Jeroen van de Pol

172 Chapter 6 model act as accessible locations within healthcare centers to retrieve medicines and OTC products, but above all, these spokes are places in which CPS is provided close to people’s homes. This model is possible because activities considered part of CPS are not necessarily bound to the dispensing of medicines. Instead, these activities can be viewed separately from each other. However, this model keeps the community pharmacy profession integral with expertise of both distribution and CPS. The challenges regarding medicines shortages highlight the importance of the integrity of the community pharmacy profession [73]. Medicine shortages increasingly hamper continuity of treatment. Within the Netherlands, medicine shortages increased from 769 medicines in 2018 to 1,492 in 2019; the low pricing of medicines in the Netherlands was a major contributor [73]. These shortages will most likely continue for several years, thereby increasing the necessity of community pharmacists for therapy continuation. Due to the outbreak of Covid-19, medicine shortages are expected to increase in the upcoming period [74]. Shortages pose new challenges for community pharmacists and require both pharmaceutical and logistical expertise. For now, community pharmacists have been able to find solutions for 99% of shortages [75]. Separating this expertise may reduce the quality and efficiency of dispensing. Therefore, current (and future) medicine shortages should remind professional bodies and policymakers to be careful when considering the separation of CPS and dispensing. As mentioned before, the hub-and-spoke model could be a viable option to efficiently manage medicine shortages. Separate provisions for CPS and dispensing in community pharmacy practice could also be established by embedding clinical pharmacists in GP practices. The benefits of such a collaboration between pharmacists andGPs have been proposed [76]. However, debate still remains regarding the exact design of such a model [1]. An important issue is the independent role of the community pharmacist as the person responsible for the safe and effective use of medication. Embedding a pharmacist in a GP practice could potentially introduce dependency of the clinical pharmacist on the GP. The combination of the community pharmacist working within the premises of a GP practice with the previously introduced hub-and- spoke model may be of interest. This combination would reinforce collaboration between the two professions while maintaining the independent role of the community pharmacist and a direct link with the hub, for example, regarding solutions for logistical issues, such as shortages.