No evidence that hub-and-spoke dispensing will save money, admit pharmacy negotiators

Exclusive: The Pharmacy Services Negotiating Committee has said that although the hub-and-spoke model may help increase pharmacies’ capacity, there has been no evidence of a financial benefit.

simon dukes being interviewed

Pharmacy negotiators have not seen any evidence that extending the hub-and-spoke model of dispensing in community pharmacy will save money, the chief executive of the Pharmaceutical Services Negotiating Committee (PSNC) has said.

But in an interview with The Pharmaceutical Journal
, Dukes said extending the model to apply beyond the same pharmacy business will be needed to “free up” pharmacists’ time, amid growing concerns about capacity in the sector and “a shortage of pharmacists generally”.

His comments come after the PSNC agreed to engage with the government over its proposals to change legislation that would enable a hub-and-spoke model of dispensing to be used across different entities, as part of the ‘Community pharmacy contractual framework for 2019/2020 to 2023/2024’.

Dukes said the PSNC agreed to enter into talks about the model with the government because “the government’s side was adamant that there were efficiencies to be had within the sector … and, therefore, it would proceed with legislative change to change the current situation with regard to hub-and-spoke”.

“On that basis, I felt that we either stand on the side-lines and watch it, or we stand in the centre and have the opportunity to help influence and steer that dialogue.”

However, when asked whether the PSNC had seen evidence that the model would create efficiencies, he said: “It may well build capacity. But does it save money? I don’t think any of us have seen any evidence that it would”.

The government previously consulted on allowing the model to operate across different entities in 2016, but the proposals raised several questions, including whether the model was safe and how the system would be affected by the falsified medicines directive.

As a result, the government shelved plans to implement the model in June 2016.

More recently, the PSNC raised concerns in January 2019 over the model’s implications for professional liability, as well as reiterating outstanding questions over “the spoke’s costs for using a hub, and how we would deal with margin and payments/fees”.

However, Dukes has now said concerns about capacity in community pharmacy means the PSNC is “going to have to have those conversations about wider automation, hub-and-spoke, skill mix,” along with “how the pharmacy team is used in the most efficient way, to provide pharmacists with the amount of time they need to perform the services that they need to”.

“Community pharmacy is suffering from a lack of pharmacists,” he said. “And I’m really concerned about how we can find that capacity to conduct the services that NHS England wants us to do … because the decommissioning of medicines use reviews (MURs) will free up some time, but it will only be some time.”

As part of the five-year pharmacy contract, community pharmacists will no longer provide MURs after the end of 2020/2021. Instead, it will conduct a range of pilots, including case finding for undiagnosed cardiovascular disease and stop-smoking referrals from secondary care.

Last updated
The Pharmaceutical Journal, PJ, November 2019, Vol 303, No 7931;303(7931):DOI:10.1211/PJ.2019.20207280

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