By Mark Lyonette
The NPA has been keen to emphasise that community pharmacy can deliver so much more for the National Health Service if pharmacists are empowered to operate at their full scope of practice. So it is right that the five-year deal for community pharmacy embraces that vision, with community pharmacy being asked to provide key new services. It will be important now for independents to deliver on this new clinical service agenda. However, we should not underestimate the change that this represents for many pharmacies and the effort that is required to implement this at scale.
And, of course, achieving these changes will be more difficult starting from the present perilous position of pharmacy finances, and with the flat funding of £2.59bn year on year. We have stated to the Government that pharmacies are being asked to manage increased workloads whilst absorbing inflationary pressures such as increases in the minimum wage, pension contributions and new regulations. The government must be prepared to direct more money into community pharmacy if it becomes clear that funding is insufficient to maintain current core services and invest in positive new developments like the Community Pharmacist Consultation Service (CPCF).
One key aspect of the contract is the proposed expanded role of community pharmacy and, as the Department of Health and Social Care (DHSC) put it, the need to make dispensing “more efficient to free pharmacists up”. In order to achieve this, both PSNC and DHSC will work together to “pursue legislative change to allow all pharmacies to benefit from more efficient hub and spoke dispensing, enabling increased use of automation and all the benefits that that brings.”
But how much do we know about the economics and the feasibility of hub and spoke? Is it more efficient and is it something that independents in the UK should be looking to embrace at this time?
On paper, hub and spoke makes sense. We have a growing dispensing workload and if we are to take on more clinical services then we need to create the time to do this work. We also have a professional responsibility to constantly improve what we do – and so if, and I stress the word if, this provides a safer and more efficient system, we are bound to consider these possibilities.
There are many options to consider. We can automate locally by putting a robot in a pharmacy; we can centralise supply support by automation; or we can adopt one of two forms of hub and spoke – intracompany where the hub supplies to branches of a multiple, and inter-company where a pharmacy outsources elements of its dispensing to a third-party. And then there are the different forms of dispensing such as standard pack dispensing and individual dose dispensing (MDS).
So we have, broadly speaking, four models of automation and two forms of dispensing – effectively eight different scenarios that we need to consider. This is not a question of whether we say yes or no to hub and spoke. This is a question of what is right for a particular pharmacy given the eight different ways of working offered up in this debate.
In 2016 the NPA established a research group to consider the implications of introducing hub and spoke in the UK. We felt that whilst some in the sector have been thinking about this for many years – most independents have no understanding of how this might work. We commissioned a literature search, surveyed over 400 members, visited a hub and interviewed 20 experts from pharmacy, the law, logistics and other sectors, from the UK and from around Europe.
While this research suggested some opportunities, it also highlighted barriers that would need to be overcome, such as the risk of introducing new process errors; lack of clarity on the ownership of problems between the hub and spoke; longer lead times; new costs; an impact on procurement margin; a reduction in system resilience and problems caused by restrictive distribution arrangements. We have supplemented this research more recently by investigating models of automation from around the world.
As technology continues to develop, we cannot rule out the adoption of hub and spoke as an option at some point. But it is important to note that globally, there has been a very limited adoption of inter-company hub and spoke for automated dose dispensing. For standard dispensing, there is even less experience and evidence.
The NPA will remain at the forefront of thinking and research in this area – to ensure that our members are not left behind. Responding to hub and spoke at this time should be an individual decision based on numerous factors (inter or intra-company model, existing capacity, level of efficiency, opportunities for new services, dose dispensing and standard dispensing). It is important that no-one – not the DHSC, not pharmacy leaders and not pharmacy owners – should make assumptions in relation to cost, ability to release capacity or safety.
Mark Lyonette is Chief Executive at the National Pharmacy Association.
This article also appears in the September issue of Pharmacy Business.