‘Hub-and-spoke: Why modern doesn't necessarily mean machines'
Laura Buckley has a lot of questions that need to be answered about the hub-and-spoke dispensing model. Will it mean patients will lose that connection to local pharmacists?
Hub-and-spoke dispensing appears to be the Marmite of the pharmacy world; I’ve seen it divide opinions in a way that only Brexit could rival.
Employing sizeable hubs to dispense medicines on a large scale for redistribution to either pharmacies or direct to patient doesn’t sit right with me, so you could say I’m not a lover of this model.
While freeing up pharmacy teams to provide more services seems to be the aim of the game, I remain unconvinced and concerned about a potential impact on job losses and patient interaction. If we consider the services that the hub-and-spoke model is supposed to be freeing pharmacy teams up for, we need to see them commissioned first and in such a way that ensures a steady income for pharmacies and adequate training provision for those involved. Patients need to benefit in a big way to make this model even worth considering; I’m not so sure a move to hub-and-spoke holds patients’ interests at heart.
For me, it all seems too business-focussed and feels like it benefits the large multiples, allowing them to churn out medicines factory-style, while minimising the costs of employing staff. What should we expect for the smaller chains and independent pharmacies that cannot possibly develop or rival models like the hub-and-spoke?
I’m concerned that the benefits of such a large-scale rollout of hub-and-spoke will be severely outweighed by the negative impact on so many job roles and will risk destroying the infrastructure that underpins patient access to community pharmacy. As more hubs open, are we to expect fewer spokes in the community, thereby reducing the pharmacy/pharmacist-to-patient ratio? Will this reduce local access to community pharmacy?
Are we to see a move to robotics, which is expensive and replaces a workforce? And what of the evidence to support the move in this direction?
As a pharmacist, I very much believe in community pharmacies and their work remaining in the heart of the community. I think building patient relationships and being familiar with their medicinal needs is safer, more satisfying for the patient and a more personalised form of care. There’s comfort in knowing those who prepare your prescriptions and there’s comfort in knowing you can call in at your local pharmacy at any point. Robotics don’t have the same senses that pharmacists do and while you can programme a machine to be efficient, can you instil the sixth sense for concern that pharmacists develop from years of training and experience?
Without adequate commissioning of services and a lack of need to dispense due to hubs, it wouldn’t be economically viable to keep pharmacies open and I fear it would be the end for traditional community pharmacy as we know it. Patients deserve better than this and we as a workforce deserve more than being subjected to a system overhaul to make us more of a factory and less of a pharmacy.
Change is inevitable and we have been clamouring for change in the community pharmacy sector for a long time. But change in the form of developing more hub-and-spoke dispensing, and without evidence to support safety for patients and the safeguarding of jobs and patient access, feels like a rash move. I’m yet to see compelling information to convince me that hub-and-spoke is a positive move for pharmacy; modern doesn’t mean machines and factory settings, it means personalised care for patients without cutting corners to make profit.
Laura Buckley is a locum and a pharmacist at a PCN in East Yorkshire
Find out more about the hub-and-spoke model here