NHS England reconsiders ‘hub and spoke’ dispensing model as part of its long-term plan

Regulation of ‘hub and spoke’ dispensing could be revisited after publication of the new NHS plan.

Celesio's hub and spoke facility in Warrington, in the north east of England

NHS England is again considering changes to government regulations around ‘hub and spoke’ dispensing as part of its ten-year plan.

The ‘NHS Long-Term Plan’, published on 7 January 2018, discussed “exploring further efficiencies through reform of reimbursement and wider supply arrangements”.

NHS England told The Pharmaceutical Journal that these efficiencies refer to efficiency of dispensing by using new technology and automation, as the pharmacy “sector continues to flag shortcomings in the operation of the reimbursement system”. 

It added that improving dispensing efficiencies may require changes to government regulations around hub and spoke dispensing.

The hub and spoke dispensing model is currently permitted under legislation within the same pharmacy business, but in 2016 the Department of Health and Social Care consulted on changing regulations to allow it across different entities.

The consultation, launched in March 2016, suggested allowing “independent pharmacists to make use of ‘hub and spoke’ dispensing models — a ‘hub’ pharmacy dispenses medicines on a large scale, often by making use of automation, preparing and assembling the medicines for regular ‘spoke’ pharmacies that supply the medicines to the patient”.

However, the proposals raised several questions, including whether the model was safe and how pharmacy organisations would comply with the Falsified Medicines Directive. As a result, the government shelved plans in June 2016 to implement the model.

In its planning report for 2019, the Pharmaceutical Services Negotiating Committee (PSNC) said any move to alter hub and spoke dispensing models raised both concerns and opportunities.

The report said: “The PSNC considered whether there might be greater benefits from automated dispensing/hub and spoke dispensing that can be realised under revised legislation. There was consensus that community pharmacy needs to lead the development of any changes and that PSNC must have conversations with government about hub and spoke dispensing and technology.”

The report expressed “concerns about what hub and spoke dispensing would mean for professional liability” as well as outstanding questions over “the spoke’s costs for using a hub and how we would deal with margin and payments/fees”.

Lee Dentith, chief executive of Now Healthcare Group, which provides a smartphone app that allows patients to order repeat prescriptions, told The Pharmaceutical Journal that plans “to adapt the present pharmacy model to increase the ‘efficiency’ of dispensing, cannot come soon enough”.

While he said it was “too early” to comment on how a hub and spoke system would impact its business model, he added that the online pharmacy company — which dispenses around 20,000 prescriptions per month — “could evolve and become a ‘hub’ for community pharmacies, bridging a gap and meeting the aims set out by the NHS to free-up time for community pharmacists to spend with patients”.

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Citation
The Pharmaceutical Journal, PJ, January 2019, Vol 302, No 7921;302(7921):DOI:10.1211/PJ.2019.20205985