Community pharmacy is being asked to do more with less than at any point in recent years.
Workload continues to rise. Care home expectations are increasing. Clinical service pressures have expanded. Recruitment remains difficult. Yet funding has not moved in line with the operational reality pharmacies are now dealing with every day.
For pharmacies running an MDS service, that creates a very specific challenge.
MDS packing is still one of the most labour intensive workflows inside the dispensary. At the same time, patients, families, and care providers increasingly view it as a standard service rather than an additional one.
That combination, growing demand alongside flat funding, is making the economics of traditional MDS packing harder to sustain year after year.
The pharmacies still running profitable and scalable MDS services are rarely the ones simply trying to reduce costs. More often, they are the ones that have changed how the service itself is structured.
Pack format. Production cadence. Verification model. Where labour sits inside the workflow.
Those decisions are what usually determine whether an MDS service becomes sustainable long term.
The Real Cost Pressure Behind Traditional MDS Packing
Manual MDS packing scales almost directly with patient volume.
More patients create more trays. More trays create more technician hours. More technician hours create more pharmacist and ACT checking time.
And in most pharmacies, checking becomes the first part of the service that starts putting real strain on the dispensary.
At smaller volumes, the model can still work reasonably well. A pharmacy managing 50 or 100 MDS patients can often absorb the labour cost without major operational pressure.
The challenge usually appears once patient numbers move into the hundreds.
By the time a pharmacy is supporting 400 or 500 manual MDS patients, labour often becomes the dominant operational cost of the service. At that point, the workload can start consuming dispensing capacity that the wider pharmacy also depends on.
Community Pharmacy England has repeatedly highlighted the growing gap between rising pharmacy workload and static funding. MDS sits directly inside that pressure point.
The issue is not usually effort or commitment from the team. The issue is that the traditional model becomes increasingly difficult to scale economically.
Why Working Harder Stops Solving the Problem
When MDS profitability starts tightening, the first response is often operational discipline.
Better scheduling. More organised batching. Tighter SOPs. Cross training staff to support MDS production during quieter periods.
Those changes can help. But only to a point.
The underlying issue is that manual tray based MDS packing still depends heavily on human attention throughout every cycle. And human attention remains the most expensive resource inside the dispensary.
Improving the workflow around a labour heavy model may reduce friction slightly, but it rarely changes the overall economics of the service.
This is not a staffing problem. It is a systems problem.
The pharmacies that have made MDS sustainable at larger scale have generally done so by changing the structure of the workflow itself rather than simply pushing the team harder.
The Three Changes That Actually Affect Sustainability
There are three operational decisions that consistently have the biggest impact on long term MDS sustainability.
1. Pack Format
The first is the format the service is delivered in.
Traditional MDS blister packs remain widely used across UK pharmacy and care settings because they are familiar and well established.
They are also one of the most labour intensive delivery formats still commonly used.
Pouch based systems change the workflow considerably.
Instead of filling large weekly trays manually, medication is dispensed into sealed sachets organised by administration time. The dispensing process becomes system led rather than entirely hand filled. Checking becomes more consolidated. Storage requirements reduce. Labour scales more efficiently as patient numbers grow.
The format decision is not simply about convenience. In many pharmacies, it becomes one of the biggest factors affecting whether MDS packing remains economically sustainable long term.
2. Production Cadence
The second factor is how the service is produced operationally.
Traditional tray based MDS workflows are often reactive. Prescriptions arrive throughout the week. Patients are filled continuously. Staff move in and out of MDS production around the wider dispensing workload.
That creates unpredictability.
System supported pouch workflows allow production to become more structured and batch based. Multiple patients can be prepared during scheduled production runs rather than through constant reactive filling.
That shift changes staffing efficiency significantly.
Batch production reduces repeated setup time, improves workflow visibility, and makes staffing requirements easier to manage during busy periods.
It also creates something many pharmacies now struggle to maintain consistently: predictability.
3. Verification Model
The third structural change is verification.
Manual checking remains one of the largest ongoing pharmacist time costs in any MDS service. It is repetitive, visually demanding work that consumes a large amount of highly valuable clinical time.
Optical verification systems alter that process substantially.
MDM Core, for example, can verify up to 5,400 pouches per hour by photographing both sides of every pouch and comparing the contents against a programmed medication library.
Instead of manually checking every pouch individually, pharmacists supervise the exceptions the system identifies.
The labour impact can be substantial at larger volumes.
PillPacPlus 2025 modelling suggests that for a pharmacy managing around 500 MDS patients per month, the combined labour cost of packing and checking can reduce from roughly £7,000 per month under a manual workflow to around £1,200 per month using a pouch dispensing and optical verification model.
For pharmacies already operating under staffing pressure, that difference becomes operationally significant very quickly.
Why the Combined Model Changes the Economics
Each of these changes helps individually.
Together, they change the shape of the service entirely.
Pouch dispensing reduces the labour curve as patient numbers grow.
Batch production creates more predictable workload management.
Optical verification reduces the amount of pharmacist time absorbed by repetitive checking.
That combination changes MDS packing from a service that becomes more difficult to manage as volume increases into one that becomes more operationally efficient at scale.
That is why pharmacies that move towards structured pouch based workflows often stop viewing MDS as a margin pressure and start treating it as a sustainable long term service category.
Mark Curley from Curley’s Totalhealth Pharmacy in Ballyhaunis described the operational shift this way:
“PillPacPlus has been a game changer. It has streamlined the dispensary workflow and made medication management for our community and nursing home patients safer, faster, and more efficient.”
What Sustainability Actually Looks Like
A sustainable MDS service is not simply one that breaks even.
It is one that remains operationally manageable as patient numbers grow.
In practice, that usually means:
labour cost per patient remains controlled
workflow stays predictable
additional patients do not require proportional staffing increases
pharmacist time is protected for clinical work rather than routine checking
governance and auditability remain strong enough for care home and regulatory requirements
That profile becomes much easier to achieve when the workflow itself is structured around automation, batch production, and optical verification rather than purely manual processes.
Why This Matters Strategically
The wider funding environment is unlikely to ease in the near future.
At the same time, the drivers behind MDS demand continue moving in the opposite direction. An ageing population, increasing polypharmacy, and greater levels of care being managed in community settings all continue increasing operational pressure on pharmacies.
Care providers and commissioners are also expecting stronger governance, clearer audit trails, and more structured dispensing systems than they did previously.
That creates a difficult long term position for pharmacies still relying entirely on traditional manual MDS workflows.
Over time, the operational pressure either erodes margin completely or starts affecting wider dispensary capacity.
The pharmacies adapting their workflow structure earlier are generally placing themselves in a stronger position long term.
What a Workflow Review Normally Covers
For pharmacies reviewing MDS sustainability properly, the starting point is usually a workflow assessment.
That review typically looks at:
current MDS patient volumes
projected growth over the next three to five years
labour allocation across packing and checking
current production cadence
dispensary space and installation practicality
the wider direction of the pharmacy’s service model
At that stage, the conversation becomes far more useful operationally.
Instead of asking whether automation is worthwhile in theory, the pharmacy can assess what the service economics would actually look like within its own workflow and patient volume.
That is usually the point where clearer decisions start getting made.
Building a More Sustainable MDS Service
Sustainability in MDS is increasingly becoming a structural question rather than a financial one.
Pharmacies focusing only on tighter cost control often find the gains are limited. Pharmacies changing the underlying workflow structure tend to see much larger operational improvements over time.
The funding environment may not improve quickly.
The service model still can.
Talk to PillPacPlus About Building a Sustainable MDS Service
If your MDS service is becoming more operationally difficult to manage, it may be time to assess the structure of the workflow itself rather than continuing to push harder on the existing model.
PillPacPlus can review your current patient volumes, workflow pressures, labour allocation, and dispensary setup to help assess what a more system supported pharmacy MDS service could look like operationally.
If you would like to explore a more sustainable approach to MDS packing, contact PillPacPlus for a workflow assessment based on your current patient numbers and future growth plans.
This content is provided for general information and educational purposes only. It does not constitute legal, clinical, or regulatory advice. Pharmacies should always consult current GPhC standards, local NHS guidance, and their own professional judgement when designing and operating services.
