‘HUB AND SPOKE’


WHEELS COME OFF ‘HUB AND SPOKE’


PROPOSALS AS THE WESTMINSTER GOVERNMENT ANNOUNCES ITS RE-THINK ON ‘HUB AND SPOKE’ DISPENSING, ANNE MCALISTER, NPA REPRESENTATION MANAGER, NI, POINTS OUT THAT THE PROPOSALS WERE ALWAYS GOING TO POSE A PARTICULAR SET OF CHALLENGES HERE.


‘centralised’ dispensing system, the method is currently only available to be used within single company entities. The method involves the provision of robotised dispensing of repeat prescriptions at dispensing hubs for delivery to patients’ homes and ‘spoke’ pharmacies. The Department of Health in London’s proposals suggested extending the system’s availability to include intercompany ‘hub and spoke’ in order to improve efficiency and safety.


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In order to operate a viable ‘hub and spoke’ model, a minimum of two pharmacies is required, though, in order to get the efficiencies of scale and recoup expenses at a reasonable rate, the optimum number is upwards of five or six. The pharmacies involved also need to have sufficient script volume to make the system viable.


62 - PHARMACY IN FOCUS hile only a few


pharmacies in Northern Ireland are operating the


Concerns have been raised about where the responsibility for the accuracy and clinical check lies in these models and about the role of the Responsible Pharmacists in both the ‘hub’ and ‘spoke’ settings.


In March this year, the Government announced a ‘rethink’ on ‘hub and spoke’ dispensing in response to expressions of concern from those in the pharmacy sector, particularly the independents.


As a result of this response, the Pharmacy Minister, Alastair Burt, announced on 7 June that:


‘The consultation on changes to medicines legislation including that on ‘hub and spoke’ dispensing did not rely on any specific safety profile of hub and spoke dispensing. Instead, the consultation document specifically asked consultees to provide evidence on the issue. Nevertheless, the responses to the consultation have


raised issues around removing the bar on ‘hub and spoke’ dispensing between retail pharmacies that are not part of the same business that the Department would like to explore in more detail with stakeholders’ representatives before progressing any legislation. It does not now envisage changes to the legislation on this issue commencing on 1 October 2016.’


While bodies such as the NPA wholeheartedly welcomed the Government’s re-think on ‘hub and spoke’ dispensing, their NI Representation Manager, Anne McAlister, says that it is good news for Northern Ireland pharmacies in particular, since the proposed changes had taken little consideration of the pharmacy processes here in the first place.


‘The Department of Health proposals largely considered the models of practice in England initially,’ Anne told PiF, ‘but legislation, if passed, could have been applied UK wide. To be honest though, the Department of Health proposals had given scant regard to the circumstances singular to Northern Ireland pharmacy from the outset.


‘For a start, Northern Ireland has an abundance of rural areas, but the concept of remoteness was not taken into consideration at any time, nor reflected in potential costs associated with establishing and developing hubs. Also, there was no recognition of the fact that the necessary IT


systems aren’t in place here. The ‘hub and spoke’ system is very much reliant on electronic transmission of prescriptions and the technology simply isn’t present here yet. There simply wouldn’t have been the facilities to recognise the efficiencies that were being proposed.


‘What has happened with this consultation is yet another example – and there have been quite a few of them – of the disparity in our system and of the confusion that still seems to surround the ‘hub and spoke’ issue.


‘ The Scottish government, for example, is currently looking at providing pharmacy with capital investment to look into longer-term automated dispensing rather than ‘hub and spoke’, while England’s chief pharmaceutical officer, Dr Keith Ridge, caused controversy recently by comparing the three per cent dispensing error rate in England with a ‘0.00001 per cent’ rate at what he called ‘large-scale automated dispensing facilities in Sweden’: a statistic which turned out to be applicable to only one specific site.


‘Automation of any type – including the ‘hub and spoke’ model, certainly has its place in creating efficiencies in the dispensing process, but we believe that the ‘spoke’, ie, the pharmacy and pharmacist, must retain the pharmacist/patient relationship through interventions to ensure optimum patient safety and efficacy.’


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