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Keith Ridge: Hub-and-spoke has 'extraordinary capability'

Mr Ridge: Convinced of model’s viability after seeing examples in north west England

England’s chief pharmaceutical officer says he understands why pharmacists are “questioning the evidence base” for the dispensing model

England’s chief pharmaceutical officer has defended the “extraordinary capability” of the hub-and-spoke model to dispense the country’s prescriptions.

Keith Ridge predicted last September that centralised hubs could dispense two-thirds of England’s prescriptions, and he told C+D yesterday (February 1) that he “understood” why pharmacists are questioning the evidence base behind this.

Mr Ridge said his visits to two dispensing hubs in north west England had made him “realise the capability that is there”.

“You can see how this will impact on stock holding [and] free up people to do other things. That to me is entirely what it’s about from a clinical point-of-view,” he said.

The sector also needs to look at making hub facilities "work as efficiently as possible", Mr Ridge added. 

The Department of Health (DH) said last month that it believes encouraging the use of this model is one way to make the sector more "efficient and innovative", in a briefing document explaining the planned 6% cut to pharmacy funding.

Last month, Boots told C+D that it is “too early” for the government to base its pharmacy funding decisions on hub-and-spoke technology.

More news on hub and spoke...

All Day Lewis pharmacies to use hub-and-spoke by 2018

NPA: Do not worship ‘false gods’ of hub-and-spoke

Hub and spoke: Where does pharmacy stand? 



Jon Flitcroft, Community pharmacist

Keith Ridge: Hub-and-spoke has 'extraordinary capability' -

Unless your prescription is for a Sch 2/3 CD................

Jay Badenhorst, Superintendent Pharmacist

Thank you Keith. You may (conveniently) have forgotten the utter chaos it caused when these (or at least one of them) could not dispense accurate medicine. Who picked up the pieces? Oh, the local community pharmacies.... and let's not forget who sold patient data.... When disaster struck (recent floods) again who step up to the mark? NOT the ones you are referring to...
Keith your PhD in automation is not evidence required for a national model.
Current model: medication gets delivered by driver who needs to wait until the frail patient gets to the door. They ensures they are still taking their medicine and puts their insulin in their fridge.
Your model: medication gets delivered by courier or post. Frail patient gets to the door and finds a card 'sorry you were out. Go to your local depot to collect your medicine.' Never mind that it is insulin...
Keith you need to get with the program...

Nat Mitchell, Community pharmacist

I hope the hubs are more efficient than the machinery currently in place at our suppliers depots.  Some of the stuff that arrives in our tote boxes beggars belief.

And I'm not a luddite.  We've had a dispensing robot for over five years.  We really like it, but I don't think it's quite ready to take us over...yet!!

Shaun Steren, Pharmaceutical Adviser

London Locum is correct in his identification of contradiction and hypocrisy in the position of certain contractors. Wages have fallen significantly for pharmacists over the last five years, at no point was there a call for unity when this happened. In fact, a fully engineered oversupply of pharmacists was described as having the effect of improving quality in the pharmacist population. There has not been a single call for strikes in response to the quite appalling work conditions that have developed over the last ten years. Following the recent government announcement, there is a near perfect symmetry in the position of employee/locums and contractors.However, many contractors now ask for an asymmetric response. The treatment of pharmacists by other pharmacists over the last thirty years has been loathsome, on this point of history alone, it is quite laughable to now ask for collective action. But after nearly ten years of employee/locum pharmacists accepting their fate, to urge support from this group on the basis self-interest is moronic - whatever happens we lose badly anyway. More importantly, to use as a threat, the false predication that a contractors loss will be a employees/locums loss, is to extinguish any chance of solidarity to begin with........ There is a further validity to the contrary positions of some contractors and some locum/employee pharmacists. Many locum/employee pharmacists don't actually agree that community pharmacy is so deserving of the funding it craves. Many such pharmacists consider MURs and NMS a waste of time, with no evidence for outcomes and strong suspicions regarding the veracity of their delivery, they offer poor value to an unknowing public. Many such pharmacists know that most dispensaries they work in are dysfunctional, badly designed, chaotically operated and manned by people of questionable competence. Many such pharmacists know that the 'health promotion' role claimed by community pharmacies is merely a gimmick, the handing out of leaflets and the inane robotic verbal advice affecting little change in the health of the population. Given the shop floor reality, many pharmacists are not particularly offended by the views of Ridge et al, from their position they can see elements of truth in what is being said, and in any case, they have nothing left to lose. 

John Alan James Robinson, Superintendent Pharmacist

Problems here. Firstly , the negotiated service addons start out in life as something that NHS England desires. Contractors rarely put forward anything that is successful. Minor ailments was worked up and presented by PSNC. Look what happened. MUR and NMS was worked up but started life in NHS England.  The other problem is that if the services are not supported by both contractors and the professional in general then we are seen as all mouth and no trousers. I agree there are difficulties. Especially the way in  which NMS interacts with MUR. Most pharmacies signpost as a matter of course and giv advice without pay. This is all anecdotal and not evidence based. The gaurdians of the public purse need convoluted mechanisms to allow payment. This is entirely why these gimmicks are there. No audit no payment. Chaotic dispensaries are probably the remit of GPhC

London Locum, Locum pharmacist

Chaotic dispensaries may be the remit of the GPhC but as they don't listen to rank and file Pharmacists that leaves multipls and contractors. Their silence has been somehwhat deafening. But they seem to have found their voice since december time though when news of the cuts broke. Mysterious one could say. They've also come over all brotherly too as they try publicise it all.

Shaun Steren, Pharmaceutical Adviser

If I were Ridge, I would ask for the (private) views of employee/locum pharmacists. He might find he has hunters turned gamekeepers on his hands - an investigators most valuable resource. 

Shaun Steren, Pharmaceutical Adviser

John, all well argued points. Would you not agree, that if Ridge is looking for improvements in productivity, then the chaotic and inefficient nature of most dispensaries is his remit also? Throughout my career I have looked over the chaotic operation of most dispensaries and thought 'how do they get away with this unchallenged'. Ridge is now challenging a monopoly that has not used the best technology, not employed people of the highest standards and not experimented and innovated to achieve best value. In my opinion, he is right to do so. 

Chemical Mistry, Information Technology

You are correct in what you say and to be fair to Keith ridge this is what he said at the conference in that he wants use the pharmacist to use their clinical skills more instead of his words " tied to the dispensary bench" however like sue said this as not been explained and how the money from pharmacy intregation fund will be used to enable this as well as his and the government thinking is why should contractors be paided £25000 just to open and which is not value for money for the taxpayer.There is is no evidence show the health outcomes that pharmacist produce day in day out the pharmacy bodies such pharmacy voice etc already have the ear of Keith ridge etc but he did not say what they were telling him and the government therefore I would suggest that if the contractors want the whole pharmacy on aboard then they should first find out what the likes of pharmacy voice such rob darractor are saying to the DH and be transparent rather then the usual shaft the employee/locum grassroots pharmacists.




London Locum, Locum pharmacist

Some of these contractors behave like downright crooks if you've ever witnessed them up close and do a disservice to the upright professional ones. Quite laughable they're still saying 'support us other wise you guys won't have any work' .  Even had a chap on here suggesting Locums club together to buy a pharmacy. In other words buy an underperforming business subsidised by the taxpayer which the subsidy soon to be removed. I can only presume he was joking. I'm quite happy to take my chances and not support you. Indeed I'd stand by DoH and say let the cull begin. By the Way are you also screaming for the multiples to stand by you or do you automatically know they're too smart to pay you any mind. Also Take note of the silence at the mention of NP8. Imagine the Daily Mail getting hold of that to give a little balance to their sensational 3000 pharmacies to close headline. 

P M, Community pharmacist

again with the hate, if you want to learn about np8 look in the drug tariff contractors are not here to educate you, and the funding is no subsidy its paid as contractors provide a service to the public.. peace out

London Locum, Locum pharmacist

Funny you want to term it as hate. The treatment meted out to employees is that also hate? A service to the public? I wonder if that public were aware they were paying hundereds of ££ for simple linctus. And you're right you are not here to educate in the same way DoH are not here to prop up your business which is why i presume they have decided not to anymore.

Bhavna Patel, Community pharmacist

I am a contractor, a tax payer AND a Pharmacist. I do not use NP8, nor do I know anyone who does. I am sure it is utilised but rest assured that it will not only be independents! Think that one through for yourself. You state a minority of contractors, yet you have not had one kind word to say about the majority. I was a highly paid locum in 2000. My locums today get more than I did then, further I urge my friends to pay the same. I am not asking for your support. I will fight my own battles and whatever the outcome, I will NOT reduce locum rates. We do an incredible job as Pharmacists that GP's find invaluable. It really isn't a them and us situation.



John Alan James Robinson, Superintendent Pharmacist

I have heard of NP8 but know nothing about it. Be sure though if it involves excess profits then DH will also know and cuts / clawbacks will inevitably follow. Trouble is it will be applied across the estate irrespective of whether or not one has participated.

London Locum, Locum pharmacist

Yes thats right, the fraudulent few spoiling it for the many. Their silence speaking volumes and the one person piping up shamelessly defends it. And you all wonder why Doh are putting a stop to it all.

G K, Superintendent Pharmacist

If Mr Ridge has visited two hubs then I feel he should visit a few community pharmacies and see how we: help patients unable to get appointments with their GP, help reduce GP appointments by dealing with minor ailments, help confused patients sort out their medication and reduce wastage, highlight patients to GPs who present with symptoms needing immediate attention, reduce calls to 111 service by providing Emergency Supplies (some area NHS funded), reduce sexual health appointments by providing the morning after pill, helping patients with high risk medicines know and monitor side effects, drive down generics prices for the NHS by promoting competion between suppliers- despite the tough environment created by the government, prevent GPs from causing serious harm to their patients by clinical checking and assesment (you'de be shocked at what I've seen in my years)........................................ I could go on and on and on.  When you can find a machine that can do all this and more let me know and I'll take my certificate down.  We have studied long and hard for our degrees and are a lot more intelligent than you give us credit for.

Jonny Johal, Pharmacy Area manager/ Operations Manager

I support Keith Ridge, his responsibility is to the NHS as a whole. The NHS is not a charity for pharmacists or pharmacy contractors. I can think of many ways one can save money in pharmacies, like abolishing MURs and NMSs for a start. There are also a lot of money taken out of the NHS as profits by contractors without reinvesting. I would go as far as to suggest the government to take over the supply chain, so all contractors have to buy at the same nationally agreed price, that way we can abolish the claw back and confusion pricing which is the Drug Tariff. PS, I am no longer a pharmacist, I retired.

Bal Singh, Locum pharmacist

Pretty ignorant view.

Where did the funding for NMS AND MUR originally come from? Category M claw backs. It was not money invested by the take taken by them and then partly allowed to be worked for.

U moan about profits? Pay all NHS staff minimum happy with that?

Dave Downham, Manager

If the government takes over the supply chain, heaven help the country, let alone the NHS.

John Randell, Non Pharmacist Branch Manager

BUT....WHY MAKE THE CUTS NOW YOU DONT JUST FLICK A SWITCH AND EXPECT HUB AND SPOKE TO BE READY TO GO......IT TAKES TIME AND INVESTMENT AND CASH£££££......your local pharmacy wont have the cash to but adn setup HUB and SPOKE.....,......



London Locum, Locum pharmacist

Then the local pharmacy may well perish like many other independent retailers most of which have never received government subsidies.

John Alan James Robinson, Superintendent Pharmacist

Gosh, you regard fair funding as subsidy ? What planet are you on. No index linked pensions or gongs for independents. I know you complain a lot but how badly treated Locums are. No funding no pay for anyone. And if the dastardly plan is to reduce the worforce than no cosy civil service pharmacists. Is it contagious, might we have a centalised hospital hub and spoke?  No feasibility or risk assesments . No business contingency.  But you may have a point. Post Offices perished and luddites were slaughtered.

London Locum, Locum pharmacist

From the government perspective it will reduce the likelihood of masive frauds like  NP8. Maybe a contractor could shed some light on this ?

John Alan James Robinson, Superintendent Pharmacist

Its groundhog day. He was at least 6 weeks early when he popped out of his burrow. He didnt crawl back in so that probably means a long winter of discontent. The sun will shine for him but not for others.
Its not just Dr Ridge though. I was at a PSNC dinner in 2014 in the company of Ridge and a certain professor from UCL. The prof had a sense of humour the other thought he had. The new head of public Health was very supportive of pharmacy. Yet nothing happens. Just a kick in the teeth.

Sachin Badiani, Pharmacy owner/ Proprietor

"The new head of public Health was very supportive of pharmacy". Are you refering to Kevin Fenton (not sure)? If so, yes he definately is. We need more like him.

John Alan James Robinson, Superintendent Pharmacist

Yep it was and I agree



Nat Mitchell, Community pharmacist

I think we saw from the now infamous online pharmacy fiasco at Christmas what both a lack of face to face contact and considerable market share does to customer service.

It's far easier to say "sorry we're closing for a refit you can't have your medicines" when you don't have to deal with the patient directly.  We've all been infuriated by someone at a call centre who we know wouldn't dare treat us in that way if we were stood in front of them.  

Excellent point by Jonathan Wood.  I remember when anything you bought on Amazon was free delivery.  Not anymore.  Minimum purchase value and not all items qualify for free delivery.  Why will pharmacy be any different.

The issue here is that community pharmacy is being pulled apart by people with no idea of what we do or with no wish to learn about what we do, using a pharmacist mouthpiece who is as far detached from community pharmacy as they are anyway.  This should offend ALL  community pharmacists.

It's not about contractors vs locums.  He is pretty much saying that we are all useless.  We can at least be united in that.

Jonathan Wood, Community pharmacist

there is little evidence to support Keith Ridges statements, the hub pharmacies cannot provide the many other services community pharmacy provides on a daily basis, but more to the point once they have a monopoly. deliveries and other services will no longer be free to patients. Keith as little or no knowledge of primary care, yet he is leading the destruction of the pharmacy sector.

Simon MEDLEY, Community pharmacist

unfortunatley Keith hasn't realisd you can't automate teh general public. Thety will still turn up at the pharmacy the day the rx is signeds if not before expecting an advance of their meds. I look forward to teh total collapse of the GP's surgerys when the  one remaining pharmacy in each town sends them back  for an appointment to get an emergency script. Only to find out the the pharmacy hasn't got any stock because that medicine only goes on out on repeat.

He's very silly for a clever man

C D, Community pharmacist

Keith Ridge simply has no idea about the reality of running a pharmacy and he doesn't care one bit about the financial implications of his proposals because he does not understand the implications of his own proposals. Whether he should care or not is a different matter.

Who will deal with all the "I have run out of..." requests when the dispensing is being done by automated dispensing hubs? Likewise who will provide all the other pharmacy services?

The comments on here that say "... the majority of rxs are repeats which can be handled by ACTs" are perfectly correct, but they fail just as badly as Mr Ridge does to understand the whole point of community pharmacy. and what the word "community" means.


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