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

NHS England says hub-and-spoke will increase the efficiency of dispensing
NHS England says hub-and-spoke will increase the efficiency of dispensing

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.

Have you introduced hub-and-spoke dispensing across your pharmacy chain?

John Ellis, Community pharmacist

The NHS is determined to see the cost savings associated with robotised central dispensing by 2020. But the NHS may be being duped into short term savings, with greater long terms costs.

Companies like Pharmacy2u and Amazon's E-commerce dept actually run at a loss, online pharmacy simply is not sustainable under the current finding model, investors back these companies because they predict they will monopolise the market some time in the future. When they have this monopoly, they will no doubt be able to dictate their remuneration to the NHS.

Ironically, centralised dispensing may actually end up costing the NHS more than the current model ever did.

Community Pharmacist, Community pharmacist

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......Really ???!!!! How about a campaign for patients waste to be processsed at council waste disposal sites rather than staff and pharmacist having to sift,sort,record and destroy waste ? That would free up 'clinical time' .Do GP's Dentists,Opticians,Nurses process patients returned 'clinical waste' ?? Never mind faceless dispensing factories  - sort the outdated contract out first including waste disposal and the all useful 'annual audit'.Come on PSNC - crack on before there's no pharmacy to visit at all for communities.

Leon The Apothecary, Student

It's definitely happening. I've used and developed H&S dispensing technology personally. Its ease of use and simplification of the process is unquestionable. The savings are there.

Unfortunately, the savings are made at the expense of people's livelihoods which makes total sense. If the regular repeat dispensing is conducted off-site, it's the same in the eyes of corporate as having a very sharp drop of prescription numbers within a branch, and with that one should expect less staff as a result. How much of a percentage?

I've witnessed 50% in staffing hours.

Community Pharmacist, Community pharmacist

Automation = job losses = no human interaction= inferior service & care. We are dealing with potentially dangerous medicines NOT the usual shop/internet items available for delivery by drone/robot or whatever the latest TECH bright money making idea may be.As the Minster said - 'care always has to be available face to face, human to human '

C A, Community pharmacist

How did you train the patients not to turn up 48 hr after they had ordered their scripts? I'm going OSD this summer.

Leon The Apothecary, Student

It's a tricky one, you're breaking habits for a lot of these patients, and that's not easily changed. Being very clear with time expectations are going to go a long way and reinforce the message every time.

A text message service could be a useful tool as well and asking people to wait until they receive a message before coming in to collect.

Community Pharmacist, Community pharmacist

So the 'improvement 'for patients is actually a delay compared to usual as the 'system' processses the prescriptions ?? Sounds like a joke tbh...goodness help you if a Windows/Apple update glitch throws the proverbial spanner in the works.Tech has it's place but it's often nowhere near as good as the salesman in the Tesla/hybrid company car promises in my broad experience.

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