‘Many unknown unknowns with hub and spoke’


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Two weeks prior to the closing of the hub and spoke consultation, issues around patient safety, costs and competition as well as practicalities such as what to do with uncollected medicines were discussed in a webinar on hub and spoke dispensing on Wednesday (May 26).

The webinar was organized by Sigma Pharmaceuticals in association with the National Pharmacy Association (NPA).

NPA director of corporate affairs Gareth Jones chaired the event and was joined by Sigma’s Hatul Shah and Raj Haria as well as NPA vice chair Nick Kaye and NPA head of advice and support services Jasmine Shah.

Kaye said: “There are still many ‘unknown unknowns’ with hub and spoke and the jury’s still out on any potential benefits. I have lots of reservations about cost and it worries me how efficient this is for the business and the long term sustainability for the sector as a whole. Above all we need to think about the patient at the centre of all this and the potential confusion for them.”

Jasmine Shah felt patient safety was going to be the key in regards to whether the spoke and the hub would hold the ultimate responsibility and “who is going to take the accountability as far as patient care goes”.

She added: “It is most important that GPhC standards and NHS requirement are both met in identifying all the risks associated with the arrangement with hub and spoke and ensuring that (patient safety) measures are in place. Everything that needs to be looked at is by putting the patient at heart of the arrangement and seeing what is the safest way for them to receive care from both spoke and hub.”

‘Someone else will control my margin’

Speaking from the business point of view, Sigma CEO Hatul Shah said: “The market is so volatile in terms of pricing, what control would the spoke have on the pricing? There are lots of clinical aspects to this but there are some business aspects as well because in pharmacy industry where margins are varying and there are lots of reliance on different services, there is cost inflation coming in now, so we need to have control as spoke stores on profit margin.

“On the cost economics that I have done on spoke and hub system, I don’t understand how is it going to work because I am going to let someone else control my margin.”

A Department of Health and Social Care consultation on hub and spoke closes on 8 June and the NPA is encouraging it’s members to respond. The consultation includes a model in which hubs supply medicines directly to patients, bypassing the pharmacy spokes.

Shah dismissed the hub to patient model because it cannot match local pharmacies for “service, advice and care”.


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