A phrase in a recent issue of Pharmacy Magazine caught my eye. A contributor was asking whether hub and spoke dispensing “demeaned the value of the supply of medicines”. A very interesting question and one that got me thinking, says Liam Stapleton.

What is the value in the supply of medicines from a pharmacy? I suggest that supply is of little value. Many prescriptions are now dispensed by distance selling pharmacies.

This is done without any contact with the patient except receipts and acknowledgements sent by email or text.

Meanwhile, in the community we dispense prepacked medicines, putting the assembled items into a bag and sealing it, leaving it on a shelf to wait for the patient to collect it or getting a team member with little qualification, other than a driver’s licence, to deliver the sealed package.

When a prescription arrives as an electronic repeat, there is no need for the pharmacist to undertake another clinical check unless some change in therapy has occurred since the previous repeat was dispensed.

Dispensers can prepare it and ACTs check it before putting it on the shelf for delivery or collection.

What is the difference between this and hub and spoke dispensing? Where is the value in this?

I believe in community pharmacy and the value it can add to patients and their communities, but this value isn’t in the supply of prescription medicines – it is around it.

The supply of medicines is a vehicle around which a service can be built. A clinical check can be completed on a prescription and the medicines assembled, labelled and accuracy checked anywhere. The value is added in the relationship between the pharmacist and the patient that is created by the interaction about the medicine.

This can be as simple as a quick check in with the patient or their representative, the drip feeding of information about the medicines, providing public health messages or checking on adherence.

This relationship gives pharmacists the authority to provide a wider range of care, from vaccinations to hypertension screening to private services to many more besides.

Playing with words

Some might argue that this is simply playing with words, but it is not semantics – it is important. If we keep focusing on the importance of the process of the supply function, we lose our focus on what is important – important because it is what we do that makes a difference to patients and because it is what the NHS values from pharmacy.

And it is what the NHS will pay us for in the future.

In terms of the supply of medicines, what is important is that they are accurately dispensed. Is it important how this is achieved?

If hub and spoke dispensing allows pharmacies to get medicines to this point in a more cost-effective manner that allows pharmacists and their teams to provide more support to patients, should we not embrace it?

Not perfect

I appreciate that the whole process of hub and spoke is not perfect; there are still some questions that need answering.

I’m sure hub and spoke also provides an advantage to multiple pharmacies over independents and this is an issue that needs addressing in negotiations with the DHSC – but these challenges are not insurmountable and we should not turn our back on an opportunity just because it is not perfect.

For some patients the relationship with their pharmacist is not important. They are happy with the transactional service that they receive from a distance selling pharmacy.

If they receive the same service from a bricks and mortar pharmacy, albeit less convenient, why should they not move to a more convenient approach?

Community pharmacies can’t compete with distance selling pharmacies on supply. We need to add something that patients value. The relationship and the services that go with it are what will make a difference.

Liam Stapleton is a director and executive coach at Metaphor Development Limited and an Associate Clinical Lecturer at the University of Lincoln.