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‘Level playing field’: Hub and spoke possible for all pharmacies from January

The government has announced that it will make legislative changes that are set to allow all pharmacies to use the hub-and-spoke dispensing model from January, including those that are different legal entities.

Two models of hub-and-spoke dispensing will be permissible in community pharmacies from next year, the Department of Health and Social Care (DH) announced today (May 13).

 

According to its long-awaited consultation response on the prescription solution, the Medicines Act 1968 will be amended to permit hub-and-spoke dispensing across different legal entities according to two models.

 

The consultation, which ran from March to June 2022, “received an overwhelmingly positive response”, the DH said.

 

Read more: HSCC chair ‘fearful’ of ‘disastrous’ government hub-and-spoke decision

 

Currently, hub-and-spoke dispensing is only permitted between pharmacies within the same legal entity – meaning smaller independent pharmacies have been excluded from the model. 

 

But from January 1 2025, all pharmacies will be able to supply medicines using one of the hub-and-spoke models, subject to parliamentary approval, the DH said.

 

Read more: Government ‘finalising’ hub-and-spoke consultation response

 

Medicines that have been assembled and dispensed at a registered pharmacy can be “sold or supplied at or from a retail pharmacy business” that belongs to a different legal entity, once the legislation is passed, it added.

 

Dispensing doctors will also be permitted to access hub pharmacies and act as a “spoke”, according to the consultation response, it said.

 

 

Two models

 

 

Section 10 of the Medicines Act prevents a pharmacy from selling or supplying a medicine that was dispensed at a pharmacy belonging to a separate pharmacy business.

 

But the government will amend the law to remove this restriction and “expand the scope” of hub-and-spoke dispensing, it said.

 

Read more: Hub and spoke could pose long-term competition risks, watchdog warns

 

“Model 1” dispensing, also known as spoke-hub-spoke, will allow a “spoke” pharmacy to send a patient’s prescription to a hub, which will dispense the prescription and return it to the spoke, according to the consultation response.

 

The spoke will supply the prescription to the patient along with “providing advice on the medicine to the patient”, it said.

 

Read more: CCA boss: Hub and spoke ‘one way’ to help solve pharmacy workforce crisis

 

In “Model 2”, or spoke-hub-patient, a spoke will send a prescription to the hub, which will assemble and dispense the order “directly to the patient”, it added.

 

The government also proposed a number of other amendments to existing regulations, including that a spoke must “conspicuously display a notice on their premises detailing the name and address of any hub pharmacy” with which they deal, or on their website if an online pharmacy.

 

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

 

It also said that there must be “written arrangements” between any hub and spoke, which “must include a comprehensive statement in relation to their responsibilities and details of which party will be named on the medicine label”.

 

“There will be flexibility for the hub and spoke to determine whether the label will feature either the hub or spoke’s details, but never both,” it added.

 

 

“Level the playing field”

 

 

According to the DH, permitting hub and spoke across legal entities will “enhance efficiency” by “freeing up time for dispensing staff”.

 

Pharmacy minister Dame Andrea Leadsom said that the introduction of new hub-and-spoke rules will “level the playing field”.

 

Centralised dispensing will “free up highly skilled pharmacists from back-office duties to deliver patient-facing services”, she said.

 

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

 

The January 2025 launch date was chosen “to tie in with the commencement of the Windsor Framework” and to give time to amend secondary legislation, according to the consultation response. 

 

It will also give the community pharmacy sector “time to explore the relevance of the new hub-and-spoke models to their businesses”, it said.

 

 

How did we get here?

 

 

More than two years have passed since the government launched its consultation on hub-and-spoke dispensing in March 2022, after a previous consultation on the model in 2016. 

 

Independent pharmacies were sceptical of the proposals, with the National Pharmacy Association (NPA) telling C+D in February 2022 that it was “not hearing any clamour from lots of members to jump on board [with] hub-and-spoke [dispensing] in the short term”.

 

In 2022, the DH estimated that adopting the hub-and-spoke dispensing model would cost an average £4,000 in set-up fees per pharmacy, while the models would save the NHS a total of £27.3 million over a ten-year period.

 

But the NPA said at the time that the DH’s figure “appears to be a very low [estimate]... at first glance”.

 

Read more: Hub-and-spoke company registers ‘significant interest’ after DH consultation

 

Then in July 2022, the Competition and Markets Authority (CMA) said that there may be “potential longer-term competition risks” linked with the hub-and-spoke system in its response to the consultation.

 

The competition watchdog advocated for monitoring in case the market develops in such a way that pharmacies can only access medicines through “an increasingly limited number” of dispensing hubs.

 

In October 2022, the Company Chemists’ Association (CCA) spoke in favour of the dispensing model, saying that it was one way to “release the clinical capacity for pharmacists”.

 

Read more: ‘The DH’s hub-and-spoke dispensing consultation remains silent on key areas’

 

But in November last year, chair of the health and social care committee (HSCC) Steve Brine told delegates at the Sigma UK Community Pharmacy 2023 conference that he was “fearful” of the government’s upcoming response to the consultation.

 

“I don't think [it] will be what you will like and it certainly won't be what the contractors in my constituency will like,” he said at the time.

 

C+D reported in October that pharmacy minister Neil O’Brien had said that a government response to its hub-and-spoke consultation will be published “as soon as possible”.

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