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Avicenna plans to offer hub-and-spoke dispensing service

Current law on hub-and-spoke dispensing puts independents at a "great disadvantage" compared to multiples, says Avicenna chief executive Salim Jetha

Independent support group Avicenna has revealed plans to offer a hub-and-spoke dispensing service to members if the legal barriers are removed.


Avicenna had sought legal advice on investing in a dispensing hub and was "taking its views forward", said chief executive Salim Jetha at the Avicenna conference in Bali on Wednesday (May 28).


The current law on hub-and-spoke dispensing, which prevents the model being used unless the dispensing hub and pharmacy are both owned by the same business, put independents at a "great disadvantage" to the multiples, Mr Jetha said.



More on hub and spoke

For & against: The dispensing hub debate

Robotic dispensing hubs pilot planned for Scottish pharmacies

Professional bodies call for law change to boost use of hub and spoke


"We would require some changes in the law to able to offer a [hub-and-spoke] service to our members, but when it comes around we'll be ready for it," he added.


Avicenna members at the conference had mixed views on whether the dispensing model would benefit the profession.


Contractor Chandra Ondhia of Worlingham Pharmacy in Norwich told C+D he welcomed anything that would free up pharmacists from dispensing so they could focus on their patient-facing "strengths".


But Shamraiz Iqbal of Radcliffe Pharmacy in Bury said that, although independents were currently at a disadvantage, he was concerned a hub-and-spoke model would mean pharmacists prioritised services at the expense of supplying medicines.


"All of the services should be attached to the core part of dispensing because that's what defines us," he told C+D.


Earlier this month, Community Pharmacy Scotland warned that the Scottish government had not thought through its plans to pilot robotic dispensing hubs in selected NHS health boards.


In March, Boots announced it would pilot a dispensing hub in Preston to support 50 of its pharmacy branches. The same month, pharmacy groups called on the government to relax the rules around dispensing so independent pharmacies could operate hub-and-spoke models.

Would you welcome a change in the law so independents could be a part of hub-and-spoke dispensing?
We want to hear your views, but please express them in the spirit of a constructive, professional debate. For more information about what this means, please click here to see our community principles and information

Chandra Nathwani, Community pharmacist

I have had numerous problems with our wholesalers delivering to my pharmacy on time. Multiply this by around 2000 extra packs to deliver on time each month for each pharmacy or patient! Then pigs will fly. And emergency supply or loan will be a thing of the past as those remaining pharmacies won't have any stockholding to loan. (If they have not already gone broke) Better warn NHS 111 and A&E dept for extra patients requesting their medicines because the delivery/IT/Manufacturer/Surgery failed to provide them with their medicines. I feel sorry for the recently hospital discharged patients who are given only a weeks worth of medicines. Now where is that application form for London Transport tube driver vacancy?

Andy Thechemist, Academic pharmacist

Contractor Chandra Ondhia of Worlingham Pharmacy in Norwich told C+D he welcomed anything that would free up pharmacists from dispensing so they could focus on their patient-facing "strengths"

...any particular reason for the hypens?!

Hanbal Chaudry, Community pharmacist

I would palm off my few nursing homes and weekly dossets without hesitation if Avicenna convinced me that they would offer an effecient service and i would retain most of the profit. Alas...

London Locum, Locum pharmacist

I Locum around the South East and not in one Pharmacy are their clinical services currently financially viable. SO if you remove their dispensing how will they make money? Over to Avicenna, RPS, NPA, PSNC............

London Locum, Locum pharmacist

May I also add that many independent contractors are hardly performing any services if at all. Somebody high up somewhere with all the brains in the world has not really thought about Community Pharmacy in the medium to long term future. There simply is not any incentive to perform services in the current format for contractors.

Actual Pharmacy numbers clearly will be reduced with the inception of Hub and spoke. But what will unemployed Pharmacists do then? New Pharmacy graduates can comfort themselves knowing at least they can retrain and do something else before taking on a family and mortgage etc...

It would seem this could be a good time to sell up for contractors as goodwill values can seemingly only go down

Rajive Patel, Community pharmacist

Salim Jetha & Avicenna = Lost Souls. Come on, what do Avicenna currently offer, absolutely nothing. Waste of space.

I wouldnt trust them with a barge pole. Also, they work closely with Day Lewis. The whole organization is dodgy but we all know E Class Driving Pharmacy Contractors love their Golf Days & Conventions!!! I

[email protected], Non healthcare professional

Rajive, you are spot on!

London Locum, Locum pharmacist

This is akin to being told that slitting your own throat will benefit you long term.

Clive Hodgson, Community pharmacist

I think it is delusional to suggest that a hub’n’spoke dispensing model will have any benefit for Independents.

For Independents, dispensing provides the vast bulk of work AND of income. To voluntarily give most of it up and “focus on patient-facing strengths” sounds very naïve and a good way of going out of business. If relinquishing dispensing to concentrate on service provision is such a great idea why has everyone not done it before? Additionally would you hand over your customer base to a third party and be totally confident it would not misappropriated in some way in the future?

For Multiples it is different as the hub’n’spoke mechanism can be kept in house with considerable cost savings. In the not so distant future, a lot of Pharmacists will be “freed” or “liberated” (i.e. made redundant) by hub’n’spoke especially if combined with Remote Supervision which the Multiples are lobbying hard for. Their comments on hub’n’spoke not resulting in reduced Pharmacist numbers I believe is deliberately disingenuous.

The fundamental fact is that if a Pharmacist performed every funded service currently available, and then a few more on top, the remuneration would not come close to covering their salary.

Gerry Diamond, Primary care pharmacist

Well put Clive.....definitely hub and spoke is not for small independents unless they have a dozen branches doing it for themselves...but pass it on to a third party....not feasibel.

iIt's definitely for the medium to larger chain size models...

Rajive Patel, Community pharmacist

Gerry, I agree in principle with your views. However, if Hub and Spoke does demonstrate efficiencies and this in turns motivates the DoH to push down fees, Independents will have two choices:

1. WInd down their business due to non-viability
2. Go to Avicenna or the like, for outsourced efficient dispensing
3. MERGER mania. Independents grouping together by way of corporate merger to develop scale.

I think both 1 and 2 will not happen. Especially 2, since why would you trust a third party with your goodwill, or to some people "their pot of gold". I think Avicenna are jumping on the Hub and Spoke Band Wagon, without thinking through the realities.

However, point 3, is very likely and will most likely require a visionary to implement and push this model. Independent contractors need to smell the fear and then act. I'm sure they would rather have a small slice of a big pie, rather than a no slice at all.

Brian Austen, Senior Management

Rajive the Joint Venture Model is a way of working together and at the same time retaining control in the individual businesses.

Brian Austen, Senior Management

Clive, thank you for a good 'dose of reality'. I would suggest that independents look at ways of informing the public how much better the service will be in their pharmacies compared to pharmacies using hub and spoke model

Leon The Apothecary, Student

A Dispensing Hub would certainly put a lot of Technicians and Dispensers under pressure to retain jobs, but economically speaking what are the gains? I don't like it on a human level, but you have to admit it produces a more efficient system.

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