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The definition debate

Centralised dispensing and hub and spoke are not interchangeable

Pharmacy Voice chair Claire Ward is concerned that careless use of terminology could lead to confusion and hinder pharmacy’s progress

At the Pharmacy Show in October, the Minister for Pharmacy, Rt Hon Alistair Burt MP, announced that the Department of Health was launching a consultation to change the legislation relating to hub and spoke dispensing. In simple terms, the current law states that you cannot shift pharmaceutical items between companies for dispensing unless both the ‘hub’ and the ‘spoke’ are owned by the same legal entity.

So owners of multiple pharmacies, or even small chains, can choose to make a centralised point, or pharmacy, a hub for the fulfilling of scripts which are then returned to the spoke for dispensing to the patient. But independents don’t have this option, So they can’t currently, for example, use an alternative provider or wholesaler because they would not be part of the same legal entity.

It has been interesting to note that the increasing noise of conversation around this subject has not always been helpful. There are of course differing opinions on whether this is a good option for pharmacy and patients, especially independents. That is an important debate. However, what is not helpful is the interchangeable use of phrases such as ‘hub and spoke’ and ‘centralised dispensing’.

It is not the same thing. And while we need to understand the implications of both, one could be far more dangerous for the future of community pharmacy than the other.

Centralised dispensing

Centralised dispensing is more likely to refer to a model where prescriptions are dispensed from a central unit with supply to the patient managed from a local collection point, which could of course be a pharmacy, or sent direct.

This is an ‘Amazonisation’ of pharmacy to which I am totally opposed. It is not a sensible use of public resources, nor is it in the best interests of patients – let alone the catastrophic destruction of the pharmacy network that would likely result.

However, that is not the same as hub and spoke.This model, and again there are many detailed possibilities, is more likely to be one where the relationship between dispensing pharmacy and patient remains with the pharmacy but the assembly of repeat scripts is done at another site – the hub.

Again, it is not without its problems and financially we need to see how this would work for everyone. At the moment, only multiples have the legal power to do this – it seems only right that independents too should have the right to create a model that might work for them.

My point here is that clarity of the phrases we use is important. Centralised dispensing and hub and spoke are not interchangeable. If we are to have a sensible discussion we need to be clear.

More clarity please

There has been a similar poor use of terminology in some of the conversations at recent meetings and conferences about pharmacists working within general practice. We know that NHS England has supported the introduction of ‘clinical pharmacists’ into GP surgeries.

This wording may originally have been intended to differentiate this new role from the type of medicines management pharmacists we’ve had in the past, and the unintended consequences from script switches that I don’t need to remind you about.

But repeated use of this term as a descriptor has become a differentiator from community pharmacists, as if you are not clinicians too. Really?

On clinical pharmacy

Here is the definition of clinical pharmacy: ‘Clinical pharmacy is the branch of pharmacy where pharmacists provide patient care that optimises the use of medication and promotes health, wellness, and disease prevention.’

I suggest that most patients and pharmacists would agree that this is what happens in most cases in the 11,500 community pharmacies across Britain. Pharmacists who dispense without that additional care are surely not putting the patients’ best interests first.

It seems to me that by not challenging the sloppy use of language – and fortunately both of these conflations have been challenged in recent meetings – we will allow a myth to become fact: that community pharmacists are not of a clinical standard.

Of course, the sector needs to continue to raise standards in providing that care, but I find it insulting to thousands of pharmacists across the country to suggest that they are not clinical because they work in the community sector.

Looking forward

The next few months and years are going to be a challenge for community pharmacy. Financial pressures and evolution of the role will present many sleepless nights for people.

But if we are to work together we need to create a shared vision of what community pharmacy is capable of being. And in order to reflect the value of a physical network, housing thousands of qualified and professional people who are making a difference every day to the health and wellbeing of their patients, an essential part of that shared vision must be an ability to understand and agree on how we apply the terms and descriptions that we commonly use.

Only then can we be sure about which ones we agree on and which pose a grave threat to this great sector.

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