Government proposals to relax medicines legislation to allow greater use of centralised dispensing – also known as hub-and-spoke dispensing – have been cautiously welcomed by pharmacy leaders, although they warned the change could pose a threat to the existing pharmacy network if it was not handled carefully.
Alistair Burt, community and social care minister, announced on 19 October 2015 at the Pharmacy Show in Birmingham that the government would consult on changes to legislation to allow all community pharmacies to operate under a ‘hub-and-spoke’ dispensing model.
Under the proposed model, the assembly, dispensing and labelling of medicines takes place in a central ‘hub’ and dispensed medicines are sent to ‘spokes’ — registered pharmacies and other premises — for patients to collect.
Pharmacy Voice, which represents three community pharmacy associations including both independents and multiples, previously called for this development but is now wary of the proposal.
Claire Ward, chair of Pharmacy Voice, told the event: “If we want [this issue] to go on the right track… we need to start to shape the direction of that travel. My fear is that if we don’t do that, there will be people in the NHS, in other parts of government and policymakers who will see this as a potential opportunity for ‘Amazonisation’, and that the dispensing hub becomes a point [from which medicines are supplied] direct to patients.
“That would be disastrous, in my view, for patients but it would also be disastrous for the value of the community pharmacy network. Above all else, we need to protect the network and the supply through that network.”
More work is needed on the best model for operating centralised dispensing, said Ward. “Because, for independents, I understand that a number of them will have fears about what this will mean for their business. So we’ve got to work on how we get a model that’s going to ensure everybody benefits from this,” she said.
She added that the value of the hub-and-spoke model was about freeing up time and space for pharmacists to see patients, not solely in retaining the medicines supply.
Source: Royal Pharmaceutical Society
Ash Soni, president of the Royal Pharmaceutical Society, the professional leadership body, raised questions about the proposal. “Do we know it’s going to be more efficient? Do we know how the system will work? How do we ensure that patients continue to get the care from pharmacists and pharmacy that they deserve, and that we don’t just see this as being a transactional relationship?”
The challenge for the consultation is to show how this model would improve patient care and the use of pharmacists as professionals, he said. “If time is released from preparation, it’s then got to be utilised in a different way. Using it for [other] services is a key part of that.”
Soni believes the idea was one of the most significant challenges to be put before community pharmacy in recent years. “We’ve been shouting for a long time about pharmacy being underutilised, the opportunity to use pharmacy better,” he says. “Well, it’s going to come, but the consequence is you’re going to have much greater scrutiny. We have to recognise that you’re going to be assessed [against] the quality of what you’re providing and value for money [you’re] getting at the same time.”
Source: Pharmacists’ Defence Association
Mark Koziol, chair of the Pharmacists’ Defence Association, said: “It’s an issue that requires early agreement between the [pharmacy] regulator, employers and the trade union for pharmacists, so as to establish the final position.
“All accuracy issues would rest with the hub, but the pharmacist would continue to be responsible for the clinical checks on prescriptions, and that’s only proper.”
In terms of civil liability for accuracy errors, liability would lie with the hub, and therefore there would be less liability for pharmacists in this area, he believes.
Koziol added that the union was pleased with the proposals but, unless there were changes made to the pharmacy contract, it could represent a “potential peril” for pharmacy, as funding for medicines supply would likely drop. It would be necessary to split the medicines supply and service components of the pharmacy contract and rebalance contractual funding to avoid pharmacies losing income, he believes.
However, doing so would be a “fantastic prospect for stimulating and invigorating community pharmacy”, he adds.