton is 1.6 miles.

6.20 [4.6] – the best estimate has been properly provided.

6.21 [6.3] – it is unclear how Gordons client has accessed the dispensing records of Longstanton Dispensary. However, if the figures quoted are correct then it shows that patients come in to Longstanton to access pharmaceutical services. This supports my client’s application.

6.22 [6.4] – Gordons misunderstands the point being made in the appeal report.

6.23 [6.7] - Gordons misunderstands the point being made in the appeal report.

6.24 [6.8] – it is understandable that Gordon’s client’s level of dispensing has increased since the appeal report was written and as further housing has been built and demand for pharmaceutical services in the area has increased. This supports my client’s application.

6.25 [6.9] - Gordons misunderstands the point being made in the appeal report and their comments are simply speculation.

6.26 [7.10] - Gordons misunderstands the point being made in the appeal report.

6.27 [7.14] – Gordons is asking the Committee to ignore the needs of those who may be in the relevant area and to justify this by speculating about their access to pharmacies in other locations.

6.28 [7.26] – Population figure estimates are properly set out. Gordons cannot identify any error in the calculations. Gordons own calculations are clearly wrong as shown above.

6.29 [7.33] – dealt with repeatedly already.

Rowlands Pharmacy

6.30 As the letter from Rowlands repeats similar points as those made by Gordons the Applicant does not address these separately and refers the Committee to the answers already provided above.

7 Consideration

7.1 The Pharmacy Appeals Committee (“the Committee”), appointed by NHS Resolution, had before it the papers considered by NHS England, together with a plan of the area showing existing pharmacies and doctors’ surgeries and the location of the proposed pharmacy.

7.2 It also had before it the responses to NHS Resolution’s own statutory consultations.

7.3 On the basis of this information, the Committee considered it was not necessary to hold an Oral Hearing.

7.4 The Committee had regard to the National Health Service (Pharmaceutical and Local Pharmaceutical Services) Regulations 2013 (“the Regulations”).

7.5 Longstanton is in a controlled locality and the application was based on securing improvements or better access to pharmaceutical services in that controlled locality.

7.6 The Committee considered that the correct course was to first consider if the application must be refused pursuant to Regulation 31. The Committee will then consider if the application must be refused pursuant to Regulation 40. If the Committee is not so required to refuse the application, it will consider the issue of reserved location pursuant to Regulation 41. The Committee will then consider the application under Regulation 18. If the Committee has determined that the Applicant is seeking the listing of pharmacy premises which are in a part of a controlled locality that is not in a reserved location, it will consider the issue of prejudice under Regulation 44 last. The reason for this staged approach and in particular for dealing with prejudice last is that if the application does not meet the requirements of Regulation 18 the Committee is required to refuse it and prejudice cannot arise. The potential for prejudice only arises if the Committee has concluded that the application meets the requirements of Regulation 18 and may be granted. Depending on the determinations of the Committee in respect of the above as well as taking into consideration of whether NHS England has considered Regulation 50(1), the Committee will then consider Regulation 50(1) - discontinuance of arrangements for the provision of pharmaceutical services by doctors.

Regulation 31

7.7 The Committee first considered Regulation 31 of the Regulations which states:

(1) A routine or excepted application, other than a consolidation application, must be refused where paragraph (2) applies.

(2) This paragraph applies where -

(a) a person on the pharmaceutical list (which may or may not be the applicant) is providing or has undertaken to provide pharmaceutical services ("the existing services") from -

(i) the premises to which the application relates, or

(ii) adjacent premises; and

(b) the NHSCB is satisfied that it is reasonable to treat the services that the applicant proposes to provide as part of the same service as the existing services (and so the premises to which the application relates and the existing listed chemist premises should be treated as the same site).

7.8 The Committee noted the Applicant’s comment there is no other pharmacy in same or adjacent premises so Regulation 31 is not applicable. The Committee noted that NHS England had concluded at 2.14 above that there are no existing services from the best estimate of the proposed pharmacy premises or adjacent premises and that this had not been disputed by any party either on appeal or in subsequent representations. Based on the information before it, the Committee was of the view that it was not required to refuse the application under the provisions of Regulation 31.

7.9 The Committee noted that, if the application were granted, the successful applicant would - in due course - have to notify NHS England of the precise location of its premises (in accordance with paragraph 31 of Schedule 2). Such a notification would be invalid (and the applicant would not be able to commence provision of services) if the location then provided would (had it been known now) have led to the application being refused under Regulation 31.

Regulation 40

7.10 In those circumstances, the application (which is made under Regulation 18 of the Regulations) must be assessed against the provisions of Part 7 of the Regulations and, in particular Regulation 40 which reads:

(1) This paragraph applies to all routine applications—

(a) for inclusion in a pharmaceutical list as an NHS pharmacist; or

(b) from an NHS pharmacist included in such a list—

(i) to relocate to different pharmacy premises in the area of the relevant HWB, or

(ii) to open, within the area of the relevant HWB, additional pharmacy premises from which to provide pharmaceutical services,

where the applicant is seeking the listing of pharmacy premises which are in a controlled locality.

(2) If the NHSCB receives an application (A1) to which paragraph (1) applies, it must refuse A1 (without needing to make any notification of that application under Part 3 of Schedule 2), where the applicant is seeking the listing of premises at a location which is—

(a) in an area in relation to which outline consent has been granted under these Regulations, the 2012 Regulations or under the 2005 Regulations within the 5 year period—

(i) starting on the date on which the proceedings relating to the grant of outline consent reached their final outcome, and

(ii) ending on the date on which A1 is made; or

(b) within 1.6 kilometres of the location of proposed pharmacy premises (other than proposed distance selling premises), in respect of which—

(i) a routine application under these Regulations or the 2012 Regulations, or

(ii) an application to which regulation 22(1) or (3) of the 2005 Regulations (relevant procedures for applications) applied,

was refused within the 5 year period starting on the date on which the proceedings relating to the refusal reached their final outcome and ending on the date on which A1 is made,

unless the NHSCB is satisfied that since the date on which the 5 year period started, there has been a substantial and relevant change of circumstances affecting the controlled locality.

(3) For the purposes of paragraphs (1) and (2), if no particular premises are proposed for listing in A1, the applicant is to be treated as seeking the listing of pharmacy premises at the location which is the best estimate that the NHSCB is able to make of where the proposed listed pharmacy premises would be, having regard to the best estimate given by the applicant under paragraph 1(7)(a)(ii) of Schedule 2.

(4) Paragraph (2)(b) does not apply where the NHSCB is satisfied that there are reasonable grounds for believing the person making the refused application was motivated (wholly or partly) by a desire for that application to be refused.

(5) The refusal of an application pursuant to paragraph (2)(b), or regulation 40(2)(b) of the 2012 Regulations (applications for new pharmacy premises in controlled localities: refusals because of preliminary matters), is to be ignored for the purposes of the calculation of a 5 year period pursuant to paragraph (2)(b).

7.11 The Committee noted that there was no information to suggest that the instant application was in respect of a location where outline consent had been granted or there had been a refusal for a previous application within the last 5 years.

Regulation 41

7.12 Based on its conclusion above, the Committee went on to consider the application in light of the remainder of Part 7 of the Regulations and, in particular, Regulation 41 which reads:

(1) This paragraph applies to any routine application—

(a) for inclusion in a pharmaceutical list as an NHS pharmacist; or

(b) from an NHS pharmacist included in such a list—

(i) to relocate to different pharmacy premises in the area of the relevant HWB, or

(ii) to open, within the area of the relevant HWB, additional pharmacy premises from which to provide pharmaceutical services,

where the applicant is seeking the listing of pharmacy premises which are in a controlled locality and the NHSCB is required to notify the application under Part 3 of Schedule 2.

(2) If paragraph (1) applies to an application (referred to in this regulation and regulation 42 as “A1”), subject to paragraph (5), the NHSCB must determine whether or not the “relevant location”, that is—

(a) the location of the premises for which the applicant is seeking the listing; or

(b) if no particular premises are proposed for listing in A1, the location which is the best estimate that the NHSCB is able to make of where the proposed pharmacy premises would be, having regard to the best estimate given by the applicant under paragraph 1(7)(a)(ii) of Schedule 2, is, on basis of the circumstances that pertained on the day on which A1 was received by the NHSCB, in a reserved location.

(3) Subject to regulation 43(2), the area within a 1.6 kilometre radius of a relevant location is a “reserved location” if—

(a) the number of individuals residing in that area who are on a patient list (which may be an aggregate number of patients on more than one patient list) is less than 2,750; and

(4) Before making a determination under paragraph (2) (referred to in this regulation and regulation 42 as “D1”), the NHSCB must—

(a) notify the persons notified under Part 3 of Schedule 2 about A1 that the NHSCB is required to make D1 (and it may make this notification at the same time as it notifies those persons about A1); and

(b) invite them, within a specified period of not less than 30 days, to make representations to the NHSCB with regard to D1 (and the period specified must end no earlier than the date by which the person notified needs to make any representations that they have with regard to A1).

(5) The NHSCB must not make a determination under paragraph (2) in respect of A1 in circumstances where an earlier application which was in respect of the relevant premises and to which paragraph (1), regulation 44 of the 2012 Regulations (prejudice test in respect of routine applications for new pharmacy premises in a part of a controlled locality that is not a reserved location) or regulation 18ZA of the 2005 Regulations (refusal: premises which are in a controlled locality but not a reserved location) applied was refused—

(a) for the reasons relating to prejudice in—

(i) regulation 44(3),

(ii) regulation 44(3) of the 2012 Regulations, or

(iii) regulation 18ZA(2) of the 2005 Regulations; and

(b) within the 5 year period starting on the date on which the proceedings relating to the refusal reached their final outcome and ending on the date on which A1 is made,

unless the NHSCB is satisfied that since the date on which the 5 year period started, there has been a substantial and relevant change of circumstances affecting the controlled locality.

(6) For the purposes of paragraph (5), the “relevant premises” are—

(a) the premises which are proposed for listing; or

(b) if no particular premises are proposed for listing in A1, premises at the location which is the best estimate that the NHSCB is able to make of where the proposed listed pharmacy premises would be, having regard to the best estimate given by the applicant under paragraph 1(7)(a)(ii) of Schedule 2.

7.13 The Committee considered the issue of reserved location for premises described in the application.

7.14 The Committee noted that NHS England had provided a patient count of 4,821 and that the Applicant had not sought to challenge NHS England’s position that Longstanton is not a reserved location.

7.15 The Committee was aware that, given its view on reserved location, it may then need to deal with prejudice. However, the Committee considered that prejudice could only arise if the application meets the requirements of Regulation 18 and may therefore be granted. It therefore next considered whether the application met the requirements of Regulation 18.

Regulation 18

7.16 The Committee noted that this was an application for “unforeseen benefits” and fell to be considered under the provisions of Regulation 18 which states:

"(1) If—

(b) the improvements or better access that would be secured were or was not included in the relevant pharmaceutical needs assessment in accordance with paragraph 4 of Schedule 1,

in determining whether it is satisfied as mentioned in section 129(2A) of the 2006 Act (regulations as to pharmaceutical services), the NHSCB must have regard to the matters set out in paragraph (2).

(2) Those matters are—

(a) whether it is satisfied that granting the application would cause significant detriment to—

(i) proper planning in respect of the provision of pharmaceutical services in the area of the relevant HWB, or

(ii) the arrangements the NHSCB has in place for the provision of pharmaceutical services in that area;

granting the application would confer significant benefits on persons in the area of the relevant HWB which were not foreseen when the relevant pharmaceutical needs assessment was published;

(c) whether it is satisfied that it would be desirable to consider, at the same time as the applicant’s application, applications from other persons offering to secure the improvements or better access that the applicant is offering to secure;

(d) whether it is satisfied that another application offering to secure the improvements or better access has been submitted to it, and it would be desirable to consider, at the same time as the applicant’s application, that other application;

(e) whether it is satisfied that an appeal relating to another application offering to secure the improvements or better access is pending, and it would be desirable to await the outcome of that appeal before considering the applicant’s application;

(f) whether the application needs to be deferred or refused by virtue of any provision of Part 5 to 7.

(g) whether it is satisfied that the application presupposes that a gap in pharmaceutical services provision has been or is to be created—

(i) by the removal of chemist premises from a pharmaceutical list as a consequence of the grant of a consolidation application, and

(ii) since the last revision of the relevant HWB's pharmaceutical needs assessment other than by way of a supplementary statement.

(3) The NHSCB need only consider whether it is satisfied in accordance with paragraphs (2)(c) to (e) if it has reached at least a preliminary view (although this may change) that it is satisfied in accordance with paragraph (2)(b)."

7.17 The Committee considered that Regulation 18(1)(a) was satisfied in that it was required to determine whether it was satisfied that granting the application, or granting it in respect of some only of the services specified in it, would secure improvements, or better access, to pharmaceutical services, or pharmaceutical services of a specified type, in the area of the relevant HWB

7.18 The Committee went on to consider whether Regulation 18(1)(b) was satisfied, i.e. whether the improvements or better access that would be secured if the application was granted were or was included in the PNA in accordance with paragraph 4 of Schedule 1 of the Regulations.

7.19 Paragraph 4 of Schedule 1 requires the PNA to include: “a statement of the pharmaceutical services that the HWB had identified (if it has) as services that are not provided in the area of the HWB but which the HWB is satisfied (a) would if they were provided….secure improvements or better access, to pharmaceutical services… (b) would if in specified future circumstances they were provided…secure future improvements or better access to pharmaceutical services…” (emphasis added).

7.20 The Committee considered the Pharmaceutical Needs Assessment ("the PNA") prepared by Cambridgeshire Health and Wellbeing Board conscious that the document provides an analysis of the situation as it was assessed at the date of publication. The Committee bears in mind that, under regulation 6(2), the body responsible for the PNA must make a revised assessment as soon as reasonably practicable (after identifying changes that have occurred that are relevant to the granting of applications) unless to do so appears to be a disproportionate response to those changes. Where it appears disproportionate, the responsible body may, but is not obliged to, issue a Supplementary Statement under regulation 6(3). Such a statement then forms part of the PNA. The Committee noted that the PNA was dated 2017 and that no supplementary statements had been issued.

7.21 The Committee noted that whilst the PNA had not made specific reference to Longstanton, it had concluded that the health of the Cambridgeshire population is generally similar to or better than the England average. The PNA went on to conclude under “Current provision of local pharmaceutical services” as a ‘Key finding’ that “there is currently sufficient pharmaceutical services provision across Cambridgeshire. No need for additional pharmaceutical service providers was identified in this PNA”. The PNA went on to conclude that “Review of the locations, opening hours and access for people with disabilities, suggest there is adequate access to NHS pharmaceutical services in Cambridgeshire. There appears to be good coverage in terms of opening hours across the county.”

7.22 The Committee noted that the PNA had gone on to note that there are several large scale housing developments in progress and considerations when assessing needs for local pharmaceutical service providers should be based on a range of local factors specific to each development site. The Committee noted that the large scale housing is considered in the PNA and that the new town of Northstowe was considered within the PNA at section 6. The PNA had gone on to conclude that the HWB will monitor the development of major housing sites and produce supplementary statements to the PNA if deemed necessary to ensure that appropriate information is available to determine whether additional pharmacies might be required.

7.23 The Committee noted that the Applicant seeks to provide unforeseen benefits to the patients of Longstanton. The Committee noted that the improvements or better access that the Applicant was claiming would be secured by its application were not included in the relevant pharmaceutical needs assessment in accordance with paragraph 4 of Schedule 1.

7.24 In order to be satisfied in accordance with Regulation 18(1), regard is to be had to those matters set out in Regulation 18(2). The Committee's consideration of the issues is set out below.

Regulation 18(2)(a)(i)

7.25 The Committee had regard to

"(a) whether it is satisfied that granting the application would cause significant detriment to—

(i) proper planning in respect of the provision of pharmaceutical services in the area of the relevant HWB"

7.26 The Committee noted that NHS England had concluded that the application would not cause significant detriment to the proper planning in respect of the provision of pharmaceutical services in the area of the relevant HWB. The Committee noted that this had not been disputed either on appeal or in subsequent representations either by the Applicant or interested parties.

7.27 On the basis of the information available, the Committee was not satisfied that, if the application were to be granted and the pharmacy to open, the ability of the NHS England thereafter to plan for the provision of services would be affected in a significant way.

7.28 The Committee was therefore not satisfied that significant detriment to the proper planning of pharmaceutical services would result from a grant of the application.

Regulation 18(2)(a)(ii)

7.29 The Committee had regard to

"(a) whether it is satisfied that granting the application would cause significant detriment to— …

(ii) the arrangements the NHSCB has in place for the provision of pharmaceutical services in that area"

7.30 The Committee noted that NHS England had concluded that granting the application would not cause significant detriment to the arrangements in place for the proper provision of pharmaceutical services in the area. The Committee noted that this had not been disputed by any party either on appeal or in subsequent representations. On the basis of the information available, the Committee was therefore not satisfied that significant detriment to the arrangements currently in place for the provision of pharmaceutical services would result from a grant of the application.

7.31 In the absence of any significant detriment as described in Regulation 18(2)(a), the Committee was not obliged to refuse the application and went on to consider Regulation 18(2)(b).

Regulation 18(2)(b)

7.32 The Committee had regard to

"(b) whether, notwithstanding that the improvements or better access were not included in the relevant pharmaceutical needs assessment, it is satisfied that, having regard in particular to the desirability of—

granting the application would confer significant benefits on persons in the area of the relevant HWB which were not foreseen when the relevant pharmaceutical needs assessment was published"

Regulation 18(2)(b)(i) to (iii)

7.33 The Committee noted the comments from the Applicant that there is currently no pharmacy within Longstanton and therefore there is no choice of pharmaceutical services for those residing in the village or the surrounding new developments. The Committee was mindful that consideration needs to be given to whether there is a reasonable choice in obtaining pharmaceutical services within the area of the relevant HWB. The Committee noted that there are 3 pharmacies within 3 miles and 8 pharmacies within 5 miles and that these are operated by different contractors and are located in the vicinity of medical practices as well as other facilities and amenities within the surrounding community.

7.34 The Committee noted the distances to the nearest pharmacies as quoted by Applicant which had not been disputed. Given the information with regard to distance and from viewing the map provided by NHS England, the Committee was of the view that it was unlikely that those in Longstanton would choose to access services outside of the village by foot. The Committee was of the view, however, that difficulties of access on foot did not of itself indicate that there was not reasonable choice in obtaining pharmaceutical services. The Committee went on to consider the ease of access to the nearest pharmacies by private and public transport.

7.35 With regard to access by private transport, the Committee noted the statement from the Applicant that 6.8% do not have access to a car or van which means that over 90% of the population do have access to a car or van. The Applicant indicated, with reference to the 2011 census, that 41% (450) of households had only access to one car and that this meant that during the day almost half of households have no car at home if it is being used to commute to work. The Committee agreed that if a car was being used for commuting then that car would not be at home but little information had been provided on whether those with one car do actually use it to commute to work, e.g. retirees, those who work locally, those who use public transport, etc and even if the car was used for work, whether there was actually anyone left at home that would need to use the car. The Committee therefore treated this statement with caution especially as there was reference by the Applicant to the guided busway being used for commuting.

7.36 The Committee noted, from the maps provided, that Longstanton is situated close to major and other roads which provide easy links to Cambridge and to the other villages and towns in the area as well as it being 2.4 miles to Tesco with its 100 hours pharmacy and the retail park on which it is situated. The Committee noted that dispensing data indicated that only 1.7% of items dispensed in this pharmacy are prescribed by

Willingham Medical Practice. This is not perhaps surprising given the existence of a dispensing GP practice in Longstanton and the point made by Gordon’s on behalf of Willingham Pharmacy that the majority of patients receive dispensing services from the GP practice but it does not mean that the existence of a 100 hours pharmacy 2.4 miles away does not provide reasonable choice to the residents of Longstanton.

7.37 The Committee further noted that there was nothing provided by the Applicant to demonstrate that those who do have access to their own transport are currently having difficulties in accessing the existing pharmacies. The Committee concluded, from the information before it, that there appeared to be a relatively high level of mobility and car ownership in the area. The Committee was of the view that for those who had their own transport there was nothing provided to demonstrate that they were experiencing any difficulties in access the existing pharmaceutical provision or that they did not have reasonable choice with regard to obtaining pharmaceutical services.

7.38 The Committee noted the comments that there is a bus service that runs through Longstanton linking it to Willingham and Cambridge. The Committee noted that the bus runs once an hour, which has not been disputed by any party. The Committee noted that the Applicant had stated that use of the bus “takes time out of a patients day to make what is likely to be three hour journey to visit their nearest pharmacy”. It is not explained how the Applicant arrived at a timescale of three hours. No information had been provided on timetables for the bus service and Willingham Pharmacy had indicated that the bus stops right outside the co-located GP practice and pharmacy in Willingham. Bearing this in mind, the Committee treated this reference to a three hour return journey with caution as it was equally possible on the information provided that the return journey could be done in less than an hour.

7.39 The Committee also noted the reference to the guided busway with links Longstanton to Cambridge and that apart from the statement that it is “principally a commuter service” no further information was provided, however the Committee assumed that the guided bus would run at other times of the day. The Committee considered that it was possible that those who commuted into Cambridge could access pharmaceutical services within Cambridge but the Committee also noted that the guided busway station for Longstanton was not located in the centre of Longstanton but almost a mile away from Longstanton High Street. It was not indicated how persons access the station from the residential areas of Longstanton. The Committee could not, however, dismiss the availability of a means of public transport that could take those seeking pharmaceutical services to an area with pharmacies.

7.40 The Committee noted the comment from the Applicant that the inadequacies of the bus service are borne out by the lack of prescriptions issued by Longstanton Surgery being dispensed by Tesco Pharmacy. The Committee considered that there could be many reasons why the dispensing data is such, including the reasons referred to earlier in this determination that persons mainly use the GP practice dispensary located in Longstanton. The Committee did not therefore consider that the dispensing data necessarily led to a conclusion that the bus service was inadequate.

7.41 The Committee also noted the Appellant’s reference that using public transport adds a financial burden. Clearly using public transport may require fares to be paid but the Committee noted that there was no indication that the Longstanton area suffered from deprivation which might exacerbate this issue.

7.42 The Committee noted that the Applicant had not provided any further information that those who currently use public transport were experiencing difficulties in access the existing pharmaceutical provision in the area. Given the limited information before it, as well as taking into account the information with regard to car ownership in the area, the Committee was of the view that there was nothing provided which demonstrated that those who did use public transport were currently experiencing any difficulties in accessing the existing pharmaceutical provision.

7.43 The Committee noted the comments from parties with regard to the facilities in the area of the new developments and that in addition to these, residents were also accustomed to leaving Longstanton on a daily basis to access facilities and amenities outside of the village. The Committee was of the view that the population was a relatively affluent mobile population that would leave Longstanton on a regular basis to go to work as well as to access a variety of services in Cambridge and the surrounding area, including supermarkets, as well as other towns in the area where there were pharmacies located, which provided choice in obtaining pharmaceutical services in the area of the HWB.

7.44 The Committee also noted the references to the development in the area and the increasing population. Various estimates were provided as to population size but it was not clear to the Committee exactly what stage the development was against the estimates (in terms of houses completed) at the time the application or appeal was made. The Committee noted reference to 650 properties being built. This made it difficult to accept the figures proposed by the Applicant, particularly as they were disputed by other parties.

7.45 The Committee noted that in the PNA the HWB had stated that it would monitor housing developments and issue a supplementary statement to the PNA if necessary. The Applicant refers to there being no evidence of any monitoring and that this, coupled with the fact that the next PNA has been delayed due to the pandemic, should not delay the provision of pharmaceutical services. The Committee considered that, while it was possible that the development was proceeding at a pace unforeseen by the HWB and was not being monitored by the HWB, it was more likely that the HWB simply felt there was no necessity to issue a supplementary statement (which of course, it can do at any time – there is no need to await a new PNA).

7.46 The Committee noted that the Applicant referred a number of times to volumes of workers resorting to Longstanton to work on the development and their need for pharmaceutical services. Although a figure of 12,000 jobs had been mentioned by the Applicant, it is unclear the number of workers at the present time, whether they required pharmaceutical services or how they accessed pharmaceutical services. It is possible they are from the Longstanton area, drive to work and so can access pharmacies easily or reside in places that have easy access to pharmaceutical services. The Committee considered that while there may be some demand from those resorting to the development, it is difficult to say if this drives up the number of persons seeking pharmaceutical services within Longstanton by any significant degree.

7.47 The Committee noted references made to Oakington by the Applicant, particularly when referring to numbers of people in the area seeking pharmaceutical services. The implication appeared to be that those residing in Oakington would travel to a pharmacy in Longstanton. The Committee treated this with caution. There was reference made to those residing in Oakington accessing pharmacies in other areas – i.e. on the other side of Oakington from Longstanton as well as Tesco 100 hours pharmacy being more convenient for Oakington’s residents to access than any pharmacy that might be located in Longstanton. The Committee also noted that no patients of Longstanton Surgery resided in Oakington which the Committee considered meant there would be less expectation that those from Oakington would pick up a prescription in Longstanton as opposed to another GP practice located elsewhere.

7.48 The Committee was of the view that there is already reasonable choice with regard to obtaining pharmaceutical services in the area of the relevant HWB, such that it was not satisfied that, having regard to the desirability of there being a reasonable choice with regard to obtaining services, granting the application would confer significant benefits on persons.

7.49 In considering Regulation 18(2)(b)(ii) the Committee reminded itself that it was required to address itself to people who share a protected characteristic having access to services that meet specific needs for pharmaceutical services that are difficult for them to access. The Committee was also aware of its duties under the Equality Act 2010

which include considering the elimination of discrimination and advancement of equality between patients who share protected characteristics and those without such characteristics. The Committee noted the comments from the Applicant with regard to those in the area who would share a protected characteristic including the young and the elderly. The Committee accepted that there were always people in an area who share a protected characteristic and was of the view that whilst a pharmacy located at the proposed site may be some benefit to some people, there was no information provided by the Applicant to indicate why this was a significant benefit or how those with a protected characteristic were currently experiencing any difficulties in accessing pharmaceutical services. In the absence of any supporting information and based on the information before it, the Committee was therefore not satisfied that, having regard to the desirability of people who share a protected characteristic having access to services that meet specific needs for pharmaceutical services that are difficult for them to access, granting the application would confer significant benefits on persons.

7.50 In considering Regulation 18(2)(b)(iii) the Committee had regard to the desirability of innovative approaches to the delivery of pharmaceutical services. In doing so, the Committee would consider whether there was something more over and above the usual delivery of pharmaceutical services that might be expected from all pharmacies, some ‘added value’ on offer at the location. The Committee noted that the Applicant did not seek to rely on innovation and had therefore not provided any information with regard to innovation in their application form or on appeal. The Committee was not satisfied that, having regard to the desirability of there being innovative approaches taken with regard to the deliverability of pharmaceutical services, granting the application would confer significant benefits on persons.

Regulation 18(2)(b) generally

7.51 The Committee noted that the Applicant was proposing to open for a total of 46.5 hours a week of which 40 would be core hours. The Committee noted that the core hours were arranged so that provision would be available from 9am to 5pm Monday to Friday. The Committee noted that the Applicant proposed total opening hours from 9am to 5:30pm Monday to Friday and 9am to 1pm on a Saturday with the additional hours being supplementary. The Committee noted that the Applicant was not proposing any hours, either core or supplementary on either a Saturday afternoon or a Sunday. The Committee noted the comments from parties with regard to the opening hours of the other pharmacies in the area and that there was also a 100 hour pharmacy within 2.5 miles of the proposed site. The Committee was of the view that there was no information provided to support a finding that pharmaceutical services are not currently provided at such times as needed and therefore it was not satisfied that, having regard to obtaining services, granting the application would confer significant benefits (in relation to opening hours) on persons.

7.52 The Committee noted the information before it with regard to the new developments in the area, however the Committee noted that there was some dispute between the parties as to the number of houses completed and how the developments would be linked and were integrated with each other. Further, the Committee noted the large area given for the best estimate of the location of the pharmacy and that this had been accepted by NHS England. The Committee took no view on this, however the Committee noted that there were two areas within Longstanton where the pharmacy could be sited and further that the High Street location appeared to be almost the full length of the High Street. The Committee was of the view that it was difficult, given the large best estimate area, to ascertain the potential benefits given that part of the location might be less accessible for some of the development and the Committee did not have this information before it. The Committee was of the view that the potential area given for the potential location of the pharmacy did not assist in its consideration of whether those in Longstanton or the new developments would be able to access pharmaceutical services. Therefore the Committee was not satisfied that, having regard to there being a reasonable choice with regard to obtaining services, granting the application would confer significant benefits by way of physical access on persons.

7.53 The Committee was of the view that in accordance with Regulation 18(2)(b) the granting of this application would not confer significant benefits on persons in the area of the HWB which were not foreseen when the PNA was published.

Regulation 44 – Prejudice

7.54 Having considered the matter of reserved location and, having considered the application under Regulation 18, the Committee next considered the question of prejudice under Regulation 44.

7.55 The Committee has already indicated that if the application does not meet the requirements of Regulation 18 then the Committee is required to refuse it and prejudice cannot arise. The potential for prejudice only arises if the Committee has concluded that the application meets the requirements of Regulation 18 and may be granted. As indicated above, the Committee has determined that the application does not meet the requirements of Regulation 18 and therefore the Committee considered that consideration of prejudice was not required.

Other considerations

7.56 Having determined that Regulation 18(2)(b) had not been satisfied, the Committee did not need to have regard to Regulation 18(2)(c) to (e).

7.57 No deferral or refusal under Regulation 18(2)(f) was required in this case.

7.58 The Committee considered whether there were any further factors to be taken into account and concluded that there were not.

7.59 The Committee was not satisfied that the information provided demonstrates that there is difficulty in accessing current pharmaceutical services such that a pharmacy at the proposed site would provide better access to pharmaceutical services.

7.60 Pursuant to paragraph 9(1)(a) of Schedule 3 to the Regulations, the Committee may:

7.60.1 confirm NHS England’s decision;

7.60.2 quash NHS England’s decision and redetermine the application;

7.60.3 quash NHS England’s decision and, if it considers that there should be a further notification to the parties to make representations, remit the matter to NHS England.

8 DECISION

8.1 The Pharmacy Appeals Committee (“Committee”), appointed by NHS Resolution, confirms the decision of NHS England, therefore the application is refused.

8.2 The Committee concluded that it was not required to refuse the application under the provisions of Regulation 31.

8.3 The Committee concluded that Longstanton is in a controlled locality and that the site of the application is not in a reserved location.

8.4 The Committee has considered whether the granting of the application would cause significant detriment to proper planning in respect of the provision of pharmaceutical services in the area covered by the HWB, or the arrangements in place for the provision of pharmaceutical services in that area and is not satisfied that it would.

8.5 The Committee determined that the application should be refused on the following basis:

8.5.1 In considering whether the granting of the application would confer significant benefits, the Committee determined that –

8.5.1.1 there is already a reasonable choice with regard to obtaining pharmaceutical services;

8.5.1.2 there is no evidence of people sharing a protected characteristic having difficulty in accessing pharmaceutical services; and

8.5.1.3 there is no evidence that innovative approaches would be taken with regard to the delivery of pharmaceutical services.

8.5.2 Having taken these matters into account, the Committee is not satisfied that granting the application would confer significant benefits as outlined above that would secure improvements or better access to pharmaceutical services.

8.6 Having determined that the application should be refused, it was unnecessary for the Committee to make a decision upon whether granting the application would prejudice the proper provision of relevant NHS services in the area of (a) the relevant HWB; or (b) a neighbouring HWB of the relevant HWB.

Case Manager Primary Care Appeals