In the last week the C+D has published articles in support and in opposition of Hub dispensing (here and here). There seems to be multiple definitions and therefore misunderstanding of what Hub and Spoke Dispensing is, so what are these definitions and what are the pro’s and con’s.
In this definition the Hub receives all repeat prescriptions and owns the customer relationship. It chases and processes the prescription, assembles the items and provides the clinical and accuracy checks. The customer’s items are delivered from the Hub either direct to the customer or through the local Pharmacy.
The job of the Spoke (Branch) in this would be to find new repeat customers and to process acute and operate the other services of a local Pharmacy.
Since the Spoke is not involved in day to day repeat dispensing then this is NOT Hub and Spoke.
There is a major flaw in this approach as “messing” with the customer relationship as in “outsourcing” it to a Hub is an impersonal approach which is not compatible with a personal health service.
If this approach appeals then it will be only for the largest organisations within the UK with a brand that can carry the personal while delivering a remote service.
Within the UK where the health care system is free and large numbers of pharmacy customers are not even paying for prescriptions then service is king and the winners are those that look after their customers through their direct relationship with the staff.
UK law prevents a Pharmacy dispensing on behalf of another Pharmacy unless they are within the same Company. As part of a group you can centralise and provide your Pharmacies with a Hub service but you cannot sell these services onto other groups. There are discussions in England and Scotland that the law might change to allow this to happen. If this happens then it still could be many years before the law is changed.
“Customer Hub and Spoke”
Keeping the Spoke (Branch) at the heart of the customer relationship maintains continuity for your customers. In this mode the Spoke chases and processes any repeat prescription including performing clinical checks. The order is then communicated to the Hub for assembly and delivery purposes.
The “assembly” of the customer’s items takes place on a schedule at the Hub. All items are brought together and an accuracy check performed before items are delivered either back to the Spoke or through to the customer.
The Spoke provides the communication to the customer dealing with changes in medication and engaging with additional services like MUR and NMS. The strength of maintaining this relationship supports the investment that the Pharmacy group has made in Local Pharmacy establishments.
In this model the Hub is dealing with a large volume of orders and requires the appropriate staffing and equipment to cope. It will also need to carry the full range of medication that is offered by each of the Spokes.
Since the Hub will be a major investment possibly at a new location then there will be a tendency to consider having only one. The ability for the Hub to cope with changes in medication, out of stocks and the myriad of challenges while being at distance from the customer must be carefully considered.
“Compliance Aid Hub and Spoke”
Hub and Spoke does not need to be a revolution but could be simply an evolution of current practices.
Every Pharmacy across the UK is producing compliance aids for a percentage of their repeat customers. This production activity consumes staff time and this is significantly greater than for a customer receiving original pack dispensing. Producing a compliance aid requires manual activities in collating the drugs, de-blistering, filling, sealing and checking.
Compliance Aid Hub and Spoke moves the assembly workload of the repeat prescriptions to the Hub but everything else remains at the Spoke. The Spoke maintains the relationship with the customer and it is optional whether the Hub delivers back to the Spoke or direct to the customer. The Spoke would perform the clinical check as they know the customer and have the history of the relationship.
The Spoke could also perform an accuracy check before the Compliance Aid is delivered to the customer. Where automation is involved then our experience is that Spoke staff trust the robot after a few months and stop checking.
There is communication of the customer’s “order” between the Spoke and the Hub and this can be achieved electronically between the PMR and any Hub system avoiding re-keying.
Bringing together the “assembly” portion of compliance aids across all branches into one Hub will release significant staff time time – one of our customers reduced staff time by 80% in this area. This will only happen when you implement automation equipment to support the Hub.
In this definition the Hub can be one of your Pharmacies with a little extra space as it does not need to be a special “out of town” industrial unit. You could have multiple Hub’s to suit the spread of your branches if required as the investment in technology is smaller than the “Customer Hub and Spoke” option.
The Compliance Aid Hub and Spoke model is the one that most Pharmacy groups in the UK could adopt as its the least initial investment and is only a small step away from their current position. For any groups with more than 500 compliance aid customers then this option delivers a return on investment within 18 months.
We are presenting at the Pharmacy Show on Sunday and Monday on the subject of Hub and Spoke and we can be seen on stand PC55.