It has decided to proceed with the implementation of the two hub and spoke models that it consulted on
The Department of Health and Social Care (DHSC) has finally published its response to the 2022 consultation on hub and spoke dispensing.
Considering the consultation evidence and further discussions, the government has expressed its intention to progress the proposals for enabling hub and spoke models across different legal entities as soon as possible.
This will be achieved by using the enabling powers outlined in Part 2 of the Medicines and Medical Devices Act 2021 (MMDA) to amend the Medicines Act 1968 and the HMRs.
Furthermore, the DHSC has decided to proceed with the implementation of the two models of hub and spoke dispensing that it consulted on.
The government response to the consultation reads: “Having considered the responses, the government intend to proceed to implement the necessary changes to medicines legislation to remove the current restrictions that prevent the hub and spoke dispensing models from operating across different legal entities found in section 10 of the Medicines Act 1968.
“The proposed legislative changes that we intend to make, to enable the hub and spoke models, will also enable one of the suggested alternatives, namely that a hospital pharmacy which is a registered pharmacy could provide hub services for spokes in the community.”
What is the ‘hub and spoke’ model?
In the “hub and spoke” models, multiple “spoke” pharmacies receive prescriptions and a central “hub” pharmacy handles the routine dispensing tasks for those prescriptions on a larger scale, potentially using automation.
Currently, this arrangement is only possible between pharmacies operating within the same legal entity.
The government proposed that enabling the use of hub and spoke models between pharmacies owned by different legal entities would create equal opportunities in community pharmacy. This allows spoke pharmacies to provide more patient-facing services, relieving pressure on the wider NHS.
The proposed changes were agreed in the Community Pharmacy Contractual Framework 2019 to 2024 in England and referenced in the Primary Care Recovery Plan and the NHS Workforce Long Term Plan.
The online questionnaire was launched on 16 March 2022 and remained open for 12 weeks. In total there were 131 responses to the questionnaire, of which 71 were from individuals and 60 were from organisations.
More than 50 per cent of respondents supported the proposal on removing the legal restriction, comprising mostly of medium and larger pharmacy chains, representative sector organisations and other related businesses.
Two hub and spoke models proposed
Model 1
Model 1 is where the patient presents a prescription to the spoke. The spoke then sends the relevant information on to the hub so that they can carry out their agreed dispensing actions. The hub then sends these dispensed medicines back to the spoke, which may have further responsibilities to perform such as providing advice on the medicine to the patient, before supplying them to the patient.
Model 2
In model 2, the same pathway is followed in that the patient presents a prescription to the spoke, which then sends the relevant information to the hub. The hub then assembles and prepares the medicine before supplying the completed order directly to the patient.
Changes unlikely to benefit the sector: CCA
The government previously consulted on extending the hub and spoke models in 2016 and published its response to the consultation in November 2021.
Malcolm Harrison, Chief Executive of the Company Chemists’ Association (CCA), welcomed the “long-awaited” publication of the consultation outcome, but he is skeptical about its potential benefits for the sector.
“We are pleased to see that the Department has taken forward the proposals, but also taken on feedback from the sector through the consultation period. The changes should allow new business models, without increasing the burden on existing processes or adding confusion to patients,” he said.
“However, given the huge upfront capital investment and ongoing operating costs of hub-and spoke dispensing models, and the financial strain all pharmacy businesses are currently facing, we think it is unlikely the sector with be able to benefit from these changes.
He added that the proposed changes will not release any clinical capacity in community pharmacy unless “the government’s funding for medicines supply is increased.”
Automating original pack dispensing “crucial”
Hub and spoke provider, Centred Solutions, said the government decision to amend the legislation will make it easier for even more pharmacies to look at “the most efficient and cost-effective way” of automating their original pack dispensing process for repeat prescriptions.
Louise Laban, Sales and Marketing Director for Centred Solutions, said: “Automating original pack dispensing is going to be crucial for pharmacies who desperately need to free up time to deliver services like Pharmacy First, with consultation thresholds set to increase rapidly in the coming months.
“Our advice to pharmacies who are not considering automating their original pack dispensing process would be to act now and start looking at your options. Starting the conversation today will ensure pharmacy are one step ahead when these changes come into force in January 2025.”
Regulatory change was inevitable and necessary
Harry McQuillan, Chairman of Numark, hailed the government’s response to the consultation, stating “this is welcome clarity.”
“Regulatory change was inevitable and necessary to level the playing field for all pharmacy owners with regard to present day medicines assembly and patient need. This is particularly relevant as community pharmacy shifts towards the provision of more patient services such as Pharmacy First.”
The legislative changes are scheduled to take effect on the 1st January 2025.
“This gives Numark and PHOENIX UK some time to consider how this change can be implemented to the benefit of patients, pharmacy owners and wholesale partners whilst not undermining bricks-and-mortar pharmacies at a time when the NHS is seeking to expand local pharmacy-based face-to-face patient services,” Harry said.
He added that Phoenix has extensive knowledge regarding “how hub assembly can support the community pharmacy spoke network to flourish and release pharmacy team time to provide care.”
