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Insight: Only the big boys win from hub & spoke

By Alexander Humphries*

The pharmacy up the road has just started using a hub and spoke dispensing model, leaving one of their long serving members of staff in floods of tears because her livelihood is now under threat...

I’ve known this person for years. She is a dispenser, seen it all, tough as old boots, bless her – which made me sit up and take notice when she started to get upset when we chatted recently. Normally it would take a herd of rhinos to stop her, but this day she was really deflated.

“How is your new dispensing system working out for you?”, I asked. “Not good,” she said. “We all have had to cut our hours. I’ve had to apply for another job because I can’t afford to lose the hours.”

And that sums up where we are in community pharmacy. The last few years haven’t been easy for any contractor, large or small. Every business has had to do things it would rather not have done, cost-cutting like crazy just to survive.

Seeing both sides

I can appreciate both sides of this discussion because I understand we have to change. On the other hand, most pharmacy staff are absolute diamonds, forged under enormous stress and pressure, resilient, committed – simply marvellous, basically.

To be told that a robot is going to be doing your job (or at least a large chunk of it) is a massive kick in the teeth, especially when you consider that this lady is one of those treasures who will come in on her day off if someone is sick, or will go out of her way to drop something off for a customer on her way home.

Her employer has decided that the branch needs to save 30 per cent on its staff costs, which means either losing a bit of everyone’s hours, or losing a whole person.

It sounds easy (relatively speaking) if you’ve got three dispensers to go down to two, but what about two going down to one? How do they then cover holidays, sickness or the lunacy of bank holidays?

This is just one issue with a distribution model that sounds great on paper but, the minute you expose it to actual people, will fall flat on its face.

Patients don’t live in a perfect world where a single prescription for all of their medicines arrives regularly once every month. They live in a world where their eight different medicines run out at four different times of the month. They live in a world where GP practices lose emailed orders and miss items off repeat prescriptions. They live in a world where they don’t remember to order their medicines until they’ve taken the last one. Hub and spoke will not provide a solution for any of these things.

Patients don't live in a perfect world

No tangible benefits

Let me make this clear: I am not against hub and spoke in principle, far from it. But I do doubt its ability to deliver real, tangible benefits for both patients and pharmacies. What concerns me most is that it might work for large operators who also own their own wholesalers, but not for others.

That isn’t a problem as it stands today because it would not be allowed. But if the Government were to reintroduce plans to change the regulations, this could be potentially disastrous for the small guys. For large operators, automating and centralising some of the workload makes sense. However, for smaller contractors, handing over your workload to one of your biggest competitors just doesn’t seem logical to me.

Race to the bottom

As it is, we are picking up business from the pharmacy up the road as patients are upset about waiting times and not having items in stock.

However, should hub and spoke lead to a reduction in costs for our competitors, we could lose our own competitiveness and be forced to introduce the same model in a race to the bottom.

The question I keep asking is – what problem are we trying to solve? Is it rising workload, increasing costs, or just technology for technology’s sake? If it is about managing workload, then perhaps a model like this could be useful, as long as you can dip in and out of it when you choose – say, if your dispenser is ill.

If it is about managing costs, I can guarantee that the only people who will win are the big boys.

But if it is about turning pharmacy into some form of poster case for digitisation, then we’ve all got every reason to be annoyed. This would be a callous and insensitive insult to all of those diamonds who’ve been through the bad times with us. To throw them under the bus now feels like an absolute travesty, for them and also for our patients.

* Pen name of a practising community pharmacist. Alexander Humphries’ views are not necessarily those of Pharmacy Magazine. What are your thoughts on hub and spoke – panacea or problem? Email pm@1530.com

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