Jeroen van de Pol

171 6 General discussion care programs, innovation, and health outcome parameters. Changing GPs’ reimbursement model from solely a capitation system to a mix of capitation and fee per service indicates that GPs are performing more services within a mixed model and improving the continuity of care [68]. Thus, changing the reimbursement model for a healthcare professional can alter his or her behavior and improve the quality of healthcare. This effect can also be expected for community pharmacy practice [69]. A reimbursed continuous medication monitoring program implemented in community pharmacies had a decrease in costs of care and an improvement regarding medication adherence [70]. We, therefore, suggest changing the current reimbursement model of community pharmacy practice in the Netherlands to a capitation system mixed with fee per service for CPS. The capitation should be adequate to cover the current dispensing costs. This change will make the current volume-driven fee for dispensing superfluous. Community pharmacists can further increase their revenue by providing CPS. This reimbursement model will also be more compatible with task prioritization of community pharmacists, as chapter 3 describes. The reimbursement model can be finalized by adding a pay for health outcome system in addition to the capitation and a fee per service, using validated outcome indicators [71]. This type of reimbursement model will most likely also stimulate collaboration between community pharmacists and GPs. Furthermore, this form of reimbursement needs to be adjusted yearly for factors such as inflation and increasing personnel costs. Otherwise, financial deficits may be introduced within community pharmacies, as is currently the case within the United Kingdom [52]. Separating CPS from dispensing The hub-and-spoke model is likely to contribute to a shift toward CPS [72]. This model consists of a central hub located in a large city and spokes within residential areas and smaller nearby towns. This model will stimulate collaboration between community pharmacists. In the hub-and-spoke model, a central hub primarily focuses on dispensing medicines mostly staffed with pharmacy technicians and a small team of pharmacists who focus on managerial activities and QA and manage ad-hoc situations, such as medicine shortages [73]. By centralizing the dispensing process within the hub, more efficiency can be gained due to the increased scale. Thus, more time becomes available for CPS within the spokes. This approach is different than current models of cooperating community pharmacies, as the current model maintains dispensing in all affiliated community pharmacies. Whether the hub is accessible to patients depends on its physical location. The hub can be positioned within a business park, probably reducing costs of real estate but also reducing patient accessibility. Medicines could either be dispensed through the spokes or directly delivered to a patient’s home. The spokes within this