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Government under pressure to publish hub-and-spoke evidence

The Department of Health made assumptions in its impact assessment that pharmacy organisations say are invalid

Pharmacy organisations say there is no evidence to back up DH claims for benefits of automated dispensing

Pharmacy bodies have called on the government to publish evidence to back up its claims that a move to hub-and-spoke dispensing will lead to efficiencies and cost savings.

In their responses to the Department of Health’s consultation on hub-and-spoke dispensing, the Pharmaceutical Services Negotiating Committee (PSNC), National Pharmacy Association (NPA), Pharmacy Voice and services provider Numark, all called on ministers to publish the evidence behind the plans.

The government says allowing independent pharmacies to legally operate dispensing hubs will “create a level playing field” and give independent pharmacies a greater choice of which business model to operate.

But pharmacy organisations argued there is no evidence that hub-and-spoke dispensing will save money or improve patient safety.

Lack of evidence

PSNC said the alleged economic reasons for hub-and-spoke dispensing “are not evidenced” and that it has “significant concerns… such models will cost more overall”.

The negotiator also warned that £10 billion pounds of savings community pharmacy has made in the last decade will be lost if the government pushes ahead with its plans.

Their concerns are shared by the NPA, whose hub-and-spoke assessment found that the likely cost benefits are “minimal” while “the likely burden and risks considerable”.

The NPA assessment suggested the assumptions on the uptake of hub-and spoke-dispensing across the sector are “unrealistically optimistic”, the PSNC added.

Pharmacy Voice said it “did not recognise the validity of [the DH's] assumptions”, and hub-and-spoke is not a “fundamental game-changer” for the sector.

Some of the strongest criticism came from Numark, whose managing director John D’Arcy labelled statements that hub-and-spoke will increase efficiency and lower costs as a “significant overstatement”.

The DH’s estimates, that 25%-50% of independents and small multiples will use hub and spoke, seem “wildly exaggerated”, he added.

Safety concerns

All the organisations challenged the government’s claims that hub-and-spoke would improve patient safety by reducing dispensing error rates.

It comes after chief pharmaceutical officer for England Keith Ridge was forced to backtrack on his “inadvertently misleading” statements that a 3% dispensing error rate in England could be reduced to a "0.00001%" – similar to "large scale automated dispensing facilities in Sweden".

PSNC said the error rates Mr Ridge claims occur in community pharmacy “are now unlikely to occur” and that automated dispensing systems “are unlikely to further reduce this type of error”.

It also highlighted the problems at Pharmacy2U – which was unable to deliver medicines to thousands of patients over Christmas 2015 – as an example of “documented failures of large automated dispensing services".

In their own words – hub-and-spoke consultation responses

Numark

“We are flabbergasted by the statement that 'a collaborative hub will not require additional capital except for the introduction of automation'. [This] suggests a total lack of understanding of the myriad of complexities and costs... It also suggests that the cost efficiencies inherent within the existing arrangements are either misunderstood or being ignored.

“We believe the Department should be very clear what its true rationale is behind hub-and-spoke – the creation of headroom or an attempt to take direct costs out of the system?”

NPA 

“We reject this ill-considered, rushed and un-evidenced proposal from the Department of Health, which has the potential to increase costs for small businesses and tax payers.

"DH has failed to provide any evidence for the efficiency and safety claims for an inter-company hub and spoke model."

PSNC

“Given the consultation’s lack of clarity about what is proposed and uncertainty about the models of hub-and-spoke dispensing that might develop, it is difficult to answer the consultation questions.

"PSNC is supportive of the principle that there should be a level playing field between pharmacies, but vigorously opposes the proposals set out in the consultation.”

Pharmacy Voice

“We do not believe the hub-and-spoke model is a fundamental game-changer in terms of the economics of the sector and strongly challenge these assumptions. There is no evidence for the claims of financial efficiency savings.

“We have significant concerns about the potential unintended consequences of moving to industrial-scale centralised dispensing, ranging from the risks of reduced competition within the supply chain... through to the loss of interaction between patients and healthcare professionals.”


Would you consider operating a hub-and-spoke model? 

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3 Comments

Harry Tolly, Pharmacist

"The negotiator also warned that £10 billion pounds of savings community pharmacy has made in the last decade will be lost if the government pushes ahead with its plans."

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Can we see eviidence of that ?

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Also can we also publish how Pharmacist and locums have subsidsed (by way of salary cuts in REAL terms) the increased profitability of the vertically integrated multiples (after taking into account their creative accounting )

Ben Merriman, Community pharmacist

If everything goes hub and spoke, it'll destroy the tariff system that we have now.  Use of shortliners, PI companies, etc, allow pharmacies to buy cost effectively, reducing prices paid by the NHS for medicines via the "double corkscrew".  This system has been responsible for the £10bn savings in medicines purchasing as pharmacies have the freedom to shop around and get the best possible prices, sometimes on a daily basis.  How practical is this with a hub and spoke system?  Not at all.  Will we have to get individual patient consent for each supplier we use on each occasion?  Will labels be generated for us in the same format across the board?  Will shortliners/PI companies bother funding the infrastructure to be able to offer this service?

M Yang, Community pharmacist

I think such organisations need to tie this into their existing petition to the PM, if they haven't already done so. Petitions on their own aren't a magic bullet, but the public opinion and support behind these can be a deciding factor. The public should be informed that hub and spoke means the end of the pharmacist in their communities, a health professional they won't have access to anymore in a time when a doctor's appointment is like gold dust.

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