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Professional bodies call for law change to boost use of hub and spoke

Business Current dispensing system is disadvantaging independents, Pharmacy Voice and PDA tell Call to Action consultation

Pharmacy groups have called on the government to relax the rules around dispensing so independent pharmacies can operate a hub-and-spoke model.

The government should review the law that prevented the model being used unless the dispensing hub and pharmacy were owned by the same business, Pharmacy Voice said in its response to NHS England's Call to Action consultation, which closed last week (March 18).

The hub-and-spoke model could offer opportunities for independent pharmacies to invest in automated dispensing if this legislative barrier was removed, Pharmacy Voice said.

The hub-and-spoke model could offer opportunities for independent pharmacies to invest in automated dispensing, Pharmacy Voice said in its response to NHS England's Call to Action consultation

More on dispensing

Boots to pilot automated dispensing hub

Dispensing hub will not lead to redundancies, says Boots

Hub-and-spoke laws disadvantage independents

The Pharmacists' Defence Association (PDA) also used its consultation response to recommend that it be made easier for independents to move the dispensing function out of the pharmacy. It called for NHS England to amend the community pharmacy contract so that payments for dispensing medicines and for providing services were separated.

This would allow some pharmacists to focus on delivering services without being "too concerned about how the medicines are dispensed", it said. Medicines could even be dispensed elsewhere and then delivered to the pharmacy for distribution to the patient, the PDA suggested.

This approach could improve patient safety by encouraging the use of large-scale robotic dispensing and bar code checking, which was difficult for smaller community pharmacies to afford, it said.

Their recommendations followed Boots' announcement earlier this month that it would trial a dispensing hub in Preston that would supply 50 pharmacies. At the time, pharmacy law specialist David Reissner told C+D that independents were disadvantaged by the current legislation, as wholesalers and buying groups were not permitted to supply dispensed medicines to independents from a central hub.

Both Pharmacy Voice and the PDA also used their consultation responses to call for NHS England to commission a national minor ailments scheme and align the GP and pharmacy contracts, and for pharmacists to take on a greater medicines management role by working alongside GPs.

"Pharmacists should be able to make simple changes when a brand is out of stock or the wrong form has been prescribed, without recourse to the prescriber. They should be able to supply NHS products on verbal orders without a prescription in out-of-hours situations," Pharmacy Voice said.

The PDA advocated a "named pharmacist medicines champion" to look after frail and elderly patients as they moved between secondary and primary care. These pharmacists could act as a "medicines-related bridge" between the hospital, GP, residential home and community pharmacy, it added.

NHS England will use the Call to Action responses to inform its strategy for primary care, which is due to be published in autumn.

Should the government change the rules governing hub-and-spoke dispensing?
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S S Locum, Locum pharmacist

Anthony Onuchukwu, agree with what you say( re: sinking ship) but which other country wants services of a pharmacist? - Check with pharmacists in Australia, USA etc . All have same problems.The profession is doomed !!!

Anthony Onuchukwu, Community pharmacist

This is the beginning of the end for community pharmacist as we know it
My advise to community pharmacists is to use the little time left to abandon this sinking ship and look for some other profession to go into or to move to some other country that needs their services

N O, Pharmaceutical Adviser

And what are the options that you feel are safe and give similar returns (both monetary as well skills) ??? I would jump straight away.

London Locum, Locum pharmacist

Pharmacist generally don't assist other Pharmacists so i doubt you'll get a response to that

Brian Austen, Senior Management

Once again, those that represent pharmacy and pharmacists are giving good reasons and justification to commissioners to make pharmacy more cost effective, efficient and reduce cost to the taxpayer. Remember post offices, well it will be "remember when there use to be a pharmacy on the high street". Soon there will be Retail Pharmacies (aka Boots (or similar) without NHS contract dispensaries, the same in Supermarkets, internet/delivery pharmacies, dispensing and distribution/delivery factories, and high turnover pharmacies in health centres. The services that do get commissioned won't be enough to provide enough work for pharmacies and pharmacists. The number of independent pharmacies will slowly but surely reduce. Ironic that pharmacy will have done itself in. I agree with MESIT OZIL, open up pharmacy to competition. Remove control of entry both to providing pharmacies anywhere in England. At the same time doctors dispensaries should provide services and trade like pharmacies outside the financial envelope of the GP practice. That would create a level playing field for everyone.
Unfortunately I do not think that the anti-competition regulations will be removed. Too many have an interest in ensuring that pharmacy remains closed to new entrants and competition without regard for patients and customers.

London Locum, Locum pharmacist

If you can't beat 'em join 'em

London Locum, Locum pharmacist

Only worthwhile way forward I see is to become a contractor but then you have the problems of the multiples. However as always problems are relative. Despite the incessant complaints they're still making good money. Downgrading from a Merc to a BMW is not the end of the world.

In the short to medium term at least, it is employees and locums that are doomed and nobody seems to care.

Martin Astbury, Community pharmacist

Sorry to be pedantic but the two organisations named in this article are not “professional bodies”. One is a trade association the other is a trade union. There are many pharmacy organisations in GB but there is only one “Professional Body” for pharmacists and pharmacy in GB: The RPS.
What is vital here is that only the Assembly process (picking and labelling) should taking place at the hub. The clinical check must be conducted by a pharmacist and the medicines must return to the local pharmacy to be handed out under the supervision of a pharmacist.
We must avoid creating laws and pharmacy contracts that allow local pharmacies to be easily by-passed.

N O, Pharmaceutical Adviser

I knew it. I did mention elsewhere that this was on cards. Now, how many points the NHS England will take up from this consultation will determine not only the future of Pharmacy Practice but also the future of many pharmacists. Lets wait and see whether the NHS will go the Multiples way or the Pharmacists way.

Rajive Patel, Community pharmacist

""David Reissner told C+D that independents were disadvantaged by the current legislation, as wholesalers and buying groups were not permitted to supply dispensed medicines to independents from a central hub.""

This is extremely disturbing that Professional Bodies seek changes to promote Hub and Spoke dispensing, under the guise that Independents would be disadvantaged otherwise.

There are so many unknowns here especially where a "buying group" would provide dispensing services to their members. The biggest being the who would own the patients and is anyone, infact even able to own a patient? I seem to remember, Sigma had a scheme where they offered to dispense a customers nursing home prescriptions. Would you give another company access to your hard earned customers access?

I truly believe that in the long term hub and spoke dispensing will deliver cost savings for the government, since they can continue to down size remuneration in reflection of the efficiency savings. Make no mistake, there is NO extra funding for services, this whole cloak and dagger nonsense simply provides a means of justification in what will ultimately mean lower remuneration for all stakeholders.

The only way around this is to see more M&A activity amongst independents. Forget the buying group model, this is too loose. There needs to more M&A since the benefits are too considerable to be left ignored. As for making legislative changes to allow groups like Sigma, Alphega etc to allow contractors to outsource their dispensing services, well this is just commercial suicide. That idea is best left in the bin.

Chris Locum, Locum pharmacist

Wonderful to know you had that professional back up....dream on!

Rajive Patel, Community pharmacist

On another note, Why don't the PDA also look at the hidden purchase profits being excoriated from the NHS by the likes of Boots/LLoyds, where they use complex transfer pricing to show the NHS one false price of acquisition but hide the true cost of acquisition made via their wholesaling arm. I am sure this considerable FAT could fund services?

The PDA are basically talking out their &*%$ suggesting that NHS England seperate the dispensing and service functions. How could they ask for this, when dispensing accounts for over 90% of income for a pharmacy? This is a precursor to mass redundancies and if I was a locum I would be seriously concerned. How will contractors be able to afford current locum rates on service income?

There will only be ONE loser in this drama, and it wont be NHS England, nor will it be the contractors, it will be the Pharmacist Employees.

London Locum, Locum pharmacist

PDA are advocating individual Pharmacist practitioners which would make things interesting for those contractors only willing to chase scripts when things become more service orientated. If of course that actually happens. Then independent ccontractors will also be losers!!!

Rajive Patel, Community pharmacist

PDA can advocate all they like, but put some one like Steffano Pessina up against the the Health Secretary then I'm sure he will listen to Pessina not some PDA pen pusher representing locum pharmacists. Fact, albeit unfortunate.

As for independents, I agree, as single handed they will be unfortunate losers, since they will have a forced efficiency agenda thrust upon them, weather they like it or not. There only option would be a forced merger to be part of a scaled up, efficient operation. As for buying groups offering Hub and Spoke, well that's just plain stupid and only for those who are greedy enough to want to go it alone.

London Locum, Locum pharmacist

Would hub and spoke no then render some independents surplus to requirements ie some would simply not be financially viable anymore unless all staff are fired and they become literally single handed

Rajive Patel, Community pharmacist

I think what would most likely happen is a reduction in NHS income for dispensing to reflect the lower overheads of dispensing. This is directly linked to the efficiencies generated by the Hub and Spoke model. It would right to say that the government would get there grubby little hands on pretty much all these efficiency savings.

The local pharmacy would act as a collection conduit in the hand over of medicines. However, I am sure that this role could be lobbied to go to lower paid technicians; again the excuse will be to "FREE UP THE PHARMACISTS TIME TO PERFORM MORE SERVICES".

The next stage will see, contractors discovering that the service revenue is quite poor (plenty of evidence even now!) and that they can no longer afford to employ pharmacists at rates seen today. Hence you will see a drop in Pharmacist incomes.

Therefore the biggest loser is the Pharmacist/Locum/Manager.

What you will see is the income stolen from the Pharmacist straight into government coffers, under the approving auspices of professional bodies and contractors.

Caveat: remember when the PSNC negotiated this dreaded contract in the first place. They said the global sum would be split into Essential, Advanced and Enhanced services. The dispensing would cover Essential and Advanced. I raised an objection to say what would stop the PCT's taking the under utilized enhanced money and using it themselves and the PSNC said that the money would be used for pharmacy if there was any underutilized surplus. Obviously we all knew this was a pack of lies.

Now if we take this same approach and listen to these cowboys saying that Hub Spoke efficiencies would be channelled to service income, then we must be a collective group of idiots. I will never trust the PSNC, nor any other body like them, ever again.


Why not just open the NHS market and let the public decide who they wish to use rather than this grubby, undemocratic, cartel we currently operate in.

The winners/losers will be decided by ppl voting with their feet and not the current joke..

John Schofield, Locum pharmacist

Pharmacists must ensure that Trade Associations like Pharmacy Voice and Trade unions are never confused with Professional Bodies.
It is quite ludicrous that commercial organisations already disgracefully protected by Control of Entry which allows them to ride roughshod over members of the profession are able to pretend that by calling themselves Pharmacy Voice they represent the profession.
Thank goodness I'm retired.

Rajive Patel, Community pharmacist

On another note, Kirit (Day Lewis) has always been an advocate of the scaled up independent model. Perhaps rather than flogging own label, day lewis branding, joint buying and other airy fairy ideas; he would do well to exploit this situation and force and gently persuade, should I say, independents to merge into his organization and offer them better return on equity.

Being part of a large progressive organisation makes the most sense. It allow true competition with the larger multiples. It also helps the existance of the pharmacy network by delivering meaningful efficiency savings the government are so badly after. The case of United we Stand and Divided we Fall, has never been more truer than now.

M Yang, Community pharmacist

Rajive, I didn't know it was still as high as 90%. A lot of money when you put it that way. Separating the dispensing and service functions will only work if the way pharmacists are remunerated changes. Those in the service/clinical role would have to have direct contracts with the NHS as opposed to being an independent contractor or employee. The uncertainty surrounding this is still unsettling.

C A, Community pharmacist

Dispensing still accounts for way more than 90%, I think the official PSNC suggests that it's ~98%. For example my figures for February suggest that services accounted for ~2.5% of turnover, and that included payment for flu vaccines which have now dried up. Granted it's a multiple and they view services as profit...

Rajive Patel, Community pharmacist

Agreed. I would think the best route is to have direct contracts between individual pharmacists and NHS England. However, don't expect contractors support this. Contractors will do only what suits them as a corporation rather than the well being of staff and development of the profession. I am afraid it the sign of our times, that the size of a commercial entity has much more power than the will of the sum of its employees.

I am passionate about community pharmacy and the one thing that really gets to me is the sincerity of certain stakeholders in our sector. The employees, who have no commercial gain, look to enhance the credentials of the profession, which in turn lines the pockets of their employers, who in turn look to take action to screw the very employees that deliver them the goodwill. Sad.

M Yang, Community pharmacist

To ensure pharmacists still have a job to go, it needs to be part of a unified effort designed to change the way pharmacists practice. The PDA's proposal for developing new roles will only work to the benefit of the profession if we can lay down ground rules on hub and spoke and automation, have solid legislation in place to govern what the pharmacist's role is and have a solid plan (as well as funding) for how to develop new roles. The death of the profession is certain if the hub and spoke model becomes dominated by the multiples and used as a tool to bully pharmacists and dish out redundancies.

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