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Public to consult on ‘seismic change’ hub-and-spoke model for pharmacy

Jo Churchill: We intend to be totally transparent to ensure the right model for pharmacy
Jo Churchill: We intend to be totally transparent to ensure the right model for pharmacy

There will be a “full public consultation” on pharmacy's move to a hub-and-spoke dispensing model, to gauge opinion of this “seismic change” for the sector, ministers have said.

Legislative changes to allow independent pharmacies to operate a hub-and-spoke dispensing model were tabled as part of the Medicines and Medical Devices Bill, first presented to parliament in February 2020.

The bill – which is in its final stages of approval, before it becomes law – also includes proposals to allow large pharmacy chains with automated hubs to charge smaller chains and independent pharmacies “prescription assembly services”.

Recognising the potential impact on the sector of these legislative changes, pharmacy minister Jo Churchill said there will be a “full public consultation” on the implementation of the proposals.*

“The government will then report to parliament and include a summary of the concerns raised in the public consultation,” Ms Churchill said in a House of Commons debate on Wednesday (January 27).

“To ensure that we get the right model to assist pharmacy going forward, we intend to be totally transparent,” she stressed.

Earlier in the debate, shadow health minister Alex Norris stressed the importance of a “wide-ranging consultation with all manner of stakeholders” on something that will be a “seismic change for community pharmacy”.

“Free up pharmacists' time”

Legislative changes around hub-and-spoke dispensing were first mooted with the service-led pharmacy funding contract for England, announced in 2019.

An impact assessment published alongside the Medicines and Medical Devices Bill in 2020 said: “The government’s vision for community pharmacy is that it should provide expanded clinical services…helping to relieve pressures on other parts of the system.

“To achieve this, dispensing needs to become more efficient to free up pharmacists’ time for other activities. Permitting all pharmacies to access more efficient hub-and-spoke dispensing is part of the government’s strategy to support this transformation.”

While recognising the costs of setting up a hub-and-spoke dispensing model, changing business processes, IT and logistics and staffing the facilities, the government said benefits include “reduced staff time…potential for reduced rates of dispensing errors and potential for a calmer working environment at the spoke pharmacy”.

In its submission to ministers last year, the National Pharmacy Association (NPA) said that claims about the benefits of the hub-and-spoke model “are overblown” and that it could reduce “competition and choice in the pharmaceutical wholesale market without a level playing field”.

CCA hosts MPs to “help understanding”

The Company Chemists’ Association (CCA) – which represents the UK’s largest multiples and supermarket pharmacies – hosted a virtual event last October to “help parliamentarians understand more about the automation of medicines assembly, and the role of hub-and-spoke models”.

Attendees to the event – which included all-party pharmacy group (APPG) chair Jackie Doyle-Price, Department of Health and Social Care head of pharmacy Jeanette Howe and the NPA’s Neil Bhayani – discussed the issues that would need to be addressed before legislative changes were made.

These included: original pack dispensing; investment from the government to fund the widespread infrastructure; and fair community pharmacy funding to “improve the future viability of community pharmacies”.

*This article was updated on February 5 to clarify that the legislative changes around hub-and-spoke have not been removed from the Medicines and Medical Devices Bill.

29 Comments
Question: 
Does your pharmacy operate a hub-and-spoke dispensing model?

Nicola Jones, Accuracy checking technician

Looks like all us support staff will soon be out of work.

Mark Boland, Pharmaceutical Adviser

Bureaucrat: What do you think of the legislative changes to allow independent pharmacies to operate a hub-and-spoke dispensing model?

Man / Woman on the street: Whats that?

Bureaucrat: It is a new way of dispensing your medicines. Do you think it is a good thing?

Man / Woman on the street: Do I get my stuff quicker and cheaper?

Bureaucrat: Possibly, but there are other things to consider.....

Man / Woman on the street: I have to go [walks off - head in phone]

12 months later

Man / Woman on the street No1: That pharmacy has closed. There is nothing left in this town anymore

Man / Woman on the street No 2: Yeah, it is terrible isnt it? I'm lucky I get mine delivered from the internet.

Man / Woman on the street No 1: Yeah, I get mine from the supermarket. They do it all for me.

15 years before

Pharmacist No 1: We have a bright clinical future ahead. Those clinging onto dispensing need to 'skill up' and grab the opportunities.

Pharmacist No 2: It is an obvious nonsense. There is no evidence to support the clinical effectiveness of these services, no sustainable income attached to them and absolutely zero demand from the public for them. We must protect the dispensing role and payment for it.

Pharmacist No 1: You have no place in community pharmacy and you will be replaced by 'skilled up' pharmacists

Pharmacist No 2: I am looking at the facts and how the real world works. In ten years we will be shutting pharmacies. These pseudo-clinical services are an attempt to make it look like we are offering more value by simply increasing pointless activity. The digging of holes to fill them back in will be discarded in the next round of cuts and you will not hear a single word of complaint from patients, doctors or authentically clinical pharmacists.

15 years later

Pharmacist No2: I have lost my job / taken a real terms pay cut. Pharmacies are closing. We are getting no new investment and dispensing has been taken off-site.

Pharmacist No1: I am sorry I am unable to answer your message I have: retired / moved onto another management role in government - corporate world / sold up when I had the chance

 

Benie Locum, Locum pharmacist

Not sure about the bureaucrat but I certainly know some pharmacist No 1's. 

Benie Locum, Locum pharmacist

But it's Amazon you're suppose to fear. Lmao.

Mark Boland, Pharmaceutical Adviser

The only people I have feared in my career are the useful idiots within the profession. Of which there appears to be an endless supply.

Of course, when the health of the profession has always been measured by the bottom line of the contractor, we never stood a chance of attaining the respect and opportunity we deserved.

Getting Shorter, Community pharmacist

Why on Earth would you ask the public about this?

They have precisely zero idea of what happens in pharmacy ("it's only tablets"/"all you do is stick a label on the box") as it stands; how could you expect them to comment on possible changes?

Also: BoatyMcBoatFace.

 

Hopefully the people who feel this is a chance to quietly bury the whole thing are right...

Kirit Shah, Community pharmacist

I too think decisions have already been made and this consultation is just a publicity exercise and so appear to be fair!

Lots of pharmacies are planned to be closed to enable this hub and spoke model to work!There will be fewer numbers of pharmacies in each area as a result particularly in run down areas.

M. Rx(n), Student

I think the opposite is true.
I surmise what you say was in serious consideration, but the pandemic ushered in new realities that exposed the frailty of the concept.

Look at how big tech etc is behaving in the US. Imagine an entire healthcare infrastructure hinging on private logistical and tech companies. It'll be a disaster.

I believe this consultation is a way to put the concept out to pasture. The pandemic has shown Pharmacies to be key within the healthcare network.

That's just me.

Locum Pharmacist, Locum pharmacist

Where/how exactly is this"publuc consultation "going to take place ??
It's a done deal. All stitched up. All this lot see are pound signs and what they can get rid of next.

M. Rx(n), Student

I don't think so.

I think it was given serious consideration and reached the final stage....but the pandemic probably cast fresh doubts.

We may have just dodged one!

M. Rx(n), Student

I don't get why some tout Amazon as some vaunted organisational marvel.

Amazon merely centralises operations to save costs. It is not rocket science when you've cornered a chunk of the market through brand name.

Let's explain this to the public and see if they'll favour their medications being facelessly processed through Amazon/Amazon-like sweatshops.

In their bid to chase dubious "clinical services" money, contractors and the shallow multiples have brought the Profession to this precipice.

Maybe whilst we are at it, we could also co-opt Argos' logistical network to process and ship medications.

I'm glad the proposals have been removed from the bill to allow for further deliberation.

Benie Locum, Locum pharmacist

Multiples and independent contractors see pharmacists and indeed staff as purely a drag on profits. This is why you go to boots or Superdrug and the counter is empty with the pharmacist running around like a headless chicken. If you go to an independent the poor pharmacist is expected to take on each new tick box task(to earn money for the owner) with no increase in pay or extra staff. The Amazon model of getting rid of more people is simply the natural progression. The problem now is all those multiples and unscrupulous independents will reap some of the whirlwind they have been sowing these past 10+ years. 

Happy Sunday. 
 

 

 

 

M. Rx(n), Student

Pharmacists should actively engage their patients on whether they would prefer faceless sweatshops to handle their medications or well-resourced local Pharmacies to process their prescriptions.

See, there's a lot of value in just talking to our patients (as drug experts)!

Chris Locum, Locum pharmacist

Unfortunately, many patients these days equate speed with value and 'cheap' prices. If they don't get seriously inconvenienced for a long enough time, many won't care how they receive medication. Those who used P2U a while ago soon forgot about being dumped over one christmas period because there was a physical network to deal with the consequences. I am very much afraid that many pharmacists will have their time freed up to find another career.

M. Rx(n), Student

You make a good point which I believe greatly influenced the non-Pharmacists on board with the concept .

The absolute state of many Pharmacy premises these days do not lend much support to the contrary. From poor design to poor staffing and the waste of space on stocking junk on "sales floors", we haven't haven't helped our cause when we handed off the sector to "big retail". This was therefore a natural evolution.

The inherent clinical basis of Pharmacy, like Cinderella, has been locked away toiling in the doldrums for decades. It's great beauty has been buried under shallow commercial trappings and happenings above.

Which is why engaging and educating the public is a must. Both TV and other PSA campaigns SHOWING the value of the Pharmacist's work within the care pathway will go a long way.

The biggest countermove will be to advocate for the integration of CP into the NHS. Ending contractorship may be the last hope.

If Pharmacy is a key component of basic healthcare, should it be run for profit?

Benie Locum, Locum pharmacist

Wrong forum pal. Most on here would like community pharmacy but without pharmacists - they're a drag on profits you see. If you're a genuine student retrain and do something worthwhile.

 

M. Rx(n), Student

Ha...

I recently read an article on here about the DoH wanting to see contractor historical costs -- and the PSNC throwing a strop. Good laugh!

Gillian Brown, Accuracy checking technician

The Government need to take a look back over 2020 and see that this Pandemic would have been a whole lot worse without CP picking up the pieces when GP surgeries went running for cover and refused to see patients!! We will always need a local Pharmacy with dedcated staff helping those in need.

Adam Hall, Community pharmacist

Public consultation? Generally, the public don't care. Look at how many high street retailers have gone to the wall with the massive surge in online shopping. The 'public' will only care when their urgent antibiotics take three days to get to them, or when the hub breaksdown - we all remember the Christmas when P2U fell over, and Community Pharmacy picked up the pieces - only there won't BE Community Pharmacy; or your next pandemic when GPs run scared and shut up shop, and there's nowhere else to go. By then, hopefully I'll be out the other side and will shake my head in sadness at a profession/service destroyed whilst saying 'I told you so' to all those Millenials who allowed it to happen and will then be bemoaning what a terrible thing the NHS is.

C A, Community pharmacist

The next pandemic won't be for ages (at least politically speaking) and P2U have picked up enough patients in this pandemic that they can open another hub, so it's unlikely that both hubs will go down at once, so it's very unlikely that there will be another P2U Christmas. Therefore Community Pharmacy is done for, the government will eventually realise how much it's spent and realise their poor management of Covid/Brexit has hurt the economy, resulting in less tax income, then they will go looking for efficiencies and savings and guess where they'll come looking?

Freelance Chemist, Pre-reg Pharmacist

 

I can't believe they still want to destroy pharmacy!! Have they not seen the value of pharmacy during this pandemic when GPs shut their doors to patients seeking medical advice, pharmacy was the only Heath sector that didn't shut their doors closed. My mind boggles..... time to hang up your white Coates ladies and gents and all other genders you would like to identify as!!

very very sad to read this. 
 

Full disclosure I have no  Financial interests in pharmacy, I'm just a very disillusion pharmacist 

Brian Perry, Locum pharmacist

I too was disillusioned.

Finally I asked myself why I had illusions in the first place.

As the old Greeks used to say: know thyself.

It will help you in your next career choice.

Benie Locum, Locum pharmacist

All these decisions have already been made. Public consultation is purely for show. 

 

Freelance Chemist, Pre-reg Pharmacist

I completely agree pal. This is just a dirty paper exercise

Pear Tree, Community pharmacist

I wonder who is going to have the last laugh when Amazon enters the pharmacy market and beats the multiples at their own game. I cannot imagine Lloyds et al ever matching the logistical superiority of Amazon in the online marketplace. 

Freelance Chemist, Pre-reg Pharmacist

I agree Amazon will destroy all the multiples, mark my words!!

The old saying turkeys voting for Christmas comes to mind. 
 

they might make money in the short term, long term they will be destroyed

Leon The Apothecary, Student

Absolutely. Pharmacy is a logistical problem to solve, not a clinical one.

Clive Hodgson, Community pharmacist

Amazon entering the market will be a major disruptor to the current community pharmacy sector without doubt.

With this in mind consider the comment from this article: “dispensing needs to become more efficient to free up pharmacists’ time for other activities”.

Given the dearth of commissioned and properly funded services is this not just a euphemism for the inevitable pharmacist redundancies?

Leon The Apothecary, Student

Over the last few years, I have witnessed some of the teething problems with the technology. Ultimately, they were primarily logistical in nature. It is my opinion that if pharmacy businesses do not jump aboard this technology and learn to use it effectively, a huge portion of the market share will disappear from the local pharmacy. We can see this from March 2019 dispensing figures, where H&S pharmacies saw a massive uptake in their dispensing figures.

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