What are the pros and cons of centralised or hub-and-spoke dispensing?

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The key question for community pharmacy

The cost of dispensing varies a lot across pharmacies, depending on variable factors such as skill mix, EPS and MDS. The use of a hub can help to standardise costs and free up resources in the pharmacy, creating headroom to improve patient contact and offer a wider range of services. Paradoxically, it could also potentially reduce patient contact if a truly commoditised dispensing system is introduced, in which supply is seen as an end in itself. The true function of community pharmacy should be to improve the use of medicines and, while the efficient use of resources is an important factor, a key question seems to be “are supply and services intended to remain attached in the pharmacy service of the future”?

Peter Cattee, PCT Healthcare, Chesterfield


Pros for multiples, cons for independents

For an independent with one pharmacy, I’m afraid I see only a range of cons. For example:

  • Community pharmacy still needs to hold a full stock of meds for walk-ins, acutes and emergencies. So, there is no space saved or advantage gained
  • Taking into account the acutes, walk-ins and emergencies, full staffing levels are still required
  • Accountability is still with the Responsible Pharmacist
  • Time will still be required to check inside the prescription bags to ensure accuracy
  • With no SCR, there would be less PMR information available to aid in counselling, giving healthy living advice, etc
  • It will be harder to link service promotion with prescriptions.

For multiples with a hub within the same organisation, there are many advantages, as accountability of any errors remains with the organisation’s superintendent. This also eliminates some of the above cons with regards to time saving. PMR data can also be more easily shared, depending on the PMR system, and centralised buying of medications can lead to better purchase profits.

Amish Patel, Hodgson Pharmacy and Salveo Health


What downsides?

As long as pharmacists are still in a position to deliver high-quality pharmaceutical at the point of hand-out via the community pharmacy network, I can’t see any downsides for patients.

Johnathan Laird, pharmacy manager, Turriff


We plan to run a pilot

We have been looking at centralised dispensing for some time, and plan on starting a pilot in the next month. Some definite advantages of centralising workload is that it is great for production levelling, that is improving efficiencies and batch workload so that we are more streamlined across our group on a daily basis. Taking out regular monthly repeats, nomad patients or care home workload from each of our branches allows for additional services such as MURs, N MS and flu vaccinations. However, there needs to be robust procedures in place to ensure that each branch is not duplicating checking procedures, or what could end up happening is that pharmacists/ACT will duplicate checking back in the host pharmacy. Of course, there is currently an issue with smaller independent groups that have separate legal entities at different branches, as it is illegal to have centralised hub-and-spoke operations, although this is likely to change in the near future.

Ashley D Cohen, Pharm-Assist (Healthcare) Ltd


At a cost to patient care?

The pro is that it will save a lot of money for the NHS, but the con is that it will cost a lot more in terms of patient care and poorer medicines optimisation, access to services and NHS support.

Sultan ‘Sid’ Dajani, Wainwrights Chemist, Bishopstoke


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