Re : Application offering Unforeseen Benefits by S Chandarana within 200m of Leysdown Road, Leysdown-on-Sea, Isle of Sheppey

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1 N V Morley, MRPharmS 7-8 Prospect Court Courteenhall Road Blisworth Northamptonshire NN7 3DG Telephone: Facsimile: office@nvmholdings.com 7th January 2016 The NHS Litigation Authority Appeal Unit 1 Trevelyan Square Boar Lane Leeds LS1 7AE Also by fhsau@nhsla.com Dear Sirs Re : Application offering Unforeseen Benefits by S Chandarana within 200m of Leysdown Road, Leysdown-on-Sea, Isle of Sheppey I am instructed by St Georges Medical Centre Sheerness Kent whose interests are significantly affected by the determination to conditionally approve the above application. The determination was made by NHS England South (South East Regional Team) and my clients were informed by the communication of the 9 th December My clients are writing to you separately confirming their authority for me to represent them. My clients wish to appeal the determination to approve the substantive application. On their behalf we would say:- 1. My clients are the sole dispensing practice on the Isle of Sheppey with a dispensing branch surgery within close proximity of the best estimate location which has been defined as within 200 metres of ME12 4RE. Their interests are therefore significantly affected by this application. 2. We note that the relevant committee (as per the determination letter) did not consider a specific site visit was necessary. We respectfully adduce that in such an important matter, the committee have misdirected themselves by not having a specific site visit especially, as only one of the committee have local knowledge of the area. We would therefore

2 say that contrary to the assertion in the determination letter, the decision was not made in a safe manner. 3. We note that the committee considered Regulation 31 of the Regulations and are content with their decision. 4. We note that the committee have determined that Leysdown on Sea and the surrounding area are a controlled locality and we are content with that decision. 5. We note that on the date of notification of the postcode ME12 4RE specified by the applicant on the 18 th May 2015 as the notional central point, the total registered population residing within a 1.6km radius of that point was Therefore on that basis, the committee considered that the conditions of Regulation 41 (3) had been met and agreed that the area should be regarded as a reserved location. We concur and are content with that decision. 6. Regulation 18 On behalf of my clients we adduced substantial evidence in our letters of the 26 th August 2015 in relation to the application and on the 2 nd November 2015 in relation to the responses from interested parties. We attach both letters. However, we would wish to reiterate the following points :- a) We would robustly assert that the above Pharmaceutical Regulation 18 application should be refused as it does not meet the parameters of the NHS Pharmaceutical and Local Pharmaceutical Services Regulations 2013 in that there has been no major or minor changes to Leysdown on Sea since the publication of the last Pharmaceutical Needs Assessment (PNA) by the relevant Health and Wellbeing Board (HWB). b) Other than the assertion that there is no pharmaceutical provider in Leysdown on Sea, the applicant has provided no evidence of issues regarding choice and access let alone any benefits to people with particular characteristics or innovative services. We would therefore say this application fails to meet any of the three tests of Regulation 18. c) We would say in reference to the communication response of Kent Local Pharmaceutical Committee dated the 14 th July 2015 that significant weight should be put on the fact that Kent LPC has not supported this application.

3 Conclusion There was no support of the above application and all interested parties adduced substantial relevant evidence confirming that in their opinion, that this application did not meet the parameters of Regulation 18. We would say that on at least the balance of probabilities it is clear that the weight of evidence should allow the relevant committee of the NHSLA to grant our appeal and refuse this application. We respectfully invite the authority to refuse the applicant a grant of consent to join the pharmaceutical list of NHS England at the above location. We confirm our willingness to attend an NHSLA local oral hearing if such be constituted. Can you please confirm that all correspondence from yourselves regarding this appeal will be sent to us as our client s representative. Yours sincerely Nigel Vincent Morley, MRPharmS (GPhC No ) Encs x 2

4 N V Morley, MRPharmS 7-8 Prospect Court Courteenhall Road Blisworth Northamptonshire NN7 3DG Telephone: Facsimile: office@nvmholdings.com 26 th August 2015 NHS England South (South East) Region Team PLA Department KPCA Faith House 2 St Faiths Street Maidstone Kent ME14 1LL Dear Sirs Re : Unforeseen Benefits Application by S Chandarana within 200m of Leysdown Road, Leysdown-on-Sea, Isle of Sheppey, ME12 I am instructed by St Georges Medical Centre Sheerness Kent. You should have received a letter of authority from them. My clients are the only dispensing medical practice on the Isle of Sheppey and therefore their interests are significantly affected by this application. On behalf of my clients I would wish to comment as follows:- 1. We note that the statement by NHS England that the locality of the applicant s site is rural which we are in total agreement with. We would comment that there has been no substantial change since the last determination which would give cause to query the rurality of the area and indeed, there have been reductions in facilities and infrastructure in Leysdown on Sea. 2. We note that according to your records the number of registered patients living within 1.6km of ME12 4RE on the date of receipt of the application was 2333 and therefore, we would say that Leysdown on Sea should be designated a reserved location.

5 3.1 Should Leysdown on Sea be determined not to be a reserved location (which we do not concede) we would say that there will be prejudice to medical services due to the non viability of the maintenance of a non dispensing branch surgery at Leysdown on Sea. 3.2 My clients, the St Georges Medical Practice, have three branch surgeries at Eastchurch, Leysdown and Warden Bay. All three branches are dispensing. My clients are the only dispensing practice on the Isle of Sheppey. 3.3 It is robustly asserted by my clients that it is only the dispensing income which allows it the luxury of maintaining three branch surgeries on the island. I am informed that none of the other prescribing only medical practices on the Isle of Sheppey have branch surgeries on the East side of the Island. 3.4 It is a matter of agreement between NHS England and the practice that the three branch surgeries whilst acknowledging the great clinical and pharmaceutical benefit to the islanders, are not fit for purpose and would emphatically fail a serious CQC Inspection if such were to occur. It has therefore been agreed by NHS England that they will be very supportive of the business case proposition supplied by my clients in that a new purpose built fully compliant Health Centre be built in the Leysdown / Warden Bay locality on Sea locality to replace the three existing branches on the Eastern side of the Island. 3.5 This new facility would be open every day for extended hours. Currently none of the three branch surgeries offers a full opening hours service especially in the afternoons when patients only have a choice of one branch surgery they can access. 4. My clients have received no complaints from their patients in respect of a lack of pharmaceutical services in Leysdown. It is understood that many of the pharmacies on the Island will deliver prescriptions on request patients in the locality - as do my clients. 5. NHS England will be aware of the large number of temporary residents that are serviced for both their medical and pharmaceutical needs at the three branch surgeries. Should this pharmacy application be granted, and the pharmacy open (which we do not concede) then substantial numbers of patients will be denied the opportunity to access medical and pharmaceutical dispensing services within a reasonable distance of their caravan park, bed and breakfast or other temporary residential accommodation.. 6. In the event that NHS England decides, because of the significant impact of this application on local medical and pharmaceutical services to constitute an NHS England local oral hearing, my clients confirm their intention to attend to give oral evidence.

6 7. We would robustly assert that the above Pharmaceutical Regulation 18 application should be refused as it does not meet the parameters of of the NHS Pharmaceutical and Local Pharmaceutical Services Regulations 2013 in that there has been no major or minor changes to Leysdown on Sea since the publication of the last Pharmaceutical Needs Assessment (PNA) by the relevant Health and Wellbeing Board (HWB). 8. We would respectfully say that the applicant s application shows a poverty of evidence and information in general and in particular, is believed to be a duplicate generic application of a similar style used by the applicant in other applications to NHS Essex and other areas. 9. Other than the assertion that there is no pharmaceutical provider in Leysdown on Sea, the applicant has provided no evidence of issues regarding choice and access let alone any benefits to people with particular characteristics or innovative services. We would therefore say this application fails to meet any of the three tests of Regulation If this pharmaceutical application were to proceed to opening, then my clients assert without any hesitation or equivocation, that the new proposed health centre in Leysdown will not proceed and the future of the three branch surgeries cannot be guaranteed in view of their non compliance with CQC criteria. Conclusion We would say that Leysdown on Sea is a rural reserved location. We would robustly assert that the above Pharmaceutical Regulation 18 application should be refused as it does not meet any of the parameters of of the current NHS Pharmaceutical and Local Pharmaceutical Services Regulations. We respectfully invite NHS England after due consultation to refuse this application for unforeseen benefits as it is not compliant with the Regulations. We respectfully invite NHS England after due consultation to confirm the rurality and reserved location status of Leysdown on Sea. Since my client s interests are significant affected by this application, could you please copy myself in all correspondence to and from NHS England relating to this application. My clients are very content to engage with NHS England on any matter relating to this application or the relevance to the proposed new health centre in Leysdown on Sea or Warden Bay locality. Yours sincerely Nigel Vincent Morley, MRPharmS

7 (GPhC No )

8 N V Morley, MRPharmS 7-8 Prospect Court Courteenhall Road Blisworth Northamptonshire NN7 3DG Telephone: Facsimile: office@nvmholdings.com 2 nd November 2015 NHS England South (South East) Region Team PLA Department KPCA Faith House 2 St Faiths Street Maidstone Kent ME14 1LL Also by Dear Sirs Re : Application offering Unforeseen Benefits by S Chandarana within 200m of Leysdown Road, Leysdown-on-Sea, Isle of Sheppey, ME12 I was surprised that I was not circulated with the responses to the consultation to the above application despite the fact that I had written to you on the 26 th August 2015 informing you that I was instructed by St Georges Medical Centre Sheerness and that you would have received a letter of authority from them. I note this letter of the 26 th August is included in the responses sent to my client. I have now received belatedly a copy of the responses which was sent to the practice on second enquiry as your initial correspondence to my clients regarding the consultation responses was addressed to a Practice Manager whom I am informed left the practice 10 years ago. On behalf of my clients I would like to make the following observations regarding the consultation responses. Boots dated the 28 th August 2015 We agree with all the comments made by Boots in general and in particular agree that the applicant has not provided significant evidence even on the balance of probabilities to justify a grant of consent under the Pharmaceutical Regulations.

9 Kent Local Medical Committee dated the 24 th August 2015 We agree with the observations made by Kent Local Medical Committee in general and in particular, their reference to the current Pharmaceutical Needs Assessment. Paydens Limited 10 th August 2015 We agree with the comments by this respondent in general except for the fact that we agree with NHS England s view of the Regulations in regard to the prejudice test and reserved locations rather than the view adduced by Paydens. Kent Local Pharmaceutical Committee dated the 14 th July 2015 We would say that significant weight should be put on the fact that Kent LPC has not supported this application. We note the comments by Warden Parish Council (21 st August 2015), Lyesdown Parish Council (21 st August 2015) and Swale Clinical Commissioning Group (12 th August 2015) which are all opposed for various reasons, some peripheral to the Regulations, to the application. Conclusion None of the responses are supportive of the above application and all have adduced substantial relevant evidence which can be considered by NHS England under the Pharmaceutical Services Regulations. We would say that on at least the balance of probabilities, it is clear that the weight of evidence should allow NHS England to refuse this application without the need of a local oral hearing. We respectfully invite NHS England to refuse this applicant a grant of pharmaceutical commission. We confirm our willingness to attend a local oral hearing if NHS England were to constitute the same. Could you please confirm that all correspondence from NHS England regarding this application will be sent to us as our client s representative. Yours sincerely Nigel Vincent Morley, MRPharmS (GPhC No )