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AIMp: Cap number of patients per ‘hub’ pharmacist or risk ‘race to the bottom’ on costs

Pharmacists based in the ‘hub’ of a hub-and-spoke system should only be able to process prescriptions for a set number of patients, the Association of Independent Multiple pharmacies (AIMp) has said.

Lack of regulation in this area “might lead to a race to the bottom on pharmacists’ costs”, AIMp cautioned in its response to the Department of Health and Social Care’s (DH) consultation on hub-and-spoke dispensing.

“There is another incentive to race to the bottom due to the current pharmacist workforce shortage,” AIMp added.

The General Pharmaceutical Council (GPhC) should therefore “limit and regulate” patient numbers per “hub” pharmacist, or there will be a “clear commercial advantage” for hubs catering to a large volume of patients per pharmacist, AIMp said.

The GPhC told C+D it was finalising its own response to the DH’s consultation. It is “not appropriate” for it to comment on other organisations’ responses, it said.


Read more: DH launches long-awaited pharmacy hub-and-spoke dispensing consultation


The representative body also suggested that hubs should be registered either with the GPhC or the Medicines and Healthcare products Regulatory Agency and agreed with the DH’s suggestion that “hub dispensing” should only take place from GPhC-registered pharmacy premises.

Meanwhile, the dispensing of each item should be supervised by a pharmacist, it wrote.


Sharing supplies between hub and spoke pharmacies


At present, the legislative changes proposed by the DH do not allow for spoke pharmacies to share medicine supplies with the hub.

But the DH should reconsider this point because of the fragility of the medicines supply chain “as evidenced by the persistent shortages in recent years”, according to AIMp.

“The more potential supply opportunities of medicines there are, then the greater is our capacity to complete prescriptions. It clearly makes sense to allow the spokes to supply their hubs with product that they might have, and the hub might not have,” it commented.

The representative body also suggested that the £4,000 set-up cost for implementing a hub-and-spoke model estimated by the DH “is totally unrealistic when compared against the costs of buying hub robotics, making premises changes, and giving staff training”.


Read more: Hub and spoke: NPA says DH’s £4k set-up cost per pharmacy is ‘very low estimate’


AIMp stated that it does not believe that the DH’s hub-ans-spoke proposals raise patient safety issues but added that this applies only if “there is detailed accountability, policed by strong and consistent regulation, of all hub pharmacies, of the hub responsible pharmacists and spoke responsible pharmacist”.

Some of the DH's hub-and-spoke proposals include:
  • Amending section 10 of the Medicines Act 1968 – which at present only allows the hub-and-spoke model between businesses owned by the same company
  • Allowing dispensing doctors to access the dispensing hub
  • Requiring that the hub is a registered pharmacy
  • Amendments to the Human Medicines Regulations 2012 and the Medicines Act 1968 – which would allow for two different hub-and-spoke models (see below)


The two hub-and-spoke dispensing models

First model: Patient presents prescription to the spoke pharmacy. The pharmacy sends it to the hub, which prepares and assembles the medicines. These are sent back to the spoke, which supplies them to the patient.

Second model: Same as above but the hub sends the medicines directly to the patient’s home rather than to the retail pharmacy.”


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