Well to roll out hub-and-spoke to all pharmacies this year

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Well CEO: We’re just working through the final polish for the system
Well CEO: We’re just working through the final polish for the system
Well Pharmacy is planning to roll out hub-and-spoke dispensing across its 800 branches later this year, CEO John Nuttall has revealed.

In an exclusive interview with C+D last week (April 5), Mr Nuttall said there are currently six Well stores using this dispensing model.

“We’re just working through the final polish for the system before we roll it out across the entire business," Mr Nuttall said, "which we intend to do later this year."

"Colleagues" at the pharmacy chain were consulted on the plans to roll the model out via a "series of events", he added. "[Well staff] are now in-the-know of what we're planning to do."

Freeing up pharmacists' time

Mr Nuttall said he was "really excited" about the hub-and-spoke project.

“We want more prescriptions ready on time when the customer comes through the door,” he told C+D. “This system will automatically text customers to let them know [the product] is back in store.”

He stressed that using the hub should “relieve a lot of pharmacists' time” and allow them to be “front and centre, facing the customers”.

"We have built this system ourselves which has a number of advantages and means we can push through more into the hub," Mr Nutall said.

"Our hub is a registered pharmacy, so we are maintaining the importance of bricks and mortar pharmacy," he stressed.

Click here to find out how the multiple is coping with the funding cuts, in C+D's full exclusive interview with Mr Nuttall (pictured).

Listen to C+D's podcast below to find out whether the increasing use of hub-and-spoke will lead to the "Amazonisation" of community pharmacy.

33 Comments
Question: 
What do you make of hub-and-spoke dispensing?

Pro Re Nata, Community pharmacist

 

The route cause of all pharmacy problems is poor quality Pharmacists. Who's to blame for that I am not entirely sure, my money lies with the gatekeeper. For now Pharmacists should prove their worth clinically - leadership is key. Think like an owner....

M Yang, Community pharmacist

This sounds ominous for the staff at Well and potentially bad for the rest of the profession. However, I'd like to raise some genuine questions about hub and spoke:

1) Will the system be relaible enough that dispensing errors are completely eliminated? A great deal of work in the food and manufacturing industries is automated but still show hiccups and require a human being to supervise. When it comes to something as potentially dangerous as medicine errors, I don't think automated systems are at the level of being intelligent and able to replace a human. They won't become tired or lose concentration, but lack human judgement and discretion.

2) Why is Well the only major multiple to roll this out? Boots announced it a while ago but has quietlly shelved it for the time being. We've seen many big businesses reorganise, reshuffle, introduce a new product or introduce new ways of working, all with the intention of trying to become more efficient and avoid going into administration. Often without success. Is there a reason for Well being so eager to roll this out at such a fast pace?

3) Will the independent sector move toward hub and spoke en masse? Is there any real need for the average independent contractor to do so?

Tom Kennedy, Pharmacy Area manager/ Operations Manager

ACTs don't save money at all.  A pharmacist will accuracy check, clinical check, solve problems, know the difference between types of inhalers!!! manage the pharmacy, review staff, provide advice, answer the phone, perform MURs, NMS and run to the counter to put customers shopping through the till.  

An ACT on the other hand will merely take their time and accuracy check the same number of prescriptions as the rest of it "is't their job".  

Plus everyone knows they get locums to do all their training for them, then get it signed off by the pharmacy manager because his review is coming up and he needs good results from the colleague saticfaction survey.

We're years into electronic presctiptions and still suffering from countless technical errors so how is Hub and Spoke going to be anything but a disaster.  Think for now I'll keep paying £17/hr to have a pharmacist do the job of 5 people.

Lucas Perez, Student

Just did a Locum shift at a supermarket, bought a sandwich , pointed to self service checkout, everything is being automised. 

Locums are moaning about pay, so are contractors. Intetesting 12 months ahead 

Shaun Steren, Pharmaceutical Adviser

A 'clinical' role for community pharmacists never arrived. Pseudo-clinical box ticking events such as MURs and NMS were bureaucratised convolutions of the previously very targeted and opportune advice we gave as a part of the dispensing process. Of course, they were very useful in allowing the Labour government to create the illusion of taxpayer value, but more importantly they provided cover for the initiation of a surreptitious dismantling of the dispensing role.  

Technology and massively less expensive human substitutes (also known as ACTs) will now take over the responsibility for dispensing prescriptions.  The number of pharmacies (and so pharmacists) will be massively reduced allowing this new dispensing system to take advantage of economy scale and its own innate low operating cost. This change is actually happening and is now irreversible. I'm not sure what all these pharmacists are going to do with themselves, healthy living advice, MURs and NMS? Good luck with that. 

Benjamin Leon D'Montigny, Non Pharmacist Branch Manager

There's also Dispensing Checkers nowadays for the low price of £150 for the course. You've reminded me of a question I raised a long time ago. If Pharmacists were not a legal requirement, would every pharmacy still have them?

Shaun Steren, Pharmaceutical Adviser

Great question. 

If the legal requirement was removed I can foresee a situation where pharmacists were not deemed necessary for the following reasons:

1) ACTs with advanced scanning technology would produce a dispensing system that is no less accurate but much less expensive 

2) The clinical check could be done by a single pharmacist via a central hub before each Rx is released to a pharmacy (soon everything will be EPS2).

3) Services such as NMS and MURs are wasteful. There is virtually no demand from patients for these services nor healthy living advice (quite the opposite in fact) and there is absolutely no robust evidence for their cost-effectiveness.

Community pharmacists must be topping the lists of which jobs are going to be made redundant by technology and low-cost human operators. 

 

 

Benjamin Leon D'Montigny, Non Pharmacist Branch Manager

I agree with you, Shaun. I cannot see a Pharmacist having the same role as they did in the past if the legal requirements were removed. I don't think they would disappear, but forever changed. For better or worse though, that's the question?

Valentine Trodd, Community pharmacist

Anyone who thinks the investment in H&S is about anything other than saving money i.e. maximising profit, is deluding themselves. This BS about H&S being able to “relieve a lot of pharmacists' time” isn't so they can have a lunch break or an extra coffee or a leisurely chat with Mrs. Brown about her piles - it's so they can get on with more MURs, NMS and other cash-cow pseudo-services and quality payments points. When has 'innovation' ever eased our workload? ETP has INCREASED our workload! The ultimate dream for these people is remote supervision - a single pharmacist running a number of pharmacies via a video screen with a few minimum wagers manning the pumps - and given the way the GPhC seem to bend over for the corporates it's probably closer than we think.

Benjamin Leon D'Montigny, Non Pharmacist Branch Manager

Pharmacy would certainly be totally different when remote supervision arrives, with it own set of benefits and problems. Pharmacy is not how it was years ago. I wonder what it will be like in the future?

Chris Pharmacist, Community pharmacist

Hub and spoke is all about 'efficiency savings'...now investing millions in largescale depots, use of robots and technology would not be cost effective without savings elsewhere. Also, tell me what will dispensors and technicians be doing when instead of dispensing 500-600 EPS a day they are dispensing just 100-200 walk-in Rx's a day?

Andy Burrells, Pre-reg Pharmacist

Doing the same items per month but losing staff (as inevitable) stinks of protecting profit margins I'm afraid.

I feel sorry for our colleagues over at Well

Benjamin Leon D'Montigny, Non Pharmacist Branch Manager

Like mathematically, based on your numbers in a 9 hour working day increase the average amount of time available to complete everything from 54 seconds to dispense an item to 2 minutes 42 seconds. So maybe they can have a decent lunch break, not be stressed out of their minds, and God forbid, have a second cup of coffee!

In seriousness though, the extra strain from government is asking more from pharmacy for less money, so making it easier for our dispensary staff and technicians and pharmacists can only be positive. Of course, I agree - business wise is going to save money, I wrote a blog on C+D several years ago discussing the overall benefits of H&S.

What does this mean for in branch? Are we going to see the evolution of the traditional roles of pharmacy I foretold many moons ago? Maybe. I don't have the answer to that I'm afraid. But you have my word I'm going to ensure that both my staff and patients will be looked after to the best of my ability, I promise this.

Delectable Skeptic, Community pharmacist

From my experience, once the system is in place and the kinks ironed out, each store manager will be asked to find a large number of dispenser hours to cut.  Good luck with looking after your staff when you have to decide who to sack and who to cut their hours in half.  (I'm saying this in sympathy)

Andy Burrells, Pre-reg Pharmacist

All I can say is anecdotally, the patients who provide those items and scripts (the over 65's) won't tolerate the teething problems and the inability to know ones arse from ones elbow so they'll move to a company where they can still have all their meds needs handled onsite.

He thinks he's saving money, but my best guess is profits will slump when people vote with their feet.

La Dakinio, Community pharmacist

Agreed, but people are already voting with their feet. Plus, staff are to be cut 20% so I really wonder about the pharmacists time been "freed up". 

Syd Bashford, Community pharmacist

So, I assume that on return from the HUB the pharmacist will have to check all the items for accuracy again, or will it be fingers crossed, I'm responsible even though our branch had nothing to do with it.....? Not convinced that the patient gets it quicker, that would sureley be impossible, you would have to have some pretty imcompetant dispensers to not get them ready time for when patient arrives. Will definatley mean less staff, and ultimatley will mean as much stress/workload on the pharmacist still..... Cost cutting exercise I'm afraid....

Benjamin Leon D'Montigny, Non Pharmacist Branch Manager

Pharmacist in store will have responsibility, responsibility will be to ensure that the processes are followed. This has been a concern for pharmacists, you are definitely not the first, but think of it this way, you entrust a dispenser to dispense, you entrust a checker to check, and the clinical side of things are still being performed by the pharmacist in branch, the difference being a question of distance. Seeing their processes firsthand, a perscription gets checked more times by multiple people compared to traditional methods through the process. Thats good right? The technology used itself reduced many of the common dispensing errors by reducing the human error potential. A robot does not make mistakes, it does the same thing every time.

Delectable Skeptic, Community pharmacist

"A robot does not make mistakes, it does the same thing every time."

Have to disagree on that one.  It's only as good as the software.  I liken software to DNA, errors pop up every now and again.  Last year, the computer technicians couldn't tell me why their software scanned the (R1) prescription bar code with the scanner and called up a completely different patient's script every single time!

Secondly, redundency.  The hub breaks down a la P2U debacle due to any multitude of reasons and all hell breaks loose. 

I'm with you on reducing many of the likely human errors, just that there's other issues that I haven't seen satisfactorily addressed enough for me to worship at that altar yet.

Benjamin Leon D'Montigny, Non Pharmacist Branch Manager

I agree with you, it is important to ensure that there are backup and redundancies in place, and I believe you raise a very strong point of being super skeptical about any new technology and challenging every single aspect of it. Ultimately, there is always going to be some level of human interaction with the process so there is always going to be a certain level of risk mitigation required.

The big difference between P2U and this model is that the RX never leaves the branch, so if there was any issue with the hub, it can still be dispensed on-site either through the H&S PMR, or Pharmacy Manager, and failing that, the good old pen and paper method from ages past!

Andy Burrells, Pre-reg Pharmacist

What happens when stock is fed in, in error? Who makes sure 35'000 folk get their meds when the machine breaks? Who tells the customers/patients their prescriptions with a all that information on are being sent across the country to be made and then back again... Surely they'd have to consent to data transfer?
There's so much about this our customer base would find unsavory and run 1000 mile about

Benjamin Leon D'Montigny, Non Pharmacist Branch Manager

Good questions Andy. Barcode verification for your first question at every stage of the dispensing process. Secondly, the branch has the ability to switch any dispensing item on-site instantly if there is any issue that means the hub is unable to dispense. Finally, yes informed consent is definitely required so until consent is given, a prescription will not be done using the H&S model.

Beta Blocker, Primary care pharmacist

Well CEO: "I won't put staff under 'massive stress' over cuts" ... Anyone want to have a bet that he's talking rubbish?

Benjamin Leon D'Montigny, Non Pharmacist Branch Manager

Time will tell over the next year.

Shaun Steren, Pharmaceutical Adviser

No it won't, staff have been stressed for years.

Chris Pharmacist, Community pharmacist

Bad news for Well pharmacists but even worse for support staff who will see their jobs disappear even faster to dispensing robots based in large Amazon-style depot's. 

Branches will lose over 60% of dispensing volume, therefore also in excess of 60% of staff hours. A tough period coming up for Well employees.

Benjamin Leon D'Montigny, Non Pharmacist Branch Manager

They are aiming through attrition, so no-one is going to be losing their jobs, however do remember dispensing hours are also protected up to a point under NHS contracts. 10,000 item shop will always have 448 dispensing hours. It's obliged to legally.  

Dodo pharmacist, Community pharmacist

Not any more. The practice payment has gone so there is no minimum staffing requirement any more:

La Dakinio, Community pharmacist

Attrition initially but plan B will follow - staff will be forced to cut hours. Well do things in stages. Don't be fooled.

Benjamin Leon D'Montigny, Non Pharmacist Branch Manager

I'd certainly take on your warnings. If that happens, I'll be sure to make a noise about it as well. My focus will always be staff and patients.

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