1 Min In Healthy living
Bookmark
Record learning outcomes
The Government has yet to announce the outcome of last year’s hub and spoke consultation, but manufacturers are expecting these changes to go ahead. The proposed legislation update would make it possible for hub and spoke dispensing to take place between separate legal entities, something proponents say is long overdue.
“If the Government wants pharmacies to deliver more clinical services in branches to take pressure off the wider NHS, it has no alternative other than to move forward with hub and spoke legislation,” says Louise Laban, sales and marketing director at Centred Solutions. “When automation is added to the process, businesses can fulfil multiple prescriptions for multiple branches safely at speed, without significant resource requirements.”
Of course, it’s not just hub and spoke. Automation also involves technologies such as collection kiosks, labelling and sorting lines, eMAR (medicine administration within care homes/community) and software to help communication between patients, prescribers and pharmacy. Having various automated systems in place within the pharmacy should also help to free up staff time, some argue.
“When speaking to community pharmacists, I hear how so many of them want to move off the dispensing bench and be able to deliver better healthcare in their local community,” says Daniel Lee, ceo of HubRX, a company that hopes to help independents use hub and spoke dispensing. “Automation has been around for over 20 years, but technology is now racing along as expected, and automation is now more efficient, cheaper and more accurate. This is not just about automation in the back of the pharmacy, but also about processing and PMR, providing a better patient experience and freeing up the pharmacist’s time.”
HubRx acquired The Pharmacy Group in Yorkshire in March this year, in a bid to prove the benefits of hub and spoke and develop a business model that will expand on-demand patient access to a large range of medical services for everyday health conditions. The Pharmacy Group pharmacies (rebranding as Pharmacy+Health) will be using HubRx’s latest generation prescription assembly service in Leeds.
“We are putting our vision into practice with a transformation of pharmacies to free up capacity to do more clinical services,” says Lee.
“This means a new layout, hub and spoke, newly designed website, larger consultation rooms and clinical management systems in place. We aim to challenge the perception of what a community pharmacy can and should offer, how it should look and how it operates.”
Laban says pharmacies that have already embraced automation are seeing their business grow. “Our data shows that customers who have already made the move to hub and spoke see a reduction in pharmacist or ACT time spent on carrying out clinical and accuracy checks of up to 70 per cent, and 50 per cent more of their time spent at the counter with patients,” she says.
“Dispensers save almost 45 minutes a day putting away deliveries – that equates to 15 extra blood pressure checks per week. They also save almost an hour a day picking medication for every 50 prescriptions.”
AR Pharmacy in Totton, Southampton, has invested in Centred Solutions’ FLOWRx Hub and InStore solutions. “As we became busier and busier in the dispensary, we were finding that our pharmacists, dispensers and other technicians simply didn’t have capacity to deliver the services that we needed them to,” says superintendent pharmacist James Tibbs.
“We decided it was time to look into a sound automation solution for our medication dispensing process, one that would allow us to free up the time of the pharmacists and the rest of the team so they could better support patients. We never thought that five years ago we would buy another pharmacy, yet we have already bought one and are now in the process of buying two more.”
Kevin Murphy, superintendent of Wellbeing Pharmacies Group and co-founder of MedPoint, says automation enables pharmacies to do more with the same human resource. “We have saved well over 50 hours of valuable staff time per month and reduced hand-out errors significantly,” he adds.
“This is not just about automation in the back of the pharmacy, but also about processing and PMR, providing a better patient experience and freeing up the pharmacist’s time”
Expanding clinical services
Murphy says the recent announcement of a funded Pharmacy First service in England will necessitate new ways of working. “It is no coincidence that there are a disproportionate amount of automated collection points in Scotland,” he says. “Pharmacy First has been operational there for several years. Pharmacies in Scotland have recognised that they need their staff spending time on those customers, as opposed to rushing to get to the next customer in the queue, who just wants to collect a bag and walk.
“Many patients on regular chronic medications do not need counselling every time they collect orders. In Scotland, they can have a six or 12 monthly medication review as part of the Medicines Care and Review service.”
Bernadette Brown, owner of Cadham Pharmacy in Glenrothes, agrees that pharmacies in England will need to find new ways of dispensing and checking medicines. “Automation frees up pharmacists’ time and enables them to provide patient-centred care on the day patients need it,” she says.
“This will be important when consultations are being sent direct to the pharmacy from GP surgeries and the pharmacists will be needed for clinical assessment to support the NHS infrastructure. Automation will give pharmacists the confidence to train other members of the pharmacy team to become ACT checkers.”
Kathryn Hughes, senior national sales manager at Omnicell, says that, ultimately, automation can help community pharmacists do more with less: “Automation can help them become more efficient, spend more time with patients, deliver more clinical services that generate revenue, and reduce pharmacy opening hours.”
Tibbs explains that automation has enabled his pharmacies to expand into private services like blood testing, aesthetics and travel clinics. “Previously, we had to signpost patients to services outside the pharmacy and they would often get lost in the system,” he says. “From a business perspective, it means we can now cross-sell to these patients, we retain their custom and, because they are getting a good service, we often end up getting the prescriptions for their friends and family based on their recommendations.”
Barriers to growth
It is hoped that the Government’s proposed changes to hub and spoke legislation will benefit smaller pharmacies, in particular. “It currently isn’t a level playing field,” says Lee. “Large multiples can offer hub and spoke, but smaller pharmacies aren’t able to offer a large, automated system.”
Of course, cost is a big factor – running into the hundreds of thousands for some solutions. And automation is no quick fix, says Brown: “The machines need time to learn what the medicines are, and the pharmacy team needs time to learn how to use them. But the costs can be balanced if the robot is generating more business and helping to bring more customers into the pharmacy.”
Ingrained attitudes may be another barrier. “Some pharmacists have been fearful of automated systems, while others don’t feel confident to move into consultation,” says
Lee. “But how can they fit more clinical services into their time, such as blood pressure checks, NMS and contraception, when they are already over-saturated?”
Hughes recommends a “change management plan” to ensure pharmacy teams embrace automation once it is introduced. “Often, pharmacy teams can, quite understandably, be overwhelmed by the introduction of automation, and some may be resistant to the change,” she says, explaining that while staff may feel their jobs are at risk, in reality their time could be freed up to focus more on patient consultations.
While she agrees that the hub and spoke legislative change would be a positive step for smaller pharmacies, she adds that it potentially carries risks as well. “The big risk is that it opens up the potential for a large scale, established online retail platform, such as an ‘Amazon’, to enter this market,” she says. “The impact on the pharmacy sector of a well-established brand with a household name, a solid, robust infrastructure, an easy online ordering platform, large scale warehousing, a nationwide logistics network and ease of onward delivery/collection service can’t be underestimated.”
“You have to be brave, push boundaries and take a risk. That’s exactly what we have done and it has paid off”
Looking to the future
Tibbs believes that embracing automation is instrumental to the future of community pharmacy. “You have to be brave, push boundaries and take a risk,” he says. “That’s exactly what we have done and it has paid off.”
Hughes agrees that automation will help community pharmacies to future-proof their businesses. “Automation can help pharmacies attract new patients and, importantly, help retain them in the longer term,” she says.
“For staff, the benefits of automation can be felt immediately as it can significantly reduce the pressures placed upon them. This can help to retain staff, in addition to attracting new members of the team, as the working environment is not only more productive, but far less stressful. In the future, I believe there will be more emphasis on closed-loop healthcare that is more patient-centric and tracks the patient journey from GP, NHS, 111, 999 to pharmacy through a seamless integration process, whether they are seeking care in their own home, community, care home or hospital.”
Brown stresses that automation shouldn’t just be about dispensing, but should also be about improving clinical services. “In my clinical consultations, I use automatic machines for diagnostics, such as for hearing checks, blood pressure checks and skin cancer screening,” she says.
“Patients can have a same-day clinical consultation online with me or one of my other clinicians, which is convenient for all of us. But we still need better apps and software so that patients can send in photos, for example, and there’s an integrated appointment system with a booking calendar.”
It’s a constantly evolving market, says Murphy. “We are still in the early stages of a complete transformation of how a community pharmacy operates,” he says. “Eventually, there will be a range of different hub and spoke models from wholesaler ‘smart-tote’ services, pharmacy-run hubs like Centred Solutions, and also, when the regulations are finally changed, outsourcing solutions like HubRx. I would include patient-facing apps in the automation conversation. The growth of the NHS app and others shows these will increasingly become important ways for patients to interact digitally with their pharmacy in an efficient and convenient way.”
Healthy living
In Healthy living