‘HUB AND SPOKE’
WHEELS COME OFF ‘HUB AND SPOKE’ PROPOSALS
AS THE WESTMINSTER GOVERNMENT ANNOUNCES ITS RE-THINK ON ‘HUB AND SPOKE’ DISPENSING, JANICE OMAN, NPA SCOTLAND REPRESENTATION MANAGER POINTS OUT THAT THE PROPOSALS WERE ALWAYS GOING TO POSE A PARTICULAR SET OF CHALLENGES IN SCOTLAND.....
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nly a few pharmacies in Scotland are operating the ‘centralised’ dispensing system, and the method is currently only available to be used within single company entities. The method, which involves the provision of robotised dispensing of repeat prescriptions at dispensing hubs for delivery to patients’ homes and spoke pharmacies. Proposals to extend the availability to include intercompany hub and spoke were suggested by DH London in order to improve efficiency and safety.
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 it viable. Concerns 58 - SCOTTISH PHARMACIST
have been raised about where the responsibility for the accuracy and clinical check lies in these models and the role of the Responsible pharmacists in both the hub and spoke settings.
In June 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.’
The NPA wholeheartedly welcomed the Government’s re-think on ‘hub and spoke’ dispensing, and believes that this is good news for Scottish pharmacies, as the proposed changes had taken little consideration of the pharmacy processes here in the first place.
We very carefully examined the potential impact of the DH proposals across the entire UK and concluded that the fragility of the infrastructure supporting delivery to the large remote areas of Scotland and the impact of a hub situated within a different National Health Service had not been considered by the Department of Health. Efficiencies could not be assumed in Scotland and proposals could impact patient care.
The NPA was at the forefront of the independent sector’s challenge to the DH proposals supporting members to encourage patients to say ‘no’
to pharmacy cuts, which delivered a petition of two million signatures to Westminster. The government have to listen to such a loud voice. We also looked at the legal side of the proposals and scoped detailed investigation of the figures used by DH to show the efficiencies suggested not to be accurate, for England or across the UK.
The Scottish Government’s two-year evaluation pilot of new community pharmacy technologies including hub and spoke models is a great step forward to really understand how different dispensing systems can provide efficiencies and what risks are involved. I have spoken to quite a few members across Scotland very keen to be involved in the pilot.
We are hopeful that the appointment of new health and pharmacy ministers in Westminster should provide an opportunity for reflection and review of the proposals before any implementation which involves changing UK wide legislation moves on. My colleagues in Mallinson House will be engaging with the new ministers to encourage getting back to the drawing board on how community pharmacy moves forward for patients and the NHS in England. We will keep alert to any potential impact on independent pharmacies across the entire UK.
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