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Keith Ridge: Hubs could dispense two thirds of prescriptions

Keith Ridge: Large-scale dispensing is here

England's chief pharmaceutical officer says he wants all community pharmacies to be legally allowed to operate a hub-and-spoke model "as soon as possible"

Central dispensing hubs could potentially deal with two thirds of England’s prescriptions, the country’s chief pharmaceutical officer has suggested.

“Large, centralised dispensing facilities” already exist and the law should open up the model to independent pharmacies, Keith Ridge told the Royal Pharmaceutical Society’s conference on Monday (September 14).

“Large-scale dispensing. We knew it was coming – well now it’s here,” he told delegates at the event in Birmingham.

Mr Ridge called for legislation prohibiting independent pharmacies from using a hub-and-spoke model to be lifted “as soon as possible”, so “all community pharmacies” could benefit.

"It could be that such facilities will be capable of dealing with two thirds of dispensing volume in community pharmacy," he said.

If “implemented well”, these hubs would make dispensing “more efficient and safer” and free up "highly trained staff" to work more closely with patients, Mr Ridge stressed. 

“While we’re at it, let’s make the whole patient experience more convenient through click-and-collect [and] home delivery services, and generally digitalising a good chunk of traditional pharmacy practice,” he said.

“The future is clinical, underpinned by efficient and effective use of technology,” he added. He forecast there would be "much closer examination of how taxpayers' money is spent on pharmacy" in the near future and said a more clinical role "must quickly dominate pharmacy practice".

Mr Ridge also used his speech to refer to NHS England’s plans to pilot 250 pharmacists in GP practices as a “key development for collaborative, cross-sector pharmacy practice”. 


Would you like to work in a hub-and-spoke model?

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Chris Locum, Locum pharmacist

Talking to patients does not pay the bills Mr Ridge -and neither does the derisory sums of money currently offered for so called professional services

Hemant Patel, Community pharmacist

Hub and spoke: anyone who rocks the boat gets criticised. Sometimes visciously. Keith is flying a kite to see the reaction but technologically it is possible and do will happen. Technology and Internet change things rapidly and dramatically. It is foolish to try and oppose an avalanche with a spade and a broom. Where Keith could have been more helpful is if he can tell us how the freed pharmacy staff will be utilised to work with people to improve health and well being. Currently less than 2% of community pharmacy income comes from reducing public health funding. So, that avenue is closed. If we separate distribution of medicines from advise giving role what would the future look like and how many pharmacists would we need to serve the population? Thinking of new alternatives might prove a good investment of time rather than venting angry feelings and hoping for the status quo. In NEL LPC AREA we will consider developing alternatives and how 'freed up pharmacy resource' can be better utilised. We have no expectations from the national bodies as at a time of change like this the local solutions would be more sustainable. Natural tendency would be to preserve and protect. Resisting that urge and investing time in going with the flow and taking at least some control of the change process might be less painful and might even be more rewarding in the end. This debate highlights a need for proper business planning using established tools, techniques and experts. Keith must be pressed for his vision on what community pharmacy in a hub and spoke system would look like and what support would be available for transition. GPs are being supported by PMs challenge funds and Better Care Funds. DH still has to publish the paper on the last consultation with the profession. When will that be published?

Alan Mansfield, Community pharmacist

I think that respondents are offering a knee jerk reaction to this suggestion. I think most pharmacists have already experienced the hub type model, but they seem to not think that MDS and DDS done by another store is a hub type of service.... Clearly this has freed up time in the receiving pharmacy in most chains. It may be more efficient but it means better service or services can be provided. The only question is how this can be extended to typical repeat prescriptions without significantly depleting income in the pharmacy. We also need to see valuable additional roles added that are not just removed from profits and handed back to us if we jump through three loops whilst dealing with constant queries on what time their delivery is coming!!!

Bal Singh, Locum pharmacist

Here's an idea. How about you, Mr. Chief pharmacist, secure clinical funding for services in your sector? THEN you'll just be another voice in the wilderness, but you will not harming current employment of pharmacy. You sound almost as stupid as Andy Burnham, who also demanded pharmacy did more.... And wouldn't provide any funding to cover for more being done. No, instead you look to a more critical way taxpayer money is being spend.... How about this? I'm sure no one will object to you taking minimum wage for your job, you know, to ensure you are free to do more clinical things and offer value to the NHS!

Mark Galloway, Pharmacy

I agree this is the way forward. We need to release community pharmacists' time to offer more clinical services. It would only take an Amazon style model to come in to take the majority of dispensing from high street pharmacies in my view, the mood of the people is changing rapidly on this and delivery to the door from a remote provider is gaining a strong foothold. It really is time for our community pharmacy base, which provides great care to patients already, to be released from the shackles to provide those clinical services that will really make a difference to patients.

Mark Galloway, Pharmacy

I agree this is the way forward. We need to release community pharmacists' time to offer more clinical services. It would only take an Amazon style model to come in to take the majority of dispensing from high street pharmacies in my view, the mood of the people is changing rapidly on this and delivery to the door from a remote provider is gaining a strong foothold. It really is time for our community pharmacy base, which provides great care to patients already, to be released from the shackles to provide those clinical services that will really make a difference to patients.

Simon MEDLEY, Community pharmacist

Is it gaining a foothold ? I heard pharmacycy2u still weren't in profit - and that's st the current level of remuneration . Not aware of many elderly people demanding internet pharmacy . Recently Aah weren't giving accounts too Internet pharmacies as they kept going under. Even in the states where convenience is king and the private insurance companies are Scrooges I read that the uptake in web based dispensing is only 20% ish

Chris Locum, Locum pharmacist


Chris Locum, Locum pharmacist

Services require investment and do not expect patients to pay for them. The reduction and elimination of minor ailments in some CCG areas has already shown that and I have seen it with my own eyes (including professionals leaving in a huff because they could not get free paracetamol).

London Locum, Locum pharmacist

Nice idea except it isn't financially viable. No one is going to pay for these 'services'.

Paul Mayberry, Community pharmacist

In the real world the decision makers are going to look at where pharmacists add value to the dispensing process in the community. Surely this is only at the point of contact with the patient , either while receiving the RX or when handing out the medicines, everything else can be delegated or even automated. In the past I would agree that the government wouldn't commission more pharmacy services because there wasn't any money, now they MUST commission them because there isn't enough money not to!

Barry Pharmacist, Community pharmacist

It's always good to hear the views of grass-roots pharmacists like Mr Ridge. He's spent minutes if not tens of minutes working in a community pharmacy so he knows what's what. Respect!

Margaret O'doherty, Community pharmacist

I have a simple question. If the hubs are dispensing two-thirds of the prescriptions (the easy and profitable two-thirds) who is going to dispense the other third? There won't be any community pharmacies left to do it.

London Locum, Locum pharmacist

I'm sure the graduates currently working their socks off will be happy to do it for free. For the benefit of the nation of course. But hang on a minute, how do they pay back that pesky student loan??

Mark Ashmore, Superintendent Pharmacist

Easy, It's wiped out after 30 years :-)

Simon MEDLEY, Community pharmacist

They may have to pay for their pre ref too ! Another Keithism !

Leon The Apothecary, Student

Local dispensing hubs. There's no situation where you could justify needing a local dispensing pharmacy using a comprehensive hub and spoke system. I'm happy to explain any situation anyone can think of on how it would work.

Paul Dishman, Pharmaceutical Adviser

This country's "chief pharmaceutical officer" once again shows that he has no real idea about community Pharmacy, as far as I am aware he has never worked in a community setting. He certainly doesn't understand the sector, and shows little support for it ,being just a mouthpiece for DH policies

Simon MEDLEY, Community pharmacist

Absolutely agree - I'd like him to send s week each in a variety of community pharmacies to see how much added value we pho vide that isn't measured as its not paid for. Support to the elderly for instance. The man takes after his paymaster Cameron / who was so stupid as to white to his own council earlier this year asking why they were cutting services! !

PARESH shah, Community pharmacist

OF course Keith Ridge is appointed by the government and carries governmet ideas. All pharmacies will still have to carry the full range of dispensary stock for acute and urgent prescriptions. This policy of delivery is just making our older population sit on their sofas and watch television and increase all the disease timebombs which we talk about. We have got it all wrong. Our idea of health is very narrow and needs to be looked at differently.

Z ZZzzzz, Information Technology

I'm sure Amazon are looking at providing a prescription delivery service for the two thirds of scripts that need no input from anyone as they will be original packs of long-term repeats. Accuracy checking would be done by adopting RFID technology. As they don't pay tax on profits earned in the UK they can provide the service for the NHS at a cheaper cost than current contractors. Just being devil's advocate.

Leon The Apothecary, Student

I think you're completely correct. And, again playing devil's advocate, is this a bad thing? Our NHS is in a constant struggle to balance it's books.

Simon MEDLEY, Community pharmacist

But it's s false economy if the profits leave the country and no tax is paid - can only be bad for the greater economy .

Clive Hodgson, Community pharmacist

Mr Ridge comments about Hub'n'Spoke: ""Free up highly trained staff" to work more closely with patients” is most likely a euphemism for redundancy. Embracing every funded service available now, and even a quite few new ones in the future, would only provide a living for a tiny fraction of those “freed up”. Hub’n’Spoke is all about cost saving, nothing more.

London Locum, Locum pharmacist

They'll definitely be free alright. Free to apply for other jobs

Leon The Apothecary, Student

I wrote an article on here a little while back discussing the same thing. In short, one robot does the job of many dispensers with far greater accuracy and efficiency and greater value.

Dodo pharmacist, Community pharmacist

I dont know if Mr Ridge has worked in a community pharmacy lately, but a hub and spoke approach does not save pharmacies a great deal of time. Most of the time in the EPS dispensing process is taken up by downloading, printing, collecting, endorsing and claiming the EPS items, all for the grand payment of 90p. The actual dispensing is the shortest part of the process. It is much easier and quicker to dispense the items yourself, than to label the prescription for remote dispensing and then check the dispensed prescription off when it arrives the next day and then put the remotely dispensed items together with the patient's other items which cannot be remotely dispensed, such as CD's and fridge lines.Plus all this guff about a much closer examination of how taxpayer's money is spent on pharmacy- well the hub pharmacies are not cheap to set up and will have to be paid for somehow and not with fresh air! The NHS has had the benefit of the community pharmacy network on the cheap for many years and if they don't know this then they are in the wrong job.

Harry Tolly, Pharmacist

I bet Keith was wearing his West Ham shirt when he came up with this idea :-)

Leon The Apothecary, Student

Mr Armstrong, it sounds like have some optimisation to do in your ETP process! Also batch functions. We love batch functions.

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