Sunil Sharma (right) at the central dispensary in Norwich |
Now that the new community pharmacy contractual framework has been in
place for over a year, pharmacists, more than ever, are providing a greater
range of services. Many pharmacists in the community may feel that they
simply do not have the time to do what it takes to make their business
thrive — not to mention their professional capabilities.
However, an Alliance pharmacy in Norwich is operating a central dispensary,
which dispenses repeat prescriptions for four nearby pharmacies. Sunil
Sharma, manager of the central dispensary at Alliance Pharmacy, Hall
Road, Norwich, told The Journal that having prescriptions taken care
of at a central dispensary frees pharmacists’ time, allowing them
to
do other activities within their particular pharmacy.
Hub and spoke
The central dispensary, Mr Sharma explained, uses a hub-and-spoke approach
whereby the central site acts as a hub where the dispensing of repeat
prescriptions takes place, and the spokes are pharmacies located within
driving distance, which remain the point of contact for patients.
One of the key components of the set-up is the computer system, which
is fully integrated and links the hub and spokes.
According to Mr Sharma, spoke pharmacies can see in “real time” what
is being dispensed at the hub. When a spoke switches their dispensing
system over to the central dispensary site, “hub” is displayed
on-screen. “If they wish, a prescription can be followed as it
is dispensed to see what stage it is at,” he suggested.
Not all items are suitable for repeat dispensing at the hub. Mr Sharma
gave the example of Controlled Drugs, which are not dealt with at the
central dispensary because of legal and logistical difficulties. However,
items requiring refrigeration are dispensed at the hub. Once checked,
these items are put into cool bags with frozen bricks to preserve the
cold chain, said Mr Sharma. In the case of insulins, Mr Sharma said that
it made a lot of sense to “keep all types of insulins at the hub
where there is room to store them” so that the spokes do not have
to stock the entire range.
Gillian Neal, a pharmacist and manager of one of the spoke pharmacies,
located inside a Waitrose store in Eaton, Norwich, said that the system
began at the end of last year and is running successfully.
“We have a good relationship with the hub,” she said. “Any
problems that we’ve identified or anything we want changed,
we discuss with them and come up with a solution.” Procedures and risk management
Mr Sharma explained that he has tried to minimise potential risks in
the system by developing robust standard operating procedures (SOPs) — which
are regularly reviewed — and encouraging error reporting.
“We have SOPs for the hub and for the branches,” he confirmed. “We
also keep a near miss record. When a pharmacist does the final check
and finds a mistake, they write down … the date, time, items, strength.” He
said that it is a blame-free system to help identify any problems with
the procedure and to “look at any patterns over a few months”.
Mr Sharma has also developed a system of intervention forms that aids
in communication between the hub and spokes. The forms are used to highlight
any concerns — for example, a change in labelling or a therapeutic
issue — that the spoke pharmacy may need to bring to the patient’s
or GP’s attention.
“For every interaction a label is printed and attached to an intervention
form. The intervention form is filled out and attached to the prescription.
It is then looked at by the branch pharmacist,” explained Mr Sharma.
“For new items the forms are clearly marked with a red cross,” he
added. This is because, with repeat dispensing, the interactions come
up on the computer every time, Mr Sharma pointed out. But an intervention
form is still filled out on every occasion so that nothing is missed.
Highlighting new items is an added security and helps the branch pharmacists,
he said.
Once an intervention form has been assessed and dealt with at the spoke,
it is signed by the pharmacist and photocopied for his or her records,
and the original is returned to the hub.
Mrs Neal said: “We know the majority of patients and know what
has already been sorted out and what is a priority. If they have a new
item, we can identify if there is a problem with it … and talk to
the customer.” She said that the system makes it the same as if
the prescription had been dispensed at the branch. Finding the time
Unlike other central dispensaries — most of which undertake repeat
dispensing or care home services from a dedicated site — the Hall
Road hub is incorporated into a community pharmacy. The shop dispensary
and the central dispensary are divided by a drug carousel and are staffed
by separate teams. It is not surprising that Mr Sharma has a lot on his
plate. Not only does he co-ordinate the central dispensary, but he also
manages a busy store, is proactive with medicines use reviews (MURs)
and has held successful public health promotions. Another section of
his pharmacy is dedicated to care home dispensing.
So how do the spoke pharmacies really benefit from having their repeat
prescriptions dispensed at Hall Road? Mr Sharma said that when the system
was introduced the prescription workload suddenly reduced to the level
it was many years ago. “The pharmacists simply don’t have
the time to do very much dispensing. We take much of that work away and
customer service improves, and they now have time to do other services.”
Mrs Neal explained that implementing parts of the new contract requires
a lot of extra work for pharmacists and staff, and having repeat dispensing
done offsite allows them more time to fulfil their new role.
“It gives us a chance to diversify and do different professional
activities like MURs. Job satisfaction is certainly better,” Mrs
Neal said. “Patients
now get a better service from us because we have more time to spend with
them.” |
The
Pharmaceutical Journal