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DH uses funding announcement to pledge change to hub-and-spoke law

The DH will also look to implement original pack dispensing to enable wider use of hub and spoke

The government will seek to change legislation so independent pharmacies can operate a hub-and-spoke dispensing model, it has said in a document containing the funding contract.

A five-year funding contract for England was unveiled yesterday (July 22), with the annual global sum remaining at £2.592 billion for the next five years, and medicines use reviews (MURs) phased out in favour of new clinical services.

For community pharmacy to achieve the “expanded role” and provide new services – some of which are yet to be decided – “we need dispensing to become more efficient to free pharmacists up”, the Department of Health and Social Care (DH) said.

To achieve this, the DH will work with the Pharmaceutical Services Negotiating Committee (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.

The DH also pledged to “explore and implement greater use of original pack dispensing” to support the wider use of hub-and-spoke dispensing.

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 them a greater choice of which business model to operate.

But pharmacy organisations – including PSNC – argued convincingly at the time that there was no evidence that hub-and-spoke dispensing would save money or improve patient safety.

In a briefing with journalists yesterday, PSNC director of operations and support Gordon Hockey said: “It's fair to say that we were opposed to [legislative change] last time. This time we're working with government and NHS make it work and make it work fairly for the whole sector, including independents.”

In May, C+D investigated whether NHS England’s hub-and-spoke dispensing agenda was making a comeback.

Would you you like to operate a hub-and-spoke dispensing model?

Ronald Trump, Pharmaceutical Adviser

This whole funding package and announcement is so screwed up and unclear. Where is the money coming from to build these hubs and dispensing robots? Would the independents have a collective stock at the hub if theyre working together? Arent we just forming more multiples and reducing competition as a result? I'd hate to be a contractor right now. Government has stitched you up. I still blame the multiples though for creating this mess- shouldve made it a maximum of 3 pharmacies owned per pharmacist and given everyone a fair chance to own their own business.

N patel , Non Pharmacist Branch Manager

We are stuffed.....scratch the surface of the agreement and behind all the gloss is a pile of first rate bull....t. we have given away 23k per annum and in return only have pilots which may or may not be funded by the a profession we love being stuffed everyway and say that we have to take the pain in order to look after our patients S!

N patel , Non Pharmacist Branch Manager

Sat pm ..patient has forgotten to order bp meds from hub and spoke on on Monday... as i dont have to keep stock on my shelf(why should I?) What should I do?

Dispense an emergency EPS script from 111 for 3 tablets, none of this numsas crap

Susan M Shepherd, Community pharmacist

Can't dispense if don't have the tablets. No stock held if using hub and spoke dispensing model.

Read the whole comment!.

Priyesh Desai, Superintendent Pharmacist

Yet another stupid idea from people sitting in their cosy offices.How will this benefit independents? where is the investment going to come from bearing in mind the cap at 2.59bn for next 5 yrs? Sharing hubs cannot work as this brings multitude of other problems of allocating inventory costs,purchase margins etc etc.It only benefits the multiples!!!

It is now the right time to get this done - to allow independents to share hub fascilities and to enable the heavy lifting to be done from a large offsite location. 

Patient safety is a priority and this model is the only one that will ensure that with pharmacists spending increasing time providing consultation services - both NHS and private. We can lament pharmacy of old but all businesses need to pivot as times change.

As Inderjit says patients now want something different. Contractors who can adapt to give them what they want with a service that is fit for purpose will be the ones left standing. I want to be that contractor.

Mike Hewitson, Superintendent Pharmacist

Boots and Lloyds have poured millions into developing their centralised dispensing facilities. I don't share the view that the most likely providers of hub services are other independents. Most likely providers are large multiples and regional multiples. There is a logistics infrastructure required to provide the service which most indpendents don't have or would have to invent. 

I am not against Hub & Spoke, but we have to have a rational evidence based discussion about what it means and its implications. 

Mark Boland, Pharmaceutical Adviser

'patients now want something different'

They want, what they have always wanted - 24 hour turnaround, no owings, served immediatley / next day delivery, no pharmacist obligating them to a PIL reading

ABC DEF, Primary care pharmacist

even worse - 5 mins turnaround for 10+ items script, same day delivery.

Inderjit Singh, Superintendent Pharmacist

Independent contractors need to think more broadly about the opportunities this legislation change could bring. At present independents are locked out of the homecare market. More and more pts want a 'click and collect' model rather than delivery to their home. There are also opportunities to work with local hospitals to support the pt discharge process.

At present only Lloyds and Boots can benefit from a diversified supply chain and this legislation change is essential if independents wish to diversify.

It is a significant opportunity which must not be squandered by the fearmongers.

Mike Hewitson, Superintendent Pharmacist

Inderjit, I'm not sure I follow you. There is nothing to stop you offering a click and collect model now, nothing to stop you working with local hospitals now either. The only difference with this legislative change is that you will be able to sub-contract out your dispensing (and therefore your procurement) to a third party. 

Can you explain what you mean please? 

A.S. Singh, Community pharmacist

70+ comments on the new contract C+D article suggest otherwise. What is it that you know that other contractors don't? In my view pay has always been issue- nothing new there. However ever since these funding cuts and government fiddling with the global sum into these interventions, there has been significantly more grief. I don't think there's a way around it as you suggest. Majority of the public and doctors see pharmacy as providing medicines to the public providing a few other services and will not change anytime soon (unless Boris sees otherwise-which I doubt). 

John Ellis, Community pharmacist

Robotised dispensing will be great, until we start to hear the dreaded 'unexpected medicine in the dispensing area!' and the whole thing goes belly up.

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