Highland NHS Board5 June 2012

Item 3.10

PHARMACY PRACTICES COMMITTEE MEETINGTuesday, 10 April, 2012 at 11.30 amThe Board Room, John Dewar Building, Inverness Retail & Business Park,Highlander Way, Inverness, IV2 7GE

Application by LYNNE ELIZABETH CAMPBELL for the provision of generalpharmaceutical services at Units 2 & 3 Cradlehall Shopping Centre,Cradlehall Court, Inverness, IV2 5WD

PRESENT Bill Brackenridge (Chair)Maureen Thomson (Lay Member)Margaret D Thomson (Lay member)Michael Roberts (Lay member)Alison MacRobbie (APC Non Contractor Nominate)Catriona Sinclair (APC Contractor Nominate)John McNulty (APC Contractor Nominate)

In Attendance Andrew J Green (Area Regulations, Contracts & Controlled Drugs GovernancePharmacist)Helen M MacDonald (Community Pharmacy Business Manager)Lynne Elizabeth Campbell, ApplicantKenneth Lawrie, Applicant SupportAlasdair Shearer, RowlandsLisa Gellatly, TescoPeter Mutton, Area Pharmaceutical Committee

1. The Chair welcomed everyone to Inverness. He asked all members to confirm that they hadall received the papers for the hearing and had read and considered them. All membersaffirmed these points.

2. APPLICATION FOR INCLUSION IN THE BOARD’S PHARMACEUTICAL LIST

Case No: PPC - Cradlehall_3Lynne Elizabeth Campbell, Units 2 & 3 Cradlehall Shopping Centre, Cradlehall Court,Inverness, IV2 5WD

The Chair asked each Committee member if there were any interests to declare in relation tothe application being heard from Lynne Elizabeth Campbell. No interests were declared.

3. The Committee was asked to consider the application submitted by Lynne ElizabethCampbell to provide general pharmaceutical services from premises situated at Units 2 & 3Cradlehall Shopping Centre, Cradlehall Court, Inverness, IV2 5WD under Regulation 5(10)of the National Health Service (Pharmaceutical Services) (Scotland) Regulations 2009, asamended.

The Committee had to determine whether the granting of the application was necessary ordesirable to secure the adequate provision of pharmaceutical services in the neighbourhoodin which the Applicant’s proposed premises were located.

The Committee, having previously been circulated with all the papers regarding theapplication from Lynne Elizabeth Campbell, agreed that the application should beconsidered by oral hearing.

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Prior to the hearing, the Committee had, as a group, attended a presentation which includeda site visit at the University of the Highlands and Islands Campus which was delivered byHighlands and Islands Enterprise Senior Development Manager, Mr Ian Thorburn, toascertain factual information regarding that development, which was within the Applicant’sneighbourhood and could be considered to have been an important factor in the Applicant’scase.

The Committee then visited the proposed premises where the Applicant and ApplicantSupport were on hand to guide the Committee around the premises, provide advice on theproposed plans for development and answer any questions asked of them by theCommittee.

The Committee then visited the vicinity surrounding the Applicant’s proposed premises, theexisting pharmacies at Tesco, Inshes and Rowlands, Culloden and facilities in the immediatearea and surrounding areas of Cradlehall, Castlehill, Birchwood, Westhill where socialhousing, a business park, primary school, nurseries, residential nursing home and thevarious shops, hairdressers and beauticians were pointed out. They were then drivenaround the boundaries of the neighbourhood as defined by the Applicant, over the railwaybridge to the neighbouring areas of Smithton and Culloden, passing the Boots Pharmacy, atInverness Retail & Business Park before returning to the John Dewar Building where thehearing was to be held. During the tour, the situation of the NHS and private dentalsurgeries in Castlehill, Cradlehall and Culloden and GP surgeries in Culloden were noted(the Committee were provided the opportunity to enter into all 3 pharmacies, but decided thiswas not required on this occasion, as all members had visited these pharmacies before andwere advised by Health Board officials there had been no further changes to any of thepremises since then**).

The hearing was convened under paragraph 3(2) of Schedule 3 to the National HealthService (Pharmaceutical Services) (Scotland) Regulations 2009 as amended (“theRegulations”). In terms of this paragraph, the Pharmacy Practices Committee “shalldetermine an application in such a manner as it thinks fit”. In terms of Regulation 5(10) ofthe Regulations, the question for the Pharmacy Practices Committee is whether “theprovision of pharmaceutical services at the premises named in the application is necessaryor desirable to secure adequate provision of pharmaceutical service in the neighbourhood inwhich the premises are located by persons whose names are included in thePharmaceutical List.”

The Applicant, Support and Interested parties were invited into the meeting at around11.40am

4. The Chair welcomed:-

The Applicant, Lynne Elizabeth Campbell, who represented herself and was supported byKenneth Lawrie, the Interested Parties who had submitted written representations during theconsultation period and who had chosen to attend the hearing, were Lisa Gellatly, TescoPharmacy, Alasdair Shearer, Rowlands Pharmacy and Mr Peter Mutton, AreaPharmaceutical Committee, (“the Interested parties”). The Chair then invited the Committeemembers to introduce themselves. Committee members introduced themselves to theApplicant and all other parties.

The Chair asked the Applicant and the Interested Parties to confirm that they were notattending the Committee in the capacity of solicitor, counsel or paid advocate. They eachconfirmed that they were not.

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5. The Chair reminded everyone that the meeting had been convened to hear the applicationfrom Lynne Elizabeth Campbell for the provision of general pharmaceutical services at Units2 & 3 Cradlehall Shopping Centre, Cradlehall Court, Inverness, IV2 5WD. The applicationwould be considered against the legal test contained in Regulation 5(10) of the NationalHealth Service (Pharmaceutical Services) (Scotland) Regulations 2009, as amended.

6. Regulation 5(10) was read out:

An application shall be granted if the Board is satisfied that the provision of thepharmaceutical services at the premises is necessary or desirable in order to secureadequate provision of pharmaceutical services in the neighbourhood in which thepremises are located.

7. The Chair then described the format of the hearing, reminding those attending that no newevidence could be introduced at the summing up.

The procedure adopted by the Committee at the hearing was that the Chair asked theApplicant to make her submission. There followed the opportunity for the Interested Partiesand the Committee to ask questions. The Interested Parties would then make theirsubmissions. There followed the opportunity for the Applicant and the Committee to askquestions of the Interested Parties in turn. The Interested parties and the Applicant werethen given the opportunity to sum up.

The Chair then asked the Applicant to give her statement.

7.1. The Applicant’s Case

Lynne Elizabeth Campbell stated “I am truly grateful to the Committee for inviting me toattend the hearing today and appreciate being able to present my evidence and put forwardLynne Campbell Pharmacy Limited’s case.

I would endeavour to keep the presentation as concise as possible; however, I have done agreat deal of work that I would like to bring to the attention of both the Committee and therepresentatives from Tesco and Rowlands.

To date, this is the third application made in respect to providing pharmaceutical servicesfrom Units 2 & 3 Cradlehall Court. The last application was made by Assura Pharmacywhich was unanimously agreed to by the Committee after having heard and discussed allthe evidence. The application was subsequently overturned as indicated in the submissionfrom the Area Pharmaceutical Committee by the National Appeal Panel in 2009.

I am aware that there has been additional interest from one of the representatives opposingthis new contract as well as another company in providing pharmaceutical service fromthese premises.

This application relates to a similar neighbourhood and detailed evidence of a significantchange that is currently undergoing within it will be discussed at a later stage within thispresentation.

I am here today, not only to represent my Company, Lynne Campbell Pharmacy limited,which was formed purely for the purpose of this application, but also to represent thecommunity within the Westhill and Cradlehall neighbourhood.

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The Chair, Bill (Brackenridge), in his introduction identified the legal test which theCommittee has to discuss and focus on. This test relates to the pharmaceutical services inthe neighbourhood, feedback from the local community and whether this application meetsthe test.

From a previous application I was made aware of helpful and legal guidance that LordDrummond Young provided for considering an application. He identified a two stageprocess for considering such an application:-

1 – What is the neighbourhood; and

2 – How adequate are the services?

Until the neighbourhood has been agreed the adequacy of service cannot be identified.Once the neighbourhood has been agreed the pharmaceutical services within it can beidentified and subsequently the adequacy of these services. So, what is theneighbourhood?

Neighbourhood means:-

Community – a local community with characteristics that distinguish it from areasaround it.

People living near each other – people who live near each other or in a specificneighbourhood.

There are likely to be physical aspects to boundaries within a neighbourhood which may benatural. For example, rivers or manmade such as roads or railway lines”.

The Applicant then demonstrated on a map as follows:-

“So, starting with the neighbourhood.

The proposed neighbourhood covers the area bounded by the B9006 Culloden Road,crossing the A9. From here it follows the northern edge to the right hand side of the A9 untilit meets the A96 at the Raigmore interchange. It then turns 90° east along the A96 andmeets the manmade boundary of the Inverness to Perth railway line.

The boundary is then the line of the railway along to where it goes under Tower Road. Atthis point the boundary turns back 90° to the south and runs along the edge of CullodenWoods with open ground to the left encompassing Woodlands housing to the right until itreaches the B9006 Culloden Road.

The boundary then runs down the outside of Culloden Road encompassing houses instreets off the road on both the left and right hand side (including Birchwood) and back downto where the B9006 Culloden Road meets the A9.

The information supplied within my initial application on the population within theneighbourhood was not recent data, a point which was highlighted by the AreaPharmaceutical Committee in their written submission. Previous viewing of the ScottishNeighbourhood statistics had left me really confused and unable to give a more accurateestimate on the current population within the neighbourhood.

After the initial application was presented to the Board I made contact with Mr CameronThomas, Research Officer at the Planning and Development Service of The HighlandCouncil. Mr Thomas researched and sourced information based on the National Records ofScotland Small Area Population Estimates 2010, which contains the latest available data upuntil mid 2010.

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The potential area discussed with Mr Thomas was made up of Cradlehall, Westhill andWoodside of Culloden. In mid 2010 the population of 5,271 with 21% of the population(around 1,100) were people under 16 years of age and 14% of the population (around 678)were of pensionable age. This means that 35% of the population would require morepharmaceutical services than that of the average person.

In addition to this, Mr Thomas indicated an active building site in Woodside of Culloden with110 plots nearly completed with another site in Resaurie with a capacity for 54 houses. Thisgives a total of 164 houses which are expected to be completed within the next 3 years andwould increase the population with this neighbourhood by 350 or so, taking the estimatedpopulation to over 5,500.

The neighbourhood is very diverse, containing well established homes, new homes, low costhousing and has 184 properties owned and rented by housing associations (Cairn and AlbynHousing Associations),with a further 29 properties owned by The Highland Council,indication that there is a social aspect of deprivation within the neighbourhood. In theneighbourhood of Woodlands there is supported social housing for patients who haverecently been discharged from New Craigs Hospital.

Tesco made a comment in its written submission stating that they believed theneighbourhood to be broader than that described. If we were to look at a broader areacovering Cradlehall, Westhill, Smithton, Culloden and Balloch, it is a much larger area andhas a population of 13,500. This area is too large in terms of size and population to beregarded as a neighbourhood on its own and needs to be broken down into a smaller moredefined neighbourhood and those people living in Culloden would not say that they wereneighbours with Cradlehall. Cradlehall and Westhill are recognised areas with a growingbusiness park, primary school, nursery, residential nursing home all within close proximity tothe busy, well used focal centre of Cradlehall Court. Therefore, Cradlehall is aneighbourhood and not part of a larger area.

If I am to define the neighbourhood as being broader than initially described I would includethe area of Smithton. From the Scottish Index of Multiple Deprivation (which identifies smallarea concentrations of multiple deprivation across all of Scotland), Smithton’s relativemeasure ranking is 1,399 within the 6,505 data zones identified, with one being the mostdeprived and 6,505 being the least deprived.

The index is relative as it shows whether an area is more or less deprived than another onebut not how much more or less deprived. The least deprived area is not necessarily themost affluent, it just lacks deprivation and, not everyone living in a deprived area is deprived.

Mr Thomas also discussed the area around Stratton between Smithton and the A96 asbeing identified as one of the next growth areas for Inverness with planning permissiongranted for the first phase of 750 houses with an anticipated population of 2,500. Apopulation of 2,100 is expected with another 350 houses still to be completed in Milton ofLeys. The Planning Department have set a requirement that before planning permission isgranted, the developer of a site must agree to provide 25% of these homes as low costhousing.

From The Highland Council’s area demographic fact sheet of data collated from the NationalRecords of Scotland, the population within Highland is expected to increase by 15%compared with 10% projected for the whole of Scotland. Across the UK, and Scotland, thereis a growing trend towards an ageing population and an increased amount of prescriptions.

Highland households headed by 60-70 year olds are projected to increase in numbers by35% and those headed by the 75+ years of age are projected to increase in numbers by106% between the years of 2008 and 2033.

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From an article in the Press & Journal Newspaper, just recently, in the Wednesday, 28March, 2012 edition, it was printed that “since prescriptions became free in April, 2011, thenumber of prescriptions dispensed in Scotland has risen by 2.8 million in a year, which is a3.1% increase from the previous year”.

Now that the neighbourhood has been defined, the next step is to consider thepharmaceutical services in the neighbourhood. There are currently no pharmaceuticalservices provided in the neighbourhood. If we look outside the neighbourhood for wherepharmaceutical services may be accessed – Rowlands Pharmacy at Culloden is 1.9 milesaway, Tesco Pharmacy is 1.4 miles away and Boots Pharmacy at the Retail Park is 2.6miles away.

I would like to highlight some of the points included in written submissions. The AreaPharmaceutical Committee indicate that Cradlehall is an area of high car ownership withgood bus links and are unaware of patients having difficulty accessing pharmacies.Rowlands Pharmacy also indicate that the area houses residents who are financially secure,have high car ownership levels and can easily access local services.

All the residents of the Cradlehall/Westhill area need the use of transport to reach apharmacy. In relation to access of a car, not everyone will have one and since the lastapplication in 2009, the cost of fuel has risen by 35%. With at least a 3 mile round trip tovisit a pharmacy, I would suspect that the majority of individuals – even those of us who arefinancially secure – will consider the necessity of such journeys.

Although there is a regular bus service, Stagecoach introduced changes in the Invernessarea from November, 2011. The proposed changes to the bus service were to provideimproved frequencies to many areas. As a result the new service number 3 runs every 20minutes and requires patients who live along the length of Caulfield Road to get off the busat the top of Tower Road and wait for the new service number 2/2A which will taken themdown to Rowlands Pharmacy at Culloden. This means that for a selected number ofindividuals who do not own a car, they must either rely on good neighbours or be physicallyable to hop on and off a bus four times to access pharmaceutical services at Culloden. Witha population of around 5,500 the pharmaceutical services are inadequate.

In the case of all new community pharmacy applications, a public consultation must becompleted before an application can be submitted to the Board. Before conducting this,advice and views from the Westhill Community Council, local community and staff at thelocal Co-operative store at Cradlehall Court was taken and it was decided that thenewspaper of choice for most local residents would be the Inverness Courier.

The public consultation appeared in the Inverness Courier, Courier 2 supplement on Friday18th November, 2011 and ran for a total of 20 working days, ending on Friday 16th

December, 2011.

A copy of this advert was also placed in the dental surgery, nursery, bakery, hairdressersand beauticians, after consulting with the proprietors of these businesses, which are allwithin the busy, well used focal hub at Cradlehall Court.

In addition, a copy was placed on the notice board at the local primary school – CradlehallPrimary, and within the Cradlehall Nursing Home.

Over the 20 day consultation period a total of 14 responses were received and, aftercompletion of this consultation, it became evident that the Inverness Courier had notassigned an address to the PO Box number. Subsequently, any letters that the localcommunity sent via the post were never received. The Post Office was contacted to see ifthey would be able to source or find any letters, however, to date nothing has been obtained.

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The Inverness Courier indicated to me that they would re-run the public consultation advertfree of charge as it had been their error. The incident was report to Helen MacDonald, NHSHighland Community Pharmacy Business Manager, who advised that it would beunnecessary to do this, as the requirements of completing a consultation before making anapplication to the Board had been fulfilled.

Due to the limited responses received during the public consultation process it was decidedthat a small survey would be required to collate further views from the local community onthe adequacy of pharmaceutical services provided from existing pharmacies withinterpretation of the neighbourhood in a question and any further comments from the localcommunity. The survey was designed from the website www.surveymonkey.com and wasbased on a survey that reviewed the current service provision from a medical centre. A totalof 200 surveys were handed out door to door with 122 returned to date.

The Committee received a copy of the survey results to date of the completed surveys,additional comments made on the surveys returned and the actual 122 surveys completedby the local community in and around the neighbourhood. From the surveys returned, allwere included within this submission and no comments were excluded from the tablesupplied to the Committee.

Comments from the survey indicate that there are patients who are experiencing difficulty inaccessing a pharmacy and it is the sheer inconvenience of having no other option but to usetransport to reach a pharmacy that this raises the desirability for a local pharmacy atCradlehall Court.

Looking at the result of the survey and, as the Committee has seen the results of the survey,there are four questions that I would like to bring to the attention of representatives from theAPC and Tesco, who both made submissions indicating that they were not aware of anycomplaints or did not see any gaps within the current level of service provision within theneighbourhood (at this point the Applicant furnished the Interested Parties with a copy of thepie charts summarising the survey results referred to).

Question 1 – How adequate are the pharmaceutical services currently provided byyour existing pharmacy?

From the pie chart, does this indicate that there is an inadequacy with the pharmacyprovision by the existing pharmacies? With 65% of the survey respondents indicating thatthe pharmacy services currently provided by their existing pharmacy was moderatelyaccurate or below, this led me to research the word “moderately” within the UK EnglishThesaurus – meaning fairly, reasonable, more or less, sort of. From this definition I believethat a fairly, reasonable service does not constitute an adequate service provision.

Question 2 – Overall are you satisfied with the service provision from your currentpharmacy?

The pie chart indicates quite clearly that 69% of the population surveys are moderatelysatisfied or below with the service provision from their current pharmacy.

Question 8 – If our new pharmacy were available today, how likely would you be touse it instead of your existing pharmacy?

81% of the population said that they would use our new pharmacy if it were available today.

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Question 9 – What do you consider to be the neighbourhood that the proposedpharmacy would serve?

I was very surprised to see the results of this question with 40% of the populationconsidering Milton of Leys to be part of the neighbourhood.

As discussed earlier, a major significant change that will be occurring within theneighbourhood is the development of the 215 acre Inverness Campus site at BeechwoodFarm. Inverness Campus is one of the most exciting and important projects beingdeveloped in the Highlands and Islands over the next 20 years, playing a pivotal role in boththe defined neighbourhood and in the region’s future. The Campus will create up to 6,000jobs over the next 30 years and generate £38 million per year for the area. I am aware thatthe Committee had a presentation at the site earlier today so, forgive me if I go over whatwas already covered there.

Key to the next 5 years of development is the Scottish Government granting Enterprise AreaStatus for Life Sciences to the Campus. This project represents a huge boost for the localeconomy and will bring a significant opportunity for local businesses across a wide range ofsectors, whilst bringing education, business and the community together.

Morgan Sindall started work on the infrastructure construction in January 2012, which isaimed to be completed by Spring 2013. This will allow construction of Phase I of theInverness Campus to begin with an expectation of around 20 months to complete.

A new junction to join the existing junction between the A9 slip road and the B9006 CullodenRoad has been proposed, with a secondary access point planned to connect the Campus toCaulfield Road North, which will have considerable effect on patients accessingpharmaceutical services.

Phase I on the Inverness Campus envisages a wide range of business, education andcommunity benefits including:-

Over 600 student residences have been planned within Phase I of the Campus. Inverness Campus will help to create the infrastructure necessary to deliver a

University for the region. Scottish Agricultural College A training hotel. A partnership between Albyn Housing and the Calman Trust will

provide opportunities for disadvantaged young people in a real businessenvironment.

Centre for Health Science. The Centre for Health Science plan to expand itsInverness operation onto the Inverness Campus and plans include a multidisciplinary health centre.

Also sports facilities. A high quality sports facility is planned, aspiring to create aregional venue catering for a diverse range of sports, attracting users from across theHighlands.

Community centre. A pivotal site on the Campus is earmarked for community useand the views of the local community are being sought.

At present, I am aware of 2 health centres with over 16,000 patients who are currently indiscussions with Highlands and Islands Enterprise on moving their practices out to the

Campus. I had hoped to be able to present to you today the practices with which thisconcerns. To date the press release for the public consultation with regard to this relocationwill be released on or after the 17th April, 2012.

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In addition to the academic aspects of the Campus, the project includes an innovativescience park for the private sector research and development and business incubation whichwill stimulate new employment and bring greater economic benefits to the Highlands.

In relation to core services and prescription numbers. Pharmaceutical care is changing andthe new contract services which the pharmacist is required to deliver, such as the MinorAilments Scheme, Chronic Medication Service, Public Health Service and the UnscheduledCare can be time consuming, although will help in achieving health and wellbeing but only ifdelivered properly. These new services can add extra strain on the pharmacies in the areaand it is important to consider not just the needs now but also in the future. Theneighbourhood needs a pharmacy both now and in the future.

A Freedom of Information request was made to the Information Services Division of theCommon Service Agency. When reviewing the prescription numbers and the core servicesof all the pharmacies contracted in respect to this application and sadly, with the recentclosure of Lloyds Pharmacy in Church Street, it becomes evident that the pharmacies thatwe see on the High Street appear to be experiencing the challenging conditions of beingthere.

I would like to comment on the information received, looking at the prescription numbers. Iwas provided with information on the number of paid items from December 2010 toDecember 2011and I divided these by 12 to obtain an average for each pharmacy. Whenyou look at the number of items being dispensed you get a picture of those being dispensedfrom the high street, for example, Boots, Eastgate do an average of 12,500 items per month– these will not be acute prescriptions but Boots have a very high number of nursing homebusiness, therefore, I would suggest probably only 4-5,000 are acute prescriptions.

There are similar situations at Tesco Inshes and Rowlands, with Rowlands, Cullodenaveraging at just over 10,000 items dispensed per month and Tesco at just over 8,500 andRowlands Park Pharmacy with just over 8,500 items per month.

What I find interesting, when you look at Boots at the Retail Park, setting it apart from Lloyds,Church Street, whose average was just over 2,000 items dispensed per month, is that,although their monthly average dispensings are just over 4,800, they are the ones who aremost effectively delivering the other core services compared to the others, with 1,224 MinorAilment Service prescriptions dispensed on average each month, pushing them into the nextbracket up for payment, Smoking Cessation Service payment being the highest for all thepharmacies and a very high rate of patient care records for the Chronic Medication Servicecompleted.

Compared to the figures for Rowlands, Culloden and Tesco, Inshes, they are actuallydoubling what they are doing who I would say are not necessarily delivering as effectively allthe core services, including the Minor Ailments Service. With dispensing figures of over10,000 items per month, I would expect to see more than150 patients registered for smokingcessation services and for them to be at the top end of the payment bracket for the MinorAilments Service. What you are seeing is that they are delivering a good dispensing servicebut that it is difficult for them to provide the other core services. I believe that the reasonBoots at the Retail Park provide the highest proportion of core services than otherpharmacies is because the number of paid items per month is lower than the rest and thatthey have two pharmacists on the premises during extended opening hours.

This is not the case in Culloden or Tesco, insofar as I am aware and 10,000 items is a “hellof a lot” of items for one pharmacist to dispense.

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I am working in a pharmacy which fills over 8,000 items a month but this is only possiblebecause I have a good team which allows me to provide all the services, so I would suggestfor a single pharmacist to deliver all the core services and dispense 10,000 items is prettytough going.

That said, Culloden are doing well with core services but Tesco, in its own submissionindicates that it has extended hours, however, I would expect a similar proportion of coreservices as Boots Retail Park, but there is really not much happening there. If they were toreview comments made not only within my survey but from letters received from the localcommunity with respect to their premises they may want to take action.

I did get an opportunity to visit the Practice Manager to introduce myself within the CullodenPractice and have been asked to give a presentation on the Chronic Medication Service andthe stage pharmacy is at within it. This leads me to conclude that there is not muchconsultation happening between the GP practice and the pharmacy at the moment.

Although not part of the core services, I am aware that the appointment of two newpharmacy contracts outwith Inverness are supplying weekly dosette boxes to patients andthese pharmacies are being contacted to provide this from within Inverness. I think thisindicates the inadequacy of services within and outwith the neighbourhood, resulting in a 13mile trip for either the pharmacy or the patient to receive these in Inverness.

So, what is pharmacy about. Pharmacy is about delivering patient centred care which isrespectful, compassionate and responsive to an individual’s preferences, needs and values.This application is not only about delivering a full pharmaceutical service but also providing acentre of wellbeing where all aspects of health could be addressed.

In summary, the neighbourhood has been clearly defined and the pharmaceutical serviceswithin the neighbourhood are inadequate as there is no current provision. There areservices outwith this neighbourhood but these are not accessible to everyone. Although theArea Pharmaceutical Committee indicates in its submission that they believe that RowlandsPharmacy, Culloden and Boots at the Retail Park have the capacity to providepharmaceutical services to a growing population, with the up and coming Inverness Campus,the proposed relocation of GP surgeries into the Campus and the transient and workingpopulation who will visit the area, extra strain will be placed on these existing pharmacies –and I would suspect would not be able to provide adequate services.

As indicated in a letter of support from Mr Ian Brown, the boom in Inverness’ population overthe last 10 years has not been reflected in its pharmacy provision, with the re-opening of astore at Balloan Park (a contract which previously served the Hilton area), a new contract atBoots Retail Park on the outskirts of the city and, most recently, the closure of LloydsPharmacy in Church Street means, with respect, there has been no increase in the numberof pharmacies in the Highland capital for over 10 years.

As this community expands through future housing developments in the neighbourhood,together with the development of the Inverness Campus at Beechwood, the requirement fordirect patient services under the community pharmacy contract will increase and the currentlack of provision will become a more acute problem. Therefore, I feel that the present andfuture case for a local pharmacy within the defined neighbourhood, which would include theprovision of pharmaceutical services is a strong and indeed desirable one.

The use of the term “desirable” includes the concept of improving existing pharmacy coverand, as this application will improve services to the area, the services available outwith thisneighbourhood may not be easily accessible to everyone. The services are, therefore,inadequate and I would hope this application should be granted.

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The Chair thanked Miss Campbell for her statement and invited the Interested Parties andthen members of the Committee to ask questions of her.

7.2 Questions from Lisa Gellatly, Tesco Pharmacy to the Applicant

Ms Gellatly advised that in relation to the survey she had carried out, 45% of respondentshad said that current services were moderately adequate with only 20% combined totalsaying services were slightly or extremely inadequate. How did she feel these figures provedinadequacy?

Miss Campbell replied that was the reason she had tried to define the word moderately in herpresentation.

Miss Gellatly commented that it could be said that 35% of the people surveyed feel thatcurrent service provision is extremely inadequate service but 35% of those think it is goodenough. Did Miss Campbell think that was high enough to prove inadequacy?

Miss Campbell replied that surely the 20% would tell you if it were inadequate in that caseand advised Miss Gellatly that it was identified in the response if she looked at it and clearlypeople were not happy with current services but advised that she had to do a survey to findthat out and that the survey reflected that. It was up to Ms Gellatly to interpret the results asshe wished.

7.3 Questions from Mr Alasdair Shearer, Rowlands Pharmacy to the Applicant

Mr Shearer had a few questions to ask regarding the statistics the Applicant had referred to.He stated that she had mentioned neighbourhood statistics, which he felt were based on theScottish Neighbourhood Statistics website figures. He had accessed these figures himselfand noted that the Applicant made reference that 36% of the population was of pensionableage. He asked the Applicant if she had compared that to the Scottish average.

The Applicant replied she had not.

Mr Shearer advised that this was actually 21% less than the Scottish average and askedwhere she had accessed her information from.

The Applicant advised that Mr Cameron Thomas of The Highland Council had accessed theinformation from the most accurate website available to him.

Mr Shearer asked the Applicant to confirm if 122 surveys were the total number completedand returned.

The Applicant affirmed that was the number of surveys returned to her.

Mr Shearer then enquired if the Applicant agreed that this resulted in a return for only 2.2%of a population of 5,500, whether she felt this was a true representation.

The Applicant replied that she could not say, however, she was at work, full time, five days aweek and ran a busy herbal medical practice advising that she had managed to get round200 homes but had simply not had the time to get round all the places that she would haveliked. That said, she felt it was a good representation but was done on the back of, andcomplimented the public consultation.

Mr Shearer then asked whether the Applicant would agree that a community would alwayswish a pharmacy application to succeed.

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The Applicant agreed with Mr Shearer’s supposition.

Mr Shearer then enquired whether this was more so, probably, when she was standing infront of the member of public at their front door.

The Applicant advised that she had left the surveys with people and went back to collectthem or they had forwarded them to her in a stamped addressed envelope she had left withthem. She refuted that she stood in front of them while they completed the survey, however,advised that there were additional comments from 88 people commenting on the travel timeto existing services and their provision.

Mr Shearer wanted to touch on the capacity issues the Applicant alluded to for currentpharmacies and asked of her how many prescriptions she felt a pharmacy should do everymonth.

The Applicant replied that a very well run, efficient pharmacy could deliver fantastic service,however, to actually dispense over a certain amount of items, there would become a pointwhere it would require to be considered if one pharmacist can actually deliver all that wouldbe required to them. She advised that if they were processing 12-15,000 prescriptions permonth, she would say they would not be able to provide all of the services expected fromthem as the pharmacist absolutely has to check everything, even with a dispenser or ACT(Accredited Checking Technician). In her opinion, to deliver core services, while dispensingthose amount of items, you would require an extra pharmacist.

Mr Shearer acknowledged that but asked the Applicant if she agreed that any pharmacywould be able to make the necessary changes to support a busy pharmacist and recruit therelevant staff, i.e. an ACT or an extra pharmacist.

7.4 Questions from Mr P Mutton, Area Pharmaceutical Committee to the Applicant

Mr Mutton had no questions for the Applicant.

7.5 Questions from the Committee to the Applicant

Margaret Thomson advised that she was particularly interested to hear about the survey theApplicant had carried out and asked her to recap for her how she had done this, asking if shehad said that she had gone out and left leaflets.

The Applicant advised that she had designed a survey through the websitewww.surveymonkey.com and in doing so had adapted a survey to become fit for pharmacyspecifics from the site which had previously been used in the review of medical practice.She advised that as, she did not have postcodes, nor know individuals from within theproposed neighbourhood it felt right for her to go out and knock on people’s doors but thatshe had left a stamped addressed envelope which could be used for them to return thequestionnaire to her at their convenience. She advised that she was assisted in this by hervery good neighbours but had carried around 80% of this door to door herself.

Margaret Thomson asked for clarification that the survey was an actual piece of paper.

The Applicant confirmed this was the case and she had distributed this by knocking on doorsand introducing herself, advising what her intentions and proposals were. She did have oneindividual who did not wish to participate in completion of the survey but she wanted to knockon the doors of her potential customers and let them see her, their potential pharmacist whowould be working in the pharmacy and for her to see the customers she might be caring for.

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Margaret then asked for confirmation that out of the 200 surveys dispatched, was it the case122 were returned which was around a 60% return rate and yet there was more than 60%shown on one of the pie charts?

The Applicant replied that the comments were based purely on the 122 returned so the 60%was 60% of the 122, not the 200. Unfortunately, due to work commitments, she was unableto obtain any more surveys.

Margaret Thomson asked the Applicant what her thoughts were about how to use theinformation received and was she happy with the response.

The Applicant replied that the results had been disappointing but acknowledged that inreality, it was not that often that people actually took the time to complete and return asurvey. She advised that she had visited the Westhill Community Council, nurseries and theSenior Citizens Club – not just gone round the doors, so quite a few surveys went to thembut not all responded so she then recognised she would have to give out stamped addressedenvelopes if she wanted to receive responses.

Margaret Thomson then acknowledged that the Committee could be convinced that she hadlooked for the views in her survey from the elderly and nursery ages but, in doing so, couldthey assume she had missed the age group in between – those who were mobile.

The Applicant replied that she had addressed this by going about the neighbourhood on aSunday afternoon and she had spoken to those with cars in their drive and children.

Margaret Thomson asked the Applicant if it was that population which did not return thequestionnaires.

That Applicant replied that she did not know.

Maureen Thomson asked the Applicant to describe how the pharmacy would operate andhow she would see it functioning in staffing levels.

The Applicant replied that it would not be just a pharmacy for her but a place for alternativetreatments such as herbal medicine, massage, and aromatherapy and that she would bringhercurrent herbal experience into practice there. She advised that the Drug InformationDepartment at Aberdeen Royal Infirmary advise they receive enquiries from affluent peoplelooking for information with regard to herbal medicines and that often she consults with theHighland Hospice and nursing staff. She advised that she envisaged pharmacy being thecentre of health and wellbeing centre and intended to look at chiropody, well men, wellwomen and travel clinics and obtaining locally accessible services for the local community.She advised that it was a big site and that pharmacy would be the focus with oneconsultation and two treatment rooms but that these may not be built straight away as shewouldn’t be able to do everything immediately. She advised that she knew many individualsof high calibre willing to come and work with her but initially her staffing would comprise 2dispensers and a part time ACT.

She further advised that if the business grew to where she hoped then she would recruit asecond pharmacist and probably sooner than the multiple contractors. She would not waituntil 10,000 items a month were dispensed and would seek to do so at approximately 6,000items, to enable consistent delivery of the services that pharmacy is all about. Pharmacy ischanging.

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Maureen Thomson then enquired of the Applicant how she was able to inform patients aboutwhat pharmacy is actually all about, remarking that most of the comments received aboutpharmacy relate purely to dispensing and how she felt it was possible to get people tounderstand that pharmacy is about more than that.

The Applicant advised that she had learnt so much through the experience and, quite rightly,agreed that the public have no idea about what pharmacy is all about.

Maureen Thomson then asked, in that case then, how could adequacy actually bemeasured.

The Applicant replied that she was not sure it could as the public don’t know what serviceswere delivered through pharmacy and they didn’t even know about the Minor AilmentsService. She had gone back to the pharmacy in which she works after the experience andsaid “right girls - we need to inform the public”! She advised that from the pharmacy theycould see when patients were just turning to pensionable age who did not think suchservices are for them but that it absolutely was. The Applicant further reported that 40% ofconsultations which take place within the GP surgery could be done from pharmacy and thatthis would be the best outcome for the patient rather than having to perhaps wait up to 3weeks for an appointment.

John McNulty asked the Applicant to clarify her opening hours.

She replied that she had made a change to those initially applied for as she had learnt thatother businesses within the Shopping Centre would be open until 6pm so made the decisionthat she would extend her hours to open 8.45am – 6pm, Monday to Friday and 9am-1 pm ona Saturday but advised she may further extend her hours for the purposes of herbal therapyover and above that but not for pharmacy services.

John McNulty enquired if the Applicant was of the view that services would be in moredemand when the GP surgery was closed at the weekend, either on a Saturday afternoon orSunday.

The Applicant replied that, looking at the Information Services Division figures, and, inparticular at Boots in the Retail Park, it can be seen that they are delivering all the services,but actually when you review this in line with the extended opening hours at TescoPharmacy, Inshes, these core services are not being done as well. She advised that whenshe had worked for Boots she had carried out a survey between 6-8 pm and they were luckyif 2% of their custom came in 6-7pm, dropping to 1% between 7-8pm. In her experience, shesuspected that core service provision happens, in the main, between Monday and Fridayand, although still provided at the weekend, not always the core services.

Catriona Sinclair highlighted that the Applicant had not made much mention of the ChronicMedication Service (CMS) and how did she imagine this would work through pharmacy.

The Applicant replied that it was evident that the service providers had fulfilled what isrequired of them, apart from 3 contractors where shortfalls were recognised in the figures.

Tesco, Inshes; Superdrug, High Street and Lloyds, Church Street, both Inverness CityCentre. Lloyds, Church Street is now closed.

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The Applicant thought that Superdrug was running on locums but advised that she could bewrong in saying that and that was why their figure for CMS might be low. She advised shefelt that CMS was a fabulous Service for patients but, having spoken to practice managers, itwould appear there was a lack of communication between pharmacists and medicalpractices. For Culloden, she felt that if this were improved, the practice there had advisedthat they have 1,500 patients they know would absolutely go on to use the Service and thatwas what she felt was required to be done. To go to the medical practices and tell them thatwe are now allowed to become more involved in patient care. She advised there were morenurse practitioners but not so many pharmacy practitioners and there was a real need to getinto the medical practices to let them see what can be delivered and to then work together,hand in hand, with everyone out there.

Michael Roberts enquired where the Applicant had measured the point of distances to theother pharmacies from.

The Applicant replied that these had been measured from the actual proposed pharmacypremises.

Mr Roberts highlighted that the Applicant had talked a lot about alternative therapies andasked if a person came into the Applicant’s pharmacy with a problem, such as a rash, howlikely she would be to advise that patient to use an alternative therapy rather than atraditional medicine.

The Applicant replied that she was able to gauge what was best suited to a patients needs,advising that she receives a plethora of enquiries for various conditions and that she hadextended her knowledge because she had listened to patients who were asking abouthomeopathy, aromatherapy and herbal remedies. She advised that some patients movedtowards healthcare and that some individuals have tried that and had not got what theythought and were looking for something else. She advised that she has also studiednutrition, advising that this was what pharmacists did and that they had a wealth ofinformation and could steer people in the direction which was right and best for them. Thiscould be nutrition, a bath in lavender or an orthodox treatment. That is when you see youhave a community backing you when you have that wealth of knowledge.

Alison MacRobbie asked the Applicant what she meant when she talked about perhapsextending the boundaries of her neighbourhood into Smithton.

The Applicant advised that she had meant that residents of Smithton could easily use theservices of her pharmacy in Cradlehall and that the Business Advisory Team had assistedher in deciding her neighbourhood. She advised that patients in Smithton could comethrough and use facilities and if she were to look at a broader neighbourhood, I would onlylook to Smithton, which is more deprived. In her considerations she had made contact withJohn Glenday of NHS Highland Harm Reduction Services, who has since retired, to see ifthat was a factor in the application. It was clear that the population was ageing, albeit thefigures did not agree and it was apparent that now, Inverness was developed around carownership. On the High Street there was evidence to show a slow down and not muchhappening there which was more apparent with the current economic climate.

Alison MacRobbie advised that one of the issues following on from that was the distances bycar and although reasonable car ownership, had the Applicant viewed the ways in whichpeople might move around the proposed neighbourhood and in what proportion.

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The Applicant replied that she could not say but she thought that this would be a highproportion as it was a very busy local hub for the local community containing a grocers,dentist, bakery, beautician, nursery and hairdressers, adding that people like to get out andabout if they are able to walk and access services but, in addition, it was good to walk. In mypresentation I advised that the population would increase by 106% for those 75 years andolder so something like that where they can walk and see someone – which may be on theirway to something, would enhance the local community.

The Chairman advised that he was very, very interested to hear about the Applicant’sconversation with Culloden Medical Practice and to hear they had requested her to do apresentation. That said he wondered if, in the opinion of the Applicant, this implied that theywere not happy with the current service offered by Rowlands Pharmacy there.

The Applicant replied, no, as she advised that when she was there to introduce herself, theyhad said they were happy with the service they currently received, however, when she hadgone to meet the Practice Manager in person, he had no awareness at all of CMS.

8. The Interested Party’s Case – Ms L Gellatly, Tesco Pharmacy

Ms L Gellatly stated “thank you for allowing me the chance to speak today.

Firstly I would like to refer to the legal test which requires a pharmacy to be necessary ordesirable in order to secure adequate provision of pharmaceutical services in theneighbourhood for an application to be granted.

We do not agree that this application passes the legal test. First of all let’s discuss theneighbourhood as defined by the Applicant. While we understand why the neighbourhoodwas defined as such, we don’t agree with the definition. This is because in Invernesspharmaceutical services are often accessed from outwith the patient’s local neighbourhoodand already several pharmacies deliver medication into the area proposed by the Applicant.Patients can be registered at any of the GP surgeries in Inverness and can, and do, accesspharmaceutical services on the other side of the City. For example, we have severalpatients at Tesco who are registered at Kinmylies Surgery on the other side of the City.

Within the neighbourhood of Inverness there are already 11 GP surgeries whoseprescriptions are already dispensed by 11 pharmacies, who have all worked hard to developand maintain good professional relationships. There are no pharmacies currently situated inthe defined neighbourhood, but neither are there any GP surgeries, therefore the residentswill already be accessing such services elsewhere and the area is one of high carownership.

We believe that the pharmaceutical services offered across these 11 pharmacies areadequate.

Much has been made in the application of the development of the Inverness Campus,however, this won’t be completed until at least 2015 and, as there are no plans for aresidential component, this development will have no effect on the population of theneighbourhood. The people who work or study there will already access both medical andpharmaceutical services from the area in which they live so the impact on theneighbourhood would be negligible. In fact, many parts of the new pharmacy contract relyon patients being registered at one pharmacy, for example to use the Chronic MedicationService.

We do not believe that it is necessary nor desirable to grant the application in order tosecure the adequate provision of pharmaceutical services in the neighbourhood.

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To illustrate this, I’d now like to go on to tell you a bit about our pharmacy at Tesco, Inshesand the services we offer, ranging from blood pressure, diabetes and cholesterol testing toprescribing for travel health and erectile dysfunction. We also offer health checks and fluinjections. We offer all of the core NHS services including eMAS, EHC, CMS, Public Healthand AMS and run a very successful nicotine replacement therapy service.

Access to our pharmaceutical services is greatly affected by our extended opening hours.We are open from 8am to 8pm six days a week and between 10am and 4pm on Sundays.Therefore, many of our services are accessed by people after their own working hours, or atweekends when other pharmacies (including the one proposed by the Applicant) will alreadybe closed.

I would like to point out that there is 3-4 hours cross over per day allowing two pharmaciststo provide all the services.

The pharmacy was recently refurbished and now has a much larger dispensary to allow ourcapacity for offering services like methadone supervision and dispensing of dosettes togrow. While the refurbishment was taking place, the pharmacy operated from a portakabinand it is a credit to both the service provided by the pharmacy and the loyalty of theirpatients that they managed to maintain 60% of their business during this period, a muchgreater figure than usual. Where patients choose to use other pharmacies during the refit,we have now noticed that the vast majority of them have returned to use our pharmacywhich again proves the perception of great service and convenience offered at Tesco,Inshes.

The staff at Tesco, Inshes do value their patients and customers greatly and reflect on thestandard of services that they offer on a regular basis. It is for this reason that we recentlyconducted a patient satisfaction survey, which was submitted to Helen (MacDonald, NHSHighland Community Pharmacy Business Manager). We asked a range of questions, fromthe convenience of the pharmacy to the friendliness and professionalism of staff, andsatisfaction with services that we offered and myself, Emily (Macintyre, Tesco InshesPharmacy Manager) and all the staff were overwhelmed by the response we got. Out of 186questions asked, 156 were graded as “excellent”, 29 “good” and only one as “average”.

A few examples of comments are:

“excellent staff, very caring”, “I am at the pharmacy a lot and I find that I always leave with asmile”, “I was going to get my medicines from the pharmacy beside my house but I wouldrather spend half and hour extra to get here”.

We are very proud of the level of excellent service that we’ve built into our business andbelieve it is a clear and direct result of mix of existing experienced staff and the addition tothe team of newer staff who came from other pharmacies in the area.

I do hope from your visit to Tesco that you did earlier today (**) that you saw our greatpharmacy and consultation room facilities and realise the potential and capacity we have totake on more services like dosettes, methadone supervisions and nicotine replacementtherapy patients. We are currently investing in additional hardware for the pharmacy afterlistening to patient feedback about waiting times.

In conclusion, we feel that we offer a fantastic pharmaceutical service at Tesco, Insheswhich is greatly appreciated by patients and the other healthcare professionals that we enjoyclose relationships with.

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To refer back to the legal test, we feel that this application does not pass the legal test as itis not necessary, nor desirable for this pharmacy to be granted a contract in order to secureadequate provision of pharmaceutical services in the neighbourhood as defined.

Thank you all very much for your time”.

The Chair thanked Ms Gellatly for her statement and invited the Applicant, Interested Partiesand then members of the Committee to ask questions of her.

8.1 Questions from the Applicant to Ms L Gellatly, Tesco Pharmacy

The Applicant had no questions for Ms Gellatly.

8.2 Questions from Mr A Shearer, Rowlands Pharmacy to Ms L Gellatly, Tesco Pharmacy

Mr Shearer had no questions for Ms Gellatly.

8.3 Questions from Mr P Mutton, Area Pharmaceutical Committee to Ms L Gellatly, TescoPharmacy

Mr Mutton had no questions for Ms Gellatly.

8.4 Questions from the Committee to Ms L Gellatly, Tesco Pharmacy

Maureen Thomson wondered if Ms Gellatly thought that the neighbourhood should be widerthan had been defined by the Applicant as that was how she felt it worked in Inverness butasked, if that scenario was turned on it’s head, because people would also be able to go tothe new pharmacy from other side of town so did she not feel that the point she was trying tomake was negative in that respect in that people could use any GP and any pharmacy theywished seemed to point out that people can access services from wherever they want. Theother point she noted from Ms Gellatly’s presentation was that did she not seem to think thatit had come across that patients were having to leave the proposed neighbourhood to accessmedical service but that was not necessarily a factor in a pharmacy application and did shenot agree that you don’t need to go to GP to access services. Therefore, did Miss Gellatlysee the lack of medical provision as being a negative factor which was how MaureenThomson had felt it had come across in what had been said.

Ms Gellatly replied that the core part of pharmacy services was still dispensing. Dispensingwas the “bread and butter of what we do” and that, if people are already going to apharmacy, then they will already use one closest to the GP practice.

Maureen Thomson enquired if Ms Gellatly had evidence to support that, to which Ms Gellatlyreplied she had none.

Maureen Thomson then enquired how much of making up of the prescriptions was done outof hours and at the weekend.

Ms Gellatly replied that the bulk of normal GP work was done in core hours, between 8-6 pmwith a lot of walk-ins, in and out of hours because of their proximity to the Out of HoursCentre.

Maureen Thomson asked if some of the points made by Ms Gellatly could be looked at bothways.

Ms Gellatly agreed that, yes, they probably could.

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Alison MacRobbie pointed out that Ms Gellatly had stated that there was no residentialaccommodation planned within the UHI Campus and for her information there were plans for400 and a social hotel. The Committee had also heard there would eventually be 6,000employment opportunities and those people would register with a pharmacy which often is atthe place most convenient to their workplace which is often now built in a large retail park. Interms of that with that level of opportunity did Ms Gellatly think there was potential for a greatdeal of business in the neighbourhood as defined.

Ms Gellatly replied that that depended on who this population comprised and what servicesthey required to access and of their needs which may not be as great if it were a youngpopulation as opposed to that of an elderly one.

9. The Interested Parties’ Case – Mr Alasdair Shearer, Rowlands Pharmacy

Mr A Shearer stated “thank you, Chair and panel for allowing me to present my views on theapplication at Cradlehall on behalf of Rowlands Pharmacy today.

As always, I’ll first come to neighbourhood. I would like to take the neighbourhood given atprevious PPC and NAP hearings, but will actually accept the slight adjustment made by theApplicant for the purposes of this hearing, which has obviously been made to incorporate theInverness Campus. To confirm, the boundaries I would give are:- to the west, the A9

running north to where it meets the A96; to the north, the train line running east to where itmeets Tower Road; to the east, running from the train line south to Culloden Road, throughthe open land to the west of Culloden Woods; and to the south, Culloden Road, including thehousing that runs directly off the south of it.

Using this neighbourhood boundary, you can see there is no pharmacy service within thisneighbourhood but, not every neighbourhood needs it’s own pharmacy. An adequateservice can easily be provided by pharmacies in adjoining neighbourhoods and, on thatbasis, we have ourselves at Rowlands in Culloden, Tesco at Inshes and Boots at the RetailPark.

I also think it is worth noting at this point that the population of Inverness can be registered atany GP across the City, so people from this area may be registered with a GP on the otherside of the City and, as a result, most people will quite often access a pharmacy outwith their“home neighbourhood” as such, anyway.

Now, looking at the population in this neighbourhood, I would class this as an affluent area,with certainly a number of new housing developments being created here at various pointsover the last 10+ years. It has lower than average claimants of income support, a higherthan average percentage of households with cars and a lower than average percentage ofpensionable residents. So, the community is mixed as always, on the whole. I believeyoung families with children would probably dominate this area. In fact, you just have todrive into this area first thing in the morning to see the queues of commuters driving out ofthe neighbourhood towards Inverness, sometimes as far back as Birchwood. This is atransient population, very used to travelling out of the neighbourhood to live and to work. Iwould argue if you asked these people, they have no problem accessing current pharmacyservices.

Both Boots at the Retail Park and Tesco, Inshes are open extended hours on weekdays andat weekends, so any working member of the population can easily access services at a timeto suit them.

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As a whole, I believe that the working families, generally young and older residents willgenerally have access to a car and find no problem with using existing pharmacies but wemust remember that those who may not have access to a car during the day. Again,touched on, the public transport method of choice here – and there is a regular bus serviceevery 20 minutes connecting residents with Culloden, the Retail Park at Inshes and on intoInverness. A service as often as this would be the envy of many residents in this country.These buses stop at a number of stops throughout the neighbourhood and there is a stopjust outside Rowlands Pharmacy and the main surgeries in Culloden. On the whole, I cansee no problem with access to pharmacies from this neighbourhood.

Again, a lot is made in the application around the development of the Inverness Campus andthe changes that will bring to the area. I don’t think there is no doubt that this is a thrivingdevelopment. We have to be realistic about what is being offered here. The College itself isrelocating from Harbour Road and this is not due to happen until 2015, as with the ScottishAgricultural College. The Centre for Health Science is just an expansion of current servicesat Raigmore. Again, this isn’t due for completion until 2016. I was not aware until today thatthe development included living accommodation but, a Hotel is not permanent residents sothat population is negligible. Obviously, workers will still use services around where theywork but, let’s be honest, I don’t see many seeking out services in a small row of communityshops, they are far more likely to head over – going to the Retail Parks, and there areplentiful pharmacy services there.

All 3 pharmacies around the neighbourhood are providing full pharmaceutical services. Icertainly don’t see the Applicant bringing anything new, nor is there anything to say thatcurrent provision is poor. At Culloden, we have a pharmacy kitted out with a consultationroom and a further room through the back used for MDS and homes. This gives us plenty ofroom to work in and certainly plenty of space to grow. We are constantly reviewing theservice we give. We provide a full collection service from all the surgeries and a full deliveryservice to the surrounding area including the defined neighbourhood. Gayle MacDonald, thePharmacy Manager, has been there for almost 3 years and has developed fantastic linkswith the locals and GPs alike. She currently runs an asthma clinic with Dr Kelly at SouthsideRoad. The pharmacy comprises a full trained team and has an ACT who, as a whole teamwork very well, exceeding average service figures for providing eMAS, CMS and smokingcessation. To their credit, they won Community Pharmacy Team of the Year at the ScottishPharmacist Awards this year. I would certainly like to ask what else we could do if this wasnot deemed adequate. This is not a pharmacy struggling to cope now and nor would I see itstruggling to cope in another 10 years.

So the Applicant is bringing no new services to the area in relation to NHS pharmacyservices, and the opening hours offer nothing in addition to what is already being provided.The population in this neighbourhood move freely around the city and access services wherethey need them. The development of the Campus area will not have a dramatic effect onthis locality and their access to pharmacies and I don’t believe this application is necessarynor desirable.

The Chair thanked Mr Shearer for his statement and invited the Applicant, Interested Partiesand then members of the Committee to ask questions of him.

9.1 Questions from the Applicant to Mr A Shearer, Rowlands Pharmacy

The Applicant enquired that with regard to the Inverness Campus at what stage would MrShearer say there would be a need to look at inadequacy of the provision of pharmaceuticalservices, highlighting that there would be an influx in the population through its development,although that may be transient and asked if we needed to wait to see the inadequacy prior toproviding additional services.

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Mr Shearer replied that “in a sense, yes”. He felt that the existing services could handle theinflux and that access to the Campus when it was fully open would probably be closest toTesco than trying to negotiate a maze of roads, in reality.

The Applicant then enquired how the pharmacy service at Culloden would be affected if theGP practice sited there were to relocate.

Mr Shearer considered that this might have a small effect – perhaps on collections and theloss of acute prescriptions which may be lost but that that would happen in a situation whereany GP relocated to new premises and, in reality, this may, or may not happen so couldn’tbase a decision on it at this stage.

The Applicant advised that she was aware that the residents at Milton of Leys have juststarted receiving a delivery service from Rowlands since an application was made to open anew pharmacy there and that prior to that application being made was it true that there wasno delivery service to that neighbourhood.

Mr Shearer replied that Rowlands had actually always covered that area between theBalloan Park and Culloden pharmacies but that this often interchanged as that area laybetween the two areas.

The Applicant enquired whether then, Mr Shearer now thought that as there was now evidentnotice and this was making customers more aware of the services was not previously offeredbut now being promoted.

Mr Shearer replied that the service was always offered but that the situation had changedpromotion-wise and that it was a service available which could be used but was notdedicated to this application.

9.2 Questions from Ms L Gellatly, Tesco Pharmacy to Mr A Shearer, Rowlands Pharmacy

Ms Gellatly had no questions for Mr Shearer.

9.3 Questions from Mr P Mutton, Area Pharmaceutical Committee to Mr A Shearer,Rowlands Pharmacy

Mr Mutton had no questions for Mr Shearer.

9.4 Questions from the Committee to Mr A Shearer, Rowlands Pharmacy

Alison MacRobbie enquired that, in terms of the Campus, Mr Shearer had made reference to

talking about crossing busy roads but was he aware there were a number of structuredwalking routes integrated into planning of the site and with the promotion of healthy workinglives did he not agree that this would encourage people to get out and about.

Mr Shearer replied definitely that locally this would happen but primarily not lead into a smallneighbourhood.

10. The Interested Parties’ Case – Mr P Mutton, Area Pharmaceutical Committee

Mr P Mutton stated “after reviewing and discussing the application and supportingdocumentation the Area Pharmaceutical Committee does not feel the application to benecessary nor desirable.

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The Area Pharmaceutical Committee agrees with the Applicant’s definition of herneighbourhood, however, understands that patients access pharmaceutical and GP servicesfrom across Inverness. In addition, many pharmacies within Inverness also deliver withinthe Applicant’s neighbourhood and therefore the Area Pharmaceutical Committee believes itis important to consider the services of pharmacies outwith the Applicant’s neighbourhood.The Cradlehall area has several bus services and we believe a high car ownership.

The Area Pharmaceutical Committee are not aware of pharmaceutical service inadequacywithin the Applicant’s neighbourhood or any complaints being made to the Board. Thesupporting documents provided as an outcome to the initial public consultation, in the Area

Pharmaceutical Committee’s view do not highlight an “inadequacy” in pharmaceuticalservices but note the point of failure of the Courier to assign the PO Box may impact on that.

Some of the supporting letters for the Applicant mention supply issues of medication. Therehas been, and still are, national supply issues within the pharmaceutical industry, ear dropsand suppositories are currently products “on quota”. These are issues affecting allcommunity pharmacies and the Area Pharmaceutical Committee believes it is important thatthe Pharmacy Practices Committee are aware of these national supply issues when makingtheir decision as this may impact on patients’ perception of services obtained throughpharmacy.

An appeal for an application at this site was overturned by the National Appeal Panel in2009. At that time the National Appeal Panel believed Rowlands, Keppoch Road were in aposition to adapt to the growing population. The applicant has not provided any recentdata to highlight any change in population since this appeal.

Since this decision was made by the National Appeal Panel, Boots the Chemist, EastfieldWay has had a refit, improving their facilities and capacity. Both Rowlands, Keppoch Roadand Boots the Chemist, Eastfield Way, currently service the Applicant’s neighbourhood andthe Area Pharmaceutical Committee believes that between them they have the capacity toprovide pharmaceutical services to a growing population.

Although, on the whole, the Area Pharmaceutical Committee believe pharmaceuticalservices across Inverness to be adequate, Public Health reports and current HEAT targetsare currently directing NHS Boards to review services in areas of deprivation; allowingindividuals in these areas to improve their health in line with more affluent areas. The AreaPharmaceutical Committee would support this view and acknowledge that there aredeprived areas in Inverness that would benefit from additional pharmaceutical services.NHS Highland’s Pharmaceutical Care Services Plan also highlights these areas and theArea Pharmaceutical Committee, along with the Pharmaceutical Care Services Plan, wouldnot classify Cradlehall as an area of deprivation. The Area Pharmaceutical Committeebelieves there is a need to support development of pharmaceutical services within thesedeprived areas rather than in areas where pharmaceutical services are already adequate.

The Chair thanked Mr Mutton for his statement and invited the Applicant, Interested Partiesand then members of the Committee to ask questions of him.

10.1 Questions from the Applicant to Mr P Mutton, Area Pharmaceutical Committee

The Applicant had no questions for Mr Mutton.

10.2 Questions from Ms L Gellatly, Tesco Pharmacy to Mr P Mutton, Area PharmaceuticalCommittee

Ms Gellatly had no questions for Mr Mutton.

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10.3 Questions from Mr A Shearer, Rowlands Pharmacy to Mr P Mutton, AreaPharmaceutical Committee

Mr Shearer had no questions for Mr Mutton.

10.4 Questions from the Committee to Mr P Mutton, Area Pharmaceutical Committee

The Committee had no questions for Mr Mutton.

11. Summing up

The Applicant and Interested Parties were then given the opportunity to sum up.

11.1 Mr P Mutton, Area Pharmaceutical Committee stated “to summarise I would say that theapplication is not about whether the application will provide a better service than is currentlyavailable, but is about whether the current services are adequate. The Area PharmaceuticalCommittee believe current services are adequate and therefore are of the view that thisapplication should not be granted”.

11.2 Mr A Shearer, Rowlands Pharmacy stated “a small cohort may have indicated that theyneed a pharmacy which is for convenience rather than need. There are no issues with thecurrent pharmacy contracts already in place who can meet future provision and, as such, theapplication is neither necessary nor desirable”.

11.3 Ms L Gellatly, Tesco Pharmacy stated “we do not believe that this passes the legal test.Across the 11 pharmacies there is access to adequate pharmaceutical services thereforethis application is not necessary nor desirable in order to secure adequacy”.

11.4 Miss Lynne Elizabeth Campbell, Applicant stated “I would like to take the opportunity tothank everyone very much for their help in my application. I have learned a lot during theprocess.

What is Pharmacy – pharmacy is about delivering patient centred care which is respectful,compassionate and responsive to an individual’s preferences, needs and values.

The neighbourhood has been clearly defined and the pharmaceutical services within theneighbourhood are inadequate as there is no current provision. There are services outwiththe neighbourhood but these are not accessible to everyone. With the up and comingInverness Campus the proposed relocation of GP surgeries into the Campus extra strain willbe placed on these existing pharmacies.

As this community expands through future housing developments in the neighbourhood,together with the development of the Inverness Campus at Beechwood, the requirement fordirect patient services under the community pharmacy contract will increase and the currentlack of provision will become a more acute problem. Therefore, I feel that the present andfuture case for a local pharmacy within the defined neighbourhood, which would include theprovision of pharmaceutical services is a strong and indeed desirable one”.

At the conclusion of the summing up, the Chair asked the Applicant and all of the interestedparties if they considered that they had had a fair hearing. Miss Campbell, Mr Lawrie, MsGellatly, Mr Shearer and Mr Mutton replied yes, that they did consider they had had a fairhearing..The Chair advised that a written decision would be sent out within 15 working days. A letterwould be included with the decision advising of the appeal process. The Chair then thankedthe parties for attending.

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Miss Campbell, Mr Lawrie, Ms Gellatly, Mr Shearer and Mr Mutton left the meeting.

12. DECISION

Having considered all the evidence presented to it, and the Committee's observations fromthe site visits, the Committee had firstly to decide, the question of the neighbourhood inwhich the premises to which the application related, were located.

The Committee took into account a number of factors in defining the neighbourhoodincluding the natural and man-made boundaries, who resides in it, neighbourhood statistics,the location of existing shops, health services and schools, land use and topography, and thedistance and the means by which residents are required to travel to existing pharmacies andother services.

In addition it anticipated future developments including firm plans for the further expansion ofhousing estates and the Inverness Campus.

Special regard was made to the requirements of the Equality Act 2010:

the need to eliminate unlawful discrimination, harassment and victimisation and other

conduct prohibited by the Act;

advance equality of opportunity between people who share a protected characteristic

and those who do not;

foster good relations between people who share a protected characteristic and those

who do not.

The Committee considered the Applicant's definition of the neighbourhood and how thiscompared to those put forward by the Interested Parties as well as comments received fromthe public consultation, and it was unanimously agreed that it should be as that defined bythe Applicant.

12.1 Neighbourhood: The Committee agreed that the neighbourhood had been clearly definedby the Applicant and supported the Applicant’s definition of the neighbourhood andconsidered the detail of that neighbourhood and where the boundaries would lie.

The Committee considered that the neighbourhood should be defined as follows:-

North: The northern edge of the A9 until it meets the A96 at the Raigmore Interchange andthe boundary of the Inverness to Perth railway line as these mark physical boundaries to theneighbourhood. For local people there is clear definition between the Smithton area and theCradlehall and Westhill areas defined by the route of the railway.

East: From Culloden Road along the edge of the Westfield housing development adjoiningCulloden Woods until it meets the railway line at the bridge on Tower Road as thisrepresents the extent of residential housing and the start of wooded countryside.

South: The B9006 Culloden Road and incorporating the Woodlands housing and InshesWood and Easter Muckovie until the Woodside development and the edge of CullodenWoods as this represents the extent of residential housing and the start of countryside.

West: The A9 from the Inshes exit below the B9006 flyover to the Raigmore Interchange asthis marks a physical boundary to the neighbourhood.

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12.2 Adequacy of Existing Provision of Pharmaceutical Services and Necessity orDesirability:

Having reached that decision, the Committee was then required to consider the adequacy ofpharmaceutical services within that neighbourhood, and whether the granting of theapplication was necessary or desirable to secure adequate provision of pharmaceuticalservices in that neighbourhood.

The Committee noted the content of the 15 letters of support, some of which were in emailformat, received by the Applicant and submitted to the Board with the application as a resultof her initial public consultation in the Inverness on Courier on 18 November, 2011. Itshould be noted that one of the letters of support received by the Applicant was from theWesthill Community Council in support of the application addressed “To Whom It MayConcern” although a copy of this letter was not sent to the Health Board by that CommunityCouncil as a result of the letter addressed specifically to them as referred to in the nextparagraph. Another of the 15 support letters, addressed directly to the Applicant, wasreceived from the President of the Westhill Senior Citizen’s Club in support of the applicationbut no reply was sent by them to the Health Board either in response to their consultationreferred to. In any event all letters were included in the application pack and submitted tothe Pharmacy Practices Committee for their consideration.

The Committee also noted that out of 34 letters sent by the Health Board to CommunityCouncils, Senior Citizen’s Club, Highland Councillors, MPs and MSPs and the Public Noticeposted on the NHS Highland Website only one response was received by e-mail. This e-mail, received from a Highland Councillor, but was written in a personal capacity andsupported the application. Although this response was supportive of the staff at TescoPharmacy it took issue with the size and layout of the pharmacy tucked into the back of thesupermarket and lack of privacy during consultations.

Whilst there was evidence submitted as a result of the consultations which indicated thataccess to pharmacies is not always convenient for residents in the neighbourhood, withpeople having to travel to access a pharmacy, the Committee felt there was not sufficientevidence submitted to judge the current service inadequate.

Unfortunately the Committee were of the opinion that the door-to-door survey undertaken,despite all the personal effort by the Applicant, could only have limited bearing on thedecision making process as it represented a limited sample of the total population, may havebeen biased (by the nature of the applicant personally handing the form to the surveyhouseholds and discussing what she was proposing as we as by the non random approachin handing them out), reporting had been against the forms returned rather than thoseissued and the results could not be shown to reflect the target population with anyconfidence. It was felt that the survey could have been conducted in a more systematic wayto produce scientifically valid results. The same could be said for the survey mentioned byTesco which showed high levels of customer satisfaction. However, that aside, theCommittee considered that the Applicant’s survey did not demonstrate inadequacy in theprovision of pharmaceutical services.

It was noted that the total population was more likely to be in the region of 7,000 within theneighbourhood as defined by the Applicant. This information was obtained by the HealthBoard from datazone information from Scottish Neighbourhood Statistics as at 2010 and,although could not be taken as completely accurate as some of the datazones overlappedinto other datazone areas slightly, it was perceived that the population was significantlyhigher than the 5,271 intimated by the Applicant in her statement. This is not a deprivedneighbourhood in fact it is quite affluent and there is a lower than average older populationtherefore the aging population will affect this neighbourhood less than many others. Thereare many families with young children.The Committee recognised that it was required to determine the adequacy of existing

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provision of pharmaceutical services in the defined neighbourhood at the time of the oralhearing and that in reaching its decision it needed to consider future developments. It wasrecognised that there are still new houses being built within the neighbourhood and this willresult in a further population growth. The Committee also discussed the likely impact of thePhase I development of the Inverness Campus and although it was acknowledged that thiscould potentially lead to a transient increase in the daytime population there was currentlyonly a small part of the development which was zoned for accommodation. In addition, theinfrastructure of the Campus had clearly marked access and exit routes which would tend tolead users of the site away from the proposed neighbourhood. At the current time it was feltthat any effect on the existing services was speculative, including the possible relocation ofGP practices, and the Committee decided that there was insufficient evidence to suggestthat the existing pharmacies would not be able to cope with the expected increase indemand for pharmaceutical services. It was felt by the majority of the Committee that anyincrease in the population could be managed by the existing pharmacies adjacent to theneighbourhood.

None of the 3 nearest pharmacies are particularly easy to access without transport from thedefined neighbourhood. For instance a fit person walking from Cradlehall Shopping Centreto Boots would take at least 40 minutes, however, although not an NHS service, all thesepharmacies offer a prescription collection service from all Inverness GP practices. Thismeans that patients do not have to travel to their GP to collect repeat prescriptions. All 3adjacent pharmacies also provide a delivery service to housebound patients in the definedneighbourhood. The levels of car ownership are high and the bus services are frequent.Most households were able to travel out of the neighbourhood for work or to access servicesto meet their daily needs. The population in this neighbourhood were generally consideredto be able to move freely around the City and access services where they need them.

The Committee noted that within the neighbourhood as defined there are no pharmaciesand that pharmaceutical services are currently being provided from pharmacies outwith theneighbourhood including 3 pharmacies adjacent to the boundaries of the neighbourhood,Tesco Pharmacy, Milton of Inshes, Rowlands Pharmacy, Keppoch Road, Culloden andBoots, Eastfield Way, Inverness Business & Retail Park. Consequently, the Committeerecognised that they needed to consider whether an adequate pharmaceutical service wasbeing provided from these pharmacies, bearing in mind that residents can and do choose toaccess pharmacies throughout Inverness.

The Committee then considered the pharmacy services provided by these 3 pharmaciesadjacent to the boundaries of the neighbourhood in more detail i.e. the monthly number ofprescriptions dispensed from April 2006 to December 2011 and also data related to the fourcore services of the Scottish Pharmacy Contract i.e. Minor Ailments Service (MAS), ChronicMedication Service (CMS), Acute Medication Service (AMS) and the Public Health Service.This data indicated engagement of varying degrees with the core services from thesepharmacies. It was noted that Tesco Pharmacy had recently commenced offering NHSEmergency Hormonal Contraception (EHC) but had a lower level of Pharmacy CareRecords (PCR) for CMS. It was felt that by the Committee that a pharmacy with extendedhours and some double pharmacist cover might have achieved more registrations andPCRs, however, there may have been initial technical difficulties which might explain this.The evidence showed that these pharmacies were all providing the core elements of thecontract.

Tesco had confirmed that they have capacity to provide monitored dosage systems topatients requiring them.

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It was recognised that Tesco Pharmacy are not currently engaging as actively with thepharmacy contract and there were some worries about the level of staffing and skill mix atRowlands Pharmacy at Culloden where there is only one pharmacist. However the figuresprovided on the current provision of pharmacy services indicate that the pharmacies aredelivering the required services in line with their peers.

Reference was also made to the Pharmaceutical List 2011 to establish the locally negotiatedservices each pharmacy offers. These were considered to offer an appropriate range for thepopulation of the neighbourhood.

Tesco Pharmacy and Boots, Retail Park both have extended hours in the evening and onSundays enabling them to offer pharmaceutical services beyond those expected by the NHSHighland Board Scheme and provide local access to healthcare services during the GP Out-of Hours period for this population.

There have been no complaints to NHS Highland about current pharmaceutical serviceswithin the neighbourhood. Neither has the Pharmaceutical Care Services Plan, 2012/13identified a potential gap in pharmaceutical service provision in this neighbourhood.

The increase in the Inverness population over recent years and the increased need forpharmaceutical services had and is being met by the existing pharmacies. There can beeconomies of scale which allow a single larger pharmacy to efficiently manage more thantwice the workload of two smaller ones.

The Committee, in determining the adequacy of existing provision of pharmaceuticalservices in the defined neighbourhood, took account of the evidence provided by theApplicant, and made available from other sources and concluded that the level of existingpharmaceutical services was adequate and granting the application was not necessary.

The Committee then considered whether it would be desirable to grant the application tomaintain adequacy into the future and concluded that predicted increased demand could bemanaged by the existing pharmacies adjacent to the neighbourhood and granting theapplication was not desirable.

The non-voting pharmacists then left the room.

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12.3 In accordance with the statutory procedure the Pharmacist Contractor Members ofthe Committee, and Board Officers were excluded from the decision process:

DECIDED/-

The Pharmacy Practices Committee (PPC) was satisfied that the provision ofpharmaceutical services at the premises of the Applicant were not necessary ordesirable in order to secure adequate provision of pharmaceutical services in theneighbourhood in which the premises were located by persons whose names areincluded in the Pharmaceutical List and in the circumstances, it was the majoritydecision of the PPC that the application be refused.

The non-voting pharmacists were invited back into the room and were advised that theapplication had been refused.

The Hearing then was closed.

Bill Brackenridge as Chair of the PPCDate: 18 April 2012