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Lloyds reviews number of branches using hubs as model works for ‘some’

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McKesson UK had originally planned for 900 pharmacies to use the hubs
McKesson UK had originally planned for 900 pharmacies to use the hubs

Lloydspharmacy has revaluated the number of branches suitable for its hub-and-spoke model after finding that it only works for “some” pharmacies, C+D has learned.

The multiple had originally planned for 900 of its pharmacies to use one of its three dispensing hubs – in Warrington, Ruislip and Bristol – a McKesson UK spokesperson told C+D last week (October 12).

However, since last year the multiple has reviewed this number because there are branches where the benefits of hub-and-spoke are not “realised by all” due to the pharmacy’s “size, staffing levels, the level of repeat dispensing and mixture of the workload”, the spokesperson added.

Other reasons contributing to the multiple’s decision to reconsider the number of pharmacies using its hubs include a change in GP prescribing habits, “changes to our estate” and “changing customer habits brought about by Echo subscriptions” – Lloydspharmacy’s prescription management app – the spokesperson said. Currently, 560 Lloydspharmacies utilise the hubs.

However, the multiple recently identified an additional 80 pharmacies that could “benefit from sending offsite”. This will see the number of branches using the hubs increase to around 640 in the next 10 weeks, the spokesperson added.

Toby Anderson, CEO at McKesson UK – Lloydspharmacy and AAH's parent company – told C+D in an interview last month (September 10) that “for us at least, hub dispensing is not the solution for all pharmacies”.

“It works for some of our pharmacies [but] it doesn't work for all pharmacies and it doesn't work for all patients”, he said.

“What we would rather do is for the stores that are connected to and are right to use the hubs [to] try and utilise more of our spending volume through [our] hubs. Rather than a little bit across all stores, it works better for us to have a more focused effort for a selected number of stores,” Mr Anderson added.

“Not the answer to all our efficiency challenges”

Mr Anderson told C+D that he thinks the branches that are currently using McKesson UK’s hubs do “really like it”.

“There's a bit of hard work at the beginning. The important thing is making sure that everybody's clear and trained on how [to] adjust [to the new model].

“If you ask pharmacies now, what it would be like to take it away? Most would say no,” he added.

McKesson UK is “open to exploring ” the option of letting non-Lloyds pharmacies use its hub-and-spoke system if regulations around the model change, Mr Anderson said.

But he said that while the dispensing hubs are a “good tool to have in the toolbox” they are “not the final answer to all of our efficiency challenges”.

This technology is “not necessarily the sort of the silver bullet that everyone's looking for. I think it could be part of the solution. But it's definitely not the solution to how we continue to evolve pharmacy in [this] country,” he added.

Read our exclusive interview with Lloydspharmacy CEO Toby Anderson to find out what the multiple is doing to prevent further closures, its experience of the COVID-19 pandemic and more on hub-and-spoke.

13 Comments
Question: 
What do you make of the hub-and-spoke model?

Concerned Pharmacist, Community pharmacist

Having been a massive cynic, and after a torrid implementation, I believe that the Well hub and spoke model does work (in all sizes of branch).
It does need a simplification of the workflow process, as you need to be an expert to get the best out of itat present.

However, if you take more hours out of the branch than the system saves then it all falls flat on its arse.
That's where Well have gone wrong.

Leon The Apothecary, Student

I quite agree, at the very least, trying to go for a 50% cut immediately was a very ill-advised move, as the extra time to acclimatise, teach customers the workflow, learning CAPA, Primo and Scriptshelf was important. 

Nathan Wiltshire, Senior Management

This is interesting. I can tell you that our membership remain very sceptical of this model and any perceived benefits it can deliver for the sector. In a recent survey 90% of those who responded believe that the model will disadvantage independent pharmacy or are unsure of any real benefit to the sector. Over 90% also do not believe that it will save any money. It is also interesting to note that over 70% of those who responded would not consider paying a fee for this type of service or accept a reduced purchasing margin. We believe this needs a rethink.

Leon The Apothecary, Student

There are definitely strong benefits from someone who is an expert in the model. However, it requires a different mentality and workflow, and getting staff and customers to change is a real and biggest barrier.

However, I will admit that it works to-scale, for smaller pharmacies, those who can typically clear their workload of a day already, are less likely to gain a benefit from it.

A.S. Singh, Community pharmacist

Hub and spoke will not work well. The multiples will quickly find that they will lose customer base when they cannot dispense repeats quickly.

 

Also a lot of staff time will be wasted trying to locate where the packages have gone not to mention the legalities surrounding responsibility. 

Leon The Apothecary, Student

That depends on the system being used, scriptshelf for example is actually more accurate about where anything is at any one time, compared to traditional pharmacy workflow. Titan could tell you if a prescription was being dispensed, by who, and at what workstation.

As for responsibility, the legality is actually very clear, it simply likes to be contested. RPs responsibility to ensure the process is up to standard, although that is were the confusion usually lies.

C A, Community pharmacist

But Keith Ridge said hub and spoke would work for everyone! 

Locum Pharmacist , Locum pharmacist

After working with the hub and spoke system for a few big multiples, it does of course take a chunk of the workload out of the branch but the staffing hours in the branches whom use the hub has been dramatically reduced. The result is that the remaining staff are actually under more pressure as not they are a smaller team still required to carry out all tasks including dispensing items that the hub cannot supply, dispensing walk in prescriptions, date checking, in house compliance jobs, the list goes on !.

When one of the remaining members of staff takes annual leave or has a sickness, cover generally isn't provided and the branch can quickly turn into a nightmare. My biggest problem is that the big multiples have sold this to us as 'more time will be freed up for the pharmacist who can them spend more time with patients'. This is far from reality and the pharmacist generally spends more time supporting the team and trying to keep the branch running smoothly with reduced staffing hours.

It was be more honest of these big companies to just be open and honest and say that we are not making as much profit as we previously have done and therefore we need to continue to make cuts to increase our profit margins. The same goes for remote supervision..... just be honest with us and say we need to cut costs and by reducing pharmacists salaries we can continue to make our desired profits.

 

Mr CAUSTIC, Community pharmacist

Would be interesting to hear from pharmacists involved in their scheme what problems they have found . How many errors are found ? How quickly they can turn around a script etc ?  What problems arise that one would not have ever anicipated ?

Leon The Apothecary, Student

So I worked in developing one for two years. With assembling (dispensing) there were almost no errors, barcode validation means a product goes through more accuracy checks than a traditional dispensing, errors occurred almost exclusively when a manual overwrite was conducted.

Script turnaround is a fixed 72 hours from the date of the prescription being transmitted to the hub, this is were a lot of friction occurred with customers, and generally depended on how well this was communicated in-store. This caused a lot of stress to staff as customers can be very mean. 

The biggest challenge was actually retraining to think in terms of the new workflow. It highlighted a lot of shortcuts a pharmacy does in it's day-to-day, and with H&S, you have to rigidly stick to the workflow, or you cause issues.

Teaching pharmacists not to write on labels was a big one! You sign with a barcode validation.

Invictus Maneo, Student

Assuming a well-resourced Pharmacy in support of the RP, I wager it's still more cost-effective dispensing in-house along with the open-access of the Pharmacist's door within the community focused on the core duty of pharmaceutical care.

Pharmacy delivery should be based solely on local needs not arbitrary national contracting schemes.

Leon The Apothecary, Student

From figures I saw, it made some massive savings to remove it from in-house. Put it this way, if 90% of your dispensing could be removed, the money then savable through staffing hours, training, admin, ground rents is very substantial.

Dara Hughes, Community pharmacist

Couldn’t agree more. A dedicated and driven team will trash a hub and spoke model any day for efficiency and cost effectiveness AND accountability. 

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