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Dispensing

Centralised dispensing: the next step in the evolution of pharmacy?

Proposals to amend legislation so that the playing field is levelled for all pharmacies to use centralised dispensing is the right move if pharmacists are to provide more clinical services.

Proposals to amend legislation so that the playing field is levelled for all pharmacies to use centralised dispensing is the right move if pharmacists are to provide more clinical services. In the image, hands holding cogs

Source: istockphoto.com

Centralised dispensing — otherwise known as hub and spoke — is a growing model in which prescriptions are assembled, dispensed and labelled at a dedicated facility (the ‘hub’) before being transported to a local pharmacy (the ‘spoke’) either for a patient to pick up or to be delivered to a patient’s home. The process is more automated than traditional dispensing, and it has been claimed that it is safer and more efficient while reducing the need for pharmacists’ involvement in the dispensing process.

Lloydspharmacy is one chain that is developing this model in the UK, as are other multiples, but more widespread use across community pharmacy is limited by legislation that requires both the hub and the spoke to be owned by a single business. This may be about to change.

Speaking at the Pharmacy Show in Birmingham in October 2015, community and social care minister Alistair Burt announced that the government wants to introduce new legislation that would change the ownership rule to enable independent pharmacies to adopt the model as well.

The move should free the pharmacy team’s time in the dispensary to provide patients and customers with over-the-counter medicines advice, counselling and clinical services, such as medicines use reviews, the new medicine service and influenza vaccinations.

Various pharmacy organisations have responded to the plan. Sue Sharpe, chief executive of the Pharmaceutical Services Negotiating Committee, which represents NHS pharmacy contractors, says the hub-and-spoke model could divide the pharmacy sector by putting smaller businesses at a disadvantage. The National Pharmacy Association, the trade association for community pharmacies, has urged caution, pointing out that risks should be considered, including patient safety, information governance and the overall impact on patient experience. Even Pharmacy Voice — representing three large community pharmacy trade associations — which previously advocated for change in legislation to level the playing field for all pharmacies to use hub-and-spoke dispensing, is now watching carefully.

Although not opposed to the plans, the Royal Pharmaceutical Society wants more evidence that centralised dispensing does indeed increase efficiency. It also wants clarity on responsibility and accountability if a patient’s prescription journey is split between a hub and a spoke. The trade union Pharmacists’ Defence Association is more positive about the proposals but highlighted that major changes will need to be made to the pharmacy contract. Additionally, reduced dispensing fees resulting from any efficiency savings is a legitimate concern for pharmacy.

Yet if community pharmacy is to become more clinical and patient focused then a change in legislation to make centralised dispensing easier for all pharmacies is the right way forward. The number of prescriptions dispensed continues to increase year on year, meaning pharmacists and their staff spend even more time preparing prescriptions when they could be interacting with patients, counselling them about their medicines, and offering and providing appropriate services.

If it delivers what it promises, centralised dispensing will certainly free those working in the spoke to provide more of these services. Of course, questions and concerns about safety and liability must be addressed first.

Pharmacy is not alone in facing technologies that disrupt its business model. For example, some high street bookshop chains resisted the rise of Amazon and other online booksellers, and were slow to adapt to the changing market. Given these proposals from the government, the sooner pharmacy embraces the opportunities of technology and adapts to new models, the fitter it will be to survive.

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2015.20200284

Readers' comments (4)

  • I believe that in law the Pharmacist responsible for physically handing over or delivering a patient's medication from a NHS contracted pharmacy, is held accountable for any errors, for in law, that Pharmacist has a duty to ensure the medication is suitable for the patient.
    Thus in practical terms every responsible pharmacist or accredited technician should have to check the contents of each bag of medications sent from the HUB, prior to the bag being passed to the patient.
    Therefore the claim that Hub and Spoke save Pharmacists time is nonsense.
    I suggest the real motive for Hub and Spoke is to obtain profit from "untouchable" discounts obtained by the NON NHS contracted Hub pharmacy.
    At present only NHS Contracted Pharmacies have to repay monies in accordance with the Drug Tariff discounts scale, so in reality the Hub is buying at massively discounted prices and the parent company uses" creative accountancy" to re-charge costs of medications to the Spoke pharmacies ,who actually never purchased anything.
    If Hub and Spoke pharmacies are such a good idea does anyone not ask why we older pharmacists didn't think of them?
    l am sure the reason was that our interpretation of the regulations was that such a system, which manipulated discounts, would break every rule in the Drug Tariff, and leave us open to prosecution for defrauding the NHS, it is strange how time changes interpretations.
    .

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  • I believe the idea that hub and spoke will save pharmacist's time to be used in other clinical work is a fallacy no doubt promoted by those who see it as opportunity to increase their market share of prescription business and thus to negotiate better discounts on drug purchases. I am convinced there will be few if any patient benefits since it is only by studying each patient prescription that a pharmacist can properly give specific clinical advice to a patient.
    So where do the advocates of " hub and spoke " including The Minister, the Regulator and others such as Keith Ridge most of whom seem to know very little of the importance of supervising pharmacist input into the dispensing process in the middle of the second decade of the 21st. century. When they learn more these administrators would avoid putting the patient population at serious risk by exchanging the present systems to "Hub & Spoke" ones.. I suppose the next item on their agenda is to allow surgery staff to produce all repeat prescriptions without involving the patient's G.P. and so allow them ,the G.P.'s more clinical time with patients!!
    Gerry Green

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  • Glad I saw the writing on the wall for the future of community pharmacy when I sold my business!
    How long before GP practices start being approached to become 'spokes' in some nightmare mega 'hub & spoke' model that will kill off pharmacy for good?
    I now do part-time work in a 'hybrid' pharmacy (NHS contract pharmacy and GP dispensary, co-located). I can assure you GP's are already there regarding repeat prescriptions.

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  • I do not wish to be a dinosaur and dismiss this idea of hub and spoke out of hand. We do indeed spend vast amounts of time on the dispensing process. However the idea that this will free up pharmacist time to interact with patients is not necessarily the case. For example, it is currently quite difficult to conduct MUR's as the patient has to be present for this to happen - with collection and delivery the patient is not present in the shop and this is likely to become even more common with hub and spoke. I work one morning per week in a community pharmacy alongside the owner just to provide MUR's and am paid according to how many I carry out - on a good morning I can undertake five in four hours!
    I also have major concerns about employment prospects in the future - what rate is likely to be paid to a pharmacist sat in a shop in the hope that a patient will wish to have a conversation with them?
    In the extreme case I can see community pharmacy just providing the acute prescriptions such as antibiotics and steroids while all other prescriptions are dispensed at a distance. What then happens when Mrs Smith has left it late to order her prescription and requires an emergency supply? No stock of medication at the pharmacy and a time delay if trying to sort this out via hub and spoke.
    The recent debacle over Pharmacy2U should be ringing alarm bells! it fell to local pharmacies to sort out the mess, something that may well be impossible in the bold new world!

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