We act for Mrs Beejal Patel ( the Appellant ) in respect of this application. On behalf of the Appellant we wish to appeal against this decision.

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1 By post and Family Health Services Appeal Unit NHS Litigation Authority 1 Trevelyan Square Boar Lane Leeds LS1 6AE 22nd February 2016 Dear Sirs Re: Application by Mrs Beejal Patel for inclusion in the Pharmaceutical List of Kent County Council Health & Wellbeing Board within a 100m radius of the Londis Convenience Store, 31 St Martins Hill, Canterbury, Kent CT1 1PU Application providing unforeseen benefits best estimate of location. We have been notified by NHS England in their letter dated 25 th January 2016 that the above application has been refused. I have enclosed a copy of their decision letter for your information. We act for Mrs Beejal Patel ( the Appellant ) in respect of this application. On behalf of the Appellant we wish to appeal against this decision. When considering the above application the FHSAU must decide whether it meets the requirements of Regulation 18(2) as follows: (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 (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

2 (iii) there being innovative approaches taken with regard to the delivery of pharmaceutical services. In the Kent HWB PNA published in March 2015 there is no specific mention of a gap in pharmaceutical services within the St Martins Hill area of Canterbury and therefore we can safely conclude that the granting of this contract is clearly an unforeseen benefit to the local community. In their letter dated 25 th January NHS England has confirmed that this application is not near/adjacent to any existing pharmacy so could not be refused under Regulation 31 and we agree with those findings. In addition NHS England confirmed that this application should not be refused under Regulation 18(2)(a)(i) or 18(2)(a)(ii). As neither NHS England nor any of the other interested parties (with the exception of Canterbury Pharmacies who failed to explain why they felt this would be the case) have disputed the above we do not intend to comment further on these matters within this document although we may wish to do so at a later stage. It is worth noting that the amendments to the 2013 Regulations, which came into force in April 2014, make an important change to Regulation 18(2)(b) as highlighted below: (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(b) (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(c) (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(a) (duty to promote innovation)), granting the application would confer significant benefits on persons in the area of the relevant HWB which were not foreseen when the relevant pharmaceutical needs assessment was published;

3 The implication is NHS England does not have to find that all three of these matters apply. If it finds that one of these one of these points apply then it may grant the application. Proposed location for the pharmacy This application continues to be a best estimate of location but our client is currently in negotiations with the proprietor of the Londis convenience store located at 31 St Martins Hill to secure some space within that building. A copy of the layout of that building is attached to this document and we ask you to note the area to the rear right hand side that is earmarked for the pharmacy should this application be approved and terms can be agreed. We must stress that at the time of preparing this document there is no legal agreement between the two parties. The Londis store has been established for many years and been in the same hands for almost 30. As a result it is extremely well used and popular with the local community. Located to the rear of the store there is a well-used post office counter. It is intended to relocate the post office counter to the front right hand side of the store should the pharmacy application be approved and terms can be agreed between the two parties. A cash point has been installed to the front of the premises which is available 24 hours/day to the public. To the front of the shop there is off-street parking for 4/5 cars plus space for a further 5/6 cars on the road itself. Attached to this document is some recent data for the period 31 January 2016 to 6 th February 2016 showing customer numbers visiting the convenience store. Over this period the store averaged 473 customers/day which emphasises how well it is used. We are informed that most of these customers are mainly regulars who live in the surrounding residential streets. In addition we understand that the convenience store in Sussex Avenue (see below) is also very well used (the proprietor of the Londis store used to own that shop) and in our view proves that many local people shop locally rather than travel to the city to meet their everyday needs. Local Area Summary Our clients application is primarily aimed at securing better access for the residents who live, work or visit the St Martins Hill/Littlebourne Road/Spring Lane Estate area as in our view they are not easily able to access the nearest existing pharmacies within the city centre. At the present time there are no GP surgeries or pharmacies in this immediate area and as a result people are forced to travel to the city centre to access pharmaceutical services. The location our client is proposing for the pharmacy is a densely populated residential area distinct in character from the city centre. Within this area there are a number of existing facilities in addition to the Londis store including:

4 a second convenience store and a couple of takeaways in a parade of shops in Sussex Avenue within the Spring Lane estate children s day nursery in Spring Lane neighbourhood centre churches St Martins hospital specialising in mental health newly constructed 60 bed care home virtually opposite the proposed pharmacy site another residential home on Littlebourne Road (Highland House) vocational & educational centre for adults with learning difficulties charity specializing in learning disability, mental health and autism in Sussex Avenue Canterbury golf club extensive sports complex including tennis & cricket facilities recreational areas The area basically comprises residential housing dotted all the way along Longport/St Martins Hill/Littlebourne Road which varies from local authority housing to more substantial properties as you travel east. To the south of Littlebourne Road there is a large residential housing area known as the Spring Lane Estate. The properties here comprise primarily of local authority/ex local authority dwellings including houses, bungalows and flats/apartments. Many of the local facilities mentioned above are located within this estate. This area is encompassed within Lower Layer Super Output Area Canterbury 014b and the statistics for this region paint the picture of a deprived area.

5 Canterbury 14b England Population 1,817 53,012,456 Car ownership No car in household 45.0% 25.8% One car in household 37.0% 41.7% Health Day to day activities limited a lot 11.6% 8.3% Day to day abilities limited a little 8.3% 9.3% Living in social housing Social rented (council) 42.6% 18.9% Social rent (other) 17.4% 17.4% Deprivation IMD rank 5383* Health Deprivation & Disability 3075* * Out of 32,844 where 1 is the most deprived We will comment further in relation to these statistics throughout this document but it is plain to see from the above table that this area of Canterbury contains residents with a higher % of disability issues compared to the national average. In addition car ownership in the area is very low compared to the national and South East with a staggering 45% of households having no car compared a national figure of 25.5%. To the north of St Martins Hill/Littlebourne Road there is another area based around Queens Road which primarily comprises local/ex local authority properties of a similar ilk to those within the Spring Lane Estate. A little further along to the north of Littlebourne Road heading east away from the city centre lies Howe Barracks which has now been virtually vacated by the military. In addition to the traditional army buildings there are approx. 245 military quarter residential properties of which all except around 30 (which have been retained by the military) are owned by Annington Homes and until recently had been leased back to the army.

6 We have been informed that approx. 180 properties are imminently to be handed back from the military to Annington Homes who are intending to refurbish the properties and either sell them to the private sector or a local Housing Association. It is expected that the majority of these properties will be occupied by late summer/early autumn of this year. These properties will add at least another 350/400 people to the local population once they are occupied The remaining 30 odd properties are to be handed back from the military to Annington Homes later in the year and these will follow a similar route to those above although with have not been given any information in relation to timescales for these particular properties. New Housing Developments In addition to the existing housing stock, the area is one earmarked for expansion to include the following new/recent developments. The Mount, Stodmarsh Road This development was completed and fully sold last year by Monro homes. It comprised 14 new properties along with 7 further dwellings converted from an old hospital building. Pilgrims Place, Littlebourne Road This is a development of 93 dwellings being built by Abbey Homes of which 23 are earmarked for Social housing. It comprises a mixture of 2, 3 and 4 bed houses plus some 2 bedroom apartments. At the time of this document 12 properties are completed and occupied and another 13 will be completed and occupied by the end of April. A further 5 are due for completion at the end of May and the developers expect to have completely finished the development and be off site by December The sales representative confirmed that there is a very high demand for all types of property and they are selling well. Below are some photographs taken from a recent site visit showing how swiftly this development is being constructed along with some of the completed properties.

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8 These two developments alone will add somewhere in the region 300 people to the immediate area by the end of this year. Howe Barracks In addition to the existing housing mentioned earlier which we expect to be sold to the private sector or housing associations over the coming months there are plans/proposals to build a further 500 dwellings on the site of the barracks. The outline proposal is for 400 houses and 100 flats. St Martins Hospital There are proposals to convert some existing buildings and build new dwellings on some of the grounds of the hospital. All these developments are within easy walking distance of the proposed pharmacy and the terrain from all of them to the proposed site is relatively flat and well lit. Old Prison,Longport This building which is located about 300m to the west of the proposed pharmacy was recently been acquired by Canterbury Christchurch University with a view to converting it to student accommodation which again will bring more people into the area and further demand for healthcare. An announcement on this proposal is expected within the next 2/3 months. Therefore in summary it can be seen that this application was approved it would not only serve the existing population, many of whom don t own a motor vehicle and suffer from

9 serious day to day limiting illness or disability, but will also cater for the new people moving into the area over the coming months. The above developments will add a significant number of people to the local area and none of them will have health services available unless they travel considerable distances. Securing Better Access At present people wishing to access pharmaceutical services are forced to travel to the city centre. The nearest existing contractor is: Boots Unit 2 St Georges Centre CT1 1UL This is a small community pharmacy located in a parade of shops comprising a Hi Fi store, Binnys newsagents (closed at the time of our visit on Thursday 12 February) and a Chinese restaurant. The parade is tucked behind Waitrose and is not visible from Broad Street the main road off which it is located. Accessing this pharmacy by foot from the proposed location of the pharmacy involves a long walk down the steep incline of St Martins Hill/Longport where there is only pavement on one side of the road for part of the journey. The photo above on the left shows part of St Martins Hill travelling easterly away from the city centre clearly showing no pavement to the left hand side. The photo to the right is taken from the other direction travelling towards the town centre again showing lack of pavement on one side of the road.

10 The journey would also involve crossing several busy streets. This walk is far from easy for those who are less abled, have a push chair or rely on a mobility scooter for example. Access by car would involve a convoluted route due to the one way systems in place as one would need to drive past the pharmacy via Broad Street, go all the way around the roundabout where Broad Street meets Upper Bridge Street and then branch off left into Waitrose car park. If customers are intending to visit the city for any length of time they may be forced to find alternative parking as the Waitrose car park is time restricted. The nearest pay & display car park to this Boots store is Longport car park where charges are 1.20/hour. The store opening hours displayed in the window states that it is closed between pm Monday-Friday so people will be unable to gain medication during that time. Our client is intending to open the pharmacy throughout the day without interruption should the application be approved. The next nearest existing pharmacy is Boots 29 Oaten Hill CT1 3HZ Once again customers who are on foot face the same long walk down the steep gradient of St Martins Hill/ Longport and also need to cross several busy junctions to access the pharmacy. The pharmacy lies in a secondary location with little support trade with the exception of a newsagents/convenience store adjoining. If customers are in a motor vehicle they may face problems parking as there are double yellow lines outside the Boots store. There are a few spaces along Cossington Road (opposite the branch) but these are limited to a maximum of 20 minutes and at the time of our visit were all full. Neither of these two pharmacies are located in the heart of the shopping area of the city centre and therefore it is likely if people are accessing them it is likely they will be making a specific journey to do so rather than visiting the city centre generally. The next nearest pharmacies are Boots & Superdrug which are both located in the heart of the city retail area. People accessing this area on foot face a return journey of at least 1.5 miles from the proposed pharmacy location (and in many cases a lot further) and they will face the same difficulties highlighted above. If they are in a motor vehicle they once again face a convoluted route and are almost certain to have to park in a pay and display car park. The nearest two car parks to the Boots/Superdrug stores are Whitefriars multi storey ( 1.70/hour) and Watling Street ( 1.50/hour) and residents will still have to walk to the pharmacies once they have parked their cars adding to the time of their visit.

11 The other existing pharmacies within the city are even further afield and as such would require local residents to make a specific journey should they require pharmaceutical services. Protected Characteristics We have considered the demographics of the local population paying particular regard to protected characteristics. It is our position that access to pharmaceutical services is not reasonable for most of the residents of the St Martins Hill area but is particularly poor for patient groups with protected characteristics. As age and disability are protected characteristics it is clear due to the distance to the nearest pharmacies and the hilly terrain of the area there are people with protected characteristics who find pharmaceutical services difficult to access. Parents of young children, particularly those who do not have access to a car during the day, and elderly people with reduced mobility are unlikely to have easy access to pharmaceutical services as part of their day-to-day lives. Visiting a pharmacy at present requires a special journey and whilst they would have little choice but to find a way to access a pharmacy should they have an acute need it is unlikely that they will benefit from the extensive health promotion services that would offered by a pharmacy situated in the heart of their community. In areas where no medical services are provided, it is critical to consider the full range of services offered by a community pharmacy beyond traditional dispensing when assessing whether these patient groups have reasonable access to services. A delivery service may be useful for dispensed medication but cannot provide advanced or local enhanced services. There is no substitute for the provision of these services in a location that residents access as part of their day to day lives. Choice of Pharmaceutical Provider In their letter dated 25 th January NHS England concluded that there was a choice of providers of pharmaceutical services within a reasonable distance and cites this as one of the reasons for refusing the application. Whilst the Regulations refer to choice within the HWB area, the correct test is whether the reliant population within the proposed area can reasonably access these pharmacies to enable people to exercise this choice. In a recent case the Appeals Authority committee made the following comment in respect of choice: In the circumstances, the Committee concluded there was a reasonable choice for patients once they were in the town but, the journey that necessitated and the circumstances of that

12 journey for residents on the development placed an unreasonable fetter upon their ability to exercise reasonable choice. It is clear, therefore, in our view that NHS England was incorrect in referring to the choice of providers of pharmaceutical services in the area as satisfying reasonable choice in the context of Regulation 18. They should have had regard to whether the journey required for residents to exercise that choice was reasonable. As described above for those residents who live in the area of the proposed application the journey for residents to access the existing pharmacies is difficult. The statistics of Lower Layer Super Output Level Canterbury 014b show that 45% of the local households do not have access to a motor vehicle. This means that those people either have to access the existing pharmacies either on foot or by public transport. We have already highlighted how difficult the journey is for pedestrians due to the steep gradient of St Martins Hill, the fact there is only pavement on one side of the road for part of that journey and the need to cross numerous roads to access any of the existing pharmacies. In addition the local statistics indicate that 11.6% (compared to a national average of 8.3%) of the population have day to day activities limited a lot so their journey on foot would be even more difficult than those who are able bodied. Whilst we accept that there are buses that run through the Spring Lane Estate and along St Martins Hill people still have to get to the appropriate bus stops, wait for a bus, disembark and then make their way to a pharmacy and wait for their medication. They of course then have to repeat that journey to return home so the entire journey could easily take some time. In addition there is of course a cost involved. For those people who are fortunate to have a motor vehicle whilst the distance to the existing pharmacies may be deemed to be short the route to actually access them is generally convoluted due to the complex one way systems in place within the city centre. These systems will of course also affect the local bus services. In addition to that there is the cost of parking which appears to be at least 1.20/hour in the cheapest pay & display car parks but maybe most significant factor to consider is the congestion of the city centre itself. Canterbury is a very popular tourist attraction due to amongst other things the cathedral, local museum, theatres etc and there a large number of colleges/universities meaning that a large number of people travel to the city to work and study. As a result there is often major congestion within the city. The problem is one that is well known locally and there are numerous complaints about the traffic systems.

13 For example Canterbury District Green Party recently stated Traffic - a serious issue in Canterbury. Like many cities in the UK, Canterbury has a serious issue with traffic there s just too much of it. This leads to the following problems 2) Traffic Congestion Recent surveys of traffic congestion in Canterbury indicate that driving times in the rush hour from one side of the city to the other average 45 minutes and even 28 minutes during the daytime. Congestion itself is a serious problem since it causes higher absenteeism from school and work, it leads to stress, cars are running in low gear thus releasing more pollutants, and additional traffic impedes cyclists and pedestrians Canterbury Council also acknowledge the traffic issues and a recent article from the Canterbury Times reads as follows Designing and building new roads could be the key to overcoming the traffic problems that currently plague parts of Canterbury. A new road that links the existing A257 with the A28 as well as a brand new junction at Wincheap are two of the projects said to be at the centre of a plan to resolve the city's traffic issues, reports the Canterbury Times. Canterbury City Council last week announced its draft transportation policy, in which it set out some of its key ideas and intentions for the area's road developments over the next 17 years. Its proposals are said to be the biggest changes Canterbury would have seen at any point since the 1970s and are designed to alleviate the strain many of its roads are currently under at busy times. Overall, some four new roads are planned for the city in the 17-year period, including a link road off Sturry Hill to Broad Oak Road and Sturry Road, while a bridge will also be built over the railway in this part of the city. At the present time local residents in the area of the proposed location are forced to travel to the city centre to access pharmaceutical services as they have no healthcare within the local area. For the reasons stated above none of the three accepted modes of accessing those pharmacies is particularly straightforward and we firmly believes that restricts their choice of provider. If local residents wanted to avoid the city to access services elsewhere they would be forced to travel long distances either north east to Sturry or south east to Bridge which we believe is totally unreasonable. Therefore in conclusion we do not feel local residents have a reasonable choice of provider due to the difficulties described in accessing the existing pharmacies. We would now like to take this opportunity to address the various comments which have been raised in relation to this application as follows.

14 Decision Letter from NHS England 25 th January We note that a member of the Pharmacy Contract Team carried out a site visit and the following is presumably an extract from that person s report: Leaving Canterbury City centre heading East up St Martins Hill towards the proposed site I noted that the road was very busy. There was housing on both sides with a constant flow of two-way traffic. I headed up the steep hill which could be quite an obstacle to elderly, infirmed or parents with small children. Double yellow lines were on both sides of the road, some metered parking bays were half way up, about 5-10 minutes walk from the proposed site, with space for up to four cars. The road is well-lit and there is a pavement on both sides of the road leading up to proposed site These comments further support our arguments of how busy the roads are in this part of Canterbury and it confirms the steep gradient of St Martins Hill/Longport which is potentially an obstacle for the elderly, infirm etc. The report is inaccurate in that halfway up the hill there is a stretch of road where there is pavement only on the RHS as you climb the hill which is shown in the photos above. NHS England then go on to describe where the local existing contractors are located and approximate distances/times taken to reach them from the proposed location of the pharmacy. We believe those distances are taken from google maps and fail to take into account the geography of the area (for those on foot) or the traffic congestion and one way systems for those with a motor vehicle. We have explained the latest position in relation to Howe Barracks earlier in this document and we believe that things are about to move very swiftly in relation to the existing housing within that area They correctly state that there is no mention of a gap in services within the PNA and that is why this application is for unforeseen benefits. We would argue that the local situation has already changed since it was published in March 2015 (presumably it was formulated a little prior to that) in that the Abbey Homes development of 93 homes is now well underway and The Mount development has been completed We have addressed the matter of choice in detail earlier in this report and do not agree that the local residents do enjoy reasonable choice due to the difficulties in accessing the existing pharmacies. We have also outlined those residents we believe share protected characteristics and the reasons why they have difficulty accessing pharmaceutical services.

15 NHS Canterbury Coastal and Coastal CCG- dated 5 th October 2015 In their it states: I would agree in principle with this application. As stated there are a large number of housing units being built in the area slightly further away from the city centre than the proposed pharmacy.although the distance from the pharmacy is not very far, it is a very steep hill which could cause problems to anyone with mobility problems. In addition the traffic has become very congested.the position of this pharmacy will provide services which would be within walking distance of the current and new development and by walking on relatively level ground These comments simply further confirm that access to the existing pharmacies is difficult and the new developments will add to the need for services within the immdiate area. Boots-Letter dated 11 th September Boots highlight the number of pharmacies located within a mile radius but fail to state how difficult it is for people to access them. They then comment on the proposed new developments within the area and that it is reasonable to suggest that they were taken into account when the PNA was published which we have commented on earlier within this document. We have clearly addressed their comments on choice within this document along with people with protected characteristics within the area. Kent LMC-letter dated 16 th September As with other responses they have stated the number of contractors locally and that there was no mention of a gap in services within the PNA. The main crux of their argument seems to revolve around the fact that existing contractors can offer a collection/delivery service to both the existing local residents and the new ones that move into the area once the new housing is completed. In our view that just strengthens our arguments further that those residents have difficulty accessing the existing services so rely on deliveries. A delivery service is no substitution for a community pharmacy offering a full range of services. Canterbury Pharmacies-letter dated 2 nd October We have now clarified where our client is intending to open the pharmacy should this application be approved. Canterbury Pharmacies make comment on the lack of a gap in services within the PNA which we have addressed earlier within this document.

16 They go on to say that the Abbey Homes development at Pilgrims place is a small one which we refute as we consider 93 dwellings to of significant size. We have addressed their comments in relation to St Martins Hospital and Howe Barracks earlier in this document They confirm our arguments that Canterbury has traffic congestion problems when they cite the chronic congestion on the A 28 We accept that since our application was originally submitted the Chaucer School within the Spring Lane Estate has closed however it may well be utilised again over the coming years as outlined in this article: We have already commented on the facilities within the parade of shops in Sussex Avenue and the issues surrounding public transport. Conclusions In our view taking all of the above evidence into account, NHS England Area Team has reached the wrong conclusion in deciding to refuse this application. This application will secure both improvements in, and better access to, pharmaceutical services for people resident in St Martins Hill area as well as visitors and employees accustomed to using the facilities within the area. If our clients negotiations are successful the local residents will enjoy access to a community pharmacy within a very well used convenience store which has a post office and cash point facilities negating the need for them to travel to access the existing pharmacies. The nearest pharmacies are located a significant distance away and are not easily accessible for many people in the local area but particularly those with protected characteristics. The Spring Lane Estate is a deprived area where residents have very low car ownership. In addition the journey into the town centre for pedestrians is far from straightforward and as a result in our opinion they do not currently have reasonable choice in respect of access to pharmaceutical services. The provision of a genuine community pharmacy in the area will not only address the current access difficulties but will make a significant difference to the health of the local population.

17 We respectfully request, therefore, this appeal is upheld and the decision on NHS England is overturned. Yours faithfully Martin Phypers Director pharmacy sales & consultancy t: m:

18 25 January 2016 Mrs B Patel c/o Martin Phypers Pharmacy Advice and Consultancy Services 28 Garnon Mead Coopersale Epping Essex CM16 7RN South (South East) Region Team Wharf House Medway Wharf Road Tonbridge TN9 1RE Correspondence address: PLA Department KPCA Faith House 2 St Faiths Street Maidstone Kent, ME14 1LL Dear Mr Phypers Re: Application offering unforeseen benefits within 100m of the Londis Convenience Store, 31 St Martins Hill, Canterbury, CT1 1PU. NHS England has considered the above application and I am writing to notify you that it has been refused. The case was considered was as follows:- An application made under Regulation 18 from Mrs Beejal Patel for a pharmacy offering unforeseen benefits specifying within 100 metres of the Londis Convenience Store, 31 St Martins Hill, Canterbury, CT1 1PU. There were no declarations of interest. On the basis of the information before the Committee, it was agreed that it was not necessary to hold an oral hearing. Notification Exercise It was noted that responses had been received from the following parties: Paydens t/a Canterbury Pharmacy Boots the Chemist Devkipharm Ltd t/a Porter Chemist NHS Canterbury & Coastal Clinical Commissioning Group Kent Local Pharmaceutical Committee Consideration The Committee considered whether or not to approve the application for a proposed new pharmacy and took into account the relevant Regulation(s) and a range of other factors including those set out in the Department of Health s publication Information for Primary Care Trusts, published in August 2012.

19 Site visit Prior to the meeting, a member of the Pharmacy Contract Team had undertaken a visit to the proposed best estimate location including the immediately surrounding area. Her findings are outlined below for the Committee s consideration. Leaving Canterbury City centre heading East up St Martins Hill towards the proposed site I noted that the road was very busy. There was housing on both sides with a constant flow of twoway traffic. I headed up the steep hill which could be quite an obstacle to elderly, infirmed or parents with small children. Double yellow lines were on both sides of the road, some metered parking bays were half way up, about 5-10 minutes walk from the proposed site, with space for up to four cars. The road is well-lit and there is a pavement on both sides of the road leading up to proposed site. The best estimate for the proposed site is centred on a Londis shop. This nestled between houses on that side of the road in a residential area. There is very restricted parking, just space for 3-4 cars in temporary bays (free parking) outside Londis. Directly opposite the Londis store is an open field and, a few metres further along the road, a light-controlled pedestrian crossing. Adjacent to the field is Chaucer Care Home. Just past the Londis, St Martins Hill becomes Littlebourne Road. Howe Barracks are on the same side of the road as Londis and are about 5-10 minutes walk away, with what looks like service housing on opposite side of road. Further along Littlebourne Road, about 10 minutes walk away from Londis, is a large housing development currently under construction. St Martins Hospital site stretches along about 400 metres along on the opposite side of road. There is a pavement on one side of the road in the some places along Littlebourne Road. New Dover Road Surgery is 1.2 km away from the proposed site back towards the City centre in a south westerly direction. This is journey would take about 4 minutes by car or 12 minutes on foot. There is a branch of Your Local Boots close by this surgery but slightly nearer the proposed site at the end of New Dover Road in the St George s Centre. This is approximately 1 km from the proposed site.. Cossington House Surgery is approximately 1.3 km away from the proposed site in the same direction. Another branch of Your Local Boots is very close by (near a Waitrose store), with similar journey times as mentioned above.. Northgate Medical Practice is approximately 1.4 km away from the proposed site in a northerly direction and further in to the City centre with two pharmacies (Sainsbury s and Eckersley) relatively nearby. Because of the road system in this part of Canterbury, the journey by car would take about 8 minutes (or 16 minutes on foot). All distances and timings are taken from Google maps. There are a number of bus services running to and from Canterbury city centre and which, between them, run frequent services linking the city centre with the surrounding area. These include routes 11, 13, 13a, 14 and 14a starting at 6.30am. Regulation 31 The Committee first considered Regulation 31 of the regulations which states: (1) A routine or excepted application must be refused where paragraph (2) applies

20 (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). From the information before it, the Committee was of the view that it was not required to refuse the application under the provisions of Regulation 31 provided that any pharmacy subsequently opening as a result of this application was neither within, nor next door to, any premises occupied by an existing pharmacy contractor. As the site visit had shown, the nearest existing pharmacy to the proposed site is the Your Local Boots Pharmacy, St Georges Centre, St Georges Place, Canterbury, CT1 1UL. This is located near the local GP practice and is approximately 1km to the west of the proposed site. Based on the information before it, the Committee concluded that it was not required to refuse the application under the provisions of Regulation 31. Regulation 18 The Committee noted that this was an application for unforeseen benefits and therefore was 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;

21 (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) (ii) 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 to promote innovation)), 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. (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). 1. Will approving the application(s) secure improvements or better access to pharmaceutical services? (Reg 18(1)(a)) The applicant proposed to provide pharmaceutical services for 40 core hours a week, the pattern of which was as follows:- Monday to Friday: Saturdays: Sundays: 9.00 am 1.00 pm and 2.00 pm pm 9.00 am noon Closed

22 It was noted that including the supplementary hours, the pharmacy would be open for 48 hours per week, the pattern of which was as follows:- Monday to Friday: Saturdays: Sundays: 9.00 am 6.00 pm 9.00 am pm Closed The nearest two pharmacies to the proposed site would appear to be two Boots Pharmacies, one at St Georges Centre, St Georges Place, Canterbury, CT1 1UL and 29 Oaten Hill, Canterbury, CT1 3HZ. As the site visit had indicated, the nearest GP practice to the proposed site is the practice at New Dover Road, 10 New Dover Street, Canterbury, CT1 3AP, is approximately 0.2km away from Boots Pharmacy. The four nearest pharmacies to the proposed site are adjacent to the three nearest GP practices. As the site visit showed, these pharmacies are between 1km and 1.4km away from the proposed site. Additionally, there is a Boots pharmacy that holds a 100 hour contract about 1.7 km away from the proposed location and in a large shopping centre in the city. It was noted that there was also regular buses from the town centre along St Martins Hill; bus routes include 11, 13, 13a, 14 and 14a which run from 6.30am until 11pm Monday to Friday and offer weekend coverage. The applicant highlighted the development planned at the Howe Barracks. However, substantial development and population growth had not yet happened in the area, particularly since March 2015 when the new PNA was published. Therefore, the Committee agreed that the application did not provide significant improvements or better access to pharmaceutical services for either residents of St Martins Hill, or those residents of the surrounding area. 2. Were these improvements included in the PNA? (Reg 18(1)(b)) The Committee then considered the 2015 PNA, published by Kent HWB, which contains an analysis of the situation as it was assessed at the time of publication March The Committee noted the following statement which the Committee felt to be relevant:- The key findings and recommendations of the PNA steering group are 1) Overall there is good pharmaceutical service provision in the majority of Kent. The best estimate location was identified by the applicant as near the Londis Convenience Store, St Martins Hill, Canterbury. The Committee noted that the PNA did not specifically mention Canterbury or the proposed development of the Howe Barracks site or other local housing developments with the potential future increase in local population that would result. Furthermore, it was noted that the housing planned on the Howe Barracks site was a phased development. Therefore, needs of the local population may change over time. However, the Committee agreed that the needs of the area had not changed since March 2015.

23 3. Would granting the application cause significant detriment to the proper planning of the provision of pharmaceutical services in the HWB s area? (Reg 18(2)(a)(i)) There was already good pharmaceutical coverage in the HWB area with no current plans for any changes. However, if the application was to be granted and the pharmacy opened the Committee felt that NHS England would be able to plan for the provision of services and that the existing arrangements for provision of pharmaceutical services in the area would not cause significant detriment to the planning of pharmaceutical services. 4. Would granting the application cause significant detriment to the arrangements for the provision of pharmaceutical services in the area? (Reg 18(2)(a)(ii)) The Committee had no information to demonstrate that pharmaceutical services would be significantly affected by the opening of a further pharmacy. 5. Would significant benefits be conferred on persons in the HWB s area in relation to:- a. Reasonable choice? (Reg 18(2)(b)(1)) The Committee was of the view that St Martins Hill was mainly a residential area on the outskirts of Canterbury city centre and that the residents would travel into Canterbury for the majority of their day to day living requirements. As already indicated above, there was a choice of providers of pharmaceutical services within a reasonable distance and, additionally, the local GP practices had a range of pharmacies situated close to their surgeries. Therefore, the Committee considered that, to have a pharmacy in the proposed location, would not result in a significant increase in choice to the persons in the HWB area. b. Reducing the difficulty of access to services of people with a protected characteristic? (Reg 18(2)(b)(ii)) The applicant had not presented any evidence to support the notion that there were persons with protected characteristics who are currently experiencing any difficulty accessing services. c. Providing an innovative approach to the delivery of pharmaceutical services? (Reg 18(2)(b)(iii)) The Committee considered the range of services set out in the application and which the applicant intended to provide should the application be granted. The Committee was of the view that the proposed services were merely the normal range of pharmaceutical services to be supplied by any pharmacist under the NHS contract e.g. essential, advanced and enhanced services. Additionally, the Committee did not consider these to be innovative, either in type or method of delivery as envisaged by the Regulations.

24 Decision The Committee carefully considered the various factors against which applications made under Regulation 18 must be determined and decided that the required criteria had not been satisfied and accordingly refused the application. You have a right of appeal to the Secretary of State against NHS England s decision. Should you choose to appeal then you should send a concise and reasoned statement of the grounds for your appeal within 30 days of the date of this letter to: Family Health Services Appeal Unit 1 Trevelyan Square Boar Lane Leeds LS1 6AE Yours sincerely Felicity Cox Director of Commissioning Operations NHS England South (South East)

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