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Dispensing

Government bill could enable hub-and-spoke dispensing between separate pharmacies

The Medical Devices Bill 2019/2020 moves towards allowing large multiple pharmacies with dispensing hubs to charge smaller pharmacies to use those services.

Independent pharmacy

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The Bill paves the way for independent pharmacies to access hub-and-spoke dispensing options

Legislation paving the way towards allowing legally separate pharmacies to set up shared hub-and-spoke dispensing services has been presented to Parliament.

An impact assessment of the ‘Medicines and Medical Devices Bill 2019/2020’, which was first announced on 13 February 2020, says that following secondary legislation, the Bill would also allow large multiple pharmacies with existing dispensing hubs to “expand their capacity” and “offer chargeable prescription assembly services to independent and small multiple pharmacies”.

The assessment added that the secondary legislations could also see the NHS, wholesalers and new companies set up “new large-scale hub facilities”.

The Bill was launched with the promise of enabling a wider range of healthcare professionals — which could include pharmacists — to prescribe ‘low-risk’ medicines, and it is expected to give the government continued power to amend the Human Medicines Regulations 2012 after the end of the Brexit transition period.

The Bill’s impact assessment set out the legislation’s implications “for how the powers may be used in the future” following secondary legislation.

These include “enabling hub-and-spoke arrangements across legal entities,” which will ultimately require a change to the Human Medicines Regulations 2012.

Previous government proposals to introduce cross-firm hub-and-spoke dispensing in 2016 were shelved after pharmacy bodies expressed concern over the safety of the plans.

The concept was revived in July 2019 when the community pharmacy contract said the government would be pursuing “legislative change to allow all pharmacies to benefit from more efficient hub-and-spoke dispensing, enabling increased use of automation and all the benefits that that brings”.

However, in its impact assessment of the medicines Bill, the government noted that the “the costs and benefits [of the model] remain uncertain, as do some details around the policy design”, adding that it “intends to continue to work with the sector in order to explore and set out the framework for how hub-and-spoke could be ‘operationalised’ in the NHS”.

While the assessment stated that the model’s “costs and benefits will depend on pharmacy businesses’ decisions”, it suggested some “high-level” financial costs could include “capital investment (hub) and changing business processes, IT and logistics (spoke)”.

“The benefits of hub-and-spoke [dispensing] are expected to include reduced staff time on dispensing at the spoke pharmacy (freeing up time to provide other services), potential for reduced rates of dispensing errors and potential for a calmer working environment at the spoke pharmacy,” it continued.

The government said in the document that it “would only expect to see take-up of hub-and-spoke arrangements where businesses deemed it would be beneficial for them to do so”.

Any secondary legislation to implement hub-and-spoke dispensing is expected to be “accompanied by a full economic appraisal”, it said.

The Pharmaceutical Services Negotiating Committee (PSNC) told The Pharmaceutical Journal in November 2019 that it had not seen any evidence that extending the hub-and-spoke model of dispensing in community pharmacy would save money.

Gordon Hockey, director of operations and support at the PSNC, told The Pharmaceutical Journal that the Bill “will provide the primary legislation to enable hub-and-spoke dispensing to be implemented between different legal entities”.

“This may, in time, give more pharmacies, including independent pharmacies, access to hub-and-spoke dispensing options,” he said, adding that the PSNC “agreed in principle to this change” as part of the five-year pharmacy contract but also ”gained agreement from the government to work with us to ensure that the arrangements are fair to all pharmacies”.  

“There is much detail still to work out, with questions such as whether hub-and-spoke dispensing will work for all prescription types and what the implications for patient safety might be,” he continued.

“We are also not convinced that there is an economic case for hub-and-spoke dispensing — if it works well then it may help to release capacity in pharmacies, but it is unclear whether this model will deliver any cost savings.”

Hockey added that the PSNC was working with other pharmacy organisations “to explore how hub-and-spoke might work for the sector in practice” and to ensure community pharmacy is “not in any way adversely impacted by the introduction of this legislation”.

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2020.20207714

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