Doing dispensing differently
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Should pharmacists give up or delegate dispensing
to technicians? This was a question raised at the Webstar Health “Doing
dispensing differently” conference in London on 23 October. Hannah
Pike (on the staff of The Journal) reports
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New models for dispensing needed to deliver vision for pharmacy
Dispensing: can pharmacists delegate most of the process and be
free to undertake new roles? |
Re-engineering the dispensing process is long overdue, said Colette McCreedy,
director of pharmacy practice of the National Pharmaceutical Association. “The
vast majority of pharmacists think it is right that they are inextricably
linked to the dispensing process” she said, “far [closer]
than they need to be to be under current legislation and ethical obligations.”
Ms McCreedy was referring to the section in the Department of Health’s “Vision
for pharmacy in the new NHS” document that states that relieving
pharmacists of dispensing will allow them to undertake new roles. She
described a technician-led dispensing model for the future whereby the
pharmacist
would undertake a pharmaceutical assessment (contraindications, appropriateness,
etc) at the beginning of the dispensing process and appropriately qualified
technicians would assemble, label and check the prescription, as well
as counsel the patient. The technician would carry out a risk assessment
for
each prescription to decide if pharmacist involvement were needed.
MsMcCreedy suggested that the technicians would have to be trained to
a minimum of National Vocational Qualification level three and have four
years’ full-time equivalent experience working in a community pharmacy.
She said that the aspects of pharmaceutical assessment outlined in the
NPA standard operating procedures (SOPs) pack might be the key to giving
pharmacists the confidence to delegate the dispensing process (PJ, 4 October,
p443). She noted that technician-led dispensing models pose
questions regarding
the possibility of the pharmacist being absent from the pharmacy, and whether
this would be in the patient’s best interest (PJ, 25 October, p569).
Questions of accountability were also raised. “Should pharmacists be accountable
for mistakes made by technicians if the SOP has not been followed” she
asked.
“There is also a huge political dilemma for the profession,” she
said. “Is
the Government’s wish to take pharmacists out of the dispensing process
based on a [desire] to pay less for the service?”
Alternative models for dispensing
Without redesigning dispensing we are not going to make best use of pharmacists,
and they are potentially the biggest untapped resource that the NHS has,
said Magnus Hird, head of medicines management, Blackpool Primary Care
Trust.
He described what PCTs want for dispensing services of the future as
being: cost neutral or cost saving, accessible to all patients, safe,
efficient
and quick, able to reduce workload elsewhere and a better use of skill
mix.
Mr Hird pointed out that the volume of prescriptions dispensed will continue
to increase although many pharmacies are already at “saturation point” in
their dispensing. He asked how pharmacists could develop new roles for
the future if they have no free time, and described three alternative models:
Small scale merging Small scale merging would involve two high street
pharmacies joining together and using one dispensary between them. One
pharmacist could check the dispensing and one could counsel the patients,
on a rotational basis. This may provide extra space for a consulting area
in addition to freeing pharmacists’ time. Would two companies or
contractors be able to work together to make such a system possible?
Hub and spoke One central location could dispense for all the pharmacies
in the area and delivering prescriptions twice a day. This larger scale
merger could be driven by multiples or groups. Patients could have a choice
of where and when to collect their prescriptions, and staff could rotate
between dispensing and new services. Problems would include large initial
costs, potentially unfavourable working conditions in a “prescription
factory”, and issues around how the income would be split between
the different outlets.
Wholesaler dispensing There is potential for wholesalers to label stock
before they deliver it to the pharmacy. Could their automatic pickers be
installed with labelling facilities? This would reduce stock-holding in
pharmacies and fewer support staff would be needed. Some of the automation
requirements already exist, but would the charge levied by wholesalers
make the system worthwhile? Moreover, would wholesalers be interested in
such a scheme?
Mr Hird concluded that co-operation between pharmacy bodies, wholesalers,
PCTs and outside experts is essential to overcome the dispensing problem. “Is
there anyone really brave enough to tackle this,” he asked.
Automation key to future improvements
Automation is likely to be the key to many future process improvements,
said David Watkinson of Watkinson Pharma Consultancy.
He pointed out that automation does not necessarily reduce process
costs, but typically increases the capacity to take on greater volumes
of work,
which can lead to cost savings.
There is no single solution as far as automation is concerned, he said,
but rather a series of technological developments which together can
lead to process improvement, such as the coupling of electronic transcription
of prescriptions to robotic dispensing.
Mr Watkinson noted that hospital robots are typically used during a 40-hour
working week. He pointed out that no other industry would be likely to
have such equipment
standing idle for the remaining 128 hours of the week.
Pippa Roberts, chief pharmacist at Chelsea and Westminster Hospital, London,
described the positive impact that automation has had on her pharmacy department.
She said that at the Chelsea and Westminster Hospital they were considering
using their robot for overnight dispensing of ward boxes. |
