Mergers, dispensing and appeal decisions – things to be aware of Wednesday 17 October 2018 DDA annual conference Charlotte Goodson, adviser

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Appeal decisions Appeals heard between April and September 2018 Type of application Number of appeals Number granted Unforeseen benefits 30 2 Distance selling premises 12 10 No significant change relocations 3 Current needs Future needs Improvements or better access

Unforeseen benefits applications (1) Applications offering something that was not identified in the relevant pharmaceutical needs assessment Three factors to consider: Reasonable choice with regard to obtaining pharmaceutical services in the area of the health and wellbeing board People sharing a protected characteristics having access to pharmaceutical services which meet their specific needs which are difficult for them to access Innovative approaches to the delivery of pharmaceutical services Only need to satisfy one factor

Unforeseen benefits applications (2) Choice In order to have reasonable choice pharmacies must be accessible NHS Resolution looks at access on foot, by public transport and by private transport Distance of itself does not mean that there isn’t choice Just because it’s too far to walk doesn’t mean there is difficulty in obtaining choice This factor is generally the reason why an unforeseen benefits application is granted

Reserved locations (1) Introduced in 2005 Considered in relation to applications for new pharmacies in controlled localities (excluding distance selling premises) Controlled locality – area that has been determined to be ‘rural in character’ If a reserved location is determined it means that people living within 1.6km of the new pharmacy can continue to be dispensed to once/if it opens

Reserved locations (2) Two factors to consider: Number of people who reside within 1.6km of the proposed pharmacy and who are registered with a GP, and The use of pharmaceutical services If the number of people living within 1.6km of the proposed pharmacy who are registered with a GP is less than 2,750 a reserved location has been determined

Reserved locations (3) NHS Resolution has changed its approach in considering this matter In November 2016 it took account of the total number of patients using the GP dispensary in the village – as this figure was higher than the 2,291 residents who lived within 1.6km of the proposed pharmacy it didn’t determine a reserved location

Reserved locations (4) In later cases NHS Resolution has taken into account a practice’s level of prescribing and dispensing and facilities which may draw other people in for example schools and shops Implication – don’t assume you are safe just because there are less than 2,750 residents in a village

Reserved locations (5) Figures published for number of items dispensed: Will include personally administered items – can you strip these out? Are for the whole practice, an issue if the application is near to one of your sites – can you calculate the number of items dispensed at that site? Whilst more people may visit the village because of the facilities, they will remain as dispensing patients and so won’t be able to access most of the advanced services offered by the pharmacy

Gradualisation (1) May be given to dispensing practices who are affected by the granting of an application for a new pharmacy NHS England manual says between one and three months, up to six months in exceptional circumstances: the loss by a dispensing practice of all its dispensing patients, where the reduction in the number of dispensing patients would lead to staff changes or redundancies, or where there is only one pharmacy within a 1.6km of the practice premises and that is the pharmacy that is opening and its ability to absorb former dispensing patients effectively needs to be staged over time.

Gradualisation (2) Four appeal decisions in the last year: Sept 2017, loss of 53.7% of dispensing patients – six months Nov 2017, loss of 52% of dispensing patients – three months May 2018, loss of 33% of dispensing patients – four months Sept 2018, loss of 15.5% of dispensing patients – three months

Gradualisation (3) 1996 case of R v North Yorkshire FHSA ex parte Dr Wilson and Partners Can undertake some planning prior to the opening of the pharmacy, but recognise need to continue to provide services and dispense to patients Application had been granted on the basis that it would provide significant benefits and these should not be unreasonably delayed NHSR stated that it cannot be influenced by a medical practice's reliance on an income generated from dispensing to fund other services where legal precedent clearly states it should not depend on such funding. But no information provided in support of the practice's assertions regarding redundancies and job changes.

Mergers (1) Talk to NHS England and your CCG about dispensing early on You need to be know Which premises you plan to dispense from and whether you have premises approval for them, Which area or areas you can dispense to from those premises, and Whether you have a historic right or outline consent to dispense to that area or those areas

Mergers (2) If you wish to dispense from premises for which you do not have premises approval you will need to apply for premises approval If however there is a pharmacy within 1.6km of those premises your application must be refused. Exception - the only pharmacy is a distance selling premises If you wish to dispense to a new area as a result of a merger you will need to apply for outline consent and premises approval

Mergers (3) If you merge with a non-dispensing practice you will not be able to dispense to the previously non-dispensing patients who live in areas that you have historic rights and premises approval for – patients will not meet the requirements of regulation 48(3)(b) If however you have outline consent and premises approval for those areas then you can dispense to them

Beware of outstanding pharmacy applications (1) Relevant to any application for outline consent and/or premises approval On the day before your application reaches its final outcome there is an application for a new pharmacy which is within 1.6km of the premises you are applying in respect of which: Has not yet been determined or, Has been determined but the applicant hasn’t submitted their notice of commencement

Beware of outstanding pharmacy applications (2) Even though your application may have been granted it cannot take effect for 12 months If the pharmacy opens then the grant of your application will lapse

Thank you for listening. Any questions?