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DH’s hub-and-spoke proposals blasted for being too ‘English-centric’

The Department of Health and Social Care’s (DH) proposals on hub-and-spoke dispensing models do not adequately take into account how the changes would affect pharmacies in Northern Ireland, a pharmacy body has argued.

A “full legal impact assessment” for pharmacies in Northern Ireland is needed to understand the impact the proposed changes would have, Pharmacy Forum Northern Ireland (Pharmacy Forum NI) said in its response to the DH’s consultation on hub and spoke.

“Issues related to rurality, the EU medicines directives, paper scripts… have not been appropriately considered within the consultation impact assessment,” the representative body argued.


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


The DH's consultation put forward proposals for making legislative changes across the UK allowing the operation of hub-and-spoke dispensing across different legal entities. It also set out two proposed models for this.


Proposed 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.


Pharmacy Forum NI said that the impact assessment published alongside the DH’s hub-and-spoke proposals “is driven by a focus on the English situation”.

“Northern Ireland’s circumstances, both in terms of the make-up of the pharmacy sector and the pharmacy model, is significantly different to what exists in England,” it pointed out.

However, a DH spokesperson told C+D yesterday (June 15) that its consultation on hub-and-spoke dispensing had asked “specific questions regarding Northern Ireland”.

“The consultation closed on June 8 and we will set out further details of next steps in due course,” they added.


 “Little or no analysis” of Northern Ireland impact


Pharmacy Forum NI said it is “supportive of the principle of creating a level playing field for all pharmacies in respect of hub-and-spoke dispensing”.

However, it found “little or no analysis of the unique position of the pharmacy sector in Northern Ireland in the consultation papers or the supporting impact analysis”.

The provision of pharmaceutical services in the country differs from the rest of the UK, as Northern Ireland “remains within the jurisdiction of the EU medicines directive”, it said.


Read more:
PSNC: ‘Virtually no financial efficiencies’ in DH's hub-and-spoke proposals


“This will have an impact on any proposed changes for hub-and-spoke dispensing, even more so if proposed hubs are based in Great Britain rather than in Northern Ireland,” the body added.

Consideration should have been given to the fact that the falsified medicines directive – which continues to apply in Northern Ireland – adds “extra steps into the supply of medicines”. These will need to be considered “in any regulations”, it said.

In addition, pharmacies based in Northern Ireland are often “based in the least prosperous parts of our communities”. The potential introduction of the second of the DH’s two proposed hub-and-spoke models (see above) could compromise their ability to offer other services, the representative body argued. 

“We would like to see evidence-led research based on robust data and the lived experience of pharmacy businesses that the proposed first model will indeed work in the interests of Northern Irish patients and pharmacists,” Pharmacy Forum NI said.

The first proposed model should allow “Northern Irish pharmacists to undertake broader, more clinical roles and pave the way for Northern Irish community pharmacies to play a bigger role in the delivery of health and care”, it added.

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