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.