25th August 2016
1 Trevelyan Square
Boar Lane
Leeds
LS1 6AE
REF: SHA/18385
APPEAL AGAINST NHS COMMISSIONING
BOARD ("NHS ENGLAND") DECISION TO
REFUSE AN APPLICATION BY RUSHPORT
ADVISORY LLP FOR INCLUSION IN THE
PHARMACEUTICAL
LIST
OFFERING
UNFORESEEN
BENEFITS
UNDER
REGULATION 18 WITHIN 100 METRES OF
TESCO EXPRESS, 49 CONISTON ROAD,
LINSLADE, LEIGHTON BUZZARD, LU7 2PJ
1
Tel:
Fax:
Email:
0113 86 65500
0207 821 0029
[email protected]
The Application
By application dated 29th December 2015, Rushport Advisory LLP (“the Applicant”)
applied to NHS England for inclusion in the pharmaceutical list offering unforeseen
benefits under Regulation 18 within 100 metres of Tesco Express, 49 Coniston Road,
Linslade, Leighton Buzzard, LU7 2PJ. In support of the application it was stated:
This application should not be refused pursuant to Regulation 31 for the following
reasons:
1.1
No other pharmacy in same or adjacent premises so not applicable.
Information in support of the application
1.2
Linslade is located on the Bedfordshire side of the BedfordshireBuckinghamshire border. It abuts onto the town of Leighton Buzzard with
which it forms the civil parish of Leighton-Linslade. Linslade was transferred
from Buckinghamshire in 1965, and was previously a separate urban district in
its own right. The present location superseded the original during the 1840s,
after massive growth associated with the construction of the Grand Union
Canal and, particularly, the London and Birmingham Railway (now known as
the West Coast Main Line). Linslade underwent a second major period of
expansion, again associated with the railways, during the 1970s.
1.3
The application site is to the west of the town. Linslade is clearly separated
from Leighton Buzzard by two dominating geographical features, namely the
Grand Union Canal and the West Coast Main Line. All existing pharmacies are
to the east of these two dominating features and there is no pharmacy within
the sizeable western portion of the town.
1.4
Linslade contains a range of local services including the Tesco Express which
provides local residents with shopping facilities and also a range of schools
2
including Linslade Lower School, Greenleas Lower School and Southcott
Lower School. The application site lies at the heart of the neighbourhood and
is located beside the community centre.
2
1.5
Granting this application will not only provide access to pharmaceutical
services for those who live in Linslade, but it will also improve the
pharmaceutical services available in the wider area.
1.6
Existing pharmacies are all located to the east in Leighton Buzzard well over 1
mile from the application site. The railway line and canal are clear barriers to
movement and can only be crossed using dedicated crossing points.
1.7
The area around Linslade and Leighton Buzzard has seen significant growth in
population as new housing has been built and the towns have expanded, but all
the pharmacies remain located in the east in Leighton Buzzard.
1.8
Linslade's population profile and the presence of a number of schools means
that patients sharing protected characteristics such as the elderly, disabled,
pregnancy and those with young children are all present within the relevant
area. Allowing this application will be of significant benefits for these groups
who will benefit from better access to pharmaceutical services.
The Decision
NHS England considered and decided to refuse the application. The decision letter
dated 9th May 2016 states:
2.1
NHS England - Midlands & East (Central Midlands) has considered Rushport
Advisory LLP’s application for inclusion in the pharmaceutical list, as detailed
above, and [is] contacting [the Applicant] to advise that the submission has
been refused.
2.2
The Pharmaceutical Services Regulations Committee (PSRC) considered and
determined this unforeseen benefits application in line with NHS
(Pharmaceutical & Local Pharmaceutical Services) Regulations 2013, as
amended, in conjunction with Department of Health market entry guidance and
the findings are set out below.
2.3
The PSRC acknowledged that it must have regard to the NHS (Pharmaceutical
& Local Pharmaceutical Services) Regulations 2013, as amended and that the
initial consideration required was in relation to Regulation 31: [quotes
Regulation 31]
2.4
The PSRC determined that this condition is not met as the proposed pharmacy
is not to be at adjacent premises and there are no existing pharmacies operating
from the proposed premises and therefore, under this provision, regulation 31
would not cause the application to be refused.
2.5
The PSRC was then required to consider the applicant’s submission against the
regulatory criteria for this routine application [Regulation 18] and subsection
2(A) of the 2006 Act. [quotes Regulation 18(1)]
3
2.6
It was confirmed that Bedfordshire’s 2015 pharmaceutical needs assessment
documents an analysis of the situation as it was assessed at the date of
publication and there had been no revised assessments issued, in the form of a
Supplementary Statement under Regulation 6(3), in regard to this area.
2.7
That the current regulations consider that any benefit is regarded as unforeseen
at the time of the pharmaceutical needs assessment simply if it is not
mentioned in the document and it can be noted that the benefits proposed in the
applications are not mentioned.
2.8
The PSRC observed that the applicant seeks to provide unforeseen benefits to
the population of Linslade and the wider locale and determined that in order to
be satisfied, in accordance with Regulation 18(1), the criteria set out in
Regulation 18(2) should be considered. [quotes Regulation 18(2)(a)]
2.9
The PSRC noted that, if the application was granted and the pharmacy was to
open, the ability of NHS England 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.
2.10
Further that granting the application would not cause significant detriment to
the arrangements currently in place for the provision of pharmaceutical
services.
2.11
[quotes Regulation 18(2)(b)(i)]
2.12
The PSRC observed that the NHS Choices website identifies that there are six
existing pharmacies within a 1.5 mile radius of the applicants proposed site,
however that these measurements are ‘as the crow-flies’ and measurements via
road indicate that distances are much greater. i.e. the in-store pharmacy at
Vimy Road is the only pharmacy that is 1.5 miles from the proposed location |
the two pharmacies in the High Street are approximately 1.7 miles without
accessing parking | Market Square is 1.9 miles without accessing parking |
Lake Street is approximately 2 miles without accessing parking | and
Enterprise Court is approximately 3 miles avoiding traffic congestion.
2.13
The PSRC noted that, the supermarket’s in-store pharmacy, at Vimy Road,
provides extended contracted hours of Monday to Saturday from 8am until
8pm and Sunday 10am until 4pm and that there are no 100 hour contracts
within this locality. It was confirmed that Leighton Buzzard town centre,
including the High Street and Market Square where three of the existing
pharmacies are located, has a number of pedestrianized areas, but that it is also
accessed by a high density of traffic.
2.14
The PSRC observed that there are a number of bus services that provide public
transport links between Linslade and Leighton Buzzard, one of which is the
route 36A that leaves on an hourly basis from Grasmere Way North (a walk of
approximately 2 minutes from the applicants proposed locality) which
disembarks at Leighton Road opposite the supermarket and in-store pharmacy;
a journey time of approximately 25 minutes. The PSRC acknowledged that
4
residents could alternatively use private transport to access the pharmaceutical
services and that it was also possible to walk, using the estates footpaths, to
Leighton Road opposite Vimy Road and the in-store pharmacy; this journey
would take approximately 30 minutes depending on the person’s gait.
2.15
The PSRC considered that the usual social flow of Linslade would either be
into Leighton Buzzard town centre where, during the course of their everyday
lives, residents would access local amenities including grocery shopping,
medical providers and the pharmaceutical services located within their
vicinities or commuting to places of work, outside of the immediate vicinity,
where pharmaceutical services could be accessed.
2.16
Office of National Statistics (ONS) data for 2001 shows the resident
population of the Linslade (Ward) as 10,805; 7,978 of these residents travelled
via various means to places of work outside of the locality (additionally 596
worked mainly at or from home and 2,231 were not currently working). The
PSRC therefore concluded that, due to the very limited employment
opportunities within the Ward, residents routinely commute away from the
area to localities where access to pharmaceutical services could be achieved.
2.17
The PSRC observed that car ownership information from ONS data for 2011,
for the Linslade (Ward), documents that 46% of households have at least one
car/van, 41.2% have two or more and that 12.9% (a count of 644 households)
has no private transport; the PSRC noted that the percentage of households
without private transport may be due to the proximity of the Leighton Buzzard
train station and therefore the ease of commuting into London.
2.18
Taking this data into account the PSRC went on to consider whether there is
already reasonable choice, with regard to obtaining pharmaceutical services in
the area of the relevant HWB, or whether granting the application would lead
to significant benefits based on choice.
2.19
In view of the lack of evidence identified by Rushport Advisory LLP, to
support the Regulation 18 criteria, the PSRC determined that the application
had not demonstrated that there was not already reasonable choice in the area.
2.20
[quotes Regulation 18(2)(b)(ii)]
2.21
The PSRC observed that, although the applicant has referred to patient groups
within the locality in the submitted documentation, there has been no evidence
provided that indicates that these patient groups are experiencing difficulties
obtaining or accessing pharmaceutical services.
2.22
The PSRC noted from ONS data for 2011 that the majority of the population of
Linslade (ward) are residents between the age of 30 to 59 (43.6% of the
population), however that there appeared to be a high proportion (15.3%) of
people aged 65 and over, a count of 1,813 residents; and that of these 72 were
aged 90 or over. Further that children under 4 years of age only account for
5.5% of the population, a count of 643.
5
2.23
The PSRC determined that as the applicant has not identified and evidenced
that a specific patient group who share a protected characteristic is
experiencing difficulties in accessing any specific needs or difficulty accessing
current pharmaceutical services in the area of the HWB NHS England could
not consider that any patient group, that shares a protected characteristic,
would derive significant benefits from the granting of this application.
2.24
[quotes Regulation 18(2)(b)(iii)]
2.25
The PSRC considered that the applicant has not included within their
application or the supporting documentation details or evidence that the
proposed pharmacy would provide new or innovative approaches with regard
to the delivery of pharmaceutical services and therefore determined that the
granting of the application would not lead to significant benefits on the merits
of innovation.
2.26
NHS England - Midlands & East (Central Midlands) Pharmaceutical Services
Regulations Committee’s (PSRCs) additional considerations and
determination:
2.27
The PSRC observed that Rushport Advisory LLP is proposing 42.5 core
contracted hours, to support and secure the purported unforeseen benefit, and
these are to comprise of Monday to Friday opening 9am until 5:30pm.
2.28
Further that the nearest existing pharmacy, located at Vimy Road, currently
provides pharmaceutical services during contracted hours of Monday to
Saturday 8am until 8pm | Sunday 10am until 4pm.
2.29
The two pharmacies located in the High Street provide pharmaceutical services
during contracted hours of Monday to Saturday 8:30am until 5:30pm | Sunday
10am until 4pm.
2.30
The pharmacy at Market Square provides contacted hours of Monday to Friday
9am until 6pm | Saturday 9am until 5:30pm; &
2.31
The pharmacy at Lake Street provides contracted hours of Monday to Friday
8:45am until 1pm & 2pm until 6:30pm | Saturday 9am until 1pm.
2.32
The PSRC considered that there is no evidence to demonstrate that
pharmaceutical services are not currently available at such times as needed and
that granting this application would not lead to significant benefits in regard to
opening hours.
2.33
The PSRC observed that currently the pharmaceutical services in Leighton
Buzzard are located either adjacent to or in close proximity to medical services
providers, however within the Linslade locality, which has a mid-year
population of 11,970 in 2012 (data from Central Bedfordshire’s
pharmaceutical needs assessment), residents do not have direct access to either
medical or pharmaceutical service providers and that this can only be achieved
by undertaking a journey into the adjoining town of Leighton Buzzard.
6
3
2.34
The PSRC acknowledged that Rushport Advisory LLP lists proposed services,
however that the applicant does not evidence that existing pharmacies are not
already providing these services nor that, if they are not, they are unable to or
unwilling to provide said pharmaceutical services.
2.35
The PSRC further noted that the applicant has not provided evidence of any
gaps in the provision of pharmaceutical services or of any difficulty in
obtaining access to pharmaceutical services either in or out of normal hours.
2.36
It was confirmed that Central Bedfordshire’s recently published 2015
pharmaceutical needs assessment (PNA), produced following extensive and
robust consultations, it has been documented that one of the strategic sites for
development within Central Bedfordshire is Leighton Linslade (page 27) and
that the area of planned development is “Land East of Leighton Linslade” with
a proposal of up to 2,500 homes, however it is also stated that “The level of
pharmaceutical provision will have to be assessed with regard to the rate of
actual housing development” (page 28).
2.37
Jardines (UK) Ltd. trading as Grovebury Pharmacy, at Unit 2 Enterprise Court,
Enterprise Way LU& 4SZ has recently been included in the pharmaceutical list
to the southeast of Leighton Buzzard due to, amongst other considerations, the
expanding area of the South Ward; this pharmacy commenced trading 30
March 2016.
2.38
The PSRC considered that it was not satisfied that the information provided by
the applicant demonstrates that there is a difficulty in accessing current
pharmaceutical services nor that a pharmacy at the propose site would
significantly improve access, and determined that the granting of this
application would not confer significant benefits on the residents of Linslade.
2.39
The PSRC acknowledged that NHS England is required to consider and
determine applications in conjunction with the criteria as set out in the NHS
(Pharmaceutical & Local Pharmaceutical Services) Regulations 2013, as
amended, and that approval can only be granted if the regulations have been
satisfied.
2.40
The PSRC considered that there is already reasonable choice with regard to
obtaining pharmaceutical services, that there is no evidence of people sharing a
protected characteristic having difficulty accessing pharmaceutical services,
and that there is no evidence that innovative approaches would be taken with
regard to pharmaceutical services it was determined that NHS England is not
satisfied that granting the application would secure improvements or better
access to pharmaceutical services.
The Appeal
In a letter to the Family Health Services Appeal Unit of the NHS Litigation Authority
(“the Appeal Unit”), dated 19th May 2016, the Applicant appealed against NHS
England's decision. The grounds of appeal are:
7
3.1
The Applicant writes to appeal the decision of NHS England to refuse the
above application. In addition to this letter of appeal which sets out the
grounds for the appeal the Applicant has also provided an additional
supporting document which provides additional support for the grounds raised.
3.2
In addition to setting out the grounds of appeal it is instructive to consider the
content of the PSRC report (attached).
3.3
The bottom of page 2 of the report sets out the positions of pharmacies in
Leighton Buzzard (as there are none in Linslade). The report acknowledges
that distances to pharmacies are “much greater” that the 1.5 mile radius used.
The report highlights that many of the pharmacies also do not have accessible
parking for those who travel by car.
3.4
The report also highlights traffic congestion as a problem and states;
3.4.1
“It was confirmed that Leighton Buzzard town centre, including the
High Street and Market Square where three of the existing pharmacies
are located, has a number of pedestrianized areas, but that it is also
accessed by a high density of traffic.”
3.5
The PSRC report goes on to note that the bus service to Leighton Buzzard
from Linslade only runs on an hourly basis (in fact it is every two hours at
times) and notes that whilst it would be “possible” to walk this would take 30
minutes or more.
3.6
These comments all support the granting of a new contract at the proposal site.
They are a clear acknowledgment of the difficulties faced by residents in
accessing pharmaceutical services. However, the PSCR then says;
3.6.1
“In view of the lack of evidence identified by Rushport Advisory LLP,
to support the Regulation 18 criteria, the PSRC determined that the
application had not demonstrated that there was not already
reasonable choice in the area.”
3.7
It would appear that the PSCR has simply ignored its own findings from their
site visit when coming to this conclusion.
3.8
The report then states;
3.8.1
3.9
“The PSRC observed that, although the applicant has referred to
patient groups within the locality in the submitted documentation, there
has been no evidence provided that indicates that these patient groups
are experiencing difficulties obtaining or accessing pharmaceutical
services.”
and
3.9.1
“The PSRC determined that as the applicant has not identified and
evidenced that a specific patient group who share a protected
characteristic is experiencing difficulties in accessing any specific
needs or difficulty accessing current pharmaceutical services in the
8
area of the HWB NHS England could not consider that any patient
group, that shares a protected characteristic, would derive significant
benefits from the granting of this application.”
3.10
The Applicant’s attached report deals specifically with these issues and
provides clear evidence that there are specific patient groups (the elderly,
young and mothers with young children) who share a protected characteristic
and are experiencing difficulties in accessing specific needs and difficulty
accessing current pharmaceutical services in the area of the HWB.
3.11
The report then states;
3.11.1 “The PSRC considered that there is no evidence to demonstrate that
pharmaceutical services are not currently available at such times as
needed and that granting this application would not lead to significant
benefits in regard to opening hours.”
3.12
This comment can only be made if one completely ignores the fact that access
to alternate pharmacies is poor by whatever means a patient uses. Providing a
pharmacy that is open during normal opening hours will be an enormous
benefit in Linslade as other pharmacies are difficult to access, particularly on
foot or by public transport.
3.13
The report then goes on to note the significant expected increase in population
expected within the area in coming year. The report states;
3.13.1 “It was confirmed that Central Bedfordshire’s recently published 2015
pharmaceutical needs assessment (PNA), produced following extensive
and robust consultations, it has been documented that one of the
strategic sites for development within Central Bedfordshire is Leighton
Linslade (page 27) and that the area of planned development is “Land
East of Leighton Linslade” with a proposal of up to 2,500 homes,
however it is also stated that “The level of pharmaceutical provision
will have to be assessed with regard to the rate of actual housing
development” (page 28).”
3.14
The attached report fully addresses the issues identified within the PSRC
report.
3.15
The Applicant considers that the site visit report prepared for the PSRC is of a
very different tone to the eventual decision reached by NHS England. It may
well be that the recommendations of the report were not disclosed within the
decision letter or that the recommendation was overturned.
3.16
The Applicant asks the NHSLA to convene an oral hearing in relation to this
application so that any decision can be taken with the benefit of a site visit to
fully appreciate the scale of the Linslade area that has over 12,000 residents
and a range of community and retail facilities, but no pharmacy or healthcare
provision at all.
9
Applicant’s report
INTRODUCTION
3.17
This is a routine application by Rushport Advisory LLP for inclusion in the
Pharmaceutical List made under Regulation 18 of the NHS (Pharmacy Service)
Regulations 2013.
3.18
The application is made on the basis of unforeseen benefits. It is offering to
secure improvements and better access to pharmaceutical services that have
not been identified in the Central Bedfordshire Pharmaceutical Needs
Assessment [2015] (the “PNA”).
3.19
This application is made to Bedford Health and Wellbeing Board (HWB) and
is for premises within 100m radius of the Tesco Express, 49 Coniston Road,
Linslade, Leighton Buzzard, LU7 2PJ.
SITE AND SURROUNDINGS
Linslade
3.20
Linslade is located in Central Bedfordshire. It is positioned west of Leighton
Buzzard. It is positioned north and east of the A4146 dual carriageway which
wraps around the outer edge of the town.
3.21
While a settlement in its own right, Linslade has grown to coalesce with
Leighton Buzzard to the east. The two settlements form a civil parish of
Leighton-Linslade. The two towns have a combined population of about
39,300. The boundary of the town settlements is sign posted at the crossing of
the River Ouzel. The river extends north-south across Leighton Road (between
Vimy Road and Bridge Street). The separation is reinforced by the West Coast
Main Line and the Grand Union Canal, which also run north-south and bisect
the two towns.
3.22
Linslade has a population of 12,200 (in the Linslade electoral ward). Its town
centre is off centre, and located to the eastern edge of the town around Old
Road, New Road, Church Road and Wing Road.
3.23
It has a variety of local shops and services including local food shops,
butchers, laundrette, hardware shops, accountants, public houses, hair salons,
cafes, fast food take aways, restaurants, bookmakers and a hotel.
General location of the Application Site
3.24
The proposal site is located about 1200m west of Leighton Buzzard town
centre (when measured from the junction of Old Road and Soulbury Road).
Unlike Leighton Buzzard town centre, the proposal site is in the geographical
heart of Linslade. The proposal site is located about 550m south of the
Soulbury Road.
3.25
[The Committee had regard to the map showing ‘General Location of
Proposal Site’]
10
3.26
The proposal will be close to the Tesco Express supermarket at Coniston Road.
Also in this area is a take away and a hair salon and the Southcott Village
Community Centre.
3.27
The location of the proposal is accessed via number of roads such as Coniston
Road, Grasmere Way and Bideford Green. Car parking is provided at the site
for about 40 cars in three separate parking areas.
3.28
A site visit to the area will show that in addition to main roads around the area,
the proposal site area is easily accessible on foot using pedestrian only paths
that permeate through the housing areas, giving residents easy access to the
proposal site without using vehicular traffic roads.
Surrounding Area
3.29
The area around the proposal site is predominantly residential use. This use is
supported by a number of community facilities.
3.30
To the north are the housing areas accessed off Bideford Green and Mowbray
Drive. As part of this area is the Southcott Lower School. Across Soulbury
Road is further housing at Knaves Hill, St Mary’s Way, Chestnut Hill and
Milebush. This area has a local food shop with off licence (The Royal). At
Alwins Field there is a children’s playground, allotments and a large open park
land. Beyond this is the Linslade Wood.
3.31
To the east are the housing areas off Rock Lane, Springfield Road, Southcourt
Avenue and Grange Close. In this area is the Linslade Lower Primary School.
At Southcourt Avenue, there is a parking area and pedestrian footbridge
providing residents and visitors access to the railway station, without having to
go through the town centre.
3.32
West of the site is the Lomond Drive and Derwent Road residential areas.
Greenleas Lower School is located at Derwent Road. At Lochy Drive there is a
children’s playground and open park. It is also accessed via a number of
pedestrian paths.
3.33
To the south Bunkers Lane/Himley Green/Derwent Road is the main route
within Southcott Village. This provides access to Coniston Road.
The Proposal
3.34
The proposal is for a new pharmacy to serve the population of Linslade. The
application site is to be located within 100m of the Tesco Express store, so that
is easily accessed by local residents as part of their day-to-day lives. It will be
an easily accessible, modern pharmacy.
3.35
The premises are not yet in the Applicant’s possession, and are currently being
acquired. Once acquired they will be registered with the GPhC and be made
compliant with all relevant legal and ethical requirements for the operation of a
retail pharmacy business.
11
3.36
A consultation area will be provided for NMS, MUR, EHC, Smoking
Cessation, Chlamydia Screening, Services to Care Homes, Other Screening
Services, Services under PGDs, Palliative Care, Needle and Syringe exchange,
Supply of Gluten Free Foods, Cardiovascular Risk Assessment testing,
Hepatitis testing and Supervised Self Administration.
3.37
The pharmacy will provide essential services and clinical governance, and
appliances as listed in Part IX Drug Tariff. All commissioned services will be
provided and all pharmacists employed will be accredited to provide these
services. The premises will also be accredited. Rushport intend to provide a
number of services that are not currently being commissioned and will seek to
work with local GP practices to develop joint working on the provision of noncommissioned services.
3.38
The core opening hours are between 9:00am to 5:30pm Monday to Friday,
42.5 hours.
3.39
The proposed pharmacy will open 51.5 hours each week between the following
hours:
3.39.1 Monday 8:30am to 6:00pm
3.39.2 Tuesday 8:30am to 6:00pm
3.39.3 Wednesday 8:30am to 6:00pm
3.39.4 Thursday 8:30am to 6:00pm
3.39.5 Friday 8:30am to 6:00pm
3.39.6 Saturday 9:00am to 1:00pm
THE PHARMACEUTICAL NEEDS ASSESSMENT
3.40
As this is an application under Regulations 18, it offers benefits that were not
foreseen in the current PNA. Notwithstanding this, the Central Bedfordshire
PNA 2015 provides a useful starting point for assessing what pharmaceutical
services are available.
3.41
The PNA looks at provision across the whole HWB area, within localities
based upon Middle Layer Super Output Areas (MSOA). These have a
minimum population of 5,000 and an average population of 7200. A number of
MSOAs would be required to make up the localities.
3.42
The proposal site is within the Leighton Buzzard Locality. The PNA confirms
that Leighton Buzzard is one of the largest towns in Central Bedfordshire. The
PNA confirms that the population of Central Bedfordshire is expected to
increase from 255,600 in 2011 to 287,300 in 2021 (+12.4%). The PNA looks
at the demands from increased housing growth and identifies the 5 strategic
housing sites in the area including Land East of Leighton Linslade as an area
where pharmaceutical provision will have to be assessed with regard to the rate
of actual housing development.
12
3.43
Table 8 of the PNA shows that across England there are 22 pharmacies per
100,000 population (in other words one pharmacy per 4,545 people). The
Table has been amended to include dispensing GP surgeries. It is unclear
whether the core data for England includes dispensing GPs. In order to achieve
average levels of pharmacies and dispensing the PNA incorporates the
dispensing GP figures. On this basis does the PNA concludes that the provision
of dispensing services in Central Bedfordshire is deemed to be adequate for the
population.
3.44
Table 10 identifies the population of Leighton Buzzard as 44,000 with 5
pharmacies (i.e. 1 pharmacy per 8,800 population). On a pro rata basis this
equates to 11 pharmacies per 100,000. It falls well short of the English average
– about half the average (even adding in the dispensing GP would equate to
one dispensing location per 7,333 people). It is understood that an additional
pharmacy will open in Leighton Buzzard during 2016, but this is not close to
Linslade and is of little relevance, if any, to Rushport’s application.
3.45
The PNA carries out a ‘gap analysis’ in terms of pharmacy services, but does
not look at geographical gaps in pharmacy services where towns such as
Linslade have very limited access to pharmacy services and healthcare.
3.46
The recommendations of the PNA (section 8.2) finds the provision for
dispensing to be adequate, but to reach this conclusion it identifies 22
dispensing pharmacies and surgeries to match the England average. That
approach is not consistent when applied at the locality level as explained
above.
3.47
Overall, the PNA is much too broad brush to deal with the local geographical
gap that is evident in Linslade. The PNA does not consider Linslade residents
needs at all and it does not foresee the potential benefits that a new contract in
Linslade might bring.
REGULATION 18 COMPLIANCE
Regulation 18(1)
3.48
Regulation 18 (1) secure improvements, or better access, to pharmaceutical
services, or pharmaceutical services of a specified type, in the area of the
relevant HWB
Population Resident in the Area
3.49
The population of Linslade largely live west of the West Coast Main Line. It is
a localised area that looks into its heart for much of its day to day needs. This
is an established local community.
3.50
The population of the area around the proposal site is largely covered by the
electoral ward of Linslade. This has a mid year population estimate of about
12,200 (in 2013). This is an increase of 3% (+400 people) since 2011. That is a
significant increase in only 2 years. This is consistent with the growth across
Leighton Linslade which has experienced a 5% growth (+1,800 people) since
2011.
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3.51
As explained above, while quotas are not a demonstration of need, it can be
noted that the PNA implies that across England there is about 1 pharmacy per
4500 people. In a town such as Linslade which has a population of more than
two and half times that, it should be served by at least two or perhaps three
pharmacies. This indicates that there is likely to be a need for pharmaceutical
services.
Children in the Area
3.52
With a population of 12,200 there is likely to be about 18% (1700) children
under 15. There are three schools in the area around the proposal site.
3.53
[The Committee had regard to the map showing schools in the area around the
proposed site]
3.54
There are in the region of 760-800 children attending these three schools daily.
These are set out below.
3.54.1 Greenleas Lower Scholl has in the region of 220 children;
3.54.2 Southcott Lower School has about 300-330 children;
3.54.3 Linslade Lower School has about 240 children.
3.55
It is shown above that the proposal site is an easily accessible location for the
parents and children of three schools to reach as part of their twice daily trips.
These are groups that share protected characteristics and have specific needs
for pharmaceutical services which are currently difficult to access.
Commercial Facilities in the Area
3.56
The Tesco Express store provides the main shopping opportunity for the day to
day needs for the local people. This is a 500 sq m store that offers a variety of
fruit and vegetables, frozen food and fresh bread. It is a popular local
supermarket. While the Applicant does not have access to the store turnover or
footfall, these stores tend to attract 3500-5000 customers each week.
3.57
The area also has two local services with the hair salon and fast food take
away.
Community Identity
3.58
The Southcotts Village Residents Association has its community centre located
opposite Tesco. Its website advises that:
3.58.1 “Founded in 1977, the S.V.R.A. Community Club is situated at the
heart of the estate and provides a number of facilities for the local
community. Managed by a Committee of volunteers, the bar is open
seven days a week and provides a comfortable and friendly
environment to enjoy with friends and family”.
14
3.59
The Community Centre provides the location for the wider community to meet
up have a drink and meal in the evening and offers additional entertainment.
3.60
Among the Community Centres regular users are:
3.60.1 Socatots which is a pre school soccer club;
3.60.2 on Mondays 12:30-2:30 there is a baby clinic;
3.60.3 Pilates classes Tuesday evening;
3.60.4 Kickboxing Tuesday evenings;
3.60.5 Hartbeeps (children activity) Wednesday mornings;
3.60.6 Street dance and Performing Arts for Children Wednesday afternoons;
3.60.7 Line Dancing Wednesday evenings;
3.60.8 Zumba Thursday mornings;
3.60.9 Mummies and Toddles Thursday afternoons;
3.60.10Slimming World club Friday mornings; and
3.60.11Bingo night (first Thursday of month).
3.61
The Community Centre is also the base for a local football club Southcott
Football Club that has teams in numerous age groups such as Under 14/Under
15/Under 17/Adult Saturday and Adults Sunday leagues.
3.62
The Community Centre also has a function hall that caters for 100 people and
is used for all forms of community events, and the bar is fully licensed. It is
popular with elderly residents and acts as a meeting point for them.
3.63
It is clear that with a combination of the central location, the adjacent
community uses, the important commercial uses and the easy pedestrian access
from the surrounding houses and three schools that the proposal is well placed
to improve access to the many key community groups that visit the area on a
daily and weekly basis.
3.64
It is likewise noticeable that there is an emphasis at the Community Centre of
providing services to mothers and young children in this local environment.
This supports the application in that it demonstrates the use of the area by
those who share a protected characteristic. Therefore, in addition to the
presence of young children (who share a protected characteristic) the area also
attracts mothers of young children at other times during the school run. This
adds to the evidence that there are people who share a protected characteristic
who will require access to pharmaceutical services.
3.65
The difficulties in accessing existing pharmacies are dealt with later in this
report.
15
Deprivation and General Demography
3.66
Statistics produced by Central Bedfordshire Council confirms that one of
Linslade’s nine lower super output areas (LSOAs) is in the most deprived 4050% of LSOAs in England. This is LSOA 557 which forms part of the
Leighton Buzzard North Ward.
3.67
The core area around the proposal site would include LSOA 589 which is more
deprived than the wider Linslade area, and would be within the 60%-80% most
deprived LSOAs in England.
3.68
If the wider Leighton Buzzard area is considered, the central area of Leighton
Buzzard includes LSOA 608, 609 and 555 which are in the 50% most deprived
LSOAs in England.
3.69
LSOA 557 has 34% of children living in income deprived households.
3.70
The council has produced community profiling of the households in Linslade.
This shows that the majority of households would be classified as families in
large detached homes, suburban dwellers in mid range homes and thriving
families with children.
3.71
Linslade ward has about 15% of its population retired compared to the Central
Bedfordshire average of 13.5% and England average of 13.7%.
3.72
This is important context when considering the pharmacy services provided in
the area for Linslade. The area around the proposal site is a family dominated
location with a pocket of deprivation closer to Leighton. The wider Leighton
area has more deprivation that will place demands on health care in Leighton
Buzzard. The existing residents of Leighton place substantial demands on
healthcare in their town, and added to this the new residents of Leighton will
increase these demands. Clearly the health care in the Linslade and Leighton
towns have different streams of demand. The proposal is well placed to meet
those demands specific to Linslade.
3.73
The Council statistics show that there is a high degree of out commuting from
Linslade, with about 46% of workers leaving the town for work. This is shown
as follows:
3.73.1 Work Location
%
3.73.2 Work from home
10%
3.73.3 Work in Linslade
25%
3.73.4 Elsewhere
75% comprising mainly
3.73.5 Work elsewhere in Bedfordshire
19%
3.73.6 Work in Milton Keynes
12%
3.73.7 London
12%
16
3.73.8 Aylesbury Vale
7%
3.74
For those workers that catch the train or use the A4146 to get to work, they
will not pass a pharmacy on their walk to the station or drive away from the
town. The proposal is located to improve access for workers when they return
home.
3.75
13% of households in Linslade have no car, and 46% have access to one car.
This means that a high percentage of people have no choice but to walk or use
public transport to access all health care services. The proposal improves
access to pharmaceutical services for these people.
3.76
The majority of households with dependant children (18.6%) would be classed
as married/civil partnership parents. This is consistent with the high levels of
established families in the area of the proposal site.
Improved Distribution of Pharmacy Network
3.77
There is no surgery in Linslade and there is no pharmacy in Linslade. The
proposal will therefore introduce the first purposely located health care service
to the town population of Linslade.
3.78
Looking outside Linslade, there are 5 pharmacies in Leighton. These are:
3.78.1 Tesco, Vimy Road, about 1 mile (22 minute walk) from the proposal
site. This is located in the transitional area between Linslade and
Leighton. It is a large car borne shopping centre with a DIY hardware
warehouse beside it. It has a large surface level car park, and is plainly
not designed to cater for patients travelling on foot. This store is located
off West Street which operates as a ring road around the town centre;
3.78.2 The other four shops can be considered together as the cluster around
the town centre. They are all within 230m of each other. They are:
3.78.2.1 Rosehill Pharmacy, 41 High Street, Leighton Buzzard
3.78.2.2 Boots, 55 High Street, Leighton Buzzard
3.78.2.3 Lloyds, 3-5 Market Street, Leighton Buzzard
3.78.2.4 Cox and Robinson Chemists, 17/19 Lake Street, Leighton
Buzzard
3.78.3 All four are around 1.2 miles (25 minutes) walk from the proposal site.
To drive to these shops the route is below, where the route is 1.8 miles
and is subject to two areas of congestion.
3.78.4 [The Committee had regard to the map showing a route to drive to the
shops in Leighton Buzzard]
3.78.5 These are in a high street location and patients use on and off street
parking spaces. They are meeting the needs of the population that resort
17
to the town centre. The map below shows the type of promotional
activity undertaken for the town and it can be noted that these four
shops are in the centre of commercial activity for Leighton Buzzard;
3.78.6 [The Committee had regard to the map of Leighton Buzzard town
centre]
3.78.7 A sixth pharmacy has been granted on appeal SHA/17768 for Jardines
at Grovebury Road. This application was to cater for patients at the
surgery in Ridgeway Court. In allowing the pharmacy the Committee
noted the high incidence of car ownership in the area and that most
people came to the surgeries by car and that (para 9.25) “A further
journey to the town centre, for many of them in the opposite direction
to their homes, is not reasonable where the alternative of obtaining
pharmaceutical services on the same site, without the necessity of a
further journey could be provided”. The Committee also found that the
proposal would (para 9.26) “provide a better choice of access to
pharmaceutical services for people working in the area on, for
example, the current and future building sites and retail sites who may
otherwise have no need to travel either into the town shopping centre
or to the Tesco Store on the opposite side of town”.
3.78.8 At para 9.27 the “Committee accepts the arguments that those opposing
the application that the current arrangements are sufficient to cope
with demand but these arguments do not address sufficiently the
question of additional benefits to be derived from reasonable choice”.
3.78.9 The quickest way to access this location is to avoid the town all
together and use Dunkers Lane, Wing Road and the A4146. This is a
3.2 mile trip (6.4 miles return) and avoids the need to pass through the
town centre.
3.78.10[The Committee had regard to the map showing a route by car to 7
Grovebury Road]
3.79
Given above, there is no pharmacy catering for the day to day needs of the
Linslade population, and all residents, whether they happen to be going into
Leighton or not are required to pass through the Linslade town centre and visit
either Tesco or the pharmacies in Leighton town centre. The proposal will
bring health care to the heart of the Linslade community, to the location where
they visit on a daily basis as part of their daily patterns of movements. It will
result in a much improved access to pharmacy services for a population of
12,200.
Surgery Locations
3.80
There are 4 surgeries in Leighton Buzzard. The Leighton Road Surgery is
based at Leighton Road and has a branch surgery at Ridgeway Court (called
LRS@Ridgeway). The Leighton Road Surgery has about 14,5000 patients
[sic].
18
3.81
This surgery will merge with the Grovebury Road surgery on 1 April 2016 and
future appointments will be at the Grovebury Road and the Ridgeway
Building. Only urgent ‘sit and wait’ appointments will be held at the Leighton
Road surgery. Once merged this surgery will be about 3.2 miles by drive
(quickest but not shortest route) as outlined above.
3.82
The Grovebury Road surgery, Ridgeway Court is about 3.2miles away
(quickest route by car). It is located in the employment and industrial area to
the south of Leighton. It relocated to this area away from the town centre in
2012.
3.83
Dr Henderson’s & Partners (Leighton Buzzard Health Centre) 29 Bassett Road
is about 1.7 miles east of the proposal site. It is in a residential street and has
some off street parking available for patients.
3.84
Salisbury House Surgery, Lake Street is a town centre surgery, about 1.4 miles
walk from the proposal site. It is positioned beside Cox and Robinson
Pharmacy and within an easy walk to the three other town centre pharmacies at
Boots, Lloyds and Rosehill.
3.85
There is therefore no surgery in Linslade and the closest surgery which is at
present a mile away, while be relocating to Grovebury Road and will be 1.6
miles (33 minutes walk) away on foot and will mean its patients will not be
required to visit the town centre anymore. While the surgery may have a
pharmacy beside it (for a number of separate surgeries) to offer reasonable
choice, Linslade patients should have the opportunity to access a pharmacy on
their return to their own area.
3.86
[The Committee had regard to the map showing walking routes to 7 Grovebury
Road]
3.87
The provision of a pharmacy (alongside the schools, shops, community centre,
recreation facilities) is a normal facility that improves the daily lives of
residents. The requirement for over 12,200 people to leave their town to access
a key services is at the very least undesirable, and it must follow therefore that
provision for a pharmacy in the area is an improvement and it will clearly
provide better access.
3.88
The proposal will result in a new pharmacy equating to improvements through
better access to pharmaceutical services for population.
3.89
In order to be found in accordance with Regulation 18(1), regard must also be
given to matters set out at 18(2) which is considered below.
Regulation 18 (2)(a)(i)
3.90
Regulation 18(2)(a)(i) significant detriment to proper planning in respect of
the provision of pharmaceutical services in the area of the relevant HWB
3.91
The proposal will not cause significant detriment to the proper planning of
pharmaceutical services. No objector suggests that the proposal will cause such
detriment.
19
Regulation 18(2)(a)(ii)
3.92
Regulation 18(2)(a)(ii) significant detriment to the arrangements the NHSCB
has in place for the provision of pharmaceutical services in that area;
3.93
In the same manner that the applicant is required to provide evidence on the
significance of benefits being conferred, it must follow as a matter of fairness
and robustness that evidence of significant detriment must also be provided by
objectors.
3.94
Detriment and benefits are qualified in the legislation as being of
‘significance’. Therefore, the evidence of detriment must be as robust and
compelling as the evidence of benefits to outweigh it. The focus of Regulation
18 applications is the improvement of services to the public and with the
patient the focus of cases; self-preserving objections must carry limited weight.
3.95
There is no pharmacy that might be affected by this proposal in more than a
minimal way. All pharmacies are located sufficient distances away and serve
their own local populations.
3.96
The HWB must be given evidence from objectors that outweigh the significant
benefits of this application in order to prove significant detriment on a scale
that would result in refusal of this application. It is the Applicant’s view that
such detriment does not exist and will not occur. None of the objectors claim
significant detriment.
3.97
In response to the current objection letters the Applicant would comment as
follows:
3.98
Jardines contend that the test is the impact on the HWB area. This is not
correct. The test is to secure improvement or better access to the public in the
HWB area. The fact that 5 pharmacies are cluster 1.2 miles away from
Linslade does address the key question of improved access. The existence of 5
pharmacies in a cluster does not meet the need for a reasonable choice in
obtaining pharmaceutical services. The increase in Linslade population since
2011 indicates the population continues to grow and that there is a high level
of families with children in Linslade. This is further supported by the existence
of three schools in the area around the proposal site. The fact that Jardines have
been granted permission to meet the needs of the Leighton Buzzard south
population is irrelevant to the consideration of the 12,200 people that live in
Linslade.
3.99
Lloyds objection provides no substantive case against the needs of 12,200
people that will see their nearest surgery relocated to the south of Leighton
town centre and will have no surgery close to them and have to resort further
into to Leighton Buzzard for all their health needs.
3.100 Bedfordshire LPC does not object per se to the proposal, instead they list
information that might inform the decision and suggest that there is no
evidence in the application of people with a protected characteristic who
currently have difficulty in accessing pharmaceutical services to meet their
20
special needs. The LPC apply the wrong test in this regard, and appear to
ignore the facts that 12,200 people in Linslade have no pharmacy, and that
those 12,200 people will include a variety of people of protected
characteristics, includes children, elderly and mothers and disabled people.
3.101 Cox and Robinson Pharmacy object on the grounds that barriers identified by
the applicant are not significant and that all five town centre pharmacies which
are clustered in the town centre are accessed with relative ease. This objection
contradicts the finding of the Committee in respect of appeal decision
SHA/17768 which found that ‘accessibility does not in the Committee’s
judgement sufficiently meet the need for reasonable choice in obtaining
pharmaceutical services’.
3.102 There is no likelihood of significant detriment being caused by the proposal to
any business.
Regulation 18 (2)(b) (i-iii)
3.103 Regulation 18 (20)(b) (i-iii) reasonable choice with regard to obtaining
pharmaceutical services in the area of the relevant HWB; people who share a
protected characteristic; or innovative approaches are being taken.
Reasonable Choice
3.104 Patients in Linslade have no choice at present. There are 12,200 people that
have to leave this area to access a pharmacy.
3.105 To access the closest pharmacy requires patients to travel to a large Tesco
superstore, which is primarily focused on meeting the weekly food shopping
needs of the entire population of Leighton Buzzard and beyond. It is a
significant walk for patients from the Linslade area. It is not located beside any
surgery and for patients visiting the town surgeries in Leighton Buzzard, the
Tesco will require a second trip to have their prescription dispensed.
3.106 The other pharmacies are clustered around the town centre and while the town
centre might be accessibility [sic], the fact that they are clustered in one area
equates to limited choice.
3.107 This is particularly the case when the patterns and movements of the residents
of Linslade are considered. Parents dropping their children to any of the three
schools in Linslade, will pass the proposal site. They are not visiting Leighton
town centre for their day to day needs. The workers in the area that might
commute by road or railway out of the town will not pass Leighton town centre
or through Leighton.
3.108 People catching a train will park at Southcourt Avenue and cross the
footbridge. People driving will use Leighton Road to travel west to the A4146.
They will return home that way. They have no need to go through the town
centre.
3.109 The residents that are attending the community hall with their children, family
and friends to participate in the classes throughout the day, have no need to
21
visit the town centre. To have a pharmacy in the heart of the Linslade area will
give the local residents a choice that they have never had.
3.110 For the 46% of people in the area that might not have access to a car during the
day, a walk of over a mile to the surgery and further if they have to link that
with a trip to their pharmacy, is not adequate and reasonable choice.
3.111 There is public transport that travels around Linslade run by Grant Palmer
(service 36A and 36c). These run at either hourly or two hourly intervals
around the outskirts of Linslade (with a stop at the proposal site - Grasmere
Way). It services the town centre, but does not link to the Grovebury Surgery
to the south. A single bus service that a patient might have to wait two hours to
catch is not a replacement for local pharmacy services, in the context where the
town has no pharmacy at present and the nearest surgery is relocating away
from the main bus route. This service provides nothing more than a lifeline for
the population of the town to access pharmacy services. That is simply not
reasonable.
3.112 [The Committee had regard to the bus timetable]
Protected Characteristics
3.113 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.
3.114 The main users of primary health care services, including the GP surgery and
pharmacy services, are within the groups above who share a protected
characteristic. These also tend to be the groups that have the least access to
their own private transport and who find using bus services more difficult, i.e.
due to age, infirmity, disability or having to also push a pram / carry young
children. The proposal will be a significant benefit to the community of the
town of Linslade and to those protected characteristic groups that have no
health care support in their town at present.
3.115 As the Applicant has already highlighted, the area around the proposal site has
a number of schools as well as a community centre which provides more
services aimed at mothers with young children than any other group. These
services or services of a similar type are provided at multiple locations across
the area in different forms so that each local area is provided with reasonably
accessible services. There is clearly a need for separate service provision to
serve Linslade and this supports the application to improve the location of
pharmacy services.
3.116 The identified groups who share protected characteristics are also those who
have the highest demand for pharmaceutical services, i.e. the elderly residents,
and those using the local schools and community centre (young children,
mothers and the elderly). The elderly are particularly high users of services
such as the new Influenza Vaccine service which Rushport intends to provide
and all these group have significant demand not only for dispensing services,
22
but also for services such as support for self-care. This is particularly important
given that there is no GP surgery in Linslade.
3.117 It is unreasonable to expect these groups to walk over 1 mile to the nearest
pharmacy and the single bus service cannot be seen as a replacement for a
local pharmacy. Granting the application will therefore secure significant
benefits for groups who share a protected characteristic and have particular
needs for pharmaceutical services that are currently difficult to access.
4
Summary of Representations
This is a summary of representations received on the appeal. A summary of those
representations made to NHS England are only included insofar as they are relevant
and add to those received on the appeal.
4.1
4.2
COX & ROBINSON PHARMACY
4.1.1
Cox & Robinson Pharmacy have no further comments to make at this
stage regarding this application. A copy of their original comments
were enclosed.
4.1.2
Letter to NHS England (undated)
4.1.3
Cox & Robinson Pharmacy wish to object to the application as the
barriers indicated by the applicant to residents accessing
pharmaceutical services are not significant. All residents are able to
access one of the five pharmacies currently in the town, the residents
being to access pharmaceutical services with relative ease. The
applicant has not indicated any specific benefits to any persons with
protected characteristics other than to simply list them and mention
these groups in general terms rather than specific services that would be
offered in order to improve healthcare to those persons with protective
characteristics other than a simple convenience factor, which Cox &
Robinson Pharmacy do not believe is a healthcare benefit.
BEDFORDSHIRE LPC
4.2.1
Bedfordshire LPC have no further comments to add to their initial
response letter dated 24th February 2016.
Letter to NHS England dated 24th February 2016
Linslade Ward Profile
4.2.2
Data extracted from Central Bedfordshire’s Ward profile 2015.
4.2.3
Deprivation is not a particular issue in this ward, unemployment is low
and the proportion of residents claiming out of work benefits is around
the Central Bedfordshire figure.
4.2.4
There are no major differences in overall health in the population
compared to the Central Bedfordshire average.
23
Population of Linslade
4.2.5
There were 12,200 residents in 2013. This is an increase of some 400
people (3%) since the 2011 census. (Source – Office for National
Statistics mid 2013 population).
Age Profile
4.2.6
Linslade
Central Bedfordshire
England
Linslade’s population has a similar age profile to Central Bedfordshire
and England. (Source – Office of National Statistics 2011 census,
Usual Resident Population, table KS101EW)
Age 0 – 15 yrs
18%
19%
19%
16 – 65yrs
65%
64%
64%
65+
17%
17%
17%
Population by Ethnic origin, All residents 2011
4.2.7
Linslade has a similar ethnic profile to Central Bedfordshire. There has
been an increase of people who were not White British from 6% in
2001 to 8.9% in 2011.
Population and number of dwellings Leighton Linslade town
4.2.8
There was an increase of 1,410 (9%) dwellings across Leighton
Linslade town between 2011 and 2015. Households in Linslade are
more likely to be owned and less likely to be socially rented compared
to Central Bedfordshire. Household composition in Linslade is similar
to Central Bedfordshire with no major changes since 2001.
Deprivation 2010
4.2.9
One of Linslade’s nine lower super output areas (LSOA) is in the most
deprived 40/50% of LSOA’s in England. The remaining eight LSOAs
are in the 40% least deprived LSOA’s in England, with three of these
being in the 10% least deprived.
4.2.10 Overall 9% of older people in Linslade live in income deprived
households compared to Central Bedfordshire’s average of 13% and the
England average of 19%.
Economic profile of Linslade residents aged 16 and over in employment
2011
4.2.11 65% of residents are less likely to travel to work by car compared to
74.3% in Central Bedfordshire. 16.3% of residents are more likely to
use public transport to get to work compared to 8.7% in Central
Bedfordshire.
24
Health & Wellbeing
4.2.12 Linslade’s residents’ self-reported overall health and wellbeing in 2011
is good or very good.
4.2.13 The rate of people in Linslade who said their health was very good or
good is similar to the Central Bedfordshire average and is higher than
the England average.
Long Term health problems or disability 2011
4.2.14 A similar proportion of Linslade residents stated that their day to day
activities were limited due to long term health conditions or disabilities
compared to Central Bedfordshire.
Access to Pharmaceutical services
4.2.15 Enclosed, please find a diagrammatic map showing the location of the
proposed site to the existing pharmacies and GP practices.
Providers of Pharmaceutical Services
Pharmacies
Lloyds Pharmacy
3- 5, Market Square
LU7 1EU
Boots Pharmacy
55 High Street
LU7 1DN
Rosehill Pharmacy
41 High Street
LU7 1DN
Opening Hours
Monday - Friday
9.00am-6.00pm
Saturday
9.00am-5.30pm
Monday - Saturday
8.30am-5.30pm
Sunday
10.00am-4.00pm
Monday - Friday
9.00am-5.30pm
Services
Smoking Cessation voucher scheme
Gluten Free
Travel vaccination
NMS
MUR
Smoking Cessation voucher scheme
NMS
MUR
Smoking Cessation voucher scheme
NMS
MUR
Saturday
9.00am-5.00pm
Tesco Pharmacy
Vimy Road
LU7 1ER
Monday – Saturday
8.00am-8.00pm
Sunday
10.00am-4.00pm
Smoking Cessation voucher scheme
Supervised Methadone
End of Life
Gluten Free
NMS
MUR
25
Monday – Friday
8:45am-6:30pm
Cox & Robinson
17 Lake Road
LU7 1RS
Saturday
9:00am-1:00pm
DAAT
Palliative Care
Supervised Methadone
Gluten Free
NMS
MUR
Future housing development:
4.2.16 To Note - Central Bedfordshire County Council – Housing Trajectory
April 2014
4.2.17 http://www.centralbedfordshire.gov.uk/Images/Appendix%201%20Ho
using%20Trajetory%20Detailed%20Site%20Schedule_tcm6-55676.pdf
Pharmaceutical Needs Assessment
4.2.18 The Central Bedfordshire Pharmaceutical Needs Assessment (PNA)
published 31st March 2015 stated that based on its findings the level of
provision of dispensing services in Central Bedfordshire is deemed to
be adequate for the population.
4.2.19 Bedfordshire LPC does not believe it is appropriate to increase the
number of community pharmacy contractors and its resulting increase
in costs within the area of the application.
Findings
4.2.20 Bedfordshire LPC can find no evidence provided in the application of
people with a protected characteristic who currently have difficulty in
accessing pharmaceutical services to meet their special needs and who
may benefit significantly should the application be granted. Nor can the
LPC find any innovation or unmet needs that the applicant is proposing
to meet.
5
Observations
No observations were received by the FHSAU in response to the representations
received on appeal.
6
Unsolicited comments
6.1
LLOYDS PHARMACY LTD
6.1.1
Lloyds Pharmacy would wish to stand by the representations it
submitted to NHS England as part of the initial consultation which was:
6.1.2
In Lloyds Pharmacy’s opinion “there is no evidence within the
application the population of Linslade area of Leighton Buzzard have
problems accessing existing pharmaceutical services. The Committee
will be aware there is a Tesco Pharmacy open extended hours 7 days
26
week to the west side of the town as well as the other pharmacies in the
town centre”.
6.1.3
7
For the above reasons Lloyds Pharmacy do not believe this application
will secure improvements or better access to pharmaceutical services
and therefore ask for the application and appeal to be refused. In the
event an oral hearing is required Lloyds Pharmacy would wish to
attend.
Consideration
7.1
The Pharmacy Appeals Committee (“the Committee”) appointed by the Family
Health Services Appeal Unit of the NHS Litigation Authority, had before it the
papers considered by NHS England, together with a plan of the area showing
existing pharmacies and doctors’ surgeries and the site of the proposed
pharmacy.
7.2
It also had before it the responses to the NHS LA’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
The Committee first considered Regulation 31 of the regulations which states:
(1) A routine or excepted 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).
7.6
The Committee noted the Applicant had stated “No other pharmacy in same or
adjacent premises so not applicable” and that NHS England had determined
that “regulation 31 would not cause the application to be refused”. The
Committee was not required to refuse the application under the provisions of
Regulation 31.
27
7.7
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.
7.8
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—
(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,
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)
(b)
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;
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)),
28
(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
(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;
(3)
7.9
(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.
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)."
Pursuant to paragraph 9(1)(a) of Schedule 3 to the Regulations, the Committee
may:
7.9.1
confirm NHS England’s decision;
7.9.2
quash NHS England’s decision and redetermine the application;
7.9.3
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.
29
7.10
The Committee considered the Pharmaceutical Needs Assessment ("the PNA")
prepared by the Central Bedfordshire 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 31st March 2015 and it had not
been provided with any supplementary statements.
7.11
The Committee noted that the Applicant seeks to provide unforeseen benefits
to the patients of Linslade.
7.12
The Committee noted that there was no specific mention of Linslade within the
PNA. It noted that Section 8.2 ‘Recommendations’ states:
7.12.1 “There is currently a sufficient number of community pharmacies
providing essential and advanced services in Central Bedfordshire. The
level of provision of dispensing services in Central Bedfordshire is
deemed to be adequate for the population.”
7.13
The Committee noted that the improvements or better access that the Applicant
was claiming would be secured by its application for the residents of Linslade
were not included in the relevant pharmaceutical needs assessment in
accordance with paragraph 4 of Schedule 1.
7.14
In order to be satisfied in accordance with Regulation 18(1), regard is to be had
to those matters set out at 18(2). The Committee's consideration of the issues
is set out below.
Regulation 18(2)(a)(i)
7.15
The Committee had regard to
"(a)
whether it is satisfied that granting the application would cause
significant detriment to—
(i)
7.16
proper planning in respect of the provision of pharmaceutical
services in the area of the relevant HWB"
The Committee noted that NHS England had determined that “if the
application was granted and the pharmacy was to open, the ability of NHS
England 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”. The Committee noted that no objections had been
raised by other parties.
30
7.17
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.
7.18
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)
7.19
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"
7.20
The Committee noted that NHS England had determined that “granting the
application would not cause significant detriment to the arrangements
currently in place for the provision of pharmaceutical services”. The
Committee noted that no objections had been raised by other parties.
7.21
On the basis of the information available the Committee was 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.
7.22
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)
7.23
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—
(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)),
(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
31
(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"
Regulation 18(2)(b)(i) to (iii)
7.24
The Committee had regard to the location of the proposed site in Linslade, as
well as the location of local pharmacies and GP surgeries in neighbouring
Leighton Buzzard, as described on a map supplied by NHS England.
7.25
The Committee noted from the decision letter that the Linslade locality had a
mid-year population of 11,970 in 2012 according to data from the PNA. The
Applicant had stated that the population of Linslade electoral Ward is 12,200.
The Committee also noted that the decision letter contained ONS data for 2001
indicating that out of a resident population of 10,805 at the time. The
Committee noted that no information had been provided to indicate that this
population had decreased in more recent years, and was of the view that this is
a not insignificant level of population.
7.26
The Committee noted from ONS data provided for 2001 7,978 residents
travelled by various means to places of work outside the locality, with 596
residents who worked mainly at or from home and 2,231 not working. The
Committee noted NHS England’s view that residents of Linslade currently
travel to the adjoining town of Leighton Buzzard in order to access various
amenities including pharmaceutical and medical services, or they may access
pharmaceutical services whilst commuting to places for work outside of the
vicinity. The Committee, whilst noting that this might be the case, was
however mindful that according to the figures noted above which had not been
challenged there was also a substantial population not leaving the Linslade
area for work.
7.27
The Committee considered access to existing pharmacies and noted that the
decision letter states that there are six existing pharmacies within a 1.5 mile
radius of the proposed site, however this was “as the crow flies” and NHS
England had noted that distances were actually much greater, with the only
pharmacy that is 1.5 miles by road being the in-store pharmacy at Tescos on
Vimy Road. The Committee noted there were two pharmacies on the High
Street at approximately 1.7 miles, another on Market Square at 1.9 miles and
two other pharmacies at 2 and 3 miles distant. The Committee noted NHS
England had stated that it was “possible to walk” to the pharmacy on Vimy
Road (from the vicinity of the proposed site) and that the journey “would take
approximately 30 minutes depending on the person’s gait”. The Committee
considered this to be a substantial walk, particularly for those with mobility
issues or those feeling unwell. The Committee noted the Applicant had
estimated that it would be a 22 minute walk to this pharmacy, but had also
commented that it is a “large car borne shopping centre” with a large surface
32
level car park and is not designed to cater for those travelling on foot, which
had not been disputed. The Committee was mindful that the distance would be
less for some and more for others. Whilst access on foot is not the test, the
Committee acknowledged that there may be difficulties for some residents in
walking to the nearest pharmacies. The Committee also noted NHS England’s
comment that Leighton Buzzard town centre where three existing pharmacies
are located has a number of pedestrianized areas, but that it is also accessed by
a “high density of traffic” in Leighton Buzzard town centre, which the
Committee noted may cause difficulties for those wishing to access those
pharmacies on foot. The Committee proceeded to consider alternative options.
7.28
The Committee considered that there was a significant proportion of
households with no access to a car, or only one car which may be used by one
member of the household to travel to work during the day. The Committee
was of the view therefore that there would be a not insignificant number of
people reliant on public transport. The Committee noted that NHS England
had considered bus services between Linslade and Leighton Buzzard. It stated
that buses on route 36A run hourly from a stop approximately 2 minutes walk
from the proposed site to Leighton Road opposite the Tesco in-store pharmacy
with a journey time of approximately 25 minutes. The Committee noted the
Applicant had provided a timetable for the 36A/36C route which showed buses
running hourly or two hourly from Grasmere Way. The Committee also noted
the Applicant’s comments regarding the difficulties for those co-ordinating a
visit to a pharmacy with a visit to the Grovebury Surgery. The Committee had
concerns regarding the length of the bus journey involved particularly for the
elderly, those with mobility issues, and parents with young children. It also
considered that the frequency of the service was quite limited in the context of
an urban area. The Committee noted the Applicant’s comment that the buses
on route 36A/36C also stop in the town centre of Leighton Buzzard, but it was
mindful that these would be subject to the same limited frequency and a
lengthier journey.
7.29
The Committee considered access by private transport. Although the wording
of the statistics presented by NHS England was ambiguous, the Committee
noted the Applicant’s comment that 13% of households have no car and 46%
have one car, which, the Committee noted, left 42% with two or more cars.
The Committee noted the Applicant’s comment that this left a high percentage
of people with no choice but to walk or use public transport in order to access
health care services. The Committee noted NHS England’s comment that the
percentage of households without private transport may be due to the
proximity of the Leighton Buzzard train station and the ease of commuting to
London, however there was no information to support this conclusion. For
those with access to private transport, the Committee was mindful of NHS
England’s reference to a “high density of traffic” in Leighton Buzzard town
centre which wasn’t disputed. The Committee also had regard to the
Applicant’s map showing a route for those driving to Leighton Buzzard town
centre showing two areas of congestion, which had not been disputed. The
Committee saw no information regarding the availability of car parking in the
town centre..
33
7.30
The Committee noted the Applicant’s description of the amenities available in
Linslade which it states includes food shops, butchers, a laundrette, hardware
shops, accountants, public houses, hair salons, cafes, fast food take aways,
restaurants, bookmakers and a hotel. The Committee noted that the proposed
site was located near to a Tesco Express store and a community centre which
appeared to offer a variety of activities and clubs as listed by the Applicant.
The Committee noted NHS England’s view that the usual social flow of
Linslade would either be into Leighton Buzzard town centre where they would
access various amenities, including pharmaceutical services, during the course
of their everyday lives, or commuting to places of work outside the immediate
vicinity where they could also access pharmaceutical services. However the
Committee considered that, whilst the amenities in Linslade might not match
those available in Leighton Buzzard town centre, they were not insubstantial
and appeared to be adequate to meet the day to day needs of residents.
7.31
Having considered the not insignificant population, distance to nearest
pharmacies, limited public transport and congestion which would affect access
by both private and public transport, and the availability of services in
Linslade, the Committee was of the view that there was information to suggest
that there was not already reasonable choice with regard to obtaining
pharmaceutical services in the area of the relevant HWB, such that it was
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 by way of physical access.
7.32
In considering Regulation 18(2)(b)(ii) the Committee reminded itself that it
was required to address itself to the “specific needs” that were “difficult to
access” for those in the population “who share a protected characteristic” (as
defined in the Equality Act 2010). The Committee is therefore required to
consider the elimination of discrimination and advancement of equality
between patients who have these specific needs and difficulties and those who
do not. The Committee noted that the decision letter contained ONS data for
2011 indicating that 15.3% of the residents of Linslade ward were aged 65 and
over, which equated to 1,813 residents. The Committee noted the Applicant
had estimated that there is likely to around 1,700 children under 15 living in
the area and had highlighted the location of three schools around the proposed
site, together with other facilities likely to be used by mothers with young
children. The Committee noted the Applicant’s comments regarding the
difficulties that the groups it had identified experience in accessing the existing
pharmacies. The Committee considered that the paragraphs above deal with
any issues around access to pharmaceutical services. Regulation 18(2)(b)(ii)
focuses on the desirability of people who share a protected characteristic
having access to services that meet specific needs that are difficult for them to
access.
7.33
The Committee noted that the Applicant had briefly commented that “The
elderly are particularly high users of services such as the new Influenza
Vaccine service which Rushport intends to provide and all these group have
significant demand not only for dispensing services, but also for services such
as support for self-care”, however the Committee saw no information to
suggest that these services are not provided at the existing pharmacies. Overall,
34
the Committee did not consider that the Applicant had described how the
services it intends to provide would address specific needs that are difficult to
access for the groups it had identified. However, given its findings in relation
to access set out above the Committee was of the view that for those
particularly with mobility issues access to services of any kind could be
difficult. The Committee was therefore 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.
7.34
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 saw no information to suggest that the Applicant is
proposing any innovative approaches to the delivery of pharmaceutical
services. Therefore 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
7.35
The Committee noted that the Applicant was proposing to open for a total of
51.5 hours a week over 6 days, with a total of 42.5 core hours. The total
opening hours, including supplementary, were arranged so that provision
would be available from 8.30am to 6pm Monday to Friday and 9am to 1pm on
Saturday. The Committee had regard to the opening hours of existing
pharmacies, noting that the nearest pharmacy on Vimy Road has contracted
hours of 8am to 8pm Monday to Saturday and 10am to 4pm on Sunday. 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 the granting of this application would not lead to a
significant benefit in relation to opening hours.
7.36
The Committee had regard to the data provided by the Applicant regarding
deprivation in the Linslade area and noted that whilst there appeared to be a
pocket of deprivation, the Applicant had commented that community profiling
produced by the council shows that “the majority of households would be
classified as families in large detached homes, suburban dwellers in mid range
homes and thriving families with children”. The Committee concluded that the
pocket of deprivation was not so significant of itself that it would support the
granting of the application.
7.37
The Committee was of the view that in accordance with Regulation 18(2)(b)
the granting of this application would confer significant benefits on persons in
the area of the HWB which were not foreseen when the PNA was published.
35
Other considerations
8
7.38
Having determined that Regulation 18(2)(b) had been satisfied, the Committee
needed to have regard to Regulation 18(2)(c) to (e) and found that given there
were no other applications or pending appeals from other persons offering to
secure the improvements or better access that the Applicant is offering to
secure, it is satisfied that that there is no reason to defer the decision before
considering the Applicant’s application.
7.39
No deferral or refusal under Regulation 18(2)(f) was required in this case.
7.40
The Committee considered whether there were any further factors to be taken
into account and concluded that there were not.
7.41
The Committee was 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.
7.42
Given that it had reached a different conclusion, the Committee determined
that the decision of NHS England must be quashed.
7.43
The Committee went on to consider whether there should be a further
notification to the parties detailed at paragraph 19 of Schedule 2 of the
Regulations to allow them to make representations if they so wished (in which
case it would be appropriate to remit the matter to NHS England) or whether it
was preferable for the Committee to redetermine the application.
7.44
The Committee noted that representations on the Application had been sought
from parties by NHS England and representations had already been made by
parties to NHS England in response. These had been circulated and seen by all
parties as part of the processing of the application by NHS England. The
Committee further noted that when the appeal was circulated representations
had been sought from parties on Regulation 18.
7.45
The Committee concluded that further notification under paragraph 19 of
Schedule 2 would not be helpful in this case.
DECISION
8.1
The Committee quashes the decision of NHS England and redetermines the
application.
8.2
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;
8.3
The Committee determined that the application should be granted on the
following basis:
36
8.3.1
In considering whether the granting of the application would confer
significant benefits, the Committee determined that –
8.3.1.1 there is not already a reasonable choice with regard to obtaining
pharmaceutical services,
8.3.1.2 there is some evidence of people sharing a protected
characteristic having difficulty in accessing pharmaceutical
services, and
8.3.1.3 there is no evidence that innovative approaches would be taken
with regard to the delivery of pharmaceutical services;
8.3.2
Having taken these matters into account, the Committee is satisfied that
granting the application would confer significant benefits as outlined
above that would secure improvements or better access to
pharmaceutical services.
Abby Davies
FHSAU Case Manager
A copy of this decision is being sent to:
Rushport Advisory LLP
NHS England
Cox & Robinson Pharmacy
Bedfordshire LPC