Hub and spoke dispensing is on the horizon – Carolyn Scott finds out what that might involve

A key challenge for pharmacy is finding ways to free up pharmacist time so more services can be provided. Pharmacists who are released from the dispensing process are more able to do this. One answer, suggests Chris Frost, sales director for AAH Pharmaceuticals, could be the hub and spoke model for dispensing, in which the majority of the dispensing process is performed centrally.

This is something that the multiples, which are legally able to pursue the process, have been looking into for a number of years. Mr Frost explains: ‘It’s close to becoming a reality.’ He tells P3 about the company’s plans.

The future is on its way – and it’s heading for some pharmacy multiples at a rapid pace according to AAH. Mr Frost says that the change will happen, and at least on some level, it is now ‘inevitable’. With the market squeezed and role change for pharmacy teams on the horizon, finding efficiency is going to be key.

‘There has to be a fundamental change to the operating model in the pharmacy, where the patient sees more of the pharmacist. From our perspective, the use of automation and robotics to support the dispensing process and take some of that volume out from pharmacy – allowing the pharmacist to then concentrate on patient care – just feels like it’s going to be an inevitable outcome.’

LloydsPharmacy has been doing some off-site dispensing for a number of years, he says, but ‘not yet to the point where it’s fully automated and with all the checks and balances in place’. That’s where the next step will come, he says.

What will this look like?

A switch to automated dispensing is perhaps not so much of a huge change, he suggests, at least technically. ‘At the moment AAH will pick the product automatically, put it in a tote box and send it to the pharmacy team - who then take it out of the tote box and put it on the shelf. They then take it off the shelf, put a label on it, pack it in a bag and dispense it to the patient.

‘Wouldn’t it be a lot easier and better if all that picking, labelling and bagging happened automatically? So when the pharmacist opens the tote box, it’s already labelled for the patient, all ready in a bag and it just goes straight on to the pharmacy shelf?’

The automated model can be (and is already being) done well on a small scale, he says, ‘but we are likely to see the larger groups doing it in different ways.’

‘I think that in the next six to 12 months this will start to become a reality. I would say that the barriers are now pretty much overcome.’

Implications for multiples

It will require significant investment on behalf of a wholesaler to perfect an automated hub and spoke dispensing model he says, but the prize is the impact it will have in the pharmacy.

‘The key point is that it frees up pharmacist time. If you can take 40 to 50 per cent of volume out of the pharmacy to provide additional services, then that is our biggest win. For me, that is the primary goal and has always been the driving force behind looking at off-site dispensing over the years.’

‘I think you will always require pharmacists to make up a proportion of scripts, but it wouldn’t surprise me if the vast majority of repeat items at some stage in the future are dispensed through an automated process.’

Such a system would also have a commercial benefit in reducing the stock-holding requirement across Lloydspharmacy’s 1,600 pharmacies.

But is there a risk in removing the pharmacist and pharmacy team from the process?

‘It’s not inconceivable that you would not need an accuracy check [performed by a pharmacist], because the technology itself is guaranteed to be accurate. One tangible benefit is that you tend to see an improvement in dispensing accuracy, which is never a bad thing. It’s actually the human element that can compromise safety,’ he says. Checks along the way could include photographic evidence and barcode scanning in the pharmacy, he suggests.

‘But of course, the pharmacist would still be involved from a clinical check perspective.’ In LloydsPharmacy the clinical check is very much the responsibility of the pharmacist, he says, so that relationship is still maintained with the patient in store, and this would continue. ‘This is not about taking pharmacists away from the process, it’s around freeing them up to provide more of a health-related service.

Realistically though, not all prescriptions would be fulfilled off-site. ‘You still have 30 per cent of prescriptions that are acute, and there will always be a number of repeat scripts that you are not going to be able to do remotely for whatever reason.’

The system may also benefit the day-to-day role of the pharmacist, he argues. ‘Personally, as a pharmacist, I loved the dispensing bench. But after two or three years, I have to say that the dispensing process got a little bit boring. So from my perspective, having spent a four-year degree to become a pharmacist, I think it would be a waste not to spend most of my time doing clinical consultations with clinical conversations.’

Clearly, a change in the dispensing model would also affect other members of the team, such as technicians.

Implications for independents

What would this mean for independent pharmacists, who are legally not able to make use of third party dispensing, as it stands.

Mr Frost feels it is ‘inevitable’ that independents will also be able to take the same route in the future, but that the legal changes required to allow them to do so would take time, as it’s something that would have to change across Europe. ‘I don’t think it’s a quick and easy change,’ he says.

But he feels that the case for the whole of pharmacy will be proven on the basis of efficiency. ‘I think that fundamentally the case will be proven by the integrated chains: that pharmacist resource can be freed up and therefore that this resource can be better used.’

In the meantime, we should be careful that we don’t ‘make too much’ of the significance of potential changes, despite it seeming like such a major step, he says.

‘Hub and spoke would allow the multiples to improve much-needed efficiency. But independent pharmacies can already more easily lever the role of a highly trained technician to do the same, he suggests.

‘There’s no reason why – if they do it in the right way – that good independents with the right supporting team around them can’t free up the same amount of time.’

There could be further areas to consider. Would automated dispensing change the wholesale system and the relationship between wholesaler and pharmacist for good?

‘So, we are talking about a lag period between the legislation remaining where it is and the legislation changing. Then it’s down to the independent to decide whether they want to continue as they are or to have someone provide that service for them.’

‘I suppose that the commercial model still needs to be worked through. Going forward, we could be delivering the same products, but with a label on, and in a bag. They would receive exactly the same service from their wholesaler that they get at the moment’, he says.

But, potentially, it would involve changes to the purchasing model. ‘Pharmacies would be purchasing on a basket basis rather than an individual product basis. And how that changes the wholesale model is an interesting one.’