After six months' experience using our robot, an automated dispensing unit (ADU), here at The Deepings Practice in Lincolnshire, we are now able to properly assess its impact.
Having overcome some initial installation difficulties, a more dispassionate assessment is possible as we are now accustomed to the minor changes in work patterns its use necessitated.
Our initial contact with our new robot was not positive.
There were errors in calculating the size of the room it was to operate in, delaying installation for some weeks.
However, the supplier quickly realised the problem and made every effort to overcome our disappointment.
The initial plan was to move our dispensary and give it a long overdue refurbishment culminating in fitting the ADU.
Instead there was a delay between relocating the dispensary and fitting the ADU.
Installing it took place outside surgery hours as far as possible.
Initial problems with the ADU amounted to a few hiccups rather than major difficulties.
Dispensaries and pharmacies work in subtlety different ways, so robots have to be programmed accordingly. We dispense mostly by generic drug name and this, apparently, is not the norm.
As a result, there were minor teething problems with some medications, such as calcium/vitamin D combination tablets, which have an extremely long generic name that the ADU could not initially absorb.
This has now been resolved.
Our practice is an early ADU adopter and the supplier did not have an easy way of preloading the names of the medicines we dispense. As we use mainly generic medicines rather than brands, this could have meant a laborious process of loading medicines and educating the system about each new stock item.
Our finance manager solved this problem by suggesting we import the information stored on our dispensing check system, Dispens-It, to the ADU's database.
The robot's loading hopper is one of the more important labour-saving devices, reducing the need to stock shelves.
There were minor mechanical problems with the conveyor belt and picking head but these were quickly resolved.
The noise the ADU makes when working was louder than anticipated and it made phone calls in the dispensary problematic. However, putting soundproof screens around the telephone desk resolved this.
|The Deepings Practice and its robot|
A main reason for purchasing the system was to further reduce our already low error rate. This has been achieved.
The picking error rate of choosing the wrong medicine, strength or bar code is now neglible and this would only occur if the manufacturer had labelled the box incorrectly - something I have never known to happen.
Our only current but infrequent picking errors occur in relation to minor brand differences. Some patients have a preference for a particular brand of the generic medicine prescribed.
If this is not in stock, the machine defaults to an alternative of the same strength. This is irritating for some patients but does not generate safety concerns.
We expect other error rates to fall too, as with less moving around to do in the dispensary, staff are able to be more methodical.
Our robot is a major investment with upfront costs and annual servicing costs. At more than £150,000 including moving the dispensary and installing the ADU, the expense would be a major concern if GP dispensing was to disappear.
Meeting our hire purchase costs for the machine and its maintenance requires a reduction in other expenditure of around £20,000 a year. But the sum saved by not employing someone to put delivered medicines onto the shelves has made an inroad on this.
Saving several hours per week, even at the lower end of the dispensing staff pay scale, equates to a saving for an employer or around £3,000 once the extra costs of the employer's share of national insurance and pension contributions are taken into account.
We achieved a bigger saving however by not replacing all the hours of staff who have left or reduced their time commitment. This is despite a rise in the number of items dispensed at the practice.
I do not know how the number of items dispensed has changed for other practices, but at our practice it has increased by 4 per cent in the past six months.
The nearest pharmacy has asked patients to change from giving 48 hours' notice for repeat prescriptions to four days, but we have not felt the need to do likewise.
Even with NHS austerity measures, I cannot foresee any reduction in numbers of items dispensed. With our ADU I believe we have an element of 'future-proofing' built in to our business model that will help us to minimise additional staff recruitment.
Our business model indicated that we would break even on the ADU by year four, but it seems this will happen sooner.
From the start we felt that as long as robotic dispensing was at least cost neutral we would go ahead.
However, the biggest benefit is the improvement in the atmosphere and calm running of the dispensary. This projects an image of efficiency and high-quality care.
- Dr Phipps is a dispensing GP in Lincolnshire.