Ross Ferguson
I’M loathe to talk about dispensing hubs again – mainly due to the knee jerk reactions of individual short-sighted pharmacists who are blinkered by thoughts of self-preservation that they fail to see the bigger picture – but I’m going to. Change is coming whether we like it or not. We can drive that change or be swept along by it and see where we end up.
The announcement of changes that would enable independents to use a hub and spoke dispensing model brought predictable comments from the usual conspiracy theorists and anonymous trolls to C&D’s website (incidentally, it’s pretty pathetic – it’s easy to take pot shots at those who have opinions and hide behind your anonymity), but I think it rightly creates a level playing field for independents. Let me say from the outset, we need to retain the existing network of community pharmacies and they need to be properly funded to ensure they continue to provide excellent patient care.
But, here’s the thing: the majority of community pharmacists and their teams spend most of their time dispensing and checking prescriptions (yes, I know there are some exceptions) and that is our big problem. Ask yourself the question:
Do you spend the majority of your time involved in the dispensing process? If the answer to this is yes, then read on. If no, then perhaps you’ll share your secret.
Whatever the means (skill mix, IT, hubs), we must remove pharmacists from the mechanical dispensing process to allow them to spend all of their time with patients. “What about the clinical check?” people ask. I’m not suggesting we lose that, in fact the opposite. Pharmacists with more time will be able to conduct medication reviews, explain about new medicines and ensure acute medicines are appropriate. In addition a whole host of other services can be provided.
Again, I’m not suggesting that we give up the supply function, just that we do the bit in between receiving the prescription to having it sitting ready and dispensed on the shelf for collection, differently. And let’s be frank, the in between bit is the boring bit.
Regular patient contact is critical, so any hub system should deliver the prescription back to the pharmacy for collection by the patient. Of course this would only be for repeats, which make up over two-thirds of prescriptions, acute prescriptions would still be dealt with in the pharmacy. We need to add value and that doesn’t mean home delivery.
There are many other issues to overcome: practicalities, accountability, out of stocks, costs, and IT for example, but these are not insurmountable. The costs of a hub system could be shared between many contractors making it more affordable. The cost of not doing something could be more expensive.
The Royal Pharmaceutical Society has spent considerable efforts over the past 12 months promoting and supporting the sexy role of pharmacists in GP practices and is now turning to pharmacists in care homes. Do we have the skills and knowledge to perform these suggested roles in community? Yes. But, do we have the time? No.
In a recent interview Numark’s John D’Arcy mentioned that if required, they would support their members by providing a hub service. Do we really want that close a relationship with wholesalers?
If community pharmacy (and really I mean independents) want to ensure their survival, then they need to lead the change. This means developing the model that ensures pharmacists can spend more time with patients. They need to be driving the development of hubs or some other mechanism – I’m not a hub and spoke evangelist, I just want community pharmacy to prosper – for releasing pharmacists’ time before they are overtaken by events.
So, I’ll ask the question for a final time. If hubs aren’t the answer, how else can we totally free pharmacists from the mechanics of the dispensing process to deliver patient-centred care and improve health outcomes?
Ross Ferguson is an ex-contractor, has been lead community pharmacist and pharmacy champion for a CHP in Scotland, a member of the contractors’ committee and also has experience as a locum and an employee pharmacist. He is a pharmacy & healthcare writer, member of the RPS Faculty and has created a children’s medicines app, Kid-Dose.
Follow Ross @rosshferguson