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Hub-and-spoke legislation needs ‘sufficient scrutiny’, NPA urges

NPA: Benefits of the hub-and-spoke model “are overblown”

Legislative changes to medicine regulations impacting hub-and-spoke dispensing require “sufficient parliamentary scrutiny”, the National Pharmacy Association (NPA) has said.

If passed, the Medicines and Medical Devices Bill – which has just completed the public bill committee stage in the House of Commons – could give ministers the power to modify the law relating to human medicines and medical devices without the need for primary legislation.

This could mean that changes to regulations on medicines supply and hub-and-spoke dispensing are introduced by ministers “without sufficient parliamentary scrutiny and democratic accountability”, the NPA said in a submission to MPs last week.

The Medicines and Medical Devices Bill would replace powers currently contained in EU legislation, set to expire at the end of the transition period of the UK's departure from the trading bloc.

A lack of "equivalent delegated powers” could lead to “negative impacts on patient outcomes, population health and the UK’s competitiveness in the food and life sciences sectors”, according to the Bill's impact assessment.

“Overblown” hub-and-spoke benefits

The NPA believes that claims about the benefits of the hub-and-spoke model “are overblown” and argues that it could reduce “competition and choice in the pharmaceutical wholesale market without a level playing field”.

“Other unintended consequences could be less resilience of the medicines supply system and rises in medicines prices,” it added.

In its submission to ministers, the NPA said that “it is a concern that the government has acknowledged in its own impact assessment of this bill that the costs and benefits [of the hub-and-spoke model] remain uncertain.”

The NPA is therefore calling for the Bill to “require both full consultation with stakeholders and sufficient parliamentary scrutiny”, NPA chief executive Mark Lyonette said last week (June 12).

Debate in Parliament

Last week (June 8), MPs discussed an amendment to the Bill that, if adopted, would mean ministers only had powers to modify the regulations for two years.

Shadow health minister Alex Norris, who introduced the amendment during the debate, said the hub-and-spoke model is a “very live debate in the field of pharmacy” and that it would mean a “radical change” for the sector.

Mr Norris invited MPs to accept the amendment and have a “proper consultation with the sector and with citizens”.

However, pharmacy minister Jo Churchill said she does not see the benefits of amending the Bill. Endorsing the amendment could instead “run the serious risk that we would cease to have the legal powers” required to make the changes necessary to “address a patient safety risk or to improve access to medicines and all innovative therapies,” she said.

“We wish to empower small pharmacies to be able to use a hub-and-spoke model to secure their place on the high street and to ensure that, with appropriate training for technicians, the clinician can be freed to move forward, as per the pharmacy contract, to give advice to patients as part of the primary care team,” Ms Churchill added.

18 Comments
Question: 
What do you make of the NPA's stance?

Soon-To-Be Ex-Pharmacist, Superintendent Pharmacist

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Adam Hall, Community pharmacist

The current situation has shown the worth of pharmacy - no (percieved) access to GPs, so everyone goes to the Pharmacy. Take us out of the equation and what happens? Even now, unintentinal registration with on-line pharmacies causes more trouble than you understand

Chris Locum, Locum pharmacist

The cost benefits are unproven. However, once high street community pharmacies go the way of the butcher, baker and post offices etc., they will not return. Survivors won't be enjoying the extra profits for long. The Government will seek to readjust the excess uncovenanted money.

With no fully qualified health professional on-site, the public can just as likely receive deliveries or remote consultation if appropriate at the time. The COVID situation has shown it already. Only suppliers with deep pockets, near 24-hour operations and distribution will survive.

They may ultimately prove to be few in number in future years and force higher payments from Government or the consumer. What set of plebs is in power won't matter. They will have destroyed a network they never understood or valued in the first place.

Paul Dishman, Pharmaceutical Adviser

In areas with dispensing doctors, pharmacists will be expected to explain, comment on and probably sort out problems caused by the unqualified dispenser, allegedly 'supervised' by the GP from the golf couse.

Soon-To-Be Ex-Pharmacist, Superintendent Pharmacist

And I shall be telling them exactly where to go (politely, of course!)

Joan Richardson, Locum pharmacist

One day a worker from a local care home brought in a dosette box that had been supplied by another pharmacy as the GP had been in touch to say that the patient was no longer to take one of their tablets and the staff needed to know which tablet to remove from the dosette.  There were no descriptions on the dosette and although I thought that I knew which tablet was to be removed I was not prepared to say so as it would have been my fault had the wrong one been removed.

Advising on medication dispensed elsewhere requires, as a minimum, either sight of the prescription or access to the SCR in case there has been an error - the latter can happen with the best systems in place.

Leon The Apothecary, Student

I believe the standard protocol is to require a whole new prescription to be requested from the prescriber anyway when blister packs are concerned. It's a common thing I have had to discuss with prescribing teams before.

Soon-To-Be Ex-Pharmacist, Superintendent Pharmacist

Absolutely right to not touch it. You would then have taken responsibility for the whole box, not just that one tablet because you would have had to unseal then reseal the box. It's also a very bad showing by the original dispenser not to put descriptions on.

N O, Pharmaceutical Adviser

“We wish to empower small pharmacies to be able to use a hub-and-spoke model to secure their place on the high street and to ensure that, with appropriate training for technicians, the clinician can be freed to move forward, as per the pharmacy contract, to give advice to patients as part of the primary care team,”

Does she even know what she is talking?

How will this help small pharmacies?? If at all, it will adversley affect the smaller pharmacies and may close down many rural pharmacies.

This is definitely influenced by big corporates and I smell REMOTE SUPERVISIOn in the last sentence.

What advice do the Pharmacists give on something dispensed at a completely different premises? Looks like we will become glorified Counter Assistants and the technicians do all the Pharmacist jobs !!! 

Soon-To-Be Ex-Pharmacist, Superintendent Pharmacist

I smell ACT and no pharmacist involvement in dispensing at all. We are then in thrall to whatever pointless and unwanted 'service' they dream up next time then decide after a few years to drop it (think MUR - was going to save the world, be of massive benefit for patients and is now going the way of the dodo). Our role is being whittled away until all that will be left is the shards, and as for closing rural pharmacies, remember it is the STATED intent of the DoH to reduce the number of pharmacies. JD as the saying goes....

Leon The Apothecary, Student

I agree though that the high-street is dying a swift death. Even though C19 sped up the process; it was always dying.

Leon The Apothecary, Student

Why would your advice change dependant on where it was dispensed? If you weren't the most suitable person to speak to about a medicine that needed location-specific knowledge, then I would have respectfully thought referring would be the reasonable thing to do.

I would also say that good MCAs are worth their weight in gold; one can deal with a large majority of queries even before they reach the pharmacist.

Personally, I'd love to spend my time back on a medicine counter interacting with people. In my opinion, it's far more rewarding than working in a dispensary.

N O, Pharmaceutical Adviser

""Personally, I'd love to spend my time back on a medicine counter interacting with people. In my opinion, it's far more rewarding than working in a dispensary.""

Do you think a Pharmacy will hire a Pharmacist to just have a chat with the public, because the Pharmacist likes doing it?

The Govt is hand in glove with the Big Corporates in making sure the role of Pharmacist vanishes from the CP, hence they can still make big profits despite cuts. Once remote supervision kicks in all the Pharmacists will have to take a deep pay cut if they ever want any jobs (including talking to public at the counter.

Leon The Apothecary, Student

I quite agree that there is no way that a Pharmacist would be hired just for a medicine counter. Can you imagine what a pharmacy would look like if there wasn't a legal obligation to have a pharmacist?

Soon-To-Be Ex-Pharmacist, Superintendent Pharmacist

It would look exactly the same as it does now, except with an ACT in the dispensary, enhanced training for counter and dispensing staff (with no extra pay, of course!) to answer medicine queries, and no expenses to pay for a pharmacist. The public would soon get used to the idea and then it's curtains for us.

Soon-To-Be Ex-Pharmacist, Superintendent Pharmacist

On your last sentence, Leon - we are polar opposites then. When I locumed for Boots way back when, we were expected to run the meds counter as well. What a nightmare. No concession was given for all of the other things we were supposed to do, you know the ones, the things labelled 'essential' in our contract, or for those nice profitable advanced ones. We were still expected to do all of that AND interact with (i.e. serve) people on the counter.

As to the advice dependent on where something was dispensed - do you currently advise people on meds dispensed in another pharmacy? (unless it's the mundane 'can I take paracetamol with this?' type question? No, you tell them to go back to where it was dispensed. You don't have access to their dispensing history (yes I know we have SCR access now but that is a ball-ache in itself), you are only going by what they tell you verbally yet you are taking full legal responsibility for the consequences of any recommendations you make. I'm not prepared to do that. If a hub dispenses something it is up to that hub to explain the whys and wherefores, end of.

Leon The Apothecary, Student

That sounds horrible. There's no way that you'd be able to effectively and safely work in three different locations at the same time. Only in pharmacy is where we see that, and from what I hear, Boots is only going to get worse if they can sort out their professional shambles of an online pharmacy.

With your example, absolutely; if the information isn't there, then it should be referred to where it was dispensed. That itself is advice, in my opinion. Maybe not what the patient wants to hear, but that's respectfully irrelevant.

However, I do believe a large majority of questions can be answered even as the non-original premises. We have evidence of this being done already throughout the NHS successfully.

Synergics is something I feel could be revolutionary, but as you said, we aren't there, so your option is to deflect responsibility to mitigate risk to yourself and the patient.

Soon-To-Be Ex-Pharmacist, Superintendent Pharmacist

I wouldn't necessarily describe risk mitigation to both parties as 'deflecting responsibility'. More a case of directing to a person in a better position to satisfactorily answer their query. That's how I always word it anyway!

Oh and yes, it was bloody awful at Boots. Worst one ever was the one in Lincoln city centre. You can only imagine how bad running the meds and dispensary was that day (and to make matters worse, the toilets were about a quarter of a mile away, up two floors! Nightmare)

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