The Pharmacist spoke to Harry McQuillan, chair of pharmacy membership organisation Numark, about the incoming changes to hub and spoke legislation that will enable hub and spoke dispensing to operate across legal entities.

The pharmacist's role is about safety, not accuracy

Hub and spoke could help ensure dispensing is accurate and efficient, Mr McQuillan told The Pharmacist in an interview last month.

He said the process 'deals with the accuracy of what's been ordered'.

'In other words, if somebody's asked for 28 ramipril 5mg, then you get 28 ramipril 5mg. That’s accuracy,' he said.

But this doesn't replace the role of the pharmacist, which is about ensuring safety of supply, Mr McQuillan added.

'Safety, for me, is someone’s prescribed 28 ramipril 5mg, and the pharmacist is asking: should you be getting 28 ramipril 5mg?' he said.

'I think that's part of the reform that Stephen Kinnock's talking about: that shift from accuracy to safety,' Mr McQuillan told The Pharmacist.

And he suggested that this change in mindset about what the pharmacist does might be more difficult for pharmacists who have been in the profession a long time, compared to new pharmacists whose degree includes the safe prescribing of medicines.

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But he noted that the pharmacist role has already evolved over time.

'When I studied, a major part of my degree was that I would call small batch manufacture. I could make creams and ointments, suspensions, emulsions… Nobody does that in community pharmacy now. If they do, it’s teeny. [Now] the degree is expanding, and the MPharm is moving to include prescribing,' Mr McQuillan said.

Scanning makes dispensing safer

He told The Pharmacist that he had initially been unsure about hub and spoke dispensing.

'I think for many years, around that kind of legislation, I was one of those who thought: “How's it going to work? What's the funding going to be? Are people just after scripts? And is it a bit dubious?”

'But the more and more I've seen it operate, you go, actually, there’s something in this,' he said.

Mr McQuillan, who was formerly a negotiator at Community Pharmacy Scotland (CPS) said his 'lightbulb moment' came when he worked with Martin Green, the chairman of CPS.

'I’d say: “Robots make things safer, the automation makes it safer.”

'And he goes: “No, the hardware doesn't make the supply safer. The software does.”

'And he’s absolutely right. The safety aspect is all in the software and the scanning technology.'

Mr McQuillan suggested error rates in scanning technology were far lower than human error, adding: 'If the whole network had that sort of scanning technology, how good is it to say that your pharmacy network is 100% accurate in its supply process?'

How can independents get started?

Inexpensive scanning technology would be a good way for independents to get started with using automation in their dispensing process, he told The Pharmacist.

'The basic scanning bit is not expensive at all... it’s yesterday’s technology. What we need to do is start adopting it,' he added.

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'Most of the PMR [patient medication record] suppliers we’ve got now have got that function there, just not a lot of people switch it on. It may be a bit clunky, but seemingly it works really well.'

As well as improved safety afforded by the technology, Mr McQuillan said he 'genuinely hopes' that the recent uplift in the dispensing fee - where the single activity fee (SAF) has been uplifted 19p per item - might make contractors feel more able to invest in dispensing technology.

And he suggested that technology might become cheaper as it becomes more mainstream.

The new legislation could also enable contractors unable to automate their own dispensing to consider a different model of hub provision - for instance, through a wholesaler, or through co-owning a hub with other contractors as part of a cooperative, he noted.

'And see, if you did that, then you’re invested in it and you want it to work. There's nothing like putting your own money in to make it a success,' he said.

What's next for Numark, Phoenix and hub and spoke?

Mr McQuillan shared that some Numark members, including pharmacy chain Rowlands, already use a hub model within their groups.

And Phoenix, the wholesaler owner of Numark, uses hub and spoke as part of its distribution in Europe.

Mr McQuillan suggested that this gave Numark 'extensive experience' with the model.

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And he said that when the legislation changes in the UK, Phoenix would 'certainly have a look at it again' to consider whether it would work in the UK.

While the technology and logistics model already exists, Mr McQuillan said that the decision could be influenced by the economic viability of using hub and spoke in the UK.

'Europe doesn't use the same level of generics that the UK does. Neither is the pricing of generics as low as ours. So the ability to subsidise that type of assembly process is a lot less in the UK, because the headroom to allow that just isn’t there,' he said.

'It will be really interesting to see how it could be made to work economically. But in terms of technologically, it could be tomorrow. It all exists.'