As The Pharmaceutical Journal reported on 1 May 2025, the Labour government recently laid before Parliament draft legislative amendments to the Human Medicines Regulations 2012 for the roll-out of hub-and-spoke community pharmacy prescription filling between distinct legal organisations.
This change is not expected to come into force until October 2025, although it was originally planned to be introduced in January 2025.
The idea is slightly contentious: a patient will present their prescription to a ‘spoke’ pharmacy, which then sends the prescription to a ‘hub’ pharmacy, where the prescription is assembled and returned to the spoke pharmacy for the patient to collect.
This is already permitted between pharmacies under the same owner/legal entity, but the new legislation will allow this between different branches.
This proposed change seems to be of curiously little real relevance
Those advocating this change suggest that it will free up time spent dispensing, with the hubs picking up this slack, so that pharmacists in the smaller, spoke pharmacies can focus on other, more clinical, activities. There could also be financial benefits for smaller pharmacies being able to use larger pharmacies as hubs.
Others are less sure, and fear that smaller hub pharmacies could end up being taken over by larger brands/multiples (although the legislation is meant to guard against this) and predict that there will be no financial benefit for the sector.
What difference will the legislation make?
This proposed change seems to be of curiously little real relevance.
The community sector has for years seen significant consolidation (including among the big multiples) and is still coping with serious medicines shortages. It is addressing the problem of training new prescribing pharmacists, but this is far from straightforward.
In short, it is dealing with a lot of big problems.
It is far from obvious that ‘hub and spoke’ is going to change things very much — the consolidation in the community sector has probably taken the marginally viable businesses out of circulation.
The model sounds like it might be effective and logical in remote areas, but the rise of online pharmacy may already have bitten into that market. It really isn’t hoping to do much, and probably nothing, about the demand–supply mismatch of medicines.
The history
Nor does the history of efforts to bring this in suggest that it is a hugely important issue.
As The Pharmaceutical Journal’s May 2024 editorial noted:
“The Department of Health and Social Care’s [DHSC’s] previous consultation on similar proposals in 2016 was met with several concerns. The Pharmaceutical Services Negotiating Committee, now Community Pharmacy England (CPE), said at the time that it ‘vigorously opposed’ the proposals owing to concerns around ‘professional and legal implications’ that could lead to patient safety issues. And the Royal Pharmaceutical Society (RPS) also said it had ‘reservations around patient care and safety’ within the dispensing model.”
A DHSC impact assessment for the five-year contract, obtained by The Pharmaceutical Journal through a Freedom of Information request, described hub-and-spoke dispensing as “a key component of delivering a transformation programme to release pharmacist time from dispensing”.
These changes are very clearly not going to move the dial on the effectiveness, performance or profitability of the community pharmacy sector
The impact assessment added that the government estimated the efficiency benefits brought about by hub-and-spoke “will serve to offset some of the costs of delivering the new services”.
The sector’s representative bodies shifted their views by the time of a later consultation in 2022, with the RPS’s stating that it broadly agreed with the new proposals, although some patient safety concerns remain.
In its response, dated June 2022, CPE said that it changed it position “primarily due to assurances from the DHSC that it will agree with [CPE] which models will allow the whole sector to benefit fairly”.
Will it help with the sector’s financial pressures?
A second impact assessment drawn up by the government on its hub-and-spoke proposals estimates that a pharmacy will be able to have around 40% of its prescription items dispensed through a hub, but adds that only 38% of pharmacies would actually benefit from the new legislation giving them access to a hub in the first place. (The rest either dispense too few items to make the investment of a hub-and-spoke set up worthwhile or are part of a multiple that can already dispense from a central hub under current legislation.)
Of that 38%, the assessment says it expects only “12% of potential beneficiaries would adopt hub-and-spoke [dispensing] within the next five years, while a further 20% would adopt over the next ten years”, its modelling being based on private market research.
As a result, in the tenth year after the new hub-and-spoke legislation is implemented, only 7% of items (75 million items) dispensed would go through a hub, the assessment states.
A non-event
There are real and big problems facing the community pharmacy sector, and others that are highlighted in The Pharmaceutical Journal’s new workforce campaign.
The hub-and-spoke dispensing model is not one of them. These permissive changes are clearly going to make any contribution only at the very margins. It may be a good thing in and of itself to make hub-and-spoke dispensing possible between organisations, but it is very clearly not going to move the dial on the effectiveness, performance or profitability of the community pharmacy sector.
Andy Cowper is the editor of Health Policy Insight
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As a now VERY retired one-time community pharmacist I fail to see what advantage this will be to me, and indeed I see disadvantages. When I was a community pharmacist managing a busy (6-700 per month) dispensary I still had some idea of my 'regulars' and could pick up on changes, both deliberate... no problem... and accidental ..... problem.
Now I am a medicine taker, rather than supplier, I appreciate the fact that my monthly prescriptions are scrutinised by the same person most months. Prescription medicines are not ordinary items of commerce and should not be treated as such.