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Timeline: Pharmacy’s love-hate relationship with hub-and-spoke

C+D is holding a Big Debate on hub-and-spoke dispensing on its Community platform on April 29
C+D is holding a Big Debate on hub-and-spoke dispensing on its Community platform on April 29

As the DH looks towards rolling out hub-and-spoke across community pharmacy, C+D looks back at how the sector’s attitude towards the dispensing model has changed over the years

It’s been extolled as a safer way of dispensing and written off because it would “change the profession beyond all recognition” but, after years of intense debate within community pharmacy, hub-and-spoke looks set towards being rolled out across the sector.

The Department of Health and Social Care (DH) now has the power to change legislation to allow all community pharmacies to operate a hub-and-spoke dispensing model, regardless of whether they are part of a chain or an independent, which had hitherto not been allowed. What this will look like in practice will be subject to public consultation.

But the debate as to whether the model presents a way of freeing up pharmacists’ time for clinical services or poses a risk to patient safety still rages on.

Ahead of C+D’s Big Debate on whether a hub-and-spoke dispensing model could ever truly benefit independent pharmacies on the C+D Community platform tomorrow (April 29) at 7pm, here’s a timeline of how attitudes on the topic have changed over the years.

2008: Lloydspharmacy trials a hub-and-spoke dispensing model and the RPSGB calls for a wider debate

The multiple announced in October 2008 that it was trialling the model in north-west England by opening a dispensary at AAH’s Warrington depot, its pharmacy director Andy Murdock confirmed at the time.

Mr Murdock said: “We’re trying to understand what pharmacists might have to do to create time and space to allow pharmacists and pharmacy teams to be able to deliver the new clinical world.”

Then head of policy and communications at the Royal Pharmaceutical Society’s (RPS) forerunner the RPSGB, David Pruce, said hub-and-spoke had “potential” to free up time for clinical services, and called for a wider debate on the issue.

2014: Boots trials dispensing hub in Preston

In March 2014, C+D reported that Boots was planning to trial a dispensing hub in Preston to dispense medicines to 50 Boots branches.

2015: DH looks into allowing independents to dispense from hubs – and independent pharmacies voice their concerns

C+D exclusively revealed in October 2015 that the DH was “looking into” relaxing the laws preventing independent pharmacies from using hub-and-spoke dispensing models. Only companies that owned both the dispensing hub and the pharmacy were legally permitted to using hub-and-spoke dispensing at the time.

The news came just a month after England’s chief pharmaceutical officer Dr Keith Ridge called for the law to be waived “as soon as possible” at the RPS’s annual conference. Dr Ridge has long been a proponent of the hub-and-spoke model, claiming at the same conference that central dispensing hubs could dispense up to two-thirds of prescriptions in England.

However, the DH’s plans angered independent pharmacies, who warned that hub-and-spoke dispensing would “change pharmacy beyond all recognition” by reducing contact between patients and pharmacists.

January 2016: Government uses hub-and-spoke model to justify 6% cut to pharmacy funding

In a briefing document explaining the DH’s controversial cuts to pharmacy funding, where it slashed the global sum by 6%, the government pointed to hub-and-spoke as one way to make the sector more “efficient and innovative”.

February 2016: Keith Ridge lauds hub-and-spoke’s “extraordinary capability”

In an echo of his comments at the RPS’s 2015 annual conference, Dr Ridge defended the “extraordinary capability” of hub-and-spoke, saying his visits to two dispensing hubs in north west England had made him “realise the capability that is there”.

However, he told C+D at the time that he “understood” why some pharmacists had questioned the evidence of his assertion in 2015 that centralised dispensing hubs could dispense two-thirds of England’s prescriptions.

April 2016: A DH consultation document reveals that pharmacies would still have to assemble at least 40% of prescriptions with hub-and-spoke

In a consultation document published in March 2016, the DH estimated that between 40-70% of medicines dispensed by ‘spoke’ pharmacies would still need to be assembled on site, even if independents could legally operate dispensing hubs.

However, the document said that pharmacist labour and pharmacy technician costs could be slashed by 10% and 25% respectively in ‘spoke’ pharmacies.

Removing the legal barriers for operating a hub would “create a level playing field” and “give independent pharmacies across the UK a wider choice as to which business model they adopt”, the document said. 

May 2016: Pharmacy organisations demand evidence for DH’s assertions that hub-and-spoke is a positive move

In responses to the DH’s 2016 consultation on hub-and-spoke dispensing, pharmacy bodies such as the RPS, the National Pharmacy Association (NPA), the Pharmaceutical Services Negotiating Committee (PSNC) and Numark called for evidence to back up the government’s comments that opening up the model to independents would “create a level playing field”.

The pharmacy organisations argued that there was no evidence that hub-and-spoke dispensing would either save money or improve patient safety.

2017: Well rolls out hub-and-spoke

In April 2017, Well's then chief executive John Nuttall exclusively revealed the multiple’s plan to roll out a hub-and-spoke model across its 780-strong estate.

In 2018, the multiple told C+D that a “fair amount” of Well pharmacies were now operating a hub-and-spoke dispensing model.

2019: DH announces it will seek to change hub-and-spoke law

In its document outlining a five-year funding deal for community pharmacy, the government said it would seek to change legislation, meaning that independent pharmacies could use a hub-and-spoke dispensing model.

Dispensing needed to become “more efficient” so that pharmacists would have more time to take on an “expanded [clinical] role”, the DH said.

It would therefore work with the PSNC to “pursue legislative change to allow all pharmacies to benefit from more efficient hub-and-spoke dispensing”, it added.

This will enable “increased use of automation and all the benefits that brings”, the DH said. “We will agree with PSNC which models will allow the whole sector to benefit fairly,” it added.

2020: NPA says hub-and-spoke not necessarily safer or cheaper

review by the NPA, which looked at both the UK and international experience of hub-and-spoke dispensing, found no “demonstrable cost-benefit cases” for using the model.

The evidence “does not clearly establish either an economic case or a health outcomes case for large-scale automation”, NPA head of corporate affairs Gareth Jones said, which should make the government “pause for thought”.

“It raises serious questions about the underlying case for investing in models that allow hub-and-spoke to operate between different companies,” Mr Jones said.

February 2021: Hub-and-spoke law given royal assent

The Medicines and Medical Devices bill was given royal assent in early February, giving way to the Medicines and Medical Devices Act 2021. The government could therefore begin to make changes to UK medicines law through “secondary legislation”.

The bill includes proposals to roll out a hub-and-spoke dispensing model across community pharmacy, which pharmacy minister Jo Churchill said in January would be subject to a “full public consultation” before it is implemented across the sector.

The government will report the consultation’s findings to parliament – including highlighting any concerns that have arisen, Ms Churchill said in a House of Commons debate.

What does the future hold?

We’re yet to find out the full extent of what the law enabling independents to use hub-and-spoke will entail, pending the results of the consultation. The DH seems certain that it wants to give independents the opportunity to start using the dispensing model – but it remains to be seen whether independents recognise the same benefits hub-and-spoke poses that the government does.

Is the change in law a chance for independents to increase efficiency or is the exercise a waste of money? Do you think hub-and-spoke poses patient safety issues or are you excited by the prospect of more time to complete clinical services?

We want to hear from you. Join C+D’s Big Debate on whether a hub-and-spoke model can ever really benefit independents on the C+D Community on Thursday April 29 at 7pm.

What's your opinion of hub-and-spoke dispensing?

Grace Lewis, Editorial

Thanks for all your comments on this.

Please do consider sharing your experience on the C+D Community, via this Big Debate conversation thread:

Kind regards,

Grace, C+D deputy and news editor

Benie Locum, Locum pharmacist

Hub and spoke is about one thing only.and that is making more money for the corporates. It has nothing to do with patient satisfaction or easing pharmacist workload. It is purely about MONEY. 

Lily Gidley, Community pharmacist

I retired in 2013 and before then I managed a branch with hub and spoke dispensing. It was the best thing that ever happened. I struggled to cope with the workload before but afterwards I had time for all the extra roles, such as ehc, smoking cessation, BP monitoring. I had time to counsell patients and do murs. I understand the reservations others had but for me I found it improved my work balance.

Edward H Rowan, Locum pharmacist

Have you been to the pharmacy recently where you worked in 2013? Have they reduced the staff levels by 50% by any chance because the company doesn't want to pay staff to stand around talking (known by the profession as counselling but by the owners as gossiping with the locals)?

M. Rx(n), Student

In the right hands and with thoughtful deployment, it promises an exciting future. But from the way it is being peddled by some from our own backyard...hmmm. And it's made worse by the fact that Pharmacists themselves do not have a firm control on their own sector.

M. Rx(n), Student

The folly in the arguments of the self-serving hub and spoke peddlers is that the government could just as well acquire the same technologies and open about 5 hubs per county (e.g. the size of 24hr Asda superstores -with proper patient parking and toilets, and with each patient assigned long term to a specific on-site Pharmacist) and operate them at the same if not lesser cost, with no narcissistic middle management unethically propping up a greasy corporate pole. The pharmacist and their patient win!

I'd pursue this course and leave the so-called service delivery to those imposters who see it as the next gambit to milk. Of course I'd index their payment to proof of long-term or durable outcomes.

Steve Ridd, Community pharmacist

Hub and spoke is the only way to safely cope with the ever increasing Rx volumes, allowing community pharmacies focus on service delivery. Investment in automation and optical checking ensures accuracy, when dispensing MDS medication. The sooner legislation is changed, allowing independent pharmacies to send their MDS medication to dispensing hubs, the better for all involved.

mark straughton, Pharmaceutical Adviser

Sadly, for the Pharmacist in the Pharmacy profession the hub and spoke is the way forward in meeting operational efficiency and a multi-layer safety approach in the medicine supply function. The human input will fall on the technicians in the distribution operation. The role of a Pharmacist as we have previously known will become redundant. Unfortunately this is the future.

M. Rx(n), Student

The PHARMACIST is the Pharmacy Profession, "mr pharmaceutical adviser".

Any ignorance of that fact should send a chill down the spine of any diligent patient around the world. 

The bastardisation of Pharmacy is epitomised in the brazenness on display in that post.

mark straughton, Pharmaceutical Adviser

Not my intention whatsoever to be disparaging to the pharmacist or the pharmacy profession. However, this 'pharmaceutical adviser' is a patient, a customer, a memeber of the public and a tax payer.

I fully respect the professional input of a pharmacist but I don't want to come back in 30mins for my prescription because the pharmacist is doing an MUR. I don't want to come back pick up part of my prescription now and come back for an owing in a few days. I don't want to hear an excuse that we're short staffed so can't do x,y,z. It's ignorant but it's customer demand. It's where an efficient hub and spoke (then eventually Amazon) will meet this demand. Regretfully the professional input of the pharmacist is limited to accountability when checking the box/tray. Patients fundametally just want their meds as what their GP/hospital/nurse has prescribed......and quickly!

Edward H Rowan, Locum pharmacist

He did say "sadly" The future is automation, human-less transactions. The doctor will press "go" on his computer and the next human to touch the medicine will be the one who unwraps the parcel after it comes through the letterbox. Make sure you're trained and qualified to do as much as possible and you might get a job as some GP's underling.

M. Rx(n), Student

No offence is intended, but this line of thinking betrays a superficial understanding of medical and pharmacy education/training and care provision.

My advice will be for those of such thinking to reacquaint themselves with what the medical and pharmacy professions entail.

The technology used to pick and package a box of biscuits may help the Pharmacist's work....but cannot be a substitute! Failure to grasp that cannot be taken lightly.

mark straughton, Pharmaceutical Adviser

Exactly. It's not a substitute because there will always be a pharmacist input even with a hub and spoke. But a pharmacist in every community pharmacy which is the bread and butter of community pharmacy will be the redundant aspect. This is the problem, where does this leave the 1000's of community pharmacists?

M. Rx(n), Student

My word. Where to begin...

Pharmacy better quickly emerge out of the wilderness of its dalliance with retail consumerism and rank commercialism.

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