Government plans to expand hub and spoke dispensing across community pharmacies in the UK have been condemned by pharmacy organisations because of a lack of evidence that it will bring the benefits ministers expect.
Under current legislation, only pharmacies that are part of the same business can operate hub and spoke dispensing systems. But ministers believe that changing the law to allow pharmacies that do not have existing commercial ties to operate hub and spoke systems will create a level playing field and offer the profession more choice.
Pharmacy Voice, an association of community pharmacy trade bodies, says it has “significant concerns” about the proposal, which was out for consultation until 17 May 2016, and calls on the Department of Heath to produce the evidence to support the initiative.
Its chief executive, Rob Darracott, says: “It is a flawed assumption that hub and spoke dispensing must be more efficient, cost saving or safer and we do not recognise the validity of the assumptions which are proposed to form the basis of the impact assessment. Currently there are no hub and spoke dispensing models operating across different legal entities and therefore no data that could be used to extrapolate from. If the department has such data or hypotheses we call on them to publish it without delay.”
Numark, a buying group for independent pharmacies, echoes this view, saying that government assumptions that hub and spoke systems have the potential to save money and increase efficiency “is a significant over statement given the limited amount we know about [their] use in practice”.
The Royal Pharmaceutical Society (RPS) shares similar concerns: “Most of the evidence around this type of operation is from the United States but the health system they operate under is completely different and the efficiency savings are in what the patient pays for and are not real efficiencies within the overall system,” it says in its response.
“We are not aware of any other evidence available in the world for the type of hub and spoke model proposed in this consultation (inter-organisational) and we have concerns in relation to the hub and spoke model and the impact on patient safety.”
The RPS is also worried about the clinical governance process: “Clarity is required on several issues and to ensure patient safety,” it adds.
The National Pharmacy Association, a member organisation for independent community pharmacies, warns that the expansion of hub and spoke dispensing in England could have an impact on NHS funding and health strategies across the UK if the hub and spoke crossed borders.
“In Scotland and Northern Ireland there are particularly remote areas, such as the Highlands and the Islands, which can be particularly affected by extreme weather conditions. There appears to be a lack of appreciation of how delivery of medication from a hub that is situated in another part of the country, or indeed another country, such as England, will impact on patient care. For example, turnaround times for prescriptions may be excessive,” the NPA says.
Government proposals to display the price of medicines on packaging in England, which form part of the same consultation, have also failed to win the support from the sector.
The RPS opposes the move, arguing that the job of a medicine label is to provide information to the patient about the medicine. “We agree with the intent to make sure people take their medicines as prescribed and reduce medicines waste, however, this area is complex; people don’t take their medicines for many different reasons,” its response says. “Having the cost on labels could potentially have several different outcomes.”
Before any changes are made, the Society says the government should gather evidence to support its assumptions that displaying prices would help reduce medicines waste and encourage patients to take their medicines as prescribed.
Pharmacy Voice believes the move could compromise patient safety and discourage patients from taking their medicines properly.
“We do not believe there is substantiated evidence from the UK that it will improve quality or efficiency, or indeed have the effect the Secretary of State wants, which is to remind people that NHS services, including items which may be free at the point of use, are funded by taxpayers,” Darracott says.
The consultation ran from 22 March 2016 until 17 May 2016 and will require changes to be made to the Human Medicines Regulations 2012 and the Medicines Act 1968, which apply across the UK. However, it would be up to the UK’s devolved countries to decide whether to implement the changes the new legislation would allow.