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Boots to pilot automated dispensing hub

Practice Multiple will open a dispensing support pharmacy in Preston in early summer to dispense medicines to 50 branches

Boots has unveiled plans to trial a dispensing hub in a bid to cut the time pharmacists spend on repeat prescriptions.

A dispensing support pharmacy would open in Preston in early summer to dispense medicines to 50 Boots branches, the multiple announced yesterday (March 6).

Staff at the hub will pick stock, apply labels, perform accuracy checks and bag medicines with the help of automation, although Boots did not reveal how much of the process would be automated. The medicines will then be delivered to the branches, where they will be dispensed to patients.

Boots stressed that the pilot system would in no way compromise patient safety, which it said had been at the heart of the project.

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The pilot project came in response to the shift in funding towards pharmacy services, Boots said, which meant pharmacists needed to be freed from "some of the volume of predictable work". The multiple said it would "explore" the option of providing additional clinical services in the pilot stores.

"Boots UK has been assessing how to respond to the increased pressure on the NHS and how pharmacy can deliver greater patients care, while continuing to drive the medicines optimisation and patient safety agenda," a spokesperson said. "We want to ensure we are responding to the changing needs of both our payers and our patients."

The multiple stressed that the pilot system would in no way compromise patient safety, which it said had been at the heart of the project. Boots said pharmacists would be able to spend "more quality time" with patients as a result of the reduced dispensing workload.

While automation is already used in some hospitals and community pharmacies, Boots believed the hub's combination of approach and potential scale would be unique. The trial had been developed after consultation with its pharmacists and customers, it added.

"Boots believes that this pilot is a response to the various strategic papers and reports published in recent times that call for innovation, increased use of automated technology, improved patient safety and the liberation of time for better standards of care by professionals," it said.

Lloydspharmacy trialled a hub and spoke dispensing model in 2008, but has not announced any plans to extend it on a wider scale.

Are dispensing hubs a good idea?

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NIgel Dugmore, Superintendent

The pharmacist should only be checking, giving advice and extended services anyway. so is this to reduce dispensing staff further? Who is responsible for any error or does the pharmacist need to check all the scripts from the hub which does not reduce the workload much. The reduced stock holding in stores will reduce service levels, and finally who liases with the surgeries regarding out of stocks and script queries are just a few initial thoughts.
Sounds like another imported idea, however the NHS operates differently to other countries.

Francine Bissenden, Community pharmacist

Surely this is shooting themselves in the foot. The major money earner is MUR's which can only be completed for regular patients. If these patients are being served by a remote hub they will automatically be excluded from the service. Another idea thought up by someone in an office with no real pharmacy experience.

Shaun Hockey, Community pharmacist

Seems to me that it's pharmacy technicians that need to be more worried by pharmacy automation than pharmacists

Leon The Apothecary, Student

The concept of a dispensing hub is actually logistically quite a nice idea in my personal opinion. With one building comes one set of stock, which would make ensuring medicines are always in stock and available, as well as optimizing the dispensing process on a large scale. A centralized system such as this should be supported with a 24 hour dispensing and delivery service, funded by the savings from the system, it would truely be quite the innovation.

However, you may have to wonder with this system, would you lose the human element to dispensing medication? How many people would lose their jobs to surplus? Who should own these dispensing hubs? Is it ethical for one business to own a centralized hub system, or should it be something that should be run by the NHS at that point?

Some food for thought.

Chris Pharmacist, Community pharmacist

Slightly off-topic but had a good sort out at home and found my old diaries detailing my locum work and payments. £25/hour back in 2007 were the norm, with £200 weekly incentive payments (can't even remember what they were for).

Certainly times have changed, £19/hour nowadays (over a 25% decrease) but I guess that's progress. But it isn't progress, its regress. Has any other profession accepted such wage cuts with such little protest? We are divided and weak as a profession, if it continues we will continue to be corporate minions and not respected professionals.

Any chance of some action against the continued erosion of pharmacist pay and increased workload? Thought not.

London Locum, Locum pharmacist

No.Because the only voices seen as significant belong to multiples. And those that purport to represent pharmacists are in the pockets of the multiples.

Chris Locum, Locum pharmacist

Any chance of some action against the continued erosion of pharmacist pay and increased workload? ....

No, I did not think so either!

Clinical Pharmacist, Hospital pharmacist

This is the issue unity is a problem in the profession most of our time is spent moaning but not doing anything

William Johnson,

As a retired pharmacist I think that it would be even cheaper if I could just walk in and dispense my own medication. Why do I need a pharmacist? Maybe the new Boots hubs will have a serve yourself section?

London Locum, Locum pharmacist

Mr Johnson you could be onto something. If it means more money Boots will lobby for it. We will be a new scheme known as PatientFirst because they always put the patient first in all that they do. This will just happen to coincide with mass Pharmacy manager redundancies. Mr Ridge with a straight face will then sing it's praises and suggest it be rolled out to all community Pharmacies.

William Johnson,

I was of course only joking (lost on some people) but I seem to remember that years ago pharmacists were on the brink of striking but could not as Boots pharmacists refused to join in. I started as a Boots pharmacist but left shortly after going to a meeting in Nottingham, looking round the room, and thinking "Do I really want to be like them?"

N O, Pharmaceutical Adviser

It can be even more cheaper ... why bother going to the GP either ?? just sit at home browsing the web find a solution and self medicate. May be the government can open a huge medicine depo sort of place with self check-out points where you press a button (say for eg Cholesterol) and feed a blood test report and then WHOLA out comes the medicine. Don't you think this way it would save lots of £££s and very convenient for patients???

Please stop rubbishing and come to reality.

In this age where the biggest problem is in terms of prescribing errors and medicines wastages how can a hub and spoke method help but for a cost saving route for the big multiples??

Please answer few questions:

1. Will the entire medicines act change to incorporate this system. Eg. who keeps the record of dispensing the medicines ( a record must be kept in the pharmacy either written or electronic for .... years??) Will it be the pharmacy giving out the medicines or the hub??

2. Assuming there needs to be a RP at the HUB as well, before any dispensing takes place, as per the Medicines Act (even if checked by an ACT), in case of a dispensing error leading to harm to a patient ... which is RP is actually responsible??

3. With most of the PMR systems not showing/ flagging the patient record for more than 6 months old records while dispensing an acute medicine, how will a Pharmacist be able to minimise the risk of interactions ?? I am sure computers have a better memory than a human brain when remembering medicines use history.

4. Legally: What address will the label on the dispensed box have? HUB or the Pharmacy of actual origin for the Rx? Will there be amendments to licensing requirements?

5. Will the HUB and Spoke be considered as a separate entity --> new premises --> will it come under the regulations applied for approving new pharmacy contract ??

6. Why no one challenging these kind of pilots, where many laws are broken so openly?

Just because this has come from a multiple, why no one cares about the flaunting of so many regulations and let them always have their say? If they are really serious about freeing pharmacists time, increasing investments, patients safety and convenience, etc. then why not do it at each individual branch ?

Stephen Eggleston, Community pharmacist

The dispensing "hub & spoke" model has been around, at least as an idea, for at least 15 years, so it's not new. I am surprised it has taken the larger companies so long to put it in to place. How you think of it depends on how you think it will impact you as a pharmacist & pharmacy in general.
Remote supply is already available (internet pharmacies); robotics are already available - although how good they are (in terms of cash saving - I have assumed their accuracy of pick is 100% since it removes the human element) is open to debate.
You can say "This is all about money" - which part of pharmacy isn't all about money? You can bang on about "patients not £s" but pharmacy needs to be profitable, otherwise there IS no pharmacy. No investor will put their money into a project which will see their stake reduce - why would they?
If this takes some of the drudge out of the local pharmacy, and who can honestly say they would, given the choice, rather dispense than speak to patients, that will surely free up time for more patient support - MURs, NMS etc. Let's be honest, patients are not too bothered who actually puts the labels on the boxes - what they like it the personal relationship they have with the pharmacy team. Hub & spoke does not look like it will change that relationship.
I am concerned as to where the responsibility lies, yet anyone with an ACT can, after completing the clinical check, not be involved with the prescription any more and yet we are OK with that (at least, I am)
New technology brings new opportunities and new challenges - which you see it as will dictate whether you will still be here in 10 years time providing pharmacy services or be sat at home wringing your hands and wondering where it all went wrong!
BTW - Not a fan of Boots but that doesn't blinker my view!

London Locum, Locum pharmacist

What makes you think that before you know the powers that be won't be reducing the sums paid for the MURs, NMS etc.....Or telling us that there is no money for new clinical services which will be all that remains to make Pharmacy commercially viable. So tel me in 10 years time will you be providing Pharmacy serivces for free or peanuts? The demise of Pharmacy seems like a slow car crash and the occupants are oblivious to the fact they're soon to feel considerable pain. All of this plays into the hands of the Multiples like Boots.

Super Locum,

Look out all, rates for Pharmacists and Locums will tumble if this pilot is rolled out.

Already rates in Birmingham are as low as £16 per hour.

London Locum, Locum pharmacist

These Pharmacists are better off looking at other areas entirely. Have a relative, failed footballer due to injury with no A levels took a job temping for a bank at 20yrs old. 7 years later earning £50k plus at private bank. but for me he still under illusion Pharmacists must be earning bucks because they go to Uni for 4/5 years. There is whole new world out there. And for those students contemplating Pharmacy, simply DON'T. Could even be better off not bothering with Uni at all.

M Yang, Community pharmacist

We've already seen some jobs almost completely automated with only limited human supervision e.g. the car industry; and pharmacy will probably become more automated in future. It's more a matter of when than if.

Pharmacists have always benefited from improvements and developments in technology. At the inception of the RPSGB, we didn't have the benefit of telephones, now we have computers and the internet. Very few people want a robot taking care of them. They will always want a human face talking and treating them. Automation will be there, but it will not replace the human being. Like many people, I look at automation with a sense of dread but I also like to think that this might speed up changes that could in the long run benefit the profession.

If there wasn't such a surplus of pharmacists, then automation might not be so dreaded. After all, our greatest fear is that it'll put tens of thousands of pharmacists out of a job. If we can work out the surplus student problem and reduce it to a manageable number then suddenly automation becomes somewhat less worrying. There may still be jobs as stake, but at least it would be in the thousands and not tens of thousands.

If we can indeed work out new roles for pharmacists as proposed earlier last year, so that pharmacists take on case loads of patients and have a more clinical role, then automation could in fact be a blessing. Those thousands of unemployed pharmacists could be soaked up with these new opportunities. If it weren't for the insatiable greed of mutliples like Boots, services like MUR/CMS and eMAS would be the good thing they were meant to be rather than just another target for the sake of profit. A stronger bargaining position among pharmacists (thanks to stronger unions and multiples reigned in by new employee laws) would put us back in the driver's seat and allow us to decide how automation will aid our profession rather than erode it.

It may be worthwhile asking the public if they want pharmacy to become automated. Most patients have plenty to say about Boots and it isn't positive. They bemoan the poor service. Long waiting times, inability to get their scripts collected and dispensed on time, the list goes on. In contrast, there are independents that're fully staffed even on a saturday, and can maintain good service on every day of the week. The staff will actually smile and engage in chit chat, that's the difference when you're well staffed and happy.

Even with robots doing the dispensing, the single pharmacist on his own would still need to perform basic clinical checks. What happens when a prescription isn't ready because it was never collected from the surgery on time or the wrong thing was ordered? That happens a lot in Boots at the moment. No doubt the lone pharmacist will still have unachievable targets and workloads piled on his shoulders. Automation does not necessarily mean better service.

G W, Community pharmacist

The amount of negativity in these comments upsets me, pharmacy needs to evolve to survive. The future of the profession is in providing services, not just dispensing items. This technology provides a massive opportunity for pharmacy to reach its full potential. Those pharmacists who wish to sit in the back of the dispensary counting tablets will struggle as contractors in the evolving NHS.

N O, Pharmaceutical Adviser

You are absolutely right. The big multiples have reduced staff so drastically that the pharmacists have to do everything from receiving Rx, clinical check, dispense (including counting the tablets) etc. No wonder there is no time for providing services. By the way, what services are you talking about ??? that take so much of a Pharmacist in 8 or 10 hours in a day and are rolled out by the NHS ???

G W, Community pharmacist

There is lots going on both locally and nationally with services, its still not to late for you have your say on community pharmacy service development, just follow the link;

The more people who get involved the better!

N O, Pharmaceutical Adviser

I have done it long ago, and I do know many big names in that forum (personally). But, just look at what PSNC has just done with the Cat M clawback. Its all a game already won by the DoH and we are just playing in the replay !!!! I am always optimistic but the current situation is not very good. Lets see what happens.

London Locum, Locum pharmacist

the majority [email protected] sure do not want to count and pack tablets. And these clinical services are great, but hang on a minute, nobody wants to pay for it !!! The technology you herald is the one that will actually strangle your career if care is not taken. You think Boots wouldn't replace their entire Pharmacy workforce for robots if it was feasible and financially in their favour. You'll be there waving your Boots flag with Gordon boot licking their directors as the prepare your P45 or inform you that sadly next year your salary will be less than £20k due to unforseen economic circumstances. Wake up Guys the multiples don't care for you or even Pharmacy for that matter.

G W, Community pharmacist

I agree with your point that the technology could be the end of careers if care is not taken, however I disagree that nobody wants to pay for services - and this is our future if we are to survive as a profession. I think there are plenty of opportunities, we as pharmacists need to take them. Any willing provider can now provide services and pharmacists need to make sure that community pharmacy is considered the first choice provider. How can we do this is we are stuck dispensing and accuracy checking ever increasing volumes of prescriptions (for less and less money)?

Chris Pharmacist, Community pharmacist

You are deluded. Nearly 10 years since the onset of the new pharmacy contract and what do we have? Ok, EHC is well astablished and there is (reducing remuneration and availability of) Smoking Cessation and Minor Ailment Schemes (recently stopped in my area) and thats about it.

The NHS hasn't been interested in pushing pharmacy to provide services in the last 10 years and this is unlikely to change. Even if it was it would be strongly opposed by GPs who do not want to see NHS funds diverted into the private, multiple pharmacy chains especially when it is their own pockets that would suffer.

Many GP practices are dangerously over-stretched struggling to cope, do they look to pharmacy to support them or take the pressure off? No, they prefer to provide patients with dwindling levels of service and keep the funding themselves. The NHS needs to stand up to GPs but they have just been rewarded even more power with GP-led CCGs. As you can tell, I struggle to be optimistic about a service-led future for pharmacy.

John Collington, Community pharmacist

The Dickson chemist team of 5 branches in glasgow/lanarkshire are increasingly involved in the development/evolution of a robotic 'hub and spoke' dispensing service. Last week, we won the Scottish pharmacy award for "innovation in pharmacy practise". Currently, The branch RP(s) pre screen and clinically check all prescriptions before they are transferred to hub. Without any 'detrimental distraction to the dispensing process from patient interactions/phone calls/consultations/MURs(England) or CMS(Scotland), the hub acts merely as a factory for dispensing and accuracy checking of 'managed repeat' or serial prescriptions. For these repeat prescriptions, Only the dispensing and accuracy checking takes place at the hub - EVERYTHING else takes place at branch level: ordering of rxs, clinical check, pmr records, claim for supply of rxs. For the branch RP to remain responsible, only the dispensing and accuracy checking can be delegated to the hub. A historical clinical check of prescriptions is insufficient because medication combinations/polypharmacy patterns change on a frequent basis. By ordering prescriptions approximately 5 working days in advance of patient requirement, the process works very smoothly. Branch RPs are Fully aware of all rxs leaving the pharmacy (no more or less than a rx dispensed and checked by a ACT/pharmacist on your day off). Patient has more opportunity to spend time with branch pharmacist who is freed up from the dispensary. QUESTION: "prescription for excellence" in Scotland claims that the above will be facilitated through the "use of robotics in public/private partnerships". Anyone aware of existence of such partnerships or how to be involved in a public/private partnership?

N O, Pharmaceutical Adviser

"Currently, The branch RP(s) pre screen and clinically check all prescriptions before they are transferred to hub. Without any 'detrimental distraction to the dispensing process from patient interactions/phone calls/consultations/MURs(England) or CMS(Scotland), the hub acts merely as a factory for dispensing and accuracy checking "

So, if the process of clinical checking is still done at the pharmacy and NOT at the HUB then how does it free-up a great deal of pharmacist time ?? How much time does accuracy checking takes, once the clinical check is done? Even then, you can always have an ACT at the branch if you want to free up the time, at least the pharmacist will have a chance to overlook if needed. And does the pharmacist not answer the phone/ do MURs, NMSs etc while doing a clinical check or you are suggesting the clinical checks dont happen at all ???

How will you know which patient's Rxs are at what stage and where (HUB or at Surgery?) and what if the patient lands in the pharmacy even before he is due to collect the RD (going on an urgent trip/ lost medication) and the Rx is in the HUB what next? Don't you think this following up will eat away most of the pharmacist time than it would have if the Rx was still in the pharmacy??

All I can this will lead to is, the scripts will be picked straight from the surgery or the pharmacy, without even the knowledge of the RP (some cases the RP is signed in 2-3 hours before being physically present at the pharmacy) at the most with a list of patient names (with no Rx details) then all the bagged medicines being delivered to the respective branch at a later date. God save the delivery driver, in case wrong box delivered to wrong branch 100 miles away!!!!!

Just because BOOTS decided it does not mean it is the right thing. This system can only work for supermarkets with foods, toileteries and other stuff and not with medicines.

Brian Perry, Locum pharmacist

Glad I am almost at the end of my career and have pension arrangements. I feel very sorry for anyone who is just starting in community pharmacy.

Gordon McIllroy, Pharmaceutical Adviser

I happen to be a boots employee who was privileged to be present at the introduction of the DSP system to myself and other colleagues. It is difficult to see where some of the comments posted are coming from as they seem more interested in being negative about Boots than considering the revolutionary benefits and impact of new technology. I cant help wondering how many off them have previously been dis affected Boots employees?
Everyone is preparing themselves in an effort to absorb cut backs from the NHS and re-focus to manage the services that the NHS want to pass onto pharmacists and maintain a high Street presence. Its a changing world dinosaurs please note. So if its your contention that your job satisfaction comes from preparing and handing out scripts so be it. If however you want to become part of a dynamic company I suggest you apply quickly we only take the best.

Mohammed Akhtar Hussain, Locum pharmacist

we only take the best and turn them in to robots

Marc Borson, Community pharmacist

This was inevitable, but will it actually improve the bottom line, we have seen tesco and its like also adopt automation - however at the same time as this they have lost business to competitors particularly discounters. Why? Clearly its about price. Aldi and Lidl also offer a unique customer service. Its not good traditional polite customer service, such as bag packers. Its treating customers like they are intelligent by not overcharging. One thing Aldi has that Tesco does not have is human check out staff. People like people, Boots do not forget this. Boots do not canabilise your own business just in the name of a blind belief that technology will somehow save you money and be more efficient. History shows this is not always the case. At the time of writing confidence in Ocado (grocery and technology company), Tesco and Morrisons is low whilst Aldi and the discounters are bullish. Keep it Simple Stupid. People that shop local should be embraced as real economic assets, just today, "Poundland," floated on the stock market and was well over subscribed. Poundland are based in small local towns and have a very simple low margin business model. Their customers are community pharmacys' customers. Boots if you "manage by spreadsheet" you may not see where your actual revenue originates.


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