For independents or independence?
By Lindsey Fairbrother
There’s a lot of chatter about hub and spoke. Not just about how the big boys are operating it in their own branches, but how legislative changes would enable it for independent owners. Do we need it? What do we need to think about for the future?
Let’s look at where we are. Pharmacies are becoming community hubs and minor illness centres. Services, like the ENT and skin extended care service in Staffordshire, are supporting the move to self care and sucking workload out of GP practices. So, whilst we may be a long way from pharmacy being the first port of call for all minor ailments, we are highly trusted professionals to whom the public will go if the services are there. We just need to shout more about what we can do to support the nation’s health and remind the powers that be that we are all clinically trained healthcare professionals.
Attracting more consultations into pharmacy will have implications. Customer expectations will need to be managed or they could get frustrated by waiting too long for prescriptions or the next consultation if the pharmacist is more often than not in the consultation room. We will need to consider pharmacists too. Their role may be more rewarding and benefitting the NHS, but if they finish a consultation only to find queues of patients and prescriptions waiting for them, we are asking for trouble and cases of burnout.
Second pharmacists have proven prohibitively expensive unless there is a very sizeable dispensing volume to start with; service income alone does not cut it. We could get checking technicians to do the donkey work to allow us to focus on patient care, but that depends on them being available. The current reality is that many technicians are being tempted to take jobs with nursing homes or directly in GP surgeries.
The Amazons of this world would have us believe the high street is dead... but a pharmacy is a place of vital social support.
So, the story runs: if you can’t sort the skill mix and want to avoid burnout, pass the volume of dispensing to somebody else.
Legally, this can’t happen at the moment, but assuming it could, would it work? Many of us think ‘don’t throw the baby out with the bathwater’. Dispensing has always been the foundation of pharmacy. Many of our key services, including MURs and NMS, rely upon it. How can we look after patients properly if we are not actually providing their medication?
Independent pharmacy has campaigned against distance selling pharmacies, who take volume without providing the face-to-face care and support that a real community pharmacy provides. Embracing central dispensing models which deliver direct to patients puts valuable points of contact and opportunities for heath interventions at risk. At least if independents act as ‘spokes’ and continue to hand out prescriptions, contact will be maintained.
The Amazons of this world would have us believe the high street is dead and everyone wants home delivery. But a pharmacy is not just a shop; it’s a healthcare provider and a place of vital social support.
Hub and spoke would make sense if it were to genuinely free up capacity for us to take on roles shifted from GP surgeries, NHS 111 and elsewhere. But what are these roles, and do GPs agree that pharmacy could and should undertake them? However eagerly we embrace new things, without the support of the whole healthcare team, we will be seen as damaging GP businesses just as, years after they started, we still hear complaints about pharmacy flu vaccinations.
A patient collecting their medication does not cost anything for delivery. Medicines sent by mail incur costs for a small parcel at £3 a go, or at best that of a letter at 61p. Multiply that by thousands and it is no wonder distance selling pharmacies are yet to post a profit.
The current funding model does not support hub and spoke operations. A spoke pharmacy needs to retain dispensing income to remain open, pay its staff and provide patient services. I can’t see how paying a hub to dispense prescriptions or dispensing prescriptions without the activity fee can be affordable for either organisation. We really need to think about this, however, as a bad taste in the mouth is better than no food on the plate.
We need to start thinking about how pharmacies could work together to provide medication and services. Perhaps primary care networks (PCNs) are a route, although that will be another story. Think of this: the huge growth in the sale of SUV vehicles is not from young families wanting smaller, cheaper Range Rovers and Jeeps, but elderly people seeing them as easier to get into and out of than conventional cars. In pharmacy, we need to change the model, so we might just need to come up with something that takes most of us by surprise.