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Is NHS England’s hub-and-spoke dispensing agenda making a comeback?

While a C+D investigation has confirmed formal meetings have not taken place, a lawyer and NHS England’s own rhetoric suggest this dispensing model is due a comeback

Rumours have swirled around the possibility of NHS England making a renewed push to expand the use of hub-and-spoke dispensing since the start of the year.

The commissioner told C+D in January that changes to government regulations, for example, around hub-and-spoke dispensing, may be required as a means to reform community pharmacy’s “wider supply supplements” – an ambition set out in its long-term plan for the NHS.

New technology and automation present exciting opportunities to increase the efficiency of dispensing, while safely freeing up clinical time for pharmacists to spend caring for patients, the commissioning body claimed at the time.

As if this wasn’t enough of a hint that the hub-and-spoke agenda was back with a vengeance, healthcare lawyer Noel Wardle predicted in March that pharmacists should “watch out” for a new consultation on hub-and-spoke dispensing.

While a 2016 consultation on the model was “knocked back” because of opposition, “I suspect it will come back and I suspect it won’t be knocked back this time”, Mr Wardle told delegates at the Charles Russell Speechlys Pharmacy Law conference.

Back in 2016, the government tried to persuade the sector that allowing independent pharmacies to legally operate dispensing hubs would “create a level playing field” and give independent pharmacies a greater choice of which business model to operate.

But pharmacy organisations argued convincingly that there was no evidence that hub-and-spoke dispensing will save money or improve patient safety.

Mr Wardle told C+D in March that “more pressure on pharmacies and more pressures on remuneration” means there is “perhaps more of an appetite for the benefits of economies of scale, which hub-and-spoke might provide”, than there had been three years ago.

No formal meetings this year

To find out whether this appetite had transferred into action, C+D sent a freedom-of-information request to NHS England for details of all relevant meetings between England’s chief pharmaceutical officer Keith Ridge, a vocal proponent of the “extraordinary capability” of the dispensing model, and pharmacy representatives. This revealed that no meetings to discuss hub-and-spoke dispensing had taken place between January 2018 and March 2019.

Whatever NHS England’s preference for large-scale, centralised dispensing, these findings suggest that they aren’t yet at the stage where they are having formal conversations on the topic.

But Mr Wardle isn’t convinced that the hub-and-spoke revival is just a pipe dream. He was “surprised” to hear Dr Ridge had not held any formal meetings on hub-and-spoke dispensing when C+D shared its findings with him.

“The sense I get from talking to pharmacists and people in the industry is that those conversations are happening,” Mr Wardle tells C+D.

“Perhaps they are not yet happening in a formal manner, or at minuted meetings, but those discussions are happening at a ground level.”

With Well Pharmacy making “good progress” on its rollout of hub-and-spoke dispensing, and Boots attributing increased patient safety in its pharmacies to automation, perhaps it won't be long before it returns to the top of NHS England's agenda.


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