Changing the law to allow independent pharmacies to use a ‘hub-and-spoke’ model of dispensing will be more complex than the government anticipates, as there are question marks around liability, according to David Reissner, a partner at law firm Charles Russell Speechlys.
Speaking at Sigma’s annual conference in Jamaica on 16 February 2016, Reissner said: “If a prescription is sent from a spoke to a hub and there is a dispensing error, the [civil] liability will probably rest in both places and you will find that… both the hub and spoke can be sued.
“Then there’s the question of criminal liability for errors,” he suggested, “because we all know that making a dispensing error is still a criminal offence. So if a dispensing error is made, probably, that is where the spoke will be liable and possibly not the hub.”
Reissner said there were a number of other issues that will affect the introduction of a hub-and-spoke dispensing model, including patient confidentiality and data protection, medicines labelling and supervision.
Reissner also argued that the government had “already made up its mind” about changing the law relating to hub and spoke dispensing, because it had indicated that the changes would be implemented in October 2016 and the consultation had not yet opened.
Jay Patel, director of Day Lewis pharmacy, told delegates at the conference that any dispensing error made in a hub may be amplified. “Small errors in large central fill sites have a big impact. So if you get a recurring error of a drug being booked into the wrong location on a shelf in a central fill site, by the time you’ve noticed, you’ve then dispensed 1,000 prescriptions to 1,000 patients into 1,000 different locations.”
“To be able to rectify those errors is costly and can have a massive impact on patient safety,” he added. “What we need to understand is that there are other safety aspects outside of clinical check and accuracy check in the hub-and-spoke model.”
Patel suggested to delegates that introducing a hub and spoke model may have unintended consequences, including increasing the price of drugs to the government. “Any decision that you make that allows one company to have the competitive advantage will cost more for the NHS,” he claimed.
Patel also said that technology may be a concern. “There isn’t a PMR [patient medication record] system available at present that successfully allows you to make a hub-and-spoke offering,” he said, adding that changing the law before pharmacies are able to get a robust solution in place may force contractors to offer a service for which they do not have the appropriate infrastructure.
Mike Dent, chief financial officer of the Pharmaceutical Services Negotiating Committee, highlighted that the hub-and-spoke plans may not achieve the intended efficiencies. “I can see how [hub and spoke] could be really good for increasing capacity in pharmacies, but I can’t see how it could make a significant contribution to reducing costs,” he said. “It seems sensible to level the playing field on hub-and-spoke dispensing.”
Ash Soni, president of the Royal Pharmaceutical Society, also expressed concerns about the hub-and-spoke model being cost efficient for independent pharmacies: “As part of an independent pharmacy, I’m going to have to pay somebody else to do it. If you’re vertically integrated, the money just stays in the same organisation. So, actually, does that work for independent pharmacy? I don’t think it does.”
- The Pharmaceutical Journal reporter Emma Page attended the Sigma conference courtesy of Sigma Pharmaceuticals.