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Day Lewis: Centralised dispensing ‘absolutely not’ key to efficiencies

Jay Patel: Huge variety of products and sizes makes automated dispensing complicated
Jay Patel: Huge variety of products and sizes makes automated dispensing complicated

Large-scale, centralised dispensing is “absolutely not” what contractors need to become more efficient, Day Lewis executive director Jay Patel has said.

As part of the five-year funding contract for England – which came into force last month – the Department of Health and Social Care (DH) said the sector needs dispensing to become more efficient to free pharmacists up to provide new services, and reaffirmed plans to change legislation to encourage the use of hub-and-spoke models.

But Mr Patel stressed last week (November 7) that “large-scale dispensing” is not the answer to increased efficiencies across the sector.

He was responding to a question by C+D about what efficiencies Day Lewis may make in the future, at an event held by the Association of Independent Multiple Pharmacies (AIMp) in London.

“For the last 45 years of our pharmacy business, we have been incentivised to make efficiencies,” he said.

However, there are reasons why centralised dispensing is not “operational across the country”, Mr Patel said.

“It looks nice and shiny. Does it work? We don't know.”

The “massive range of products” and the “huge variety of different product sizes” means automating the process on a large-scale “is not easy to do”.

“Then you have the complexity of dispensing at a loss,” he added.

“The spoke is more important”

For Day Lewis, which by 2017 was using a dispensing hub to serve 30 of its 300 branches, the ‘spoke’ aspect of this model is most important, said Mr Patel. This involves looking at the various “inner processes” of a pharmacy, such as medicines deliveries or the payment claims process, to determine “how to make one strand more effective”.

For example, “using barcode scanners to verify things in the pharmacy” could prevent time wasted on “redoing” tasks, he said.

Multitasking

In her response to the same question, Indira Panchal, owner of the four-strong Meiklejohn Pharmacy chain in Bedfordshire, said “making sure staff are multitasking” is important for running an “efficient” pharmacy. It also helps to “make their jobs a bit more interesting, and you retain them as well”, she suggested.

Having “systems in place” to make sure staff can work across pharmacy branches is another way Ms Panchal makes her business more efficient.

“Technology is not the silver bullet,” she said.

“There are people and there are processes. For me, inefficiencies have been caused by the changes to the systems and tools that I have absolutely no control over.”

AIMp to analyse hub-and-spoke

AIMp chief executive Leyla Hannbeck explained that the hub-and-spoke agenda is a “key legislative focus” for the organisation, which is forming a “working group” to “analyse the practicalities” surrounding the model, including costs, workforce and equipment.

“We believe strongly that community pharmacy must speak positively and authoritatively with one voice,” Ms Hannbeck added.

10 Comments
Question: 
What do you think of hub-and-spoke dispensing?

Honest Tikes, Sales

Oh Leon,are you on module X of your studies "Stating the Bleedin' Obvious" Look up "rhetorical" and "sarcasm"

Hanbal Chaudry, Community pharmacist

There are no efficiencies that can be made apart from increasing your own working hours which I have just done to 60 hours per week. Full stop. The Government believes there are too many many Pharmacies and they are going to unsympathetic to the sector till their ideal number is achieved. Rough ride ahead. Enjoy!

Ebers Papyrus, Pharmaceutical Adviser

A different reality may well dawn for DH before too long. Unfortuately they are advised by out of touch and distant operators like Ridge et al, however well intentioned they may be. They are also advised by those with a financial interest in up scaled operation who can perhaps persuade them of percieved savings. Listen to PSNC and those on the coal face too. Ultimately which is the most efficient and safe model for the patient, can it actually free up time with pharmacies and save money, is it safer? Where is the evidence?

Leon The Apothecary, Student

I agree, ultimately I think the issue with pharmacy workload is a logistical challenge, rather than a clinical one.

Leon The Apothecary, Student

He presents a minimalistic statement here. It is not just about putting everything into one spot, it is about using technology to do things faster and more accurately, saving time and resources, and this happens to work most cost-effectively when it is in a central location(s).

Dispensing is a multifaceted solution, that requires looking at a combination of elements, synergetically working together to provide results. We need to look at the process, the technology we use, education of staff and the public in pharmaceutical services, and what makes sense from a business sense.

C A, Community pharmacist

“It looks nice and shiny. Does it work?”

No, or at least "no" in the sense that it doesn't work the way Keith and the DoH want it to. To many things prescribed in "odd" quantities, too many disorganised patients - how often do you hear "I ordered it yesterday, is it ready?"

If it were a forward thinking and progressive nation... like Scotland and we could round it might help.

Joan Richardson, Locum pharmacist

Exactly - odd quantities are the bane of a pharmacy's life.  Patients expect their medications to appear at the drop of a hat no matter how many times they are informed that the process from ordering to dispensing takes a number of days.

Taking hub dispensing to the maximum, what happens when a patient arrives for a CPCS and you don't actually have any stock in the pharmacy to provide or will there be one of everything on the shelves just in case?

I also feel for the poor assistant handing out the medications that have been dispensed at a hub as they are the ones that are getting shouted at when items that the patient is expecting are not there.  It's bad enough when you have actually handled the prescription and can see that something may well be missing.

Leon The Apothecary, Student

Taking hub dispensing to the maximum, what happens when a patient arrives for a CPCS and you don't actually have any stock in the pharmacy to provide or will there be one of everything on the shelves just in case?

You refuse the CPCS and refer it back to NHS111.

A Long Serving Pharmacist, Community pharmacist

W e are supposed to refer people onwards, not back to NHS111. 

Joan Richardson, Locum pharmacist

I am fully aware that you have to refer a CPCS onwards but if you are taking "hub and spoke" to its limits where will you find a pharmacy with stock on their shelves?
 

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