Behind the counter: Pharmacy+Health, Harrogate

Harrogate is home to the Royal Baths and the Royal Pump Room, which used to be where you’d head for a lovely long bath, or to quench your thirst at the town spa.

These days, you can still do both, via the Turkish baths or by buying a bottle of Harrogate Spring Water on your way down the Kings Road into the town centre, which is where one of Pharmacy+Health’s 31 branches sits nestled in a shopping parade.

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Pharmacy manager Joanna Dixon welcomes C+D inside. She joined the branch in September 2023 just as HubRx bought The Pharmacy Group, a chain started by Leeds community pharmacist Barry Lestner.

The branches, along with a handful of former Lloyds pharmacies bought by HubRx, were rebranded as Pharmacy+Health. It now has a presence across West Yorkshire, North Yorkshire, York and the East Riding.

The Kings Road location was a former Lloyds. Dixon says it “wasn’t a seamless transition”.

“It was difficult for staff, for patients,” she tells C+D. “It was stacked from floor to ceiling with stock, selling everything from sewing kits to Christmas presents.”

Dixon says the rebrand is attempting to change people’s mindsets of what the role of the community pharmacy is, and “making people aware that if you’re not well, come here first.”

With the vision to become “clinical service providers” the branch has more of a healthcare focus to it rather than retail.

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Staff wear uniforms now, and it has its own brand vitamins on display in the open and uncluttered retail space. Dixon laughs that a regular patient said he wants to do his ballroom dancing in the larger space now.

“They’re coming into the pharmacy and seeing a bright, welcoming pharmacy. The services are key, but so is the patient getting a good experience with their everyday prescriptions.”

Ensuring a positive experience through relationship-building with patients is core to what Dixon is instilling as the pharmacy manager.

One patient came in during C+D’s visit to pick up his prescription after complaining that he’d been having a “nightmare” with a nearby supermarket pharmacy.

“A lot of life is faceless as you’re ordering stuff online, so little things like people come in and you know their names. Things like that go a long way, particularly as we have an old population here.

“They’re more likely to come take up the additional services. That’s proved at vaccination time as you always see a tick up in nominations after vaccination because people have a good experience.”

Upskilling

The pharmacy is introducing new services and training not just pharmacists, but other staff to deliver them.

As well as being the pharmacy manager, Dixon is a pharmacy technician by background having spent 18 years working for the NHS before an 11-year stint at nearby Bradford College where she set up a clinical diploma for pharmacy technicians.

She’s been encouraged by HubRx to upskill in services she can deliver.

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“Since I’ve come here, I’ve done vaccination training, phlebotomy training and I’m currently doing my emergency contraception training.

“I came to community because I was sick of working from home. It was a massive learning curve. But this is where the opportunities are for technicians now. As pharmacist’s roles evolve, so do ours.

“I’ve been trained to do ear wax micro suction, and I do 12 to 15 consultations a month. We’re waiting for the PGDs and then we’ll be doing travel.”

Services

Considering Harrogate is known as one of the smartest towns in Yorkshire, Dixon thinks access to the wealthier demographics will make its upcoming travel and its other private services “fly”.

Word-of-mouth referrals for phlebotomy and ear wax micro suction services have grown. Dixon says “at least 50% of my new patients are recommended from other patients”.

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The pharmacy’s second consultation room will also be fully fitted out in the next couple of weeks to help manage the difficulties caused by splitting the sole existing room between Pharmacy First and flu and Covid jabs.

Dixon has been cheerfully battling with the branch’s pharmacist Shujel Ahmed to use the one room so far. He delivers weight loss services and will help to deliver upcoming adult ear health, chest and skin services.

The branch has been carrying out an average of 250 clinical services per month. During the spring Covid vaccination period, this increased to 700 and during winter flu vaccinations, peaked at 1,400 each month.

The pharmacy also does supervised consumption for methadone and buprenorphine for a handful of patients. Dixon says it is the only pharmacy in Harrogate to offer a needle exchange, carrying on the service Lloyds offered.

She adds the branch does well with Pharmacy First considering there’s only one GP surgery in Harrogate that doesn’t have a pharmacy attached, and it’s the closest one to their location.

“We have a good relationship with Church Avenue Medical Group GP surgery. They’re really good at referring – probably 80% of our consultations are referrals from the GP and we average around 30 a month.”

The spoke

Hub and Spoke dispensing will be available to independent pharmacies from October 29 this year.

Pharmacy+Health has already become a spoke, and owners HubRx have a warehouse to fulfil many of its prescriptions.

Founder Daniel Lee, formerly founder of online pharmacy Pharmacy2U, tells C+D on a visit to its head office and warehouse that its £15million automated dispensing hub sat idle due to hub-and-spoke legislation delays.

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That forced him to change his initial plans for HubRx.

“We had to buy the pharmacies because legislation hadn’t changed quickly enough,” he says. “Now we’ve proven the model in our own pharmacies. It’s the start of an opportunity to turn them into clinical service providers.”

Dixon attributes the ability to offer all the services she can precisely because it is a spoke, saying: “I can’t imagine not having the hub.

“We were dispensing all day and all it took was for one person to be off sick and you’d fall behind a day, and that’s a long way back.

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“We could never, ever offer the services we offer now if we were still dispensing 8,200 items a month.”

Lloyds previously dispensed around 7,300, but despite the increase in items, access to the hub means 89% of the branch’s prescriptions go to it, according to Dixon.

The morning is generally busier as the pharmacy receives back items from the hub and then organises what prescriptions to send to the hub via the PMR RxWeb by 3pm ahead of the next day delivery.

“Suhjel’s afternoon’s are free to do all of those NMS follow-ups and has the opportunity to have a better conversation with the patient instead of squashing them in.

“The hub has revolutionised our workflow and for the patient experience. The majority of our feedback is ‘you’re so efficient’.”

Dixon says the staff demographic also contributes to this.

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Including herself, there are two pharmacy technicians and one of them is completing their accuracy checking qualification.

It also has a recently qualified apprentice who has stayed on to work full time as a dispenser.

“The dispensary running like it does, it means me and Shujel can concentrate on doing additional services.”

Savings

The vision for what pharmacists should be doing is backed by Lee.

He says HubRx has helped three quarters of its pharmacists train to be independent prescribers so far.

“The hard bit is getting them to change from dispensing pharmacists to clinical pharmacists. We’ve proven it frees up the time in the branch.”

The hub

Seeing the other side of what happens when the Kings Road branch uses the HubRx system, the warehouse is home to around 2,000 medications and it will “deconstruct” the pharmacy order.

HubRx can integrate with other PMR providers, and all the prescriptions completed here are done only for original pack dispensing.

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Once a medication drops into the production line, it undergoes a series of automated checks, scans and labelling.

It has reduced its manual checking of all assembled orders for accuracy down to 0.5% – these checks are done by staff with a level 2 accuracy checking dispenser (ACD) qualification.

The warehouse aims to do between 50 – 70% of the dispensing volume of a branch and has the operational ability to do one million items a month for around 400 pharmacies.

Lee says currently, the warehouse is only at 5% capacity to cover its 31 branches and is ready to scale up to a 24/7 service if needed.

Pricing

He adds that work has already begun on attracting other independent community pharmacies to become a spoke to HubRx. But he understands it’s not for everyone.

“We’re not saying it’s the answer to every pharmacy’s problem. It’s for those who really want to create more capacity and are slightly busier than the average pharmacy. If you’ve already got capacity in your working day, then you don’t need a hub.

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“But with supervision relaxing, the NHS neighbourhoods, hub-and-spoke and the drive for more clinical services, higher revenue and higher margins are not in dispensing.”

The business model for HubRx sees it charge £0.75 per item with delivery and bagging included, and its customers can see the cost prices of the medication through an insights portal for transparency.

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“A lot of pharmacies had initially been against hub and spoke, they thought it would give away more of their profit to wholesalers.

“The more people that join us, the more volume we get and the more we can buy on their behalf and increase our buying power.”

Football club links

Community pharmacy has a dearth of buying power. Dixon says communication around the contract is “all theatre and spin”.

“If you were just doing dispensing, it’s not sustainable. They brought the 10-year plan out and there’s lots of information about how pharmacies can support, but you want us to do that on what you’ve given us on the contract?”

She argues a lot of the funding to the NHS is going to secondary care and it’s leaving a skills gap in non-pharmacist community pharmacy workforce too.

“I could go and do this job back in the NHS in secondary care and earn five grand a year more. The majority goes to secondary care and to me that’s short sighted, because you invest in primary care, secondary care ain’t going to be as busy!

“It seems backwards - it’s really frustrating.”

But with her pharmacy’s focus on improving services, Dixon is delivering on new initiatives to attract more patients to the Kings Road branch.

The pharmacy has established a partnership with Harrogate Town FC.

“At the start of the season, we’ll go to some home games and set up a little stand so we can capture blood pressure if people want a test.

“We’ll go to at least four or five before the end of the year. It’s an opportunity for us to have conversations with men about men’s health.”

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Lee says he has “always felt pharmacy in the community has been a passive organisation, we’re telling our teams they need to be more active and go out and communicate with anybody who can influence the people and send consultations into the pharmacy.

“Let the community know what you can do. Because in a lot of cases, they’ve got no idea.”