Hub and spoke dispensing between pharmacies owned by different legal entities will be allowed from 1 January 2025, subject to parliamentary approval, the government has announced.
In a response to a consultation on hub and spoke dispensing, published this week, the government proposed introducing two models of hub and spoke dispensing across legal entities, which would ‘level the playing field in community pharmacy’.
Currently, smaller independent pharmacies are unable to operate hub and spoke dispensing due to legal restrictions on dispensing for pharmacies under different ownership. Under the new plans, the government will make it ‘universally’ available.
One model would allow the hub to directly supply the medicine to the patient, and in the other, the medicine is sent back to the spoke pharmacy, which then supplies them to the patient.
In both models, the prescription would be presented to the spoke pharmacy, which would then send the information to the hub for assembly.
And dispensing doctors, as well as community pharmacies, will be able to act as a spoke, the government said.
In its consultation response, the government said its proposals were intended to ‘ensure the safe and effective implementation of the policy by putting in place provisions to ensure accountability, governance and transparency for patients’.
‘The proposals enable the use of hub and spoke models between pharmacies owned by different legal entities, so levelling the playing field in community pharmacy and enabling spokes to provide more patient-facing services, relieving pressure on the wider NHS,’ it added.
Paul Rees, chief executive of the National Pharmacy Association (NPA) commented that hub and spoke dispensing ‘can be a positive development if it aids efficient dispensing, assists accuracy checking and frees up pharmacists to deliver more clinical services’.
‘However, the introduction of this model must not be allowed to cut the spoke pharmacy out of dispensing medicine and must be competitive to ensure that independents have a choice of hub. In addition, new NHS funding for clinical services is required to make the business case stack-up for the spoke pharmacies,’ he added.
Meanwhile, the Royal Pharmaceutical Society warned that the changes could ‘further complicate’ medicines supply amid shortages, and raised concerns that patients might be confused by the proposed labelling requirements.
And the Company Chemists’ Association suggested that the changes ‘will not release capacity’ within the sector without increased funding for medicines supply.
Gordon Hockey, director of legal at Community Pharmacy England, said that hub and spoke reform was ‘long overdue’ and the negotiator was ‘pleased to finally get an indication of the Government’s plans for this’.
‘However, much still needs to be done to develop a model that works for community pharmacy, and we are already working with DHSC to consider the implications of these changes for NHS dispensing in England,’ he said.
The government’s consultation response indicated that 53% of respondents to its consultation supported the proposal that the legislative impediment to hub and spoke models across different legal entities, with 29% (35) agreeing strongly and 24% (29) agreeing.
Meanwhile, 47% respondents disagreed with the proposal, with 35% (42) strongly disagreeing and 12% (14) disagreeing.
‘Although the numbers make the overall split look quite close, it should be noted that these totals give an individual response the same weight as an organisation, despite the fact that an organisation could represent hundreds of members or thousands of employees,’ the government noted.
More organisations than individuals supported the change, with ‘the majority of medium and larger pharmacy chains, representative sector organisations and other related businesses’ in support of removing the restriction.
Meanwhile, of those that expressed a view on whether the two proposed models offered sufficient flexibility, 40% felt that there was sufficient flexibility – with 20% (22) strongly agreeing and 20% (23) agreeing – and 60% disagreed that there was sufficient flexibility, with 44% (50) strongly disagreeing and 16% (18) disagreeing.
When the government’s proposals to allow hub and spoke dispensing between pharmacies from different legal entities were consulted on in 2022, two models were proposed: model one, that would see hubs assembling prescriptions and sending them back to the spoke for supply to the patient, and model two, that would see the hub send the assembled prescription directly to the patient.
In its original response to the consultation in 2022, the community pharmacy negotiator said it considered that only the first model of hub and spoke dispensing across different legal entities – one that that would see hubs assembling prescriptions and sending them back to the spoke for supply to the patient – was appropriate.
Community Pharmacy England said at the time that only this model had ‘manageable risks relating to patient safety’, and had ‘the potential to allow the whole sector to benefit fairly’.
And it added that it could not support the second proposed model – where prescriptions would be supplied from the hub directly to the patient – due to potential patient safety issues.
A version of this story was first published on our sister title The Pharmacist.
