3 October 2019 REF: SHA/22113 APPEAL AGAINST NHS ENGLAND DECISION TO REFUSE AN APPLICATION BY ASCENT HEALTHCARE LTD FOR INCLUSION IN THE PHARMACEUTICAL LIST OFFERING UNFORESEEN BENEFITS UNDER REGULATION 18 WITHIN 150M OF MORRISONS SUPERMARKET, BELLONA DRIVE, STANGROUND, PETERBOROUGH, PE2 8GP 1 Outcome

1.1 The Pharmacy Appeals Committee (“Committee”), appointed by NHS Resolution, quashes the decision of NHS England and redetermines the application.

1.2 The Committee determined that the application should be refused.

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REF: SHA/22113 APPEAL AGAINST NHS ENGLAND DECISION TO REFUSE AN APPLICATION BY ASCENT HEALTHCARE LTD FOR INCLUSION IN THE PHARMACEUTICAL LIST OFFERING UNFORESEEN BENEFITS UNDER REGULATION 18 WITHIN 150M OF MORRISONS SUPERMARKET, BELLONA DRIVE, STANGROUND, PETERBOROUGH, PE2 8GP

1 A summary of the application, decision, appeal and representations and observations are attached at Annex A.

2 The Committee held an oral hearing at the Queensgate Hotel, 5-7 Fletton Avenue, Peterborough PE2 8AX. The Committee comprised of Mrs S. Hewitt [Chairman], Mrs L. Summers, and Mr. M. Beaman [Pharmacist member]. Each declared that they had no conflicts of interest.

3 Attendees were as follows:

3.1 APPLICANT/APPLICANT

3.1.1 Mr. Qammar Nazir (Ascent Healthcare) and Mrs. Saira Nazir

3.2 INTERESTED PARTIES

3.2.1 Emma Griffiths-Mbarek (Well Pharmacy)

3.2.2 Wayne Clark (Well Pharmacy)

3.2.3 Shabbir Damani (Repeat Prescription Orderline Limited)

3.2.4 Matt Cox (Lloyds Pharmacy)

3.2.5 Anil Sharma (Cambs and Peterborough LPC)

3.2.6 Karen Cox (Cambs and Peterborough LPC)

3.3 DECISION MAKING BODY

3.3.1 Sharon Grey, Contract Manager Pharmacy and Optometry (NHS England)

3.4 OBSERVING

3.4.1 Fiona Richardson (Primary Care Appeals)

4 Site Visit

4.1 Before the hearing commenced, the Committee conducted a site visit which was read out to the parties. There were no corrections or observations made upon it.

4.2 At 10am the Committee set off from the location of the hearing, the Queensgate Hotel, Peterborough. It travelled into Fletton Avenue, and reached the Stanground Community Centre. This had a busy car park and a nursery school at the side. A patron spoken to said it was always in use by various community groups including for children’s parties

Arena Point Merrion Way

Leeds LS2 8PA

Tel: 0203 928 2000 Fax: 0207 821 0029 Email: appeals@resolution.nhs.uk

etc.

4.3 From there we went along Whittlesey Road and the A605 to the Cardea Housing Development. We walked around the central hub of the development surrounding a substantial car park. We noted the Cardea Community and Sports Pavilion and a large Morrison’s Supermarket. On one side of the car park was a row of 7 small retail units, two of which were vacant. The occupied units were two take away food outlets, a barber shop, a charity shop and a hair and beauty salon.

4.4 We were told that currently no buses drop off or pick up at the Morrison’s site, although

a staff member of Morrison’s and the driver of a parked bus, Stage Coach 5, told us this was to change in the near future. The nearest bus stop from Morrison’s was approximately 400 metres away and was served by the Stage Coach No. 5 bus to Peterborough City Centre. We noted that it runs every 20 minutes from Monday to Saturday and hourly on Sundays. We noted a pub/restaurant called “Apple Cart” on the boundary of the Morrison’s car park.

4.5 The Committee returned to Morrison’s and began its walk towards the Stanground

Surgery and the Well Pharmacy. We walked past St Michael’s Church School, along Apollo Avenue. We turned on to a path which leads to Oakdale School, which appears to mark the edge of the Cardea estate.

4.6 The Cardea estate comprised a combination of detached and terraced houses and

flats. They were well kept and the pavements and paths were in very good condition with dropped kerbs, and are well lit. There were 5 mph speed limits visible and most houses had off street car parking and many had cars parked in them.

4.7 From there we went along Oakdale Avenue, which comprises of older housing, almost

all with off street parking and with many cars visible. The pavements were flat and wide.

4.8 At the junction with Whittlesey Road, we saw the No 5 bus en route. We turned left and noted that the pavement was separated by white markings for pedestrians and a cycle route, wide enough to take both. Following the pathway, we entered the Stanground Surgery and the Well Pharmacy. There was a pharmacy sign in the car park, which was of a good size, with plenty of spaces available. The walk had taken us 25 minutes at average pace. Well Pharmacy was located within the GP surgery and shared the same waiting area. Opening hours reflected those of the Surgery, a seven GP practice, these being 8.30-6pm Monday- Fridays. There was reasonable amount of seating and capacity and disabled access was good.

4.9 From there we continued along the pathway back to Whittlesey Road and noted Halls

the Chemist, a short distance along. It had parking for approximately 8 cars, and there were spaces free at the time of inspection. The pharmacy hours were 9am-6pm Monday-Friday and 9am-1pm on Saturday. It advertised a free collection and delivery service.

4.10 From there we took the car back, going via Kingston Park Industrial Estate, which

contained some large distribution warehouses including Amazon, DHL and Debenhams, and a number of medium sized units, some very new. There was space for further development. The distance from Morrison’s was such that the Committee was of the view that employees of this estate would be unlikely to frequent the Morrison’s hub during their working day.

4.11 From the industrial estate we continued by car to the Old Fletton Surgery and Odedra

Pharmacy, purpose build c.2009.

4.12 The car park was full but spaces were coming free regularly. The Surgery is a six GP dispensing surgery, open from 8am-6pm Monday-Friday, and the pharmacy opens 8.30am-6.15pm Monday-Friday. Disabled access was good and there was ample capacity. This pharmacy also did free deliveries.

4.13 The Site visit finished at the Old Fletton Surgery and returned to the Queensgate Hotel,

Peterborough.

5 Oral Hearing Submissions

5.1 The Chairman confirmed with all parties that they had been previously been served with the document bundle consisting of 260 pages. As a preliminary matter, Mr Damani of Halls the Chemist, wished to circulate a letter dated 11 September 2019 from the Chairman of the Patient Group at Halls, opposing the appeal. As there were no objections from the parties, this was done and it appears below within Mr Damani’s submissions.

5.2 Mr Nazir asked for permission to circulate an email of support dated 13 September 2019 from Councillor Ray Bisby. This too is reproduced below.

5.3 The Chairman indicated that there was no need to address the Committee on

Regulation 31.

5.4 Ascent Healthcare, the Applicant was represented by Mr Qammar Nazir, accompanied by his wife, Mrs Saira Nazir, also a pharmacist.

5.5 Supporting email provided by Mr. Nazir:

5.5.1 From: Cllr Bisby Ray

Sent: 13 September 2019 08:17 To: Qammar Nazir Dear Mr. Nazir I am one of the Councillors for Stanground South, Peterborough that covers Cardea. I am in support of a new pharmacy in Cardea for the following reasons: 1 The CCG and local surgery did not take up the option to build a new surgery in Cardea for the 1800+ homes on the development. 2 The local surgery is planning an extension but have had issues over a small area of land that is preventing the extension being progressed. 3 The two chemists/Pharmacy are located in and very close to the doctor’s surgery. 4 These Pharmacy/chemist is well away from some areas and people who need medication but have no transport find it hard to get there, especially if ill. 5 A pharmacy in Cardea, would enable people in the Cardea and Park Farm areas to get prescriptions and medical advice for minor ailments. 6 The continued population growth is putting pressure on the Doctors surgery until such times as there is capacity from the extension. 7 Cardea has shopping facilities that would be a draw for people and make a pharmacy a logical addition and convenience for the public even after the Doctors surgery extension. 8 The health and wellbeing of the local public is paramount and this addition would be in my opinion, a welcome addition. Kindest regards Cllr R Bisby Stanground South Peterborough

5.6 Mr. Nazir handed out colour maps of the local area in A2 size.

5.7 By way of introduction, he stated that Stanground is a residential area in the south east of Peterborough. The area is made up of the two wards – Fletton & Stanground and Stanground South. The total population of Stanground was approximately 18,500 in 2016 and the population is estimated to increase to around 22,000 in the next 2 years (2021). This area of Peterborough has seen a significant population increase. The

majority, if not nearly all of this population increase is due to the Cardea development, within Stanground South. The Cardea development has over 1,800 homes, with the majority of the phases now complete and occupied. Taking into consideration national averages the estimated population of Cardea once complete will be around 5,000. Therefore this is a significant sized development.

5.8 The Applicant stated that the bow shaped development is integrated with the existing

residential neighborhood, bringing new facilities to the whole area. This application relates to the new district centre created within this development.

5.9 Proposed Site:

5.10 The Applicant described the Morrison’s supermarket as the focal point of the Cardea

District Centre. The district centre has other infrastructure so residents look to use the services within the development, rather than outside it. He suggested that objectors will probably argue that residents will have to travel out of area to see a GP, to visit a bank etc. However, the services available from within the district centre are extensive and on site. Morrison’s supermarket has a 40,000 sq. ft. sales area and provides various in store services listed on page 25 of the bundle.

5.11 The district centre also includes 7 retails outlets with ample parking. Ascent Healthcare

is currently in advance negotiation with the landlord in securing one of the units, and will pursue this dependent on the outcome of this appeal.

5.12 The Applicant stated that in close proximity of his proposed site were

5.12.1 A School

5.12.2 Pre-school

5.12.3 Community Sports Pavilion (Sunday Church)

5.12.4 Pub/Restaurant

5.12.5 Petrol Station

5.13 The new district centre caters for the entire resident population of Stanground and

beyond, not just limited to those living in Cardea. This is evident, he stated, when visiting the proposed site, which has a large footfall, especially over the weekends. A pharmacy situated within the district centre will therefore improve access to pharmaceutical services for the wider area, but particularly for the residents of Cardea.

5.14 Pharmaceutical Services:

5.15 The Applicant stated that currently two pharmacies are situated next to each other on the periphery of Stanground. He stated that the very close proximity of both these sites does not provide residents with choice in terms of access. Essentially, they are in the same location, one inside the Health Centre and one just outside.

5.16 Well Pharmacy – Stanground

5.17 The Well pharmacy is a small pharmacy within Stanground Surgery. It sells a limited

amount of over the counter medication, presumably due to its size constraints, being located within the surgery. The surgery building is attached to a dentist, and a funeral centre. He stated that the pharmacy has restricted visibility from the main road.

5.18 Halls Chemist- Stanground is situated a short walk of 150 metres from the surgery,

isolated from the main road, with a small car park at the front.

5.19 He suggested that other than visiting the GP Surgery, the dentist or the funeral centre,

there is no reason to visit this part of Stanground. Both pharmacies are not located in the community hub, and they are not easily accessible for the majority of the residents they serve, as they both lie on the periphery.

5.20 The Applicant stated that he expects both Well and Halls will argue that patients will find

both pharmacies convenient after visiting the medical centre, but he questioned how often patients who are prescribed regular medication visit the doctors surgery: perhaps once every 6 months or once a year.

5.21 He illustrated the difficulties of getting an appointment at the overstretched Stanground

Surgery by quoting reviews from NHS Choices between November 2018 and June 2019, all giving it the lowest rating of one star.

5.22 The Applicant concluded that if patients are not able to book appointments and see a

GP, then the two pharmacies located next to it are of no benefit. Healthcare provision in Stanground is clearly overstretched, with only one surgery. There were plans for a medical centre at the site where the school is now located in Cardea, however this did not come to fruition. Therefore he stated, a population of 5,000 has no healthcare provision.

5.23 The need for a pharmacy is more imperative in this situation. A pharmacist could deal

with minor ailments without the need to book an appointment. With the widening role of pharmacists in community pharmacies, he will be able to offer a lot more than just dispensing prescriptions. The proposed location has the advantage of opportunistic advice, as residents are able to pop into the pharmacy after their shopping at Morrison’s, after visiting the barbers, or after picking up a takeaway.

5.24 The Applicant concluded that the current location of the two pharmacies cannot offer

that, due to their isolated location.

5.25 Opening Hours:

5.26 The Applicant is offering

5.26.1 57 Core Hours 7 days a week

5.26.2 8 Core Hours – Saturday – 9.00am to 5.00pm

5.26.3 4 Core Hours – Sunday – 12.00pm to 4.00pm

5.27 He stated that the opening hours over the weekend were specifically chosen to meet a need that was not being provided by the two closest pharmacies.

5.28 The adjoining Morrison’s supermarket is also open 7 days a week, with Sunday as its busiest day. Therefore pharmaceutical services provided over the weekend will be convenient for those who are only able to shop over the weekend due to work commitments or for those attending the church service that is held at the Cardea Community Sports Pavilion.

5.29 The Applicant stated that Well Pharmacy does not provide any pharmaceutical services

on Saturday and Sunday and Halls the Chemist provides pharmaceutical services for only 4 hours on Saturday from 9am to 1pm and none on Sunday.

5.30 Furthermore, Well Pharmacy also closes for lunch. He stated that it has been said in

the notes that it does not close for lunch, however, it was closed for lunch during his own site visit.

5.31 He stated that currently, if residents wished to access pharmaceutical services beyond

1pm on Saturday and on Sunday they would not be able to access these services by foot, and would have to catch a bus or drive over 3 miles.

5.32 Protected Characteristics:

5.33 The Applicant submitted that his proposal will be of significant benefit to the residents of

Stanground and would secure reasonable choice for those with protected characteristics, these being the very old and the very young, the disabled and those who were pregnant

5.34 These groups who share protected characteristics are also those who have the highest

demand for pharmaceutical services. It is unreasonable to expect them to walk over one mile to the nearest pharmacy.

5.35 St Michael Primary School, which is just behind the proposed site, now has 349 pupils

with a capacity of 420. The parents, who are picking and dropping their kids off to the school by car, park outside the proposed site. This provides a great opportunity, he suggested, for them to pop in for advice and treatments.

5.36 Reasonable Choice – Access

5.37 The Applicant submitted that residents from Cardea have no choice. There is no

pharmacy in Cardea and the current pharmacies are located towards the north west of the proposed site. To access the closest pharmacy requires patients to travel a mile or more which is a significant distance from Cardea, especially for those with protected characteristics. Peterborough Road has inclines and declines and has uneven pathways at places. He stated that the pathway outside the pharmacies, is halved by a large cycle lane. The shortcut via Oakdale Avenue, would not be desirable during the shorter days in winter. As both pharmacies lie on the western periphery of Stanground, they are more accessible to the residents living on the western side of Stanground, with the residents living towards east having to travel considerably longer.

5.38 There is public transport that travels around Cardea; however a bus service should not

be regarded as a replacement for local pharmacy services he submitted.

5.39 Furthermore, residents are not visiting the current pharmacy sites of Stanground for their day to day needs, whereas the proposed site is within a neighborhood district centre which is accessed daily. To have a pharmacy in the centre of Cardea will give the local residents a choice that they have never had.

5.40 Detriment: The Applicant submitted that if his application was successful, and it did

cause detriment to Halls Chemist and it closed, patients’ access to pharmaceutical services will not be affected. Well Pharmacy is a “stone’s throw away” located within the GP Surgery.

5.41 The application by Ascent Healthcare in replacement will be offering to open until 5pm

on a Saturday as well as up to 4pm on a Sunday. There is no detriment he stated, and in fact access to healthcare will be improved if this appeal is allowed.

5.42 In conclusion, the Applicant stated, the issue in this case is the distribution of

pharmacies. Historically the Well pharmacy was located centrally in the community hub. Following the grant of the Halls license, and relocation of the Well Pharmacy, the two pharmacies have ended up next to each other. He stated that he was not disputing that a pharmacy next to a Surgery is a bad location, in fact it is desirable, but two pharmacies next to the same surgery does not improve access.

5.43 Furthermore taking into consideration that since the population has increased by nearly

5,000, granting his application will secure improvements and better access overall to pharmaceutical services, and be of significant benefit for the local population, specifically those who share a protected characteristic such as the elderly, disabled or those with young children.

5.44 In response to questions, the Applicant, Mr. Nazir accepted that the population increase is not directly proportionate to an increased need for pharmaceutical services. He confirmed that the premises Ascent have in mind, previously a veterinary surgery, is still vacant. He also accepted that “choice” under the regulations, is not limited to location, and that users currently have choice by motor car, bus and by walking.

5.45 Mr. Damani clarified that the location previously designated for a Health Centre behind

the parade of shops on the Morrison’s site had remained vacant for some five years and has now been developed for housing. It has not been used for the primary school as suggested by Mr. Nazir.

5.46 Mr. Nazir clarified that the projected housing development in Cardea of 1,800 homes

would create a population of some 5,000 people when complete, and that these people will use Morrison’s for their daily needs. He did accept that for services such as banks, post office, and opticians, Cardea residents would have to go into central Peterborough.

5.47 Ms. E.Griggith-Mbarek, spoke on behalf of Well Pharmacy:

5.48 She submitted that she will not address the Committee on Regulation 31 nor Regulation

18(a) as she does not contest these. Her representations were focussed on Regulation 18(b) and surrounding matters.

5.49 She reminded the Committee that, in order to establish if the Regulations have been

met, we need to consider the application with regard to reasonable choice, service innovation and access improvements for those with protected characteristics as defined under the Equality Act 2010.

5.50 She stated that the application did not contain any proposed innovative services. The

services included in the application are all existing enhanced, advanced or locally commissioned services. Therefore she proposed that the application be not granted on the basis of service innovation as there is a lack of evidence to satisfy this element of the regulatory test.

5.51 Well stated that when considering the accessibility of existing pharmaceutical services

for patients with protected characteristics, the typography of the land, routes and methods to accessing those services must be considered, along with identifying the challenges experienced with such access routes, in order to identify if improvements or better access is actually needed.

5.52 She stated that it is possible to access pharmaceutical services by private and public

transport, by foot, and on a bicycle. The 2018 PNA states that acceptable access to pharmaceutical services is that they should be within a 20-minute drive time. A 20-minute drive time from the proposed location will afford patients access to all the pharmacies in between this location and Peterborough City Centre and beyond. It is possible to access the 3 closest pharmacies within a 5 –7 minute drive, depending on road conditions and traffic. Car ownership in the locality is slightly better than the rest of Peterborough and England according to the 2011 census, but she accepted that these figures are out of date due to the housing growth of the area. However she noted during her recent site visit, there were a lot of cars parked in drives and seen driving around the area.

5.53 She suggested that it is also possible to access local pharmacies by public transport.

There is a bus operating every 20 minutes from Cardea to Peterborough City Centre which passes pharmacies along the route. There are also buses operating on a similar timetable connecting Cardea to the surrounding areas, which also have pharmacies along the route. There is a bus stop outside Halls and outside Well. Route 5 passes through Cardea and stops outside of pharmacies, on Whittlesey Road.

5.54 Well stated that is possible to walk through the area to access the nearest pharmacies

in Stanground. It is about a 20-minute walk and just over 1.2 miles on the shortest

route. The route has pavements, dropped kerbs and is well illuminated for safe passage. The ground is also level along the whole of the route and there are benches and lights and the paths are well maintained.

5.55 It is also possible to cycle through the area. As part of the planning permission, she

submitted, the area was designed to encourage free movement throughout the area and to encourage healthy living through exercise. She concluded that there is choice of methods of access to existing pharmaceutical services.

5.56 Well submitted that the area under consideration is not a deprived area to justify any

increase in the need for pharmaceutical provision. Page 227 of the bundle identifies the population to be younger in the main than the rest of Peterborough and England as a whole. For those patients who are housebound, it is possible to have prescriptions delivered along with domiciliary MURs. Well, along with other local pharmacies, provides a home delivery service to those who need it.

5.57 Well stated that in terms of those with protected characteristics there is sufficient and reasonable access available via a choice of routes to access the existing pharmaceutical services network. There has been no evidence presented today or in the papers to suggest that there is a barrier to accessing the existing pharmacy service network. She accepted that there is always an element of convenience in having a pharmacy in every parade of shops or on every street corner, but this is not needed in all locations. Specifically, it is not needed in this location.

5.58 Well stated that the applicant has suggested there is a lack of reasonable choice on the

basis that the distance to the nearest pharmacy is more than a mile and also that both of the nearest pharmacies are located in close proximity to each other. She submitted that choice is not limited to location but extends to include who owns the pharmacy, who operates the pharmacy, and the services a pharmacy provides.

5.59 In this instance there is sufficient choice of location, owner, operator and service

provision. Within 2.4 miles there are 10 pharmacies and 12 within 2.5 miles, owned by a variety of businesses, all operated by different responsible pharmacists, offering a variety of services, over a variety of trading hours, from a variety of locations. The proposed location, opening hours and services proposed do not increase reasonable choice as there is no gap in provision. She concluded that reasonable choice is evident and as such the application fails on this element as well.

5.60 Other points she made were that there are two empty shops on the parade alongside

Morrison’s. This she suggested, indicated that the parade is not utilized as often as when it first opened, when all units were occupied, therefore there is insufficient footfall locally due to the choice of the shops available. The applicant has stated that Morrison’s has thousands of visitors each week but she suggested that they are at this location for their weekly shopping needs which can also be fulfilled at other locations as the local Asda and Sainsbury. These have pharmacies located inside and which operate extended hours. If a patient wanted to access pharmaceutical services in conjunction with carrying out their shopping, they could use these locations.

5.61 Well Pharmacy (then Co-op) applied for the pharmacy in 2013 on the same basis that

the applicant has applied this time. They were aware of circa 2000 new homes were being built and had applied to meet this pharmaceutical need. She had expected at the time that the pharmaceutical needs would be significant, and the existing network would not be able to cope with the demand. She was also aware at the time that there was a planned Medical Centre for the site and that Stanground Surgery were interested in establishing a medical centre in Cardea. The PNA at the time identified the importance of having an integrated pharmacy to improve patient care. She assumed that this medical centre would materialize, and it would allow Well to service local patients in conjunction with medical services.

5.62 However she stated, this has not materialized in the last 6 years due to the decision of the NHS.

5.63 Since the Cardea development has increased there have been more cycle routes and

short cuts established. Well Pharmacy in Stanground are currently dispensing less than the national average every week in terms of prescription volume, and Halls the Chemists are dispensing a similar volume. Well have not hit capacity and will not for many years as the majority of the houses have already been completed and occupied. The total number of prescription items dispensed by Well and Halls the Chemist in 2018 was circa.141,000. The Stanground surgery, which is part of the New Queen Street Surgery in Whittlesey, dispensed 368,000 items in the same period. The Stanground Surgery has a minimum of two doctors on duty at any one time and the patients are free to access medical services at either site. This, she suggested, shows that patients are mobile and not limited to walking access only. There is another bus stop directly outside the New Queen Street site. There is a national shortage of GPs in the industry and as such the availability of appointments is difficult.

5.64 Well stated that they are not at capacity at this unit, have scope to increase the number

of pharmacists working in the store, the number of dispensers employed and the services that they offer. The last GPhC inspection report received in 2107 was “Satisfactory” over all, with Governance, Staff and Premises being rated at a good standard. In August 2019 they received a further visit from the GPhC but have yet to receive the final report, but she had been informed that it is a “standards met” result.

5.65 Well has a designated delivery driver who works in the afternoons, with a relief driver

employed to cover holidays and sickness. They offer MDS Trays, Supervised Methadone, Naloxone, EHC, Flu Services, Blood Pressure Monitoring and Weight Management Services. It is located within the Medical Centre building and shares the waiting area with the surgery. It has its own consultation room at the rear, which may not have been visible from the entrance of the pharmacy.

5.66 She stated that when driving around the local area, it is possible to see that the area of

Cardea is infilling and rounding off as stated in the papers, the area of Stanground South. The design of the development allows for free flow throughout the area as there are walkways that are used as cycle paths, which are well-illuminated and safe to use. In summary, she stated, there has been no evidence provided to support the granting of the application as there is no need identified.

5.67 Mr Damani presented on behalf of Hall, the Chemist:

5.68 He outlined the history of his family’s ownership of the group of 6 pharmacies acquired

by his father when he arrived as a refugee from Uganda. The registered name was Repeat Prescription Orderline Ltd. The current location, has since 2010, served the existing population of Cardea, and it had sufficient capacity to cope with the anticipated population growth. It was currently accessible by bus, which drops off clients from Cardea after a 6 minute journey, had 8 parking spaces for car users and there were safe cycling and walk ways connecting it to the Morrison’s site. The bus service will in time, pick up passengers from Morrison’s and be routed through the Cardea estate, to Stanground.

5.69 Halls submitted accounts for the 11 months to 28 February 2019, to support the

contention that their viability is at risk if the application was to succeed. Mr Damani on being questioned, accepted that these were not extracted from company HMRC accounts and were site specific to this one unit only.

5.70 Hall also produced for the hearing a letter dated 11 September 2019 from the Chairman

of the Pharmacy Patient Group, objecting to the appeal.

5.70.1 11th September 2019

5.70.2 To Whom It May Concern

5.70.3 I am the chairman of the Patient Group at Halls The Chemist, 92 Peterborough Road, Farcet, Peterborough and have had this role for over four years. I am aware that you have received an application to open a pharmacy at the Cardea development also known as Stanground South.

5.70.4 There are three pharmacies within about a mile and a half of each other –

Halls The Chemist, Well Pharmacy (was previously Co-op) and Odedra Chemist. The patient group strongly believes that another pharmacy is not needed when these three are on the doorstep of Cardea. We are not aware of any complaints to Halls The Chemist and they provide both a car park and cycle racks for patients to use and there are bus stops right outside the pharmacy. There are also goof footpaths from Cardea into several places in Stanground.

5.70.5 Halls The Chemist offer many services including an invaluable free delivery

service to the local area and further afield such as Farcet Fen, Kings Dyke etc. They have expanded their services to the patients over the years, including flu vaccines and being a Healthy Living Pharmacy. They are always happy to help anyone in the local community and beyond.

5.70.6 In summary, we do not believe there is a need for another pharmacy in the

area.

5.70.7 Kind regards, Patient Group Chairman

6 Consideration

6.1 The Pharmacy Appeals Committee (“Committee”) appointed by NHS Resolution had

before it the papers considered by NHS England, together with a plan of the area showing existing pharmacies and doctors’ surgeries and the location of the proposed pharmacy.

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

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

Regulation 31

6.4 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).

6.5 The Committee was not required to refuse the application under the provisions of Regulation 31.

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

Regulation 18

6.7 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) 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;

(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

(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;

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

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

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

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

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

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

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

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

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

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

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

6.11 The Committee considered the Pharmaceutical Needs Assessment ("the PNA") prepared by Peterborough 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 19 March 2018 and that no supplementary statements had been issued to date.

6.12 The Committee noted that the Applicant seeks to provide unforeseen benefits to the patients of Cardea, South Stanground.

6.13 The Committee noted that the improvements or better access that the Applicant was claiming would be secured by its application were not included in the relevant pharmaceutical needs assessment in accordance with paragraph 4 of Schedule 1.

6.14 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)

6.15 The Committee had regard to

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

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

6.16 The Applicant has suggested no significant detriment will be caused to proper planning of services in the area. This was endorsed by Well Pharmacy.

6.17 Mr Damani for Hall, has suggested that the due to its slim profit margins on the Stanground site, it is at risk of closing if a further pharmacy was to be allowed, particularly with the proposed weekend opening hours.

6.18 He accepted that the profit/loss figures on Pages 236/7 of the bundle covering 11 months till February 2019, were not extracted from audited company accounts, and related to only one of 6 units in the business, but were typical of its situation since opening in 2010.

6.19 The Committee attached little weight to this information.

6.20 NHS England stated there would be no significant detriment to either planning or arrangements if the application was granted.

6.21 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.

6.22 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)

6.23 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"

6.24 As stated above, there was limited evidence to support the suggestion that a pharmacy would close as a result of this application being granted.

6.25 The Committee was therefore not satisfied that significant detriment to the arrangements currently in place for the provision of pharmaceutical services would result from a grant of the application.

6.26 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)

6.27 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

(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)

6.28 The Applicant acknowledged that there are two pharmacies within a short distance but suggested that these were not in locations where patients in the Cardea area would travel to for any reason other than to access the GP surgery, the dentist nearby or the Co-Op Funeral Care. In contrast, their proposed location was in a “community hub” on the Morrison’s site, which would attract footfall from users of the supermarket, barber, beautician premises, two take away food outlets, and a Barnardo’s charity shop. There

will also be users of a nearby primary school and visitors to the Cardea Sports Pavilion and Community Centre, which hosts church services on Sundays.

6.29 The Applicant quoted reviews from NHS Choices dated between November 2018 and June 2019, from patients registered with the Stanground Surgery as evidence of difficulties obtaining appointments with the seven GP partnership located there. He contended that should his appeal succeed, he would be able to provide treatment for minor ailments and opportunistic health advice to these patients.

6.30 The Committee noted the letter of support from a local councillor for the Applicant and

the letter of objection from the Halls Pharmacy Patient Group.

6.31 The Applicant stated that if the journey required to exercise any choice is not reasonable then it cannot be said that patients had reasonable choice. However, he has put forward no evidence to suggest that the journeys to the nearby pharmacies were not reasonable.

6.32 Halls and Well were within reasonable walking distance of the Cardea estate, and at

average pace, were reached in 25 minutes via marked footpaths, which were wide, with dropped kerbs and well lit.

6.33 For those who could not walk, the Committee noted that there would be little difficulty

accessing a pharmacy for those who had a car and both Well and Halls had dedicated car parks, as did Odedra Chemist, further away in Old Fletton, which sat alongside the purpose built six-GP Old Fletton Surgery, a dispensing surgery. There are four 100 hour pharmacies located within 2 and 2.1 miles in central Peterborough including Tesco and Asda. There was ample evidence of car ownership on the Cardea estate, with off street parking.

6.34 For those who did not have a car or who could not or preferred not to walk, there was public transport to enable patients to access more than one pharmacy. There was a bus route which is expected to improve once the bus stop inside the Morrison’s site becomes functional and the route through the Cardea estate is opened up, using the infrastructure which is already in place. Mr. Damani quoted a 6 minute bus journey from Morrison’s to Hall, which was not challenged by the Applicant save to state that the bus could be costly. It noted that bicycles were able to use the footpaths.

6.35 The Applicant’s main argument was that as the population of Cardea has increased

with the near completion of the development, he would provide services to this additional group. However there was no evidence to suggest that the existing local pharmacies could not cope with any additional demand.

6.36 The Committee concluded that there was not sufficient evidence to support a claim that

there was not a reasonable choice within the meaning of the Regulations. The evidence did not suggest a significant benefit would be obtained but only that there might be greater “convenience for the public”, as suggested by Cllr Bisby in his supporting email.

6.37 Therefore the Committee was not satisfied that, having regard to there being a

reasonable choice with regard to obtaining services, granting the application would confer significant benefits by way of physical access on persons.

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

6.39 In considering Regulation 18(2)(b)(ii) the Committee reminded itself that it was required to address itself to people who share a protected characteristic having access to

services that meet specific needs for pharmaceutical services that are difficult for them to access. The Committee was also aware of its duties under the Equality Act 2010 which include considering the elimination of discrimination and advancement of equality between patients who share protected characteristics and those without such characteristics.

6.40 The Applicant stated that his proposal would confer significant benefits in terms of access to “the very old, the very young, the disabled and those who are pregnant”. He did not support this assertion with any evidence.

6.41 Well in their submissions, pointed out that in terms of those with protected characteristics there is sufficient and reasonable access available via a choice of routes to access the existing pharmaceutical services network. They stated that “there has been no evidence presented today or in the papers to suggest that there is a barrier to accessing the existing pharmacy service network.”

6.42 The Committee was therefore not satisfied that, having regard to the desirability of people who share a protected characteristic having access to services that meet specific needs for pharmaceutical services that are difficult for them to access, granting the application would confer significant benefits on persons.

6.43 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.

6.44 There was no suggestion by the Applicant that services would be delivered with an innovative approach.

6.45 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

6.46 The Applicant is proposing 57 core opening hours of 9 am to 6 pm Monday to Friday and from 9 am to 5 pm on Saturday and 12noon to 4 pm on Sunday. The Committee noted that Hall, the Chemist mirrors their proposed weekday hours and offers 9am to 1pm on Saturday. There are four 100 hour pharmacies, also open on Saturday and Sunday within a distance of 2 and 2.1 miles. The Committee looked at choice with regard to opening hours within the Peterborough HWB area and the immediate vicinity of South Stanground and the Cardea housing estate, and considered this was reasonable.

6.47 As indicated above, a number of pharmacies were available within less than 25 minutes on foot; there was a bus connection and good road network for car users. The pharmacies provided reasonable choice, with a wide range of pharmaceutical services on offer.

6.48 The Committee was of the view that there was no information provided to support a finding that pharmaceutical services are not currently provided at such times as needed and therefore it was not satisfied that, having regard to the desirability of there being a reasonable choice with regard to obtaining services, granting the application would confer significant benefits (in relation to opening hours) on persons.

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

Other considerations

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

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

6.52 The Committee had regard to Regulation 18(2)(g) and found that the circumstances set out in that Regulation did not apply to the current appeal.

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

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

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

6.55.1 confirm NHS England’s decision;

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

6.55.3 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.

6.56 Given the Committee had received further information that had not been available to NHS England, the Committee determined that the decision of NHS England must be quashed.

6.57 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.

6.58 The Committee noted that representations on Regulation 18 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.

6.59 The Committee concluded that further notification under paragraph 19 of Schedule 2 would not be helpful in this case.

7 DECISION

7.1 The Pharmacy Appeals Committee (“Committee”), appointed by NHS Resolution, quashes the decision of NHS England, for the reasons given above, and redetermines the application.

7.2 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;

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

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

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

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

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

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

Mrs Sheila Hewitt Committee Chair A copy of this decision is being sent to: Ascent Healthcare, the Applicant PCSE, on behalf of NHS England Well Repeat Prescription Orderline Ltd Thomas Walker Pharmacy Millfield Pharmacy Lloyds Pharmacy Whittlesey Pharmacy Peterborough Health and Wellbeing Board Cambridge and Peterborough LPC

Annex A REF: SHA/22113 APPEAL AGAINST NHS ENGLAND DECISION TO REFUSE AN APPLICATION BY ASCENT HEALTHCARE LTD FOR INCLUSION IN THE PHARMACEUTICAL LIST OFFERING UNFORESEEN BENEFITS UNDER REGULATION 18 WITHIN 150M OF MORRISONS SUPERMARKET, BELLONA DRIVE, STANGROUND, PETERBOROUGH, PE2 8GP

1 The Application

By application dated 27 July 2017, Ascent Healthcare Ltd (“the Applicant”) applied to NHS Commissioning Board (“NHS England”) for inclusion in the pharmaceutical list offering unforeseen benefits under Regulation 18 within 150m of Morrisons Supermarket, Bellona Drive, Stanground, Peterborough, PE2 8GP. In support of the application it was stated:

1.1 In response to why the application should not be refused pursuant to Regulation 31 the Applicant stated:

1.2 No other pharmacy in same or adjacent premises so not applicable.

1.3 Wikipedia describes Peterborough as a cathedral city in Cambridgeshire, England. It is 75 miles north of London, on the River Nene which flows into the North Sea 30 miles to the north-east. The railway station is an important stop on the East Coast Main Line between London and Edinburgh.

1.4 Stanground is a residential area in the city of Peterborough. Historically in 1905, the Huntingdonshire portion of Stanground was formed into the separate civil parish of South Stanground and placed under the Old Fletton Urban District Council.

1.5 This application relates to the area of South Stanground known locally as Cardea. Cardea is a new housing development of 1500 to 2000 homes that have been under construction since 2012 providing a selection of social and private houses.

1.6 Cardea has been built with a Morrisons supermarket as the focal point of the neighbourhood centre of the wider area. As well as the supermarket Cardea has a range of facilities for local residents and visitors with sufficient provision for day to day needs.

Arena Point Merrion Way

Leeds LS2 8PA

Tel: 0203 928 2000 Fax: 0207 821 0029 Email: appeals@resolution.nhs.uk

1.7 St Michaels Church School is located close to the proposed site and in close proximity to other local services. The location of the pharmacy at this central site will secure better access to pharmaceutical services and would be of significant benefit for patients.

1.8 The PNA does not consider the benefits that would accrue from locating a pharmacy in South Stanground and this application is therefore submitted under Regulation 18 as an unforeseen benefits application.

1.9 Given the significant growing population of the area and the requirement for patients to travel a mile or more to access any type of primary care services, including pharmaceutical services, granting the application would secure better access to pharmaceutical services for the relevant population.

1.10 In addition to providing dispensing services, the pharmacy would provide all other essential, advanced and enhanced services that are commissioned by NHS England or the local authority. Providing access to these services will be of significant benefit for patients, particularly those who may have difficulty in accessing other parts of the area, such as the elderly, infirm disabled, or parents with young children (i.e. those who share a protected characteristic).

[Supporting information attached as Appendix A]

2 The Decision

NHS England considered and decided to refuse the application. The decision letter dated 19 March 2019 states:

2.1 NHS England has considered the above application and is writing to confirm that it has been refused.

2.2 Please see the attached decision report for NHS England’s reasoning behind the decision.

Decision report

2.3 The applicant is offering additional hours being Monday to Friday 09:00 until 18:00 with 09:00 to 17:00 on Saturday and 12:00 to 16:00 on Sundays. This equates to a total of 57 hours per week. There is a discrepancy in the application and subsequent documents where the Sunday hours appear to have changed from opening at 12:00 instead of the originally declared 10:00.

2.4 The applicant makes a case for the provision of a pharmacy in the vicinity of a large supermarket on the development south of Stanground known locally as Cardea.

2.5 Stanground and the new development is currently served by a dispensing GP practice and a pharmacy based within the same postcode as the surgery which is 2.2 miles by car using the parkway system and Halls pharmacy which is in the neighbouring village of Farcet. There are also two pharmacies offering late night opening and weekend opening at Serpentine Green, Hampton these are 3.6 miles away by car.

2.6 The PSRC first considered Regulation 31 of ‘the regulations’.

2.7 The PSRC agreed that this does not apply as there is no suggestion that the application will be for inclusion in the same or adjacent premises.

2.8 The PSRC noted that this was an application for “unforeseen benefits” and fell to be considered under the provisions of Regulation 18

2.9 Regulation 18(2)(a)(i)

2.10 The PSRC was satisfied that, if the application were to be granted and the pharmacy to open, the ability of NHS England thereafter to plan for the provision of services would not be affected in a significant way.

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

2.12 Regulation 18(2)(a)(ii)

2.13 The PSRC noted that no information had been provided to support a finding that significant detriment to the arrangements that are in place, would be caused.

2.14 The PSRC was therefore satisfied that significant detriment to the arrangements currently in place for the provision of pharmaceutical services would not result from a grant of the application.

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

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

2.17 The PSRC noted that there are more than 10 pharmacies within a 2.5 mile radius of the proposed site. - The PSRC agreed that there appears to more than a reasonable choice of Pharmaceutical services in the area.

2.18 The PSRC noted that there was significant photographic information provided by the applicant to demonstrate the route to the surgery, Well Pharmacy and Halls Pharmacy. Although the signage to Well Pharmacy is limited, patients using the surgery would be aware of the pharmacy. The PSRC noted that there was no evidence to support that those who were able to access the existing provision on foot were not able to do so. It was also noted that the walking distance between the proposed site and the GP surgery and Well Pharmacy was 25 minutes – The PSRC agreed therefore that access is not difficult and there is reasonable choice.

2.19 The PSRC noted that no information had been provided by the applicant to show that those who have access to private transport were currently having difficulties accessing the existing pharmaceutical provision. – The PSRC agreed that access is not difficult and there is reasonable choice.

2.20 The PSRC saw no information to suggest that the bus service does not provide a reasonable alternative to walking or private transport either by way of cost or the journey time involved for those wishing to obtain pharmaceutical services. –The PSRC agreed that access is therefore not difficult.

2.21 The PSRC was of the view that there is already reasonable choice with regard to obtaining pharmaceutical services in the area of the relevant HWB, such that granting the application would not lead to significant benefits based on choice.

2.22 In considering Regulation 18(2)(b)(ii) the PSRC reminded itself that it was required to address 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).

2.23 The PSRC noted the applicant’s comments in response to representations, however noted that no information had been provided in support of these assertions, to show that those persons sharing a protected characteristic have difficulty in accessing current pharmaceutical services, or that services specific to their needs are not currently being provided by the existing pharmacies and that they would therefore derive significant benefits from the grant of this application.

2.24 NHS England was able to confirm that their complaints department had not received any complaints or concerns from patients regarding provision in the Cardea area.

2.25 The PSRC noted that the applicant had not provided any information in relation to any innovative approaches taken with regard to the delivery of pharmaceutical services. On the contrary, the applicant stated,

2.25.1 “Innovation is not often a subject of significant debate in applications for unforeseen benefits and it is not advanced as an argument in this application.”

2.26 The PSRC therefore concluded that the granting of this application would not lead to significant benefits by virtue of innovation.

2.27 The PSRC noted the representations from Well Pharmacy, Whittlesey Pharmacy and Charles Russell Speechlys on behalf of Repeat Prescription Orderline Ltd.

2.28 The PSRC was not satisfied that the information provided demonstrates that there is difficulty in accessing current pharmaceutical services or that a pharmacy at the proposed site would improve access.

2.29 Summary:

2.30 The PSRC was not required to refuse the application under the provisions of Regulation 31.

2.31 The PSRC concluded that there was no significant detriment of a kind described in regulation 18(2)(a).

2.32 The PSRC was of the view that in accordance with Regulation 18(2)(b) the granting of this application would not confer significant benefits on persons in the relevant area of the HWB which were not foreseen when it published its PNA (2015). The Committee noted that the draft PNA, which is due to be published in 2018, has not identified this area to be lacking in pharmaceutical provision. This is confirmed in a letter from Peterborough County Council.

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

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

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

2.36 The PSRC concluded that the granting of this application would not provide better access to pharmaceutical services.

2.37 The PSRC 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 has concluded that it would not.

2.38 The PSRC has also considered whether the granting of the application would secure better access to pharmaceutical services and has had regard to the fact that there is already a reasonable choice with regard to obtaining pharmaceutical services, there is no evidence of people sharing a protected characteristic having difficulty in accessing pharmaceutical services, and there is no evidence that innovative approaches would be taken with regard to the delivery of pharmaceutical services.

2.39 Decision:

2.40 The PSRC refused the application.

3 The Appeal

In a letter dated 15 April 2019 addressed to NHS Resolution, the Applicant appealed against NHS England's decision. The grounds of appeal are:

3.1 The Applicant’s grounds of appeal are that NHS England failed to have regard to all relevant information and reached conclusions without any, or any sufficient, supporting evidence. In setting out the grounds of appeal it is instructive to consider the content of the decision report.

3.2 “The PSRC noted that there are more than 10 pharmacies within a 2.5 mile radius of the proposed site. – The PSRC agreed that there appears to more than a reasonable choice of Pharmaceutical services in the area”.

3.3 The PSRC are determining reasonable choice based on number of pharmacies with a radius. It is not reasonable to use radius as a determining factor as it doesn’t take into consideration barriers to movement.

3.4 “The PSRC noted that there was no evidence to support that those who were able to access the existing provision on foot were not able to do so. It was also noted that the walking distance between the proposed site and the GP surgery and Well Pharmacy was 25 minutes – The PSRC agreed therefore that access is not difficult and there is reasonable choice.”

3.5 The PSRC accept that a one way journey to the closet pharmacy would take 25 minutes. It is not reasonable for the growing population to make a return journey with of 50 minutes to access pharmaceutical services.

3.6 The accompanying appeals report addresses the rest of the points mentioned in the decision report.

3.7 Stanground

3.8 Stanground is a residential area in the south east of Peterborough. Over the last seventy years Stanground has grown beyond the original village boundaries and now is a large suburb of the City of Peterborough which includes the areas of Park Farm, as well as the Cardea estate. The area is made up of the two wards – Fletton and Stanground and Stanground South.

3.9 Figure 1: Fletton and Stanground - Population Census (2016) 9,980 / Estimate (2021) 10,740 [map provided]

3.10 Figure 2: Stanground South - Population Census (2016) 8,560 / - Estimate (2021) 10,770 [map provided]

3.11 The total population of Stanground was approximately 18,500 in 2016. The population is estimated to increase to around 22,000 within the next 3 years with the ongoing Cardea development.

3.12 Cardea

3.13 This application relates to the newly developed estate situated off South Stanground known as Cardea. The bow shaped development is integrated with the existing residential neighbourhood, bringing new facilities to the area (the Applicant’s proposal site).

3.14 Figure 3: Cardea Development [map provided]

3.15 Cardea has a range of facilities for local residents and visitors with sufficient provision for day to day needs, to mean that there is no requirement for people to leave the area on a daily basis. One notable exception is the lack of healthcare provision. A health centre was incorporated in the original plans for the development, however this did not materialise.

3.16 Proposal Site

3.17 The proposal site is situated next to the Morrison Supermarket which is accessed via a number of surrounding roads; the A605, Jupiter Avenue, Apollo Avenue and Constantine Drive.

3.18 Figure 4: The New District Centre [aerial photograph map provided]

3.19 Morrison’s Supermarket

3.20 The Morrison’s supermarket is the focal point of the Cardea District Centre. The 40,000 sq ft sales area store has various instore services that have been listed below, with ample free onsite parking.

3.20.1 Bakery

3.20.2 Café

3.20.3 Butcher

3.20.4 Fishmonger

3.20.5 Greengrocers

3.20.6 Salad Bar

3.20.7 Cake Shop

3.20.8 Dry Cleaners

3.20.9 Florists

3.20.10 National Lottery

3.20.11 Petrol Station

3.20.12 Car Wash

3.20.13 ATM

3.21 Additional Retail Units

3.22 There are also 7 retail units which encompass of:

3.22.1 Charity Shop

3.22.2 Sales and Letting Agent

3.22.3 Takeaway

3.22.4 Vacant Unit (Proposal Site)

3.22.5 Barber shop

3.22.6 Takeaway

3.22.7 Hair and Beauty Shop

3.23 Restaurant / Pub

3.24 Applecart Restaurant and Pub – Spacious modern pub with kids play area.

3.25 Saint Michael Primary School

3.26 The school currently has 14 classes with about 287 pupils (2016/17) aged between 4 and 11 attending daily. Taking into consideration the development is ongoing you would expect a growth in the number of students attending as new residents move in. These are groups that share protected characteristics and have specific needs for pharmaceutical services which are currently difficult to access.

3.27 All parents travelling in Cardea would have improved access to pharmaceutical services given the location of the proposal site as part of their twice daily trips. Furthermore, for those with access to a vehicle, the car park for the proposal site is well used by parents for pickups and drop offs.

3.28 Saint Michaels Ark Pre-School

3.29 The Pre-School is situated next to the primary school catering for children aged 2-5.

3.30 Cardea Community Sports Association (CCSA)

3.31 The Cardea Community Sports Association (CCSA) is a registered charity which is run by residents from Cardea and the surrounding Stanground area. The organisation was created to provide a central core group for the whole community of South Stanground and offers the facilities that the community can utilise to promote togetherness, community spirit and improve community life through sporting activities.

3.32 The purpose-built facility that facilitates sporting activities for Cardea and the wider Stanground encourages non sporting activities, including meeting and conference facilities for local community interest groups, businesses and schools.

3.32.1 The Cardea Community Church is based here, with services every Sundays.

3.32.2 Cardea Tots continues to provide a fun & friendly, voluntary run toddler group for the under 5s. They provide a community group for mum’s and their little ones to meet each other and make new friends.

3.32.3 Little Voices is also based here. It is one of the UK’s most outstanding, professional and successful performing arts training organisation, dedicated to helping your child reach their full potential in drama and singing.

3.33 The CCSA is located just across the Applicant’s proposal site. The proposal will therefore improve access to those attending the church on Sundays, with the pharmacy open 7 days a week. As well as benefit parents and children travelling to the various classes and groups provided by CCSA.

3.34 Reliant Population

3.35 Kingston Park

3.36 There is also a significant reliant population that would access the Applicant’s proposal site. The Kingston Industrial park is located east of Cardea off the A605. The

below list is not an exhaustive list of the companies present at the park which employ a significant number of employees.

3.37 Figure 5: Proposal Site to Kingston Park [aerial photograph map provided]

3.37.1 Amazon UK Services Ltd

3.37.2 Debenhams Centre

3.37.3 Bartlett Automotive

3.37.4 Dart Products Europe Ltd

3.37.5 Capital Hair & Beauty

3.37.6 DanKan Mini Shop

3.37.7 The Remark Group

3.37.8 Vanquish Autos Ltd

3.37.9 Webbs Motorcycle

3.37.10 Hearty’s of Peterborough

3.38 The Amazon centre itself which covers a half million square feet of space has approximately 1,000 employees.

3.39 Surrounding population

3.40 The surrounding villages of Farcet (pop.4,500), Yaxley (pop.9,000) and Whittlesey (pop.16,000) have a total population of around 30,000 with no large supermarket, therefore residents have to travel out for their weekly/monthly shopping.

3.41 The Morrison’s supermarket next to the Applicant’s proposal site is the closest supermarket, for Whittlesey and Farcet in particular. Therefore, you can also expect a significant reliant population that would access the Applicant’s proposal site that would benefit from onsite pharmaceutical services.

3.42 Integration of the development

3.43 The developers understood the importance of integration between the new development and existing community when designing the layout of Cardea. It was important to create a district centre (the Applicant’s proposal site) for the whole area and not just for Cardea residents.

3.44 The development brief mentioned –

3.44.1 “INTEGRATION OF THE DEVELOPMENT

3.44.2 There are several physical characteristics and locational factors which help to formulate ideas on how the site should be developed and effectively integrated into its surroundings. These included:-

3.44.3 Linkages

3.44.4 This development is essentially a physical “rounding off” of Stanground and the interplay between the existing community and its facilities and the new development should be a major consideration in the layout design.

3.44.5 External Links

3.44.6 The development is to be provided with two external transport links, in addition to the main access to the bypass. Two access points for use by buses, cycles, pedestrians and emergency vehicles are proposed, one on the B1091, and the other at the Park Farm roundabout on the A605. These links will assist in integrating the development into the existing urban area, and will encourage use of non-car modes, given that the routes would be more direct than travelling via the bypass. This would particularly be the case for localised trips. The two access points would not be available for use by private vehicles, be they residential or commercial. Traffic control measures would be installed at each of the access points that allow only buses or emergency vehicles to pass.

3.44.7 There are several shops, pubs, community halls and churches in loose groups and on individual sites throughout the built up area of Stanground which is just over 2 kilometres from north to south and east to west. There is no single “centre” or focus with the biggest grouping being just to the south of the Peterborough Road at Central Square, about 400m in a direct line from the proposed development site boundary.”

3.45 The Cardea development was premature when the FHSAU considered applications at the Applicant’s proposed site in the past. Furthermore, the integration of Cardea with Stanground was not addressed by previous applicants and therefore not taken into consideration.

3.46 However, the [attached] aerial map (Figure 6) and the final development plans (Figure 7) provide a clear vision of the existing community of Stanground linking with Cardea. The new district centre will therefore cater for all the resident population of Stanground and not just Cardea.

3.47 Figure 6: Cardea Linkages to South Stanground [aerial photograph map provided]

3.48 A pharmacy situated within the district centre will therefore improve access to pharmaceutical services for the whole of Stanground. The current 2 pharmacies (red circles) are situated together on the periphery of Stanground.

3.49 Figure 7: Cardea Development Plans [plan attached]

3.50 Peterborough Pharmaceutical Needs Assessment (PNA) 2018-2021

3.51 The application was initially submitted when the 2015-2018 PNA was in force, however the 2018-2021 PNA has been published since. The 2018-2021 PNA does acknowledge the future growth of Peterborough as a whole and Stanground;

3.52 “Future Population Changes and Housing Growth Over the coming years the population in Peterborough is expected to both age and grow substantially in numbers. An increase in population size is likely to generate an increased need for pharmaceutical services, but on a local level changes in population size may not necessarily be directly proportionate to changes in the number of pharmaceutical service providers required, due to the range of other factors z\influencing local pharmaceutical needs.”

3.53 “Several large-scale housing developments are in progress and considerations, when assessing needs for local pharmaceutical service providers, should be based on a range of local factors specific to each development site. To facilitate commissioning of pharmaceutical services responsive to population needs, the Health and Wellbeing Board partners will, in accordance with regulations, monitor the development of major housing sites and produce supplementary statements to the PNA if deemed

necessary, to ensure that appropriate information is available to determine whether additional pharmaceutical services provision might be required.”

3.54 “At 31 March 2017 there were 8,188 dwellings with outstanding planning permission. Of the unimplemented permissions 2,893 had full permission and 5,295 had outline permission. Of the outline permissions 3,675 (69.4%) are located in urban extensions, 2,349 at Hampton, 963 at Paston Reserve and 363 at Stanground South.”

3.55 Page 26 - Figure 4: Population Growth Estimates, 2016-36, Peterborough Electoral Wards

Electoral Ward 2016 2021 2026 2031 2036 Numerical Increase 2016-36

% Increase 2016-36

Rank of Numerical Increase 2016-36

Rank of %

Increase 2016-36

Fletton and Stanground

9,980 10,740 11,360 11,440 11,480 1,500 15.0% 8 10

Stanground South 8,560 10,770 11,090 10,880 10,660 2,100 24.5% 6 5

3.56 Page 75 - Figure 32: Wards and parishes with the greatest number of outstanding permissions, as at 31 March 2017

Location of Outstanding Permissions at 31 March 2017

Urban Wards

Stanground South 668

Fletton and Stanground 313

3.57 6.5 Growth during the PNA period (2018 – 2021)

3.58 “The Peterborough Core Strategy makes provision for an annual equivalent of 1,500 net new dwellings for the period 2009-2026. The greater proportion of these are planned to be delivered within the urban extensions of Peterborough. Urban extensions can take many years in the planning system before delivering new homes. In Peterborough there are five urban extensions:

3.58.1 Stanground South, started in 2010, and during this PNA period is likely to increase by another 600 dwellings.”

3.59 Page 76 - Figure 33: Location of major developments in Peterborough (2009 to 2026)

Site/Location

Minimum Number of

Dwellings at 2009

% of Minimum delivered

Completions since

2009 (NET)

Outstanding Permissions/allocatio

ns

Stanground South 1500 6 1196 515

3.60 The PNA however did not foresee the potential benefits that a new contract in Cardea might bring in improving the limited access to pharmacy services and healthcare and concluded that “There is currently sufficient pharmaceutical service provision across Peterborough. No need for additional pharmaceutical service providers was identified in this PNA.”

3.61 Regulation 31 Compliance

3.62 There is no pharmacy on the pharmaceutical list providing or undertaking to provide pharmaceutical services from or adjacent to the premises. The application is therefore not required to be refused under the provisions of Regulation 31.

3.63 Regulation 18 Compliance

3.64 Overall, the PNA is much too broad brush to deal with the local geographical gap that is evident in Cardea. The Committee should therefore be satisfied that the improvements or better access that the applicant is claiming would be secured by its application were not included in the relevant pharmaceutical needs assessment in accordance with paragraph 4 of Schedule 1.

3.65 Regulation 18(1)

3.66 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.

3.67 The proposal will secure improvements and better access to pharmaceutical services in the HWB area, because it will provide Cardea with a new pharmacy contract and the associated health services that that offers.

3.68 This is an area of significant population of residents, with a significant reliant population that come into the area to work or to use the ample facilities.

3.69 Offering a pharmacy with ample parking next to a major Supermarket, is an improvement to the pharmaceutical offer in Stanground. It is also important to note that the proposal will improve access to future residents in the area that will come to live in Cardea as the new housing development continues to expand.

3.70 Regulation 18(2)(a)(i)

3.71 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;

3.72 The proposal will not cause significant detriment to the proper planning of pharmaceutical services.

3.73 Regulation 18(2)(a)(ii)

3.74 Regulation 18(2)(a)(ii) significant detriment to the arrangements the NHSCB has in place for the provision of pharmaceutical services in that area;

3.75 There is no pharmacy that might be affected by this proposal. All pharmacies are located sufficient distances away.

3.76 Regulation 18 (2)(b)(i-iii)

3.77 Regulation 18 (2)(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.

3.78 Reasonable Choice

3.79 It is clear that residents from Cardea have no choice. There is no pharmacy in Cardea with current pharmacies located towards the north west of the Applicant’s proposal site. This therefore requires a significant population to have to leave the Applicant’s proposal area to access a pharmacy.

3.80 To access the closest pharmacy requires patients to travel a mile or more which is a significant walk for patients from Cardea. Furthermore, with both of the closest pharmacies clustered together it equates to limited choice.

3.81 They are not visiting the current pharmacy sites of Peterborough for their day to day needs. The Applicant’s proposal site is within neighbourhood district centre which is accessed daily. To have a pharmacy in the centre of Cardea will give the local residents a choice that they have never had.

3.82 For the people in the area that might not have access to a car during the day, a walk of over a mile to their pharmacy, is not adequate and reasonable choice. There is public transport that travels around Cardea however a bus service is not a replacement for local pharmacy services.

3.83 Pharmacies further on are meeting the needs of their own resident and reliant population. They are all 1 mile or more away and in a separate residential neighbourhood, with their own demographic characteristics.

3.84 It is important to consider the history of Stanground in terms of pharmaceutical provision to consider if the grant of the second pharmacy provided choice for the new residents of Cardea.

3.85 Figure 8: Historic Aerial view of Stanground & Farcet (Pre- Cardea development) [aerial photograph map provided]

3.86 Pharmaceutical provision for Stanground consisted of one pharmacy located within the local neighbourhood centre of South Stanground (red circle).

3.87 The village of Farcet (outlined in yellow) and Stanground were separated by open land where the proposed development of Cardea was planned for.

3.88 Approval of pharmacy license

3.89 On 29 December 2008 an appeal against Cambridgeshire PCT Decision to refuse an application by Repeat Prescription Order Online Ltd for Preliminary consent prior to inclusion in the pharmaceutical list at 70 to 145 Peterborough road, Farcet, Peterborough, PE7 3BN was overturned and the pharmacy application was granted (Appendix 1 – SHA 14673).

3.90 Adopted Neighbourhood

3.91 In terms of the neighbourhood, the oral hearing panel adopted the village and parish of Farcet as the Neighbourhood as indicated by point 7.4 of the decision report.

3.92 “7.4 Looking at the situation as it is now, the Panel was of the view that the neighbourhood should be the village and parish of Farcet.”

3.93 Proposal Address

3.94 The Committee deliberated the wide proposed estimated address and accepted that the proposed location may not result in the eventual premises being ideally situated. However, decided that the proposed location will still go some way to securing an adequate provision within the neighbourhood for the reliant population by providing

the option of access in the neighbourhood without the need to access pharmaceutical services elsewhere.

3.95 Following the approval Repeat Prescription Order Online Ltd (Halls Chemist) secured premises (yellow circle) adjacent to Stanground surgery (red circle).

3.96 Figure 5: Location of Halls Chemist and Stanground Surgery [aerial photograph map provided]

3.97 Halls Chemist disappointingly opened over a mile away from the majority of residents of Farcet. Therefore, as the Committee had deliberated, not ideally situated in securing adequate provision for the residents of Farcet.

3.98 Relocation of Co-op Pharmacy (Now Well Pharmacy)

3.99 To make matters worse the Co-op pharmacy in Stanground then relocated from within the local neighbourhood centre to within Stanground Surgery medical centre next to the site where Halls Chemist opened.

3.100 Figure 6: Location of Halls Chemist and Well Pharmacy [aerial photograph provided]

3.101 In terms of choice, following the opening of Halls Chemist and relocation of the then Co-op pharmacy to a similar site, this has essentially limited the choice in terms of access.

3.102 Both pharmacies are located next to each other on the western edge of Stanground and a significant distance from the majority of the population of Stanground and Cardea.

3.103 The proposal

3.104 The proposal is for a new pharmacy to serve the population of Cardea and neighbouring Stanground. The application site is to be located within the retail premises on Bellona Drive facing the Morrison’s supermarket. The proposal site is easily accessed by local residents as part of their day-to-day lives. It will be an easily accessible, modern pharmacy.

3.105 The core and supplementary opening hours are between 9:00am to 6:00pm Monday to Friday, 9.00am to 5.00pm on Saturday and 12.00pm to 4.00pm on a Sunday. The proposed pharmacy will open for 7 days a week for 57 hours in total each week without closing for lunch.

3.106 Access to Well Pharmacy/Halls Chemist from proposal site

3.107 The distance from the proposal site to the closest pharmacies Well and Halls is 1.2 miles. [map provided]

3.108 Access to Well Pharmacy/Halls Chemist from east of proposal site

3.109 The distance from east of the proposal area which is currently in construction will be approximately 1.5 miles +/- [map provided]

3.110 Access to Well Pharmacy/Halls Chemist from west of proposal site

3.111 The distance would be less for those living west of the proposal site. [map provided]

3.112 Access to Well Pharmacy/Halls Chemist from north of Stanground

3.113 The distance from the [sic] [map provided]

3.114 Please refer to accompanying site visit report which includes photos of the routes involved. The site visit carried out by the Applicant highlighted difficulties in accessing all pharmacies by foot. The pathways have various inclines and declines and at parts the pathways are narrow.

3.115 Improved Distribution of Pharmacy Network

3.116 The location of pharmacies in the area are unevenly spread. There is no surgery in Cardea and there is no pharmacy in Cardea. The proposal will therefore introduce the first purposely located health care service to the population of Cardea.

3.117 Looking outside of Cardea, there are 2 pharmacies in Stanground. Both clustered together.

3.118 The pharmacies are Well Pharmacy Stanground and Halls Chemist which are both 1.1 miles (22 minute walk) from the proposal site.

3.119 Given above, there is no pharmacy catering for the day to day needs of Cardea population, and all residents. The proposal will bring health care to the centre of Cardea, 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 significant population.

3.120 Surgery Locations

3.121 There is one surgery in Stanground.

3.121.1 Stanground Surgery on Whittlesey Road is a large seven doctor partnership.

3.122 The Practice is a large seven doctor partnership jointly operating from two surgeries with a total of 19,096 patients.

3.123 They accept patients from Stanground, Fletton, Woodston, Farcet, Farcet Fen, Whittlesey, Eastrea, Coates, Turves, Northside, Pondersbridge, Kings Dyke and Kings Delph.

3.124 There is therefore no surgery in Cardea and the closest surgery is 1.1 miles away. While the surgery may have a pharmacy onsite to offer choice, Cardea patients should have the opportunity to access a pharmacy on their return to their own area.

3.125 The provision of a pharmacy (shops, community centre) is a normal facility that improves the daily lives of residents. The requirement for a significant population to leave their locality to access 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.

3.126 The proposal will result in a new pharmacy equating to improvements through better access to pharmaceutical services for population.

3.127 Deprivation and Car ownership

3.128 The wider Stanground area has more deprivation that will place demands on health care in Stanground.

3.129 The existing residents of Stanground place substantial demands on healthcare in Stanground, and added to this the new residents moving into Cardea will increase these demands. Clearly the health care in Cardea and Stanground have different

streams of demand. The proposal is well placed to meet those demands specific to Cardea.

3.130 Protected Characteristics

3.131 The proposal will cater for people of protected characteristics, namely those people of a particular age, disability, religion and pregnancy and maternity.

3.132 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 Cardea and parts of Stanground and those protected characteristic groups that have no health care support at present.

3.133 The area around the proposal site has a community centre which provides services aimed at elderly and mothers with young children. There is clearly a need for separate service provision to serve Cardea and this supports the application to improve the location of pharmacy services.

3.134 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 school and community centre (elderly, and mothers with young children).

3.135 The elderly are particularly high users of services such as the new Influenza Vaccine service which Ascent Healthcare intends to provide and all these groups have significant demand not only for dispensing services, but also for services such as support for self-care. This is particularly important given that there is no GP surgery in Cardea.

3.136 It is unreasonable to expect these groups to walk over 1 mile to the nearest pharmacy and the bus service cannot be seen as a replacement for a local pharmacy.

3.137 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.

3.138 Summary

3.139 The proposal satisfies the Regulation 18 tests. It will: • Secure better access to pharmaceutical services for:-

3.139.1 the residents of the Cardea

3.139.2 the residents of the wider Stanground area;

3.139.3 the workers, school children/parent and commuters passing through the area daily;

3.139.4 the growing population;

3.140 Will not cause detriment to the proper planning of pharmaceutical services in the HWB;

3.141 Will not cause detriment to the provision of pharmaceutical service in the area;

3.142 Will confer significant benefits to the local population of the Cardea and its surrounding area by improving choice of pharmacy services particularly through increased access to such services and will be a source of contracted and non-contracted health care in the community;

3.143 and

3.144 Will confer significant benefit to people of protected characteristics, particularly with elderly and mothers with children that need access to health care within reasonable proximity to their daily activities.

3.145 The Applicant therefore requests Primary Care Appeals to grant this application.

[Supporting information attached as Appendix B]

4 Summary of Representations

This is a summary of representations received on the appeal.

4.1 WHITTLESEY PHARMACY

4.1.1 Whittlesey Pharmacy would like to respectfully request that when considering this application the following is noted:

4.1.2 Whittlesey Pharmacy does not support this application as it is not necessary or desirable, as there is already a reasonable choice with regard to obtaining pharmaceutical services.

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

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

4.1.5 There is no need in the PNA for additional pharmaceutical services as there are already service providers within a close proximity of the intended location.

4.1.6 It is also very difficult to comment the possible location of this application as the proposed address is very vague and non-specific. The status of the proposed premises has also not been notified.

4.1.7 This application is not offering unforeseen benefits and therefore should be refused within the regulations as there isn’t any.

4.2 WELL

4.2.1 Well is willing and able to attend an oral hearing should NHS Resolution deem it necessary to hold one.

4.2.2 Well believes that this application fails to satisfy Regulation 18 of the NHS (Pharmaceutical Services) Regulations 2014 as an application to secure an improvement or better access to the existing pharmacy network if the need had been identified with the Health and Wellbeing Boards pharmaceutical needs assessment (unforeseen benefit). The Area Team must have regard to reasonable choice, service innovation and a protected characteristic being able to access pharmaceutical services.

4.2.3 The application fails to fully satisfy the regulations on all elements. The applicant has failed to describe how the patients with protected characteristic

whose access would be significantly improved as a result of the application being granted, could be improved. The applicant has failed to describe the access issues currently experienced by local patients, distance alone is insufficient for satisfying the regulatory test for granting a new pharmacy contract.

4.2.4 Access is possible by walking, public and private transport. The walking route between the proposed site and the existing pharmacies is over level ground with well illuminated pavements with drop curbs as appropriate. There is a path between the Cardea development and the more established area of Stanground. The applicant has included pictures of those walking routes within the appeals documentation and they illustrate that there are drop curbs, adequate street lighting and pedestrian only paths which are well used. There is also a bus operating every 20 minutes between Cardea and Peterborough.

4.2.5 There are 12 pharmacies within a 2.5 mile radius of the proposed site, the closest three pharmacies operate from a range of locations, one of which operates at the medical centre, one outside the medical centre and one trading 100 hours a week. The applicant’s proposed opening hours are not in excess of these nor will it improve access to pharmaceutical services on late weekday evenings and weekends as the 100 hour pharmacy already covers these hours. The 12 pharmacies afford patients a choice as to where to access pharmaceutical services and the pharmacies are owned and operated by different companies.

4.2.6 The applicant is not proposing to offer any innovative services over and above services which are provided by local contractors. Well Pharmacy located at Stanground Surgery, is open from 08.30 – 18.00 Monday to Friday and has never closed for lunch as the applicant states in the appeal documentation. Well offers a full range of services including a delivery service to the wider Stanground area, including Cardea.

4.2.7 It is up to the Area Team to set the standards of pharmaceutical services within its area and they are satisfied that the current standards and availability of pharmaceutical services within this locality are meeting the needs of the local population.

4.2.8 It is worth noting that an application for this locality was refused by the NHS Litigation Authority in 2014, (SHA/17663). The same level of access to pharmaceutical service provision exists today as it did when the application was submitted and refused. There are no capacity issues in the existing pharmacies already providing a full range of services to the Cardea area of Stanground as a result of the increased population. The applicant has made reference to older decisions in the appeal documentation which Well contends are not relevant to the unforeseen benefits application under consideration.

4.2.9 In summary, Well maintains that this application is not meeting any unmet need of a protected characteristic within the locality for it to meet the regulatory requirements under regulation 18 and Well respectfully requests that NHS Resolution dismiss the appeal and refuse the application.

4.3 PETERBOROUGH HEALTH AND WELLBEING BOARD

4.3.1 The current Peterborough Pharmaceutical Needs Assessment (PNA), published 19 March 2018, states that:

4.3.1.1 ‘There is currently sufficient pharmaceutical service provision across Peterborough. No need for additional pharmaceutical service providers was identified in this PNA.’

4.3.2 The PNA also concludes that: over the coming years, the population in Peterborough is expected to both age and grow substantially in numbers. Several large-scale housing developments are in progress. The Peterborough HWB will monitor the development of major housing sites and produce supplementary statements to the PNA if deemed necessary, to ensure that appropriate information is available to determine whether additional pharmaceutical services provision might be required. To date it has not been deemed necessary to issue any supplementary statements.

4.3.3 The Cardea development as mentioned in the appeal submission is one of these large-scale housing developments still in progress.

4.3.4 Since the PNA was produced 108 new dwellings have been completed in the Stanground South (Cardea) development during 2017-18, in addition there are 670 outstanding permissions in the Stanground South Ward as at 31 March 2019 (the Stanground South ward is a larger geography than the Cardea development, although it is likely that the majority of outstanding permissions will relate to the Cardea development, there is therefore several more years of build out before the Cardea development is complete.

4.3.5 The PNA, at the time of publication, stated that “Peterborough has one pharmaceutical service provider per 4,409 people, equivalent to 23 pharmaceutical service providers per 100,000 resident population in Peterborough. This is the same as the national average of 23 per 100,000 resident population and similar to the East of England average of 24 pharmaceutical providers per 100,000 resident population. Estimates of the average number of people per pharmaceutical service provider across Peterborough have remained relatively stable since 2011”

4.3.6 Having reviewed this statement there has been an increase in population in the Peterborough City Council area. The 2018 Peterborough PNA calculated an average of one service provider per 4,409 people within Peterborough, based on the Office for National Statistics (ONS) mid-year 2015 population estimate of 193,980 and 44 providers of pharmaceutical services (41 pharmacies and 3 dispensing practices). This is equivalent to 23 pharmaceutical providers per 100,000 population within the area, the same as the national average of 23 pharmaceutical providers per 100,000 residents (12,713 providers for a population of approximately 54.32 million). However, as of 21/05/2019, the number of pharmaceutical providers in Peterborough remains 44 but, as the latest (2017) ONS mid-year population for Peterborough is 198,914; this equates to one provider per 4,521 people and a rate of 22 providers per 100,000 residents.

4.3.7 The England mid-year population for 2017 is 55,619,400 and data show a total of 12,642 pharmaceutical providers in England for 2017 (11,619 community pharmacies and 1,023 dispensing practices. This equates to a rate of 23/100,000 for England and one provider per 4,400 people.

4.3.8 An increase of one additional pharmacy would increase the rate of pharmaceutical providers per 100,000 in Peterborough from the current 22 per 100,000 to the national average of 23 per 100,000. It is important to note that this is based on the population increase in Peterborough as a whole and not specifically to the Cardea development.

4.3.9 The current population for the Stanground South Ward is given in figure 1 below

4.3.10 Figure 1: Stanground South Population by Age Group (2017) [table provided]

4.3.11 The PNA also states that “The HWB is not aware of any robust evidence to suggest a generic ‘population trigger point’ for when a housing development in a location might need a pharmaceutical service provider. The HWB is also not aware of any measure of the extent to which existing local pharmaceutical service providers can accommodate the increase in need for pharmaceutical services created by an increase in local population size. The current ratio of one pharmacy per 4,409 people is close to the England average, however if the expected growth in Peterborough is delivered and the population increases to 216,420 by 2021, and no additional pharmaceutical services are provided the ratio will change to one pharmacy per 4,918 or 20.3 providers per 100,000 population, this would make Peterborough below the England average and an outlier nationally. It is important to note that this is a simplistic view and assumes the growth is uniformly spread across Peterborough when in reality the growth is clustered in a few locations and as such the decision to allow additional pharmaceutical providers to open needs to take into account local factors as outlined below. An increase in population size is likely to generate an increased need for pharmaceutical services, but, on a local level, changes in population size may not necessarily be directly proportionate to changes in the number of pharmaceutical service providers required to meet local pharmaceutical needs, due to the range of other factors influencing such needs”.

4.3.12 Considerations, when assessing needs for local pharmaceutical service providers, should be based on a range of local factors specific to each development site. Such factors may include:

4.3.12.1 Average household size of new builds on the site.

4.3.12.2 Demographics: People moving to new housing developments are often young and expanding families, but some housing developments are expected to have an older population with different needs for health and social care services.

4.3.12.3 Tenure mix, i.e. the proportion of affordable housing at the development.

4.3.12.4 Existing pharmaceutical service provision in nearby areas and elsewhere in the county and opportunities to optimise existing local pharmaceutical service provision.

4.3.12.5 Access to delivery services, distance selling pharmacies, and Dispensing Appliance Contractors that can supply services.

4.3.12.6 Developments in pharmaceutical supply models (e.g. delivery services, robotic dispensing, centralised hub dispensing and electronic transmission of prescriptions) that could affect the volume of services a pharmaceutical service provider can deliver.

4.3.12.7 Skill mix. A pharmacy’s capacity to dispense larger volumes of prescriptions and/or deliver other services is greatly influenced by the number of pharmacists working in the pharmacy and, increasingly more importantly, the number of support staff. There have been significant developments in the roles that support staff can now fulfil to support the pharmacy operation. Medicines Counter Assistants, Dispensers, Pharmacy Technicians and Accredited Checking Technicians all now make a significant contribution to the delivery of pharmacy services and their availability to support a pharmacist should be considered by commissioners when considering how services can be commissioned from pharmacies.

4.3.12.8 Considerations of health inequalities and strategic priorities for Cambridgeshire. (This should read Peterborough not Cambridgeshire and is an error in the published PNA)

4.3.13 In terms of the proposed location of the pharmacy in the appeal it is important to consider access to any existing pharmacy provision and any gaps in access from the Cardea development to these pharmacies.

4.3.14 The current PNA states:

4.3.15 Distance & Travel Times

4.3.16 The 2008 White Paper ‘Pharmacy in England: Building on Strengths, Delivering t he Future’ states that it is a strength of the current system that community pharmacies are easily accessible and that 99% of the population – even those living in the most deprived areas – can get to a pharmacy within 20 minutes by car and 96% by walking or using public transport.

4.3.17 Figure 18 (in the Peterborough PNA) shows the locations of both pharmacies and dispensing practices in Peterborough, together with the major roads in the area.

4.3.18 Figure 19 (in the Peterborough PNA) was created to identify which areas in Peterborough were within and which were not within a 20 minute driving distance of either a pharmacy or a dispensing practice as of July 2017. For this map, pharmacies and dispensing practices could be located either within the boundaries of Peterborough Unitary Authority or outside of the boundaries. Road speed assumptions were made dependent on road type and ranged up to 65mph (for motorways) but down to 20mph in urban areas.

4.3.19 The maps below were created using the Strategic Health Asset Planning and Evaluation (SHAPE)2 mapping tool and illustrate a 20 minute travel time (by car, public transport, cycling and walking) from the Cardea development (a 20 minute journey time by each mode of transport has been used as this tends to be an acceptable journey time used nationally) to the three nearest pharmacies to Cardea.

4.3.20 The two nearest pharmacies to Cardea are “Well Stanground” which is located in the Stanground Surgery and “Halls the Chemist” both on Peterborough Road to the North West of the Cardea development, for clarity on the maps below they are represented as one location as they are about 150 metres walking distance apart, which is the southern of the labelled pharmacies on each map. The next-nearest pharmacy is ‘Odedra RC’ which is the northern of the labelled pharmacies on each map.

4.3.21 a) Car Travel Time – Cardea and nearest pharmacies

4.3.22 The map below shows that, when a car is used as method of transport, Well Stanground, Halls the Chemist and Odedra RC are both accessible to residents of Cardea within a journey time of approximately 20 minutes.

4.3.23 For the Peterborough Health and Wellbeing Board area, the vast majority of residents are within a 20 minute travel time by car, with only one small area in the north west of the district not being within a 20 minute drive of pharmacies in Peterborough (there may be pharmacies within a 20 minute drive of this area located in another Health and Wellbeing Board Area). Therefore the Cardea development is no different to other areas of Peterborough and access to pharmacy services within 20 minutes is achievable.

4.3.24 [map provided]

4.3.25 b) Public Transport Travel Time – Cardea and nearest pharmacies

4.3.26 [map provided]

4.3.27 Approximately two-thirds of the existing Cardea Development can reach a pharmacy within 20 minutes by Public Transport, this is based on travel time only and does not reflect frequency of public transport services or hours of operation of public transport at weekends, the area not well served by public transport reflects the undeveloped areas of Cardea where the infrastructure and housing is not yet in place.

4.3.28 c) Cycle Travel Time – Cardea and nearest pharmacies

4.3.29 [map provided]

4.3.30 “Well Stanground” and “Halls the Chemist” are accessible to all Cardea residents within 20 minutes when cycling is the used as the method of transportation.

4.3.31 d) Walking Travel Time – Cardea and nearest pharmacies

4.3.32 [map provided]

4.3.33 Approximately 50% of the Cardea development (in part due to the undeveloped areas of Cardea where the infrastructure is not yet in place) and the eastern most part of Stanground North cannot access a pharmacy within 20 minutes when walking.

4.3.34 Opening times

4.3.35 Neither of the existing pharmacies are 100 hours pharmacies, the opening times as stated by NHS choices are as follows:

Halls the chemist Well Stanground surgery

Monday 09:00 - 18:00 Monday 08:30 - 18:00

Tuesday 09:00 - 18:00 Tuesday 08:30 - 18:00

Wednesday 09:00 - 18:00 Wednesday 08:30 - 18:00

Thursday 09:00 - 18:00 Thursday 08:30 - 18:00

Friday 09:00 - 18:00 Friday 08:30 - 18:00

Saturday 09:00 - 13:00 Saturday Closed

Sunday Closed Sunday Closed

4.3.36 It is further noted that “Halls the Chemist” offer a prescription delivery service meaning vulnerable residents should not be disadvantaged in terms of access to prescription services.

4.3.37 Car ownership

4.3.38 Just under a quarter of residents of Stanground South have no access to a car, however the two nearest pharmacies are accessible by public transport and cycling within 20 minutes.

4.3.39 [table provided]

4.3.40 Summary and Conclusions

4.3.41 In conclusion, the amount of growth linked to the Cardea development has not triggered a need to review the current PNA or issue a supplementary statement. An increase of one additional pharmacy would increase the rate of pharmaceutical providers per 100,000 in Peterborough from the current 22 per 100,000 to the national average of 23 per 100,000. It is important to note that this is based on the population increase in Peterborough as a whole and not specifically to the Cardea development.

4.3.42 Access to pharmacy services from the Cardea Development is comparable with the rest of Peterborough with access to the nearest existing pharmacies within 20 minutes by car and cycle.

4.3.43 The population profile of the Stanground South Ward shows a normal population distribution, comparable to Peterborough as a whole.

4.3.44 Therefore the level of access and provision of pharmacy provision for the Cardea Development is comparable with the rest of the Peterborough Health and Wellbeing Board area and that the statement within the Current Peterborough Pharmaceutical Needs Assessment that “There is currently sufficient pharmaceutical service provision across Peterborough, No need for additional pharmaceutical service providers was identified in this PNA” still stands.

[Supporting information attached as Appendix C]

4.4 CAMBRIDGESHIRE AND PETERBOROUGH LPC

4.4.1 This application has now been reviewed by the LPC’s Contracts Group, and Declarations of Interest made.

4.4.2 The LPC notes that a new PNA was published in 2018 and that the original application was considered against the previous PNA dated 2015.

4.4.3 The LPC would like to be kept updated of this appeal and should an Oral Hearing be held it would like to send a representative to observe (or give evidence).

4.5 NHS ENGLAND

4.5.1 Please find below the link to the Peterborough Pharmaceutical Needs Assessment (2018) published in March 2018 (Regulation 22, this is the current published PNA).

4.5.2 https://pcc-live.storage.googleapis.com/upload/www.peterborough.gov.uk/healthcare/public-health/PeterboroughPNA2018-FullReport.PDF?inline=true

4.5.3 The PNA states that “there is currently sufficient pharmaceutical service provision across Peterborough. No need for additional pharmaceutical service providers was identified in this PNA” (PNA, Page 6, Item 4 – Current provision of local pharmaceutical services).

4.5.4 As per NHS Resolution’s letter NHS England has taken each matter in turn.

4.5.5 Regulation 31

4.5.6 This does not apply as there is no suggestion that the application will be for inclusion in the same or adjacent premises (see extract from PSRC minutes attached).

4.5.7 In relation to Regulation 18, the matters to which consideration will be given are whether:

4.5.8 (a) granting the application would cause significant detriment to –

(i) proper planning in respect of the provision of pharmaceutical services in the Health and Wellbeing Board area; or

(ii) the arrangements which the NHS Commissioning Board has in place for the provision of pharmaceutical services in the Health and Wellbeing Board area;

4.5.9 Regulation 18(2)(a)(i) and (ii)

4.5.10 NHS England is satisfied that significant detriment to the proper planning of pharmaceutical services and arrangements currently in place for the provision of pharmaceutical services would not result from a grant of the application. (see extract from PSRC minutes attached)

4.5.11 (b) notwithstanding that the improvements or better access were not included in the pharmaceutical needs assessment, granting the application would confer significant benefits on persons in the area (which were not foreseen when the pharmaceutical needs assessment was published), having regard to the desirability of –

(i) there being a reasonable choice with regard to obtaining pharmaceutical services in the area of the Health and Wellbeing Board;

(ii) people who share a protected characteristic (as listed in section 149(7) of the Equality Act 2010 - age, disability, gender reassignment, race, religion or belief, sex, sexual orientation, marriage and civil partnership, and pregnancy and maternity) having access to services that meet specific needs for pharmaceutical services that, in the area of the Health and Wellbeing Board, are difficult for them to access, or

(iii) there being innovative approaches taken with regard to delivery of pharmaceutical services.

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

4.5.13 There are more than 10 pharmacies within a 2.5 mile radius of the proposed site. There appears to be more than a reasonable choice of Pharmaceutical services in the HWB area. Granting the application would not lead to significant benefits based on choice.

4.5.14 The applicant states that “it is not reasonable to use radius as a determining factor as it doesn’t take into consideration barriers to movement”. As outlined above there are 10 pharmacies within 2.5 miles of the proposed site. There is 1 pharmacy within close proximity to the GP Dispensing Surgery nearest the proposed location. The PNA states that “35 out of 37 pharmacies (95%) and one of one dispensing GP practices (100%) reported that they provide free delivery services” (PNA, Page 39, 4.3.2). The PNA does not identify any barriers to movement and this is supported within the PNA (PNA, Page 39, 4.3.1).

4.5.15 In considering Regulation 18(2)(b)(ii), no information had been provided to show that those persons sharing a protected characteristic have difficulty in accessing current pharmaceutical services, or that services specific to their needs are not currently being provided by the existing pharmacies and that

they would therefore derive significant benefits from the grant of this application.

4.5.16 The applicant had not provided any information in relation to any innovative approaches therefore the granting of this application would not lead to significant benefits by virtue of innovation (see extract from PSRC minutes attached).

4.5.17 In addition to the above it is important to note that the PNA does account for the growth in the area and states “To facilitate commissioning of pharmaceutical services responsive to population needs, the Health and Wellbeing Board partners will, in accordance with regulations, monitor the development of major housing sites and produce supplementary statements to the PNA if deemed necessary, to ensure that appropriate information is available to determine whether additional pharmaceutical services provision might be required” (PNA, Page 73, 6.1, paragraph 2).

4.6 REPEAT PRESCRIPTION ORDER LINE LTD

4.6.1 Background

4.6.2 The applicant refers to the background of Repeat Prescription Order Line Ltd’s application for inclusion in the pharmaceutical list being granted, and the Well Pharmacy (formerly Co-op) minor relocation application being granted. It is not clear what the applicant believes to be the relevance of these comments, save that it is clear that the capacity of the existing pharmacy network has increased in recent years with the opening up of Repeat Prescription Order Line Ltd’s pharmacy.

4.6.3 The FHSAU has previously considered an unforeseen benefits application in the immediate vicinity of the parade of shops at Bellona Drive (ref: SHA/17663). That application was very similar to the present application, and was also based on the new housing being built in Cardea. The FHSAU concluded that there was already a reasonable choice with regard to obtaining pharmaceutical services; that there was no evidence that people sharing protected characteristic had difficulty in accessing pharmaceutical services; and there was no evidence of innovative approaches. The FHSAU concluded that there was no information to show that when the development in Cardea was complete, access to existing pharmacies would be difficult or that the existing pharmacies would not be able to cope with any increase in demand.

4.6.4 The applicant states that granting its application would improve the distribution of the pharmacy network, but this is not part of the relevant regulatory test.

4.6.5 It is agreed that there is no GP surgery in Cardea, but the consequence of the absence of a GP surgery is that there is no focus for demand for pharmaceutical services in Cardea because there is no source of prescriptions. Existing pharmacies are located in close proximity to existing GP surgeries and can be easily accessed by patients who require access to pharmaceutical services immediately after a visit to their GP.

4.6.6 2018 Pharmaceutical Needs Assessment

4.6.7 The application is made on the basis that it would secure improvements or better access to pharmaceutical services that were not foreseen in the local Pharmaceutical Needs Assessment. However, none of the matters raised by the applicant are unforeseen in the context of the relevant PNA.

4.6.8 In regard to the Pharmaceutical Needs Assessment 2018, Repeat Prescription Order Line Ltd comment as follows:

4.6.9 Page 6 of the 2018 Peterborough PNA

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

4.6.11 Peterborough has one pharmaceutical service provider per 4,409 people, equivalent to 23 pharmaceutical service providers per 100,000 resident population in Peterborough. This is the same as the national average of 23 per 100,000 resident population and similar to the East of England average of 24 pharmaceutical providers per 100,000 resident population.

4.6.12 This shows that we have an adequate number of pharmacies to care for the population, with sufficient capacity to meet existing and envisaged demand, and no unmet need for a new pharmacy contract.

4.6.13 Page 12 of the 2018 Peterborough PNA

4.6.14 Over the coming years the population in Peterborough is expected to both age and grow substantially in numbers. An increase in population size is likely to generate an increased need for pharmaceutical services, but on a local level changes in population size may not necessarily be directly proportionate to changes in the number of pharmaceutical service providers required, due to the range of other factors influencing local pharmaceutical needs.

4.6.15 To facilitate commissioning of pharmaceutical services responsive to population needs, the Health and Wellbeing Board partners will, in accordance with regulations, monitor the development of major housing sites and produce supplementary statements to the PNA if deemed necessary, to ensure that appropriate information is available to determine whether additional pharmaceutical services provision might be required.

4.6.16 We have not seen any supplementary statements from the Health and Wellbeing Board and in reality due to the financial challenges on the NHS, we are seeing local GP surgeries merging, to be able to sustain services to communities.

4.6.17 The PNA therefore already had regard to the age profile of the local community (referred to by the applicant) and determined that there was no unmet need for additional pharmaceutical service provision.

4.6.18 Page 26 of the 2018 Peterborough PNA

4.6.19 "Stanground and South" population expected to increase by 2100 between 2016 and 2036. The PNA therefore clearly had regard to the housing developments in the Stanground/Cardea locality (the area identified by the applicant) and determined that there was no unmet need for a pharmacy in respect of that population.

4.6.20 Page 39 of the 2018 Peterborough PNA

4.6.21 Findings of the public consultation

4.6.22 63 of 69 respondents (91%) agreed with the key findings about pharmaceutical services in Peterborough as outlined in the PNA, and 58 of 69 respondents (84%) agreed that there are enough pharmacies across Peterborough. The feedback gathered in the consultation is described in the

Consultation report (see Appendix 6) and a summary of how the draft PNA was amended to produce this final report in response to the feedback received is included as Appendix 7.

4.6.23 In summary, taking into account current information from stakeholders including community pharmacies and dispensing GP practices, the number and distribution of pharmaceutical service provision in Peterborough appears to be adequate.

4.6.24 Page 42 of the 2018 Peterborough PNA

4.6.25 The results of the PNA questionnaire, which all Peterborough community pharmacies and dispensing practices were invited to complete, have been used to get more details about the opening hours of local pharmacies. Overall, out of 41 community pharmacies, 23 (56%) are open after 18:00 and 12 (29%) are open after 19:00 on weekdays; 28 (68%) open on Saturdays and 10 (24%) open on Sundays. These findings are similar to those in the 2015 PNA. One community pharmacy stated that it opens until midnight on weekdays and one pharmacy stated that it is open until midnight on weekends.

4.6.26 Currently, five pharmacies are contractually obliged to open for 100 hours per week due to the conditions on their application. This inevitably means that they are open until late at night and at the weekend.

4.6.27 The above shows the significant choice of pharmacies available in the Peterborough area and with 100 hour pharmacies, providing extended hours results in a very comprehensive access to pharmacy in Peterborough which greatly exceed those proposed by the applicant. The PNA does not identify any unmet need for pharmaceutical service provision during extended hours.

4.6.28 If NHS England believed that there was a need for additional service provision in terms of opening hours for the community, they could notify Repeat Prescription Order Line Ltd and direct them to open. No such direction has been made.

4.6.29 Page 78 of the 2018 Peterborough PNA

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

4.6.31 Based on the above and an understanding that the developments will be monitored then growth had clearly been identified and foreseen, therefore this application cannot be said to be unforeseen when clearly documented plans have been put in place and provision and resource are already delivering the needs of the growing community locally.

4.6.32 Page 117 of the 2018 Peterborough PNA

4.6.33 The steering group will meet every six months to review the latest data on housing development sites and population projections, and the potential implications for pharmaceutical provision. If changes to the need for pharmaceutical services are identified, the steering group will either issue a supplementary statement of fact which acts as an amendment to the PNA, or propose a revised assessment of need if the changes are significant.

4.6.34 As Repeat Prescription Order Line Ltd has not been notified of any supplementary changes etc, then as per the planning of the PNA, they believe all is provided, within the expectation of the experts who monitor this for the community.

4.6.35 Regulation 18(2)(b)

4.6.36 Having regard to the contents of the relevant PNA and the conclusions reached in the PNA, it is clear that none of the matters referred to by the applicant in support of its application are unforeseen in the context of the PNA. Repeat Prescription Order Line Ltd does not agree that the PNA is "too broad brush", not least since it specifically refers to the Stanground development and concludes that there is no unmet need in respect of the provision of pharmaceutical services.

4.6.37 Notwithstanding the above, it is also clear that granting this application would not secure improvements in, or better access to, pharmaceutical services in the HWB's area.

4.6.38 Reasonable choice

4.6.39 In relation to whether patients have a reasonable choice, firstly Repeat Prescription Order Line Ltd would point out that NHS Resolution is required to consider choice in the HWB's area. Where the appellant refers to choice in its letter of appeal, it focusses only on the immediate vicinity of the proposed site (Cardea), which is not the correct approach.

4.6.40 In fact, patients have a reasonable choice of service provision both in the immediate vicinity and in the wider area. Firstly, patients can use Repeat Prescription Order Line Ltd’s pharmacy, Halls the Chemist at 92 Peterborough Road, Well Pharmacy located at Stanground Surgery, or the Odedra's Pharmacy at Rectory Gardens. There are also a number of other pharmacies a short car journey away e.g. Tesco and Boots pharmacy in Hampton. In its decision letter, NHS England notes that there are 10 pharmacies within 2.5 miles of the proposed site, all of which are capable of providing a reasonable choice for the reliant population.

4.6.41 The applicant refers to populations in Yaxley and Whittlesey, although it is not clear why the applicant believes that these are relevant to NHS Resolution's determination of this appeal. For example, there are already 2 pharmacies in Yaxley and 3 pharmacies in Whittlesey. Patients who live in those areas can therefore access pharmaceutical services in those areas should they choose to do so.

4.6.42 Granting the application would therefore not confer significant benefits on the reliant population since patients already have a reasonable choice of service provision in the HWB's area.

4.6.43 Access to existing pharmacies

4.6.44 Firstly, the appellant provides no evidence that there are patients who share a protected characteristic and who require access to pharmaceutical services but who currently find access difficult. The applicant makes vague reference to the "elderly" and "parents with small children" but this is not evidenced and is meaningless since every community will contain this sort of age range of population.

4.6.45 Referring to people who live in Cardea, the applicant says that patients have to travel a mile or more to access any type of primary care services, including pharmaceutical services. With respect, this is a meaningless statement,

because the distance travelled depends on a patient's starting point and means of transport, and no patient will start and finish their journey at the Morrison's store.

4.6.46 As the applicant is not locally based but from their midlands office, they may not be aware of the local paths that are available to enable patients to walk to the pharmacy, doctors, dentist and secondary school. These footpaths significantly shorten the walking distances. From Repeat Prescription Order Line Ltd’s measured distances, from the proposed site to Well pharmacy the distance is 0.9 miles, which takes 15 minutes to walk, rather than 1.2 miles and 22 minutes to walk as referred to by the applicant.

4.6.47 Footpaths are largely new, and are appropriately lit and well-maintained. The local terrain is level, and there are no busy roads to cross. There are no barriers to accessing existing pharmacies by foot.

4.6.48 In addition to those who walk, Repeat Prescription Order Line Ltd has many patients that cycle to the pharmacy and it has cycle stands for them to secure their bikes.

4.6.49 Existing pharmacies are therefore not difficult for the local population to access either by foot or bicycle.

4.6.50 The applicant refers to the Kingston Park industrial estate, although it is not clear the extent to which workers in that industrial estate would need to, or choose to, access pharmaceutical services from the proposed site. It is of note, however, that the applicant is happy to suggest that those in Kingston Park would travel 1.2 miles to access the proposed pharmacy, but those in Cardea could not travel a similar (or shorter) distance in order to access the existing pharmacy network.

4.6.51 Whilst up-to-date census data is not available, since the application is for premises which are in a new housing estate in an edge-of-town location, it is reasonable to assume that car ownership in Cardea is high. The applicant refers to "more deprivation" in "the wider Stanground area", but this statement is not evidenced and is meaningless.

4.6.52 Certainly everyone, or almost everyone, visiting the Morrison's store will drive to the store if only because they would not want to walk home with shopping bags even if they live in Stanground.

4.6.53 Access to the existing pharmacy network by car is easy and straightforward. It is a 5-minute drive to Halls the Chemist and Well Pharmacy from the proposed site, and both pharmacies have car parking facilities. Pharmacies are also easily accessible as patients go about their daily lives. For example, for patients who are travelling from home, save for those who live in the immediate vicinity of the Morrison's store, the journey time and distance to Morrison's is very similar to the Tesco and Boots pharmacies in Hampton, which provide even greater hours of service than the applicant is proposing and, again, have ample free car parking.

4.6.54 Previously submitted evidence from Well Pharmacy showed there is adequate bus service provision from Cardea to the City Centre and beyond, using the local service e.g. Stagecoach service Citi 5.

4.6.55 For the avoidance of doubt, Repeat Prescription Order Line Ltd provides its delivery service to the community of Stanground South/Cardea and also other areas in its local area for free. This has been the same position since the pharmacy opened in 2010 and the service is protected by the ability of the patient to speak to Repeat Prescription Order Line Ltd’s pharmacist when

needed to discuss their health needs or medication, using the land line number and also it has a free phone number.

4.6.56 Conclusion

4.6.57 In conclusion, in all the circumstances, having regard to the choice and accessibility of existing pharmacies, the absence of difficulties for people who share a protected characteristics and who require access to pharmaceutical services, and the absence of innovative means of delivery, granting this application would not confer significant benefits on people in the HWB area.

4.6.58 Repeat Prescription Order Line Ltd therefore invites NHS Resolution to refuse this application.

4.6.59 Should NHS Resolution decide to hold an oral hearing prior to its determination of this appeal, Repeat Prescription Order Line Ltd would wish to have the opportunity to attend the hearing and make oral representations.

In a further email Repeat Prescription Order Line Ltd stated:

4.6.60 In the submission earlier, Repeat Prescription Order Line Ltd had not included its position that the opening of a new pharmacy would prejudice its pharmacy and therefore effect the existing provision / proper planning of pharmaceutical service in the HWB area.

4.6.61 Repeat Prescription Order Line Ltd would like to submit financial information but unsure to what extent this confidential information will be circulated and therefore requests clarification prior to release of financial numbers.

4.6.62 Due to the substantial financial cuts imposed on community pharmacy from

the NHS, which the national bodies had judicially reviewed in the High Court, it has been identified that the funding cuts would result in closure of pharmacies. The total funding cuts come through a variety of measures against pharmacy and have in some instances have been to efficiencies. Repeat Prescription Order Line Ltd has as an organisation been working hard to ensure the viability of its pharmacy, but with the challenge due to the massive drug shortages and increased pricing of medication, which at a number of instances has resulted in the pharmacy dispensing at a loss (e.g. Naproxen 500mg tablets), which it cannot control due to its primary professional responsibility to make sure that patients do not run out of medication and to fulfil prescription with reasonable promptness.

4.6.63 Therefore over the last year financial year 2018/19, the pharmacy has only

made under £800 profit after taking into consideration expenses at the pharmacy, e.g. the rent, rates, staffing costs, services cost, insurance, bank charges & interest, delivery of medicine cost, pharmacy system costs, maintenance and repairs just to identify the main categories.

4.6.64 Therefore the introduction of another pharmacy will impact the pharmacy

substantially and result in the closure of the pharmacy, this will impact the proper provision of pharmaceutical services locally particularly on Saturday morning 9am to 1pm when Repeat Prescription Order Line Ltd is the only pharmacy of the three in the local area to be open and therefore patients travel a larger distance to reach the pharmacy. If Repeat Prescription Order Line Ltd’s pharmacy were to close then those patients would loose access to a pharmacy and the additional distance from their existing journey may result in them not being able to access pharmaceutical services.

4.7 THOMAS WALKER PHARMACY

4.7.1 With regards to the appeal SHA/22113 made by Ascent Healthcare, Thomas Walker Pharmacy would like to add to the comments it made on 27 November 2017.

4.7.2 Thomas Walker Pharmacy understands from the Peterborough 2018 PNA that nothing has changed with regards to the need of additional pharmacies i.e. no additional pharmacies are needed, even when considering population growth.

4.7.3 Also, in light of the government agenda to close about a quarter of the country's community pharmacies, the granting of authority to open a new pharmacy seems contradictory.

4.7.4 In summary, Thomas Walker Pharmacy does not agree that a new pharmacy would offer "unforeseen benefits".

Letter to Primary Care Support England dated 27 November 2017

4.7.5 In response to the application made by Ascent Healthcare Limited (Nabbs Pharmacy) for inclusion in the Pharmaceutical List within 150m of Morrisons Supermarket at Bellona Drive, Stanground, Peterborough PE2 8GP (CAS-221295- L5FSK5), Thomas Walker Pharmacy would like to make the following representations:

4.7.6 The Cardea (South Stanground) development started around 2012, so will have been fully considered in the Peterborough Pharmaceutical Needs Assessment 2015 ("the PNA").

4.7.7 The PNA (1.5 Conclusions) states "There is currently sufficient essential and advanced pharmaceutical service provision in Peterborough". Thomas Walker Pharmacy does not believe there is a change in this position.

4.7.8 If Morrisons Supermarket had felt the need for a pharmacy, they would have applied under the "100 hour rule" (now defunct), having considerable experience of extended hour pharmacies in their estate.

4.7.9 A new pharmacy Halls the Chemist opened in 2010, in readiness in the growth in population in the area.

4.7.10 The opening hours stated in the application, particularly those at the weekend, do not confer an unforeseen benefit as the PNA states there are five "100 hour" pharmacies in Peterborough. Additionally, there are other pharmacies in the area offering extended hours (above the 40 core hours), including Millfield Pharmacy opening 7 days a week, and another 9 pharmacies opening on Sundays.

4.7.11 Point 4 in the application states "we intend to provide all commissioned services...", yet the applicant answers "No" to all current accreditation.

4.7.12 The application is contradictory stating premises have "not yet been identified", but also "under negotiation".

4.7.13 In point 5 in the application, the applicant does not answer the question that is asked; the question asks about close proximity, not premises, which "have not yet been identified".

4.7.14 The PNA states there are three pharmacies in the local area, offering smoking cessation, NMS, MUR, flu vaccination, supervised consumption and needle exchange services. (There is also a dispensing practice and two Dispensing Appliance Contractors (in Peterborough).)

4.7.15 The applicant states in point 6 "The PNA does not consider the benefits that would accrue from locating a pharmacy in South Stanground". Neither does the PNA consider each and every other location in and around Peterborough that does not have a pharmacy.

4.7.16 Upon driving around Cardea, most households would seem to own at least one car, and the population seems biased away from the elderly, therefore it is not unreasonable to suggest that travel to other pharmacies is not problematic. Furthermore, both Halls The Chemist and Well pharmacies have their own car parking facilities (with dedicated disabled spaces); home delivery services from community pharmacies in Peterborough is widespread. Equally, Cardea has its own bus stop, with very frequent routes into the city centre.

4.7.17 In the current financially challenged NHS, whereby resources are stretched to the greatest and clear intention towards community pharmacy, with an agenda to close 3000 pharmacies in England, when they are closely situated, the opening of another pharmacy in this location is illogical and would result in another area with an oversupply, to the financial detriment to the NHS.

4.7.18 In summary, Thomas Walker Pharmacy cannot determine any unforeseen benefits by opening a pharmacy at this location and therefore believe the application should be rejected.

4.8 MILLFIELD PHARMACY

4.8.1 Having been notified of the appeal SHA/22113, Millfield Pharmacy believes its existing comments (dated 27 November 2017) regarding this application are still valid. Millfield Pharmacy would add further that having reviewed the Peterborough 2018 PNA it continues to state no new pharmacies are required and identifies the growth in the population in this area therefore l cannot believe that an unforeseen application is valid with so much consideration for this growing community.

4.8.2 With the government agenda to close 3000 pharmacies and significant funding cuts to all pharmacies where we are now seeing pharmacy closures, the opening of this pharmacy would show a lack of cohesion between the various NHS entities, when there is a finite sum of resource for the population.

4.8.3 Millfield Pharmacy would therefore ask NHS Resolution to refuse this appeal.

Letter to Primary Care Support England dated 27 November 2017

4.8.4 Millfield Pharmacy writes with regards to the application (CAS-221295-LSFSKS) made by Ascent Healthcare Limited for inclusion in the Pharmaceutical List within 150m of Morrisons Supermarket at Bellona Drive, Stanground, Peterborough PEZ 8GP. Millfield Pharmacy would like to make the following representations:

4.8.5 Millfield Pharmacy believe the applicant is using the offer of extended hours to obtain a pharmacy contract. Millfield Pharmacy opens 71 hours each week, until 8 pm each day, 7 days a week. We are also recognised by many people and the local NHS for opening on Bank Holidays, including Christmas and New Year.

4.8.6 There are five 100 hour pharmacies in and around Peterborough, plus another in Whittlesey, just a few miles from Stanground, but still part of Cambridgeshire (on the border of Peterborough and Cambridgeshire areas). There are numerous pharmacies with widespread distribution offering extended hours with generous access to pharmaceutical services.

4.8.7 Millfield Pharmacy currently offers numerous services including supervised consumption, needle exchange, blood borne virus (BBV) screening, provision of Naloxone under PGD, NUMSAS, MUR, NMS and flu vaccination. Millfield Pharmacy understands that the majority of pharmacies offer a large range of services too. The applicant offers no current accreditation for services.

4.8.8 The 2015 Peterborough PNA states "There is currently sufficient essential and advanced pharmaceutical service provision in Peterborough" and Millfield Pharmacy strongly believes this is still the case.

4.8.9 The applicant states premises "have not yet been identified" and thus there is no guarantee as to when services could be provided.

4.8.10 Cardea is predominantly an area of young families, which Millfield Pharmacy feels would easily be able to access current pharmacies, either by car, bus or on foot.

4.8.11 Millfield Pharmacy notes that there are two pharmacies very close to the proposed site for this pharmacy- Well pharmacy and Halls The Chemist.

4.8.12 In conclusion, Millfield Pharmacy is unable to identify any unforeseen benefits by opening a pharmacy in this location.

4.9 LLOYDS PHARMACY LTD

4.9.1 The applicant fails to provide evidence the population has difficulty accessing existing pharmaceutical services. There is also limited evidence with regards to whether the application will confer significant benefits in terms of choice within the area of the HBW, to those groups who may share a protected characteristic, and innovative services.

4.9.2 In the absence of such evidence the application does not satisfy Regulation 18 and should be refused.

5 Late representations

5.1 REPEAT PRESCRIPTION ORDER LINE LTD

5.1.1 Repeat Prescription Order Line Ltd provided a copy of its management accounts for the 11 months to 28 February 2019 which is attached as Appendix D.

6 Unsolicited representations

6.1 GRANVILLE PHARMACY

6.1.1 With regards to the above appeal, Granville Pharmacy is of the position that its previous comments submitted to PCSE still stand.

6.1.2 In addition, Granville Pharmacy would also like to reiterate the findings of the Peterborough 2018 PNA - no new pharmacies are required, even when duly considering the forecasted population growth for the city and surrounding area. Furthermore, as the government wish to close around 25% of the community pharmacy network any new pharmacies are at odds to their policy.

6.1.3 Therefore, Granville Pharmacy does not see any unforeseen benefits of a new pharmacy in this location.

Letter to Primary Care Support England dated 27 November 2017

6.1.4 Granville Pharmacy would like to make representations against the application made by Ascent Healthcare Ltd for inclusion in the Pharmaceutical List within 150m of Morrisons Supermarket at Bellona Drive, Stanground, Peterborough PE2 8GP (Ref: CAS-221295-L5F5K5).

6.1.5 There are 5 pharmacies in and around Peterborough that open one hundred hours per week. In the town of Whittlesey in the adjacent Cambridgeshire, but only a few miles from Stanground, there is another one hundred hour pharmacy.

6.1.6 In and around Peterborough there are many pharmacies opening extended hours (including Saturdays and Sundays) offering a wide range of services, including home delivery services.

6.1.7 In close proximity to Granville Pharmacy is Millfield Pharmacy where they are open until 8 pm each day, 7 days a week. They also open on Bank Holidays, including Christmas and New Year.

6.1.8 It is stated in the Peterborough 2015 PNA "There is currently sufficient essential and advanced pharmaceutical service provision in Peterborough" and Granville Pharmacy fervently feels this has not changed.

6.1.9 South Stanground has a significant population of young families. Granville Pharmacy does not envisage they would have problems travelling to an existing pharmacy either on foot or by car or bus.

6.1.10 There are two pharmacies in close proximity to South Stanground, namely Halls The Chemist and Well pharmacy.

6.1.11 There are many pharmacies in the area that have achieved Level1 Healthy Living Pharmacy status and offer an elevated level of public health advice.

6.1.12 To finish, Granville Pharmacy does not see any unforeseen benefits by allowing a pharmacy to open in this location.

7 Observations

7.1 THE APPLICANT

7.1.1 DMB

7.1.2 DMB mention that “The PNA does not identify any barriers to movement and this is supported within the PNA”. However, unfortunately the PNA is too broad to identify barriers to movement at a local level. The authors do not have the resources to carry out site visits to investigate barriers such as gradients of roads/pathways, the condition of the roads/pathways, street lighting etc.

7.1.3 The Applicant has carried out a thorough site visit from the proposal site to current pharmacy providers and concluded that there are barriers to movement. Therefore, a pharmacy at the proposal site would be of significant benefit.

7.1.4 The Applicant requests that NHS Resolution considers holding an oral hearing so it can see first hand the barriers to movement as well as evaluate the ongoing large scale Cardea development. Previous applications at this site have been premature and have not submitted the evidence put forward this time. The proposal location has significant footfall, located next to a large Morrisons supermarket. The Cardea development has been built so residents seek to use the services within the development.

7.1.5 Granville Pharmacy

7.1.6 Granville Pharmacy mention that any new pharmacies are odds to their policy. However, this statement is incorrect. The pharmacy market entry specifically exists to allow new pharmacies to open where a need exists. Whether this need was identified in the Pharmaceutical Needs Assessment (PNA) or not. As the need was not identified in the PNA an unforeseen benefits application was submitted and is appropriate, irrespective of the governments supposed agenda.

7.1.7 Lloyds Pharmacy

7.1.8 Lloyds pharmacy mention that the applicant fails to provide evidence the population has difficulty accessing existing pharmaceutical services.

7.1.9 The Applicant’s proposal site is located centrally within the Cardea development, which is a bow shaped development south of the wider Stanground area. As both of the pharmacies in Stanground are located on the western boundary, access is particularly more difficult for residents living east of the Stanground and Cardea.

7.1.10 In order to access current pharmaceutical provision residents would have to first travel via internal roads or pathways within Cardea, before joining onto roads linked to South Stanground. The shortest route involves crossing a pathway within open land between Apollo Avenue and Oakdale Avenue. The pathway would be particularly off putting to use in the shorter winter months when daylight is less, especially for those with protected characteristics.

7.1.11 Further on, as you travel down Whittlesey Road (B1092), half of the pathway is occupied by a cycle lane. This narrows the pathway leading to the pharmacies which is not ideal for prams and wheelchair users. If one was to travel to the pharmacies via Peterborough Road, then this route has a relatively steep incline, which would make access difficult.

7.1.12 Peterborough City Council

7.1.13 The PCC “accept that both pharmacies in Stanground, essentially represent one location when mentioning that “for clarity on the maps below they are represented as one location as they are about 150 metres walking distance apart”.

7.1.14 The PCC also acknowledges that the Cardea development is a large-scale housing development however conclude that the amount of growth linked to the Cardea development has not triggered a need to review the current PNA or issue a supplementary statement. The PCC however fail to provide a review point.

7.1.15 The majority of the Cardea development is now complete, with the extensive retail complex, school and nursery complete and occupied. This application was submitted 2 years, the development has well progressed since with more residents having moved in. The need for pharmaceutical provision has only increased since the application was first submitted.

7.1.16 Repeat Prescription Order Online Ltd

7.1.17 RPOO have mentioned that “the introduction of another pharmacy will impact the pharmacy substantially and result in the closure of the pharmacy, this will impact the proper provision of pharmaceutical services locally particularly on Saturday morning 9am to 1pm when we are the only pharmacy of the three in

the local area to be open and therefore patient travel a larger distance to reach the pharmacy”.

7.1.18 If the Applicant were to accept the statement with regards to the closure with the accounts provided (which it does not), it is important to note that it is proposing core hours 7 days a week, with Saturday opening hours from 9am to 5pm and Sunday 12pm to 4pm.

7.1.19 Therefore, if the application was granted it would increase access to pharmaceutical provision over the weekends, not reduce.

7.1.20 Furthermore, there is another pharmacy (Well) merely 150m away from Halls Chemist (RPOO Ltd). Therefore, in terms of physical access the closure will not reduce access.

7.1.21 RPOO also mention that the FHSAU have previously considered an application at the proposal site. However, fail to mention that there are some significant differences to this application. The Applicant is proposing core opening hours 7 days a week. Furthermore, the development has significantly matured since the previous application. The substantial shopping area which forms the focal point of the development is now complete and occupied.

7.1.22 There may not be a direct source of prescriptions from within the development due to no GP surgery present, however the footfall of the proposal site should not be ignored. The Morrisons supermarket on its own has thousands of transactions on a daily basis. These customers would benefit from an onsite pharmacy.

7.1.23 RPOO mention that “certainly everyone, or almost everyone visiting the Morrisons store will drive to the store if only they would not want to walk home with shopping bags even if they live in Stanground”. This is a clear assumption made and only confirms that the proposal site has not been visited by the objector.

7.1.24 The Morrisons supermarket is not an out of town retail supermarket like most. It is situated centrally within the large development, so it is not only used for large weekly/monthly shopping but also for daily shopping needs i.e. for bread and milk etc. Spending time on the proposal site, it is clear access is mixed. With residents accessing the site by walking, via public transport and by using a private vehicle.

7.1.25 Well Pharmacy

7.1.26 Well pharmacy object to this application, however in a previous application at the same site state that “The closest pharmacy is in excess of 2.5 kilometres by the most effective route. The distance of 5 km round trip to access enhanced or advanced services is difficult for elderly patients, patients who have specific mobility issues and parents with young children without access to a vehicle”.

7.1.27 The Applicant therefore invites NHS Resolutions to grant this application as this will confer significant benefits to the residents of the HWB or consider holding an oral hearing to determine the application.

7.1.28 The Cardea development is ongoing and the scale of the development including the proposal site can only be appreciated following a site visit.

Appendix A – Applicant’s maps supplied with application Appendix B – Applicant’s supporting information with appeal Appendix C – Peterborough HWB’s supporting information with representations Appendix D – Repeat Prescription Order Line Ltd’s supporting information with late representations Appendix E – decision ref. SHA/17663