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‘Hub-and-spoke: Why modern doesn't necessarily mean machines'

"I remain concerned about hub-and-spoke's potential impact on job losses and patient interaction"

Laura Buckley has a lot of questions that need to be answered about the hub-and-spoke dispensing model. Will it mean patients will lose that connection to local pharmacists?

Hub-and-spoke dispensing appears to be the Marmite of the pharmacy world; I’ve seen it divide opinions in a way that only Brexit could rival.

Employing sizeable hubs to dispense medicines on a large scale for redistribution to either pharmacies or direct to patient doesn’t sit right with me, so you could say I’m not a lover of this model.

While freeing up pharmacy teams to provide more services seems to be the aim of the game, I remain unconvinced and concerned about a potential impact on job losses and patient interaction. If we consider the services that the hub-and-spoke model is supposed to be freeing pharmacy teams up for, we need to see them commissioned first and in such a way that ensures a steady income for pharmacies and adequate training provision for those involved. Patients need to benefit in a big way to make this model even worth considering; I’m not so sure a move to hub-and-spoke holds patients’ interests at heart.

For me, it all seems too business-focussed and feels like it benefits the large multiples, allowing them to churn out medicines factory-style, while minimising the costs of employing staff. What should we expect for the smaller chains and independent pharmacies that cannot possibly develop or rival models like the hub-and-spoke?

I’m concerned that the benefits of such a large-scale rollout of hub-and-spoke will be severely outweighed by the negative impact on so many job roles and will risk destroying the infrastructure that underpins patient access to community pharmacy. As more hubs open, are we to expect fewer spokes in the community, thereby reducing the pharmacy/pharmacist-to-patient ratio? Will this reduce local access to community pharmacy?

Are we to see a move to robotics, which is expensive and replaces a workforce? And what of the evidence to support the move in this direction?

As a pharmacist, I very much believe in community pharmacies and their work remaining in the heart of the community. I think building patient relationships and being familiar with their medicinal needs is safer, more satisfying for the patient and a more personalised form of care. There’s comfort in knowing those who prepare your prescriptions and there’s comfort in knowing you can call in at your local pharmacy at any point. Robotics don’t have the same senses that pharmacists do and while you can programme a machine to be efficient, can you instil the sixth sense for concern that pharmacists develop from years of training and experience?

Without adequate commissioning of services and a lack of need to dispense due to hubs, it wouldn’t be economically viable to keep pharmacies open and I fear it would be the end for traditional community pharmacy as we know it. Patients deserve better than this and we as a workforce deserve more than being subjected to a system overhaul to make us more of a factory and less of a pharmacy.

Change is inevitable and we have been clamouring for change in the community pharmacy sector for a long time. But change in the form of developing more hub-and-spoke dispensing, and without evidence to support safety for patients and the safeguarding of jobs and patient access, feels like a rash move. I’m yet to see compelling information to convince me that hub-and-spoke is a positive move for pharmacy; modern doesn’t mean machines and factory settings, it means personalised care for patients without cutting corners to make profit.

Laura Buckley is a locum and a pharmacist at a PCN in East Yorkshire

Find out more about the hub-and-spoke model here

6 Comments

M. Rx(n), Student

It is not a difficult concept.

NHS hubs equivalent of hospitals centrally processing long-term stabilised treatments for hand over to patients by their local pharmacies is efficient and PATIENT-CENTERED. 

It eases the absurd congestion in local Pharmacies who can better focus on NOT providing more useless services, but delivering quality acute care and support for long-term conditions.

But this will only work as intended if the NHS itself runs the hubs.

The other alternative is in-pharmacy dispensing technology, although I don't think that would yield the same gains in terms of easing congestion to facilitate better care provision.

As for these being "business-like", well, the business of healthcare is to provide cost-effective and efficient PATIENT-CENTERED CARE. And the current dingy living-room-sized local Pharmacies can do with a better care model that makes the patient journey and experience safer and without frills.

C A, Community pharmacist

"It is not a difficult concept."

Agreed, it's not, it's a divisive concept

 

"NHS hubs equivalent of hospitals"

Have you seen how much a hospital costs? How easy do you think it will be to develop and deploy these new NHS hubs? How much do you think it will cost? What will be the break even point and return on investment?

 

"centrally processing long-term stabilised treatments for hand over to patients by their local pharmacies is efficient and PATIENT-CENTERED."

So you are going to do at distance what is already done locally, what metrics of efficiency are you using? Is it Cheaper? Faster? Better? More accurate? More convenient?

 

"It eases the absurd congestion in local Pharmacies"

Great so less foot fall, means less counter sales and less turnover

 

"who can better focus on NOT providing more useless services, but delivering quality acute care and support for long-term conditions."

So less services but more services... great, how are you going to design the "new" services, how are they going to be funded, how are you going to police them and prevent them turning into KPIs and targets? Basically what ideas do you have to prevent any new services from being "useless"?

 

"But this will only work as intended if the NHS itself runs the hubs."

How are you going to fund core pharmacy? The DOH certainly won't entertain a "dispensing" fee for just handing out medication. Or are you suggesting that pharmacies hand out the medication for free and be paid solely on acute care and LTC?

 

"The other alternative is in-pharmacy dispensing technology, although I don't think that would yield the same gains in terms of easing congestion to facilitate better care provision."

Again, have you got anything to back this up or is it just feelings?

 

"As for these being "business-like", well, the business of healthcare is to provide cost-effective and efficient PATIENT-CENTERED CARE. "

Ah... precapatalist ideals. I think you'll find the business of business is to make money. Anything else is just the means to make the money.

 

"And the current dingy living-room-sized local Pharmacies can do with a better care model that makes the patient journey and experience safer and without frills."

Don't worry, the funding cut backs, the clawback of the Covid-19 advances and the flat funding for the next 5 years will soon see those dingy living-room sized local pharmacies disapper, giving you a better patient journey... over the extra miles you have to travel to get to the nearest pharmacy that's still open.

M. Rx(n), Student

Strange argument.

Did you miss the "cost-effective and efficient" bits of my post? Could the NHS be run better? Of course. But as a public good is it better or at least comparable to anything else out there? Certainly!

Also, it is "divisive" for whom? The vested interests or the patient?

Because you'll find that as a Pharmacist/healthcare Professional, the latter should contextualise your thinking more than any pre-capitalist/capitalist notions. Certainly, whichever is in the best interest of the PATIENT should be your primary concern!

Being in Pharmacy/healthcare practice for the money is like going camping to seek luxury. Earning a decent wage for your efforts, on the other hand, is a different story.

C A, Community pharmacist

 

Yes I saw your comments on "efficient" - all two of them, where you suggested that assembling off-site was more "efficient" and patient centric, but failed to provide any metrics of efficiency or even propose any metrics that could be used to measure current efficiency vs proposed future efficiency.

Then onto "the business of healthcare is to be efficient" - arguably as the businesses haven't gone bankrupt the are "efficient", thus what you want is to be more efficient, and again you don't provide much input other that stating the new way will be "better, more efficient, cheaper (by virtue of being more cost efficient) and more patient centric".

Next you'll be suggesting that every Pharmacy has a rainbow in it and is funded by the pot of gold at the bottom of it! No cost to the tax payer and infinite cost efficiency!

"Also, it is "divisive" for whom? The vested interests or the patient?"

I'll go with the luddites and the forward thinkers

"Certainly, whichever is in the best interest of the PATIENT should be your primary concern!"

The best interests of the patient are my primary concern so nice strawman

"Being in Pharmacy/healthcare practice for the money is like going camping to seek luxury."

I agree with you in regards Pharmacy, but being a GP can earn you a pretty penny, and they certainly are motivated by money. Oh and glamping... yeah it's a thing.

"Earning a decent wage for your efforts, on the other hand, is a different story."

Ah yes the flat line of pharmacy wages, locum rates now being about the same as they were 10 years ago.

"Retooling the entire setup to make efficiency gains and re-align costs NOT at the expense of the patient or taxpayer is a strangely radical notion, I'm sure."

I'm sure everybody would like to retool to get efficiency gains, but at what cost and it's the NHS, what makes you think for a second it won't be at the public expense?

Quick lets buy lots of warehouses and the NHS can run them as hubs, and pay rent, ultilities and rates on the buildings that it previously didn't need, then the NHS can hire more staff and pay their wages, again a cost previously born by private industry. 

What's it going to get you? A small increase in efficiency with an increase in ongoing costs, how long before inflation and expenditures eclipse the cost savings and you end up with a system that costs more than the one it replaced? How are you going to rate that efficiency?

 

M. Rx(n), Student

Read my posts again! The metrics you claim are absent, are all there. They just don't fit your dogmatic worldview.

If you are a Pharmacist, think like one working in a "dingy, living-room-sized" Pharmacy, with your PATIENTS queued up into the cold waiting for the repeat Rx that they were promised would be ready last week but isn't. Along with them is a mother of three waiting for over 45mins for a simple amoxicillin elixir for their toddler.

Now, read my posts again and try and work out the "efficiency metrics" and then try harder still to reconcile your views with PATIENT-CENTERED access to a critical PUBLIC GOOD!

You'll get it.

M. Rx(n), Student

Certainly, the problem seems to be the provincial thinking of vested interests who cannot see beyond their immediate interests.

Retooling the entire setup to make efficiency gains and re-align costs NOT at the expense of the patient or taxpayer is a strangely radical notion, I'm sure.

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