NPA webinar Hub & Spoke – the results and an update 7.30pm – 10 March National Pharmacy Association 1
Presenters • Mike Hewitson – Pharmacy owner & NPA Board Member • Gareth Jones – Public Affairs Manager Host • Fin Mc Caul National Pharmacy Association 4
Hub & Spoke Policy Review Mike Hewitson, Board Member, NPA. Chair, NPA Hub & Spoke Group.
BACKGROUND • Alistair Burt announced intention to change legislation to allow inter-company Hub & Spoke by October 1st 2016. • Prior lobbying from a regional wholesaler to allow H&S for independents. • Keith Ridge has long held views on automation inc. PhD on hospital pharmacy automation. • Mentioned speci fi cally in Dec 17th letter.
OBJECTIVES • Understand & agree consistent terminology. • Take a holistic approach, and understand implications on NPA Members interests: • Strategic • Economic • Operational • Financial • Understand implications of inter-company assembly on professional practice including patients & the public. • Close the information gap between large multiples and the SME sector.
OUR APPROACH • NPA Practice & Policy Committee, Nov 2015 established Task & Finish approach: • Membership outside of Board at ‘arms length’. • Opportunity to draw in wider base of opinions. • Join up other organisations such as PSNC & PV to bring two-way added value.
MEMBERSHIP SUPPORTED BY • Gareth Jones, NPA Public Affairs • Mike Hewitson MRPharmS Manager. • Raj Patel MBE FRPharmS • Nathan Draper, NPA Policy & Public Affairs Of fi cer. • Dr Nitin Sodha MRPharmS • Elizabeth Ward, Director of Policy. • Nick Kaye MRPharmS Pharmacy Voice. • Kim Packham, Senior Policy & • Jay Badenhorst MRPharmS Programmes Advisor. Pharmacy Voice • Garry Myers MRPharmS • Fin McCaul, Consultant to NPA • Claire Ward LLB Board.
DEFINITIONS Registered Pharmacy • Important to (± NHS Contract) be consistent. Hub Spoke Spoke Spoke Spoke Registered Pharmacy Spoke + NHS Contract Pts Pts • Centralised dispensing is direct to patient and is out of scope
UNIQUE INFORMATION • Expert witness programme: • Nobody has all of the answers. • 20+ witnesses covering all aspects of the issue. • Literature Review: • Independent. • Respected academic from Manchester University. • Little published evidence. • Member Consultation: • Baseline views of members. • Sense-check of risks and bene fi ts.
EXPERT WITNESS PROGRAMME Meeting 1 Meeting 2 Meeting 3 David Simons. Chief Operations Visit to Celesio PAS Hub Richard Brown. Chief Of fi cer Avon Of fi cer, NPA. LPC. BRR Consulting Inc: Cormac Tobin. Omar Shakoor. Pharmacy Leyla Hannbeck. Chief Pharmacist, Managing Director Services Director, Mawdsleys NPA. Chris Frost. Head of Sales Drew Warner. Head of Change & Claire Kerr. Head of Member Consultation Programmes NPA. Healthcare Policy & results Remy Croese. Intl. Sales Strategy Manager VMI Care. Dr Ellen Schafheutle. University Paul Mayberry. Independent Dr Bharat Shah. Director Sigma Pharmaceuticals. Contractor. of Manchester. Andy Beesley. Medication Fin McCaul. Independent Contractor. Costings Workshop LTC Lead Bury CCG. Management Solutions. Chris Brooker. Former consultant Noel Wardle. Partner. Willach Pharmacy Solutions CharlesRussellSpeechlys. to Mawdsleys.
LITERATURE REVIEW • As expected - very little published evidence of any quality. • Some international examples, but how applicable are they to UK systems/issues? • Closed a gap in knowledge. Reassuring that there is nothing obvious that we have missed.
MEMBER CONSULTATION • Members given brie fi ng document, and video introduction from Group chair. • Promoted via NPA channels, trade press, and buying groups. • Great response rate: 416 individual responses, covering more than 1,000 pharmacies.
KEY RESULT: PREPAREDNESS S ingle 2-10 11+ Total independent branches branches Negative 135 (63.7% ) 51 (49.0% ) 5 (17.2% ) 191 (55.4% ) attitude 1% towards hub & 4% spoke 5% Positive 77 (36.3% ) 53 (51.0% ) 24 (82.8% ) 154 (44.6% ) attitude towards hub & spoke Total 212 104 29 345 Χ 2 = 24.670; p ≤ 0.005 55% 36% 1 Never under any circumstances 2 Not at the moment, but might consider in the future 3 We are in the planning stages 4 We are currently operating a Hub & Spoke system 5 We have trialled but removed a Hub & Spoke system
KEY RESULT: PROVIDERS Strongly Against Slightly Against Neutral Slightly In Favour Strongly In Favour Another branch in your group A local cooperative hub in which your pharmacy owned a share An NHS hospital trust An independent wholesaler A national wholesaler (eg, Alliance, AAH) 0% 25% 50% 75% 100%
KEY RESULT: RISKS & BENEFITS Strongly Disagree Disagree Neutral Agree Strongly Agree Improve the operational ef fi ciency of my business Improve the pro fi tability of my business Be in the long-term interests of independent community pharmacy Improve safety of dispensing operations Create capacity to deliver services Reduce stock levels and availability in my pharmacy Reduce choice of wholesalers Increase the complexity of my business Delay patients' access to their medicines Reduce staf fi ng levels in my pharmacy Lead to pharmacies closing Create a data security risk 0% 25% 50% 75% 100%
KEY RESULTS: WORKLOAD SHIFT Unfavourable Favourable 100% 75% 50% 25% 0% Regular Repeats Nursing Homes MDS
KEY RESULTS: IMPACT 70.0% Patients 52.5% My pharmacy company The community pharmacy network overall 35.0% 17.5% 0.0% Very Negative Negative Neutral Positive Very Positive
KEY FINDINGS - BENEFITS • Capacity Figure 1: Hub & Spoke Ef fi ciency Curve Service Tail - not enough service income to fi ll Income • Some evidence to support free capacity capacity release to deliver other services. Optimal zone - Free capacity used to deliver other services • However, as only limited number Head - Not enough free capacity generated to of services it is dif fi cult to make make a difference to services the business case today. 25% 33% • MDS is large opportunity to Proportion of dispensing volume transferred to reduce workload in community Hub pharmacy.
KEY FINDINGS - BENEFITS • Cost savings • Business case is different for inter-company H&S vs intra- company. • Intra-company is about centralisation of cost. • Inter-company is about outsourcing. • Staff reduction at the Spoke is the only variable cost impacted. • No reduction in cost base for NPA Members .
KEY FINDINGS - BENEFITS • Safety • Difference between accuracy and validity : • Hubs likely to be more accurate. • Data input at Spoke is critical - Garbage In Garbage Out. • One large multiple’s model - Data Validation exercise 5000 items without a mistake (reset 83 times for 1 branch!). • Not possible with inter-company model. • New risks - reconciliation at Spoke, complexity of process. • May be more accurate but this could be re-produceable with other technology and may not be a bene fi t of H&S per-se, and could introduce new risks.
KEY FINDINGS - RISKS • Professional Accountability • Explicit, written patient consent required. • Criminal liability - potentially undermines Statutory Defence & creates confusion over who is responsible. • Civil liability - Hub Responsible Pharmacist has Duty of Care to deal with obvious clinical errors. • Legal issues. Especially with MDS - WDL & FMD. • Major concerns. Need expert legal opinion.
KEY FINDINGS - RISKS • Procurement & Supply Chain • Key concern about reduction of competition & choice in the wholesale/Hub market. • Barriers to entry: DTP , logistics infrastructure, capital investment, technical and professional knowledge. • Investment needs to be recovered - reduce margins, item of service payment, subscription… • Could undermine short-line wholesalers - against taxpayer interests as this creates leverage through competition. • Major concerns. Need to promote competition & choice between Hub providers.
KEY FINDINGS - RISKS • System Resilience • Impact on stockholding: • Increase in supply chain sensitivity to stock shortages. • Hub failure e.g. P2U technological, Pharmacy Plus fi nancial collapse, Boots D90 fi re. • Concerns. This could easily impact on patients and the public, and may be a risk for politicians post P2U failure.
ENABLERS • Planned workload - electronic Repeat Dispensing. • Original pack dispensing: • What about splits? Cost to the Spoke! • Fair contracts to protect Spokes. • New service commitment.
ENABLERS • Hub Standards • Superintendents will need to quality assure their Hub partner. • GPhC Standards alone may not be enough for inter-company H&S. • Would help to reduce variation between providers - very important to enabling competition. • Could frame KPIs to allow for fair comparison between Hubs. • NPA could be key driver on development of a Public Speci fi cation - controlling rate & development of concept.
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