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Why government's hub-and-spoke figures are 'laughable'

Mike Hewitson: Government has excluded inconvenient truths

NPA board member Mike Hewitson says dispensing hub predictions don't stack up


The National Pharmacy Association (NPA) has branded the government’s financial predictions for hub-and-spoke dispensing as “laughable”.

NPA board member Mike Hewitson said the organisation had assessed the Department of Health’s figures on the benefits of running a dispensing hub against the lowest base costs. But the NPA “couldn’t make the finances stack”, he told C+D.

The government had appeared to “exclude all of the inconvenient truths” about the costs of setting up a hub-and-spoke model in its consultation last month, such as capital expenditure costs, Mr Hewitson said.

Using the model will not necessarily save pharmacists any time, Mr Hewitson added, because the legal advice the NPA has taken on the proposals suggested that accuracy checks would still have to be made on prescriptions from a hub before they could be dispensed at a ‘spoke’ pharmacy.

Mr Hewitson predicted that, under a hub-and-spoke model, pharmacists will still have to dispense a much higher number of prescriptions on site than the government’s best-case calculation of 40%.

“All [hub and spoke] does is allow somebody else to stick the label on the box for you,” he said.

"Difficult" to understand business case

NPA spokesperson Gareth Jones told C+D that pharmacists would not benefit financially from any time saved from using a hub-and-spoke model unless the government commissioned additional services, such as a national minor ailments scheme.

It is “difficult” to understand the government’s business case for backing the model, he added.

Mr Jones said the NPA will be sharing its views on the consultation with its members and encouraging them to send their own responses.

“It’s important that the government gets as many informed views as possible here,” he said.


The Twitter reaction



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Sarah Willis-owen, Community pharmacist

I thought they had already started this hub and spoke model but I have seen no evidence of it working in practise where I live. 

Harry Tolly, Pharmacist


This is what its all about.

Steve Churton, Senior Management

Properly designed, operated and funded centralised automated H&S dispensaries can be safer and considerably more efficient than conventional dispensaries. Given the inevitable downward pressure on costs, and the recognition that pharmacists can and should engage in more clinically focused, patient facing roles, the opportunity for more innovative models needs to be carefully considered (and I would suggest embraced) by all those bodies and agencies interested in enhancing the role of pharmacists and the public perception of the profession. Yes - it will require people to think more laterally and progressively. Yes - we will need to navigate the regulations and work closely with the GPhC to ensure high standards of safety and safeguard patient interest. Yes - it will require investment and the forging of different partnerships and relationships (maybe at one time considered impractical or improbable) BUT we will not be able to continue doing what we have always done in the way we have always done it! This is inconceivable in the modern health economy, and pharmacy must move (and be seen to move) with renewed vigour and opportunity to embrace these changes. For not to do so is not a viable option for the profession and its patients.

Harry Tolly, Pharmacist

Presumably this is what Boots told Burt in their private meeting with him in September 2015 (just before the 6% cuts were announced). Steven, maybe deskbound pharmacists with little (or zero) patient facing experience would say that.

Those of us with current patient facing experience KNOW what our patients value.

There are far too many fat backsided pen pushing pharmacists telling those that actually practise CLINICAL pharmacy on a daily basis what is of value and what is not.


Steve Churton, Senior Management

Hello Harry. I think what patients tell us they want is an efficient, quality service with easy access to a pharmacist who has the expertise and time to help and support them with their health needs and a better understanding of their medicines and how to use them safely and effectively. Centralised automated H&S services will be a key enabler for this, by liberating pharmacists to enjoy expanded and more fulfilling roles. This is what patients want, and it should be what pharmacists (and those who employ and represent them) want. It should also be what Government wants - and they must be prepared to recognise the need for medium-term gain (financially and health outcomes) and the need to provide funding for capital investment to bring about this fundamental change. This will not happen however if the profession continues to find every reason imaginable not to engage. The recent fudning cuts are clearly unpalatable (although not surprising) and I fear that there will be more to follow, which will only be off-set by the absolute focus of the profession on developing and delivering more cost effective (and actually safer) dispensing models.

Ebers Papyrus, Pharmaceutical Adviser

Cost effective and safer? Show me the evidence. Show me how the model is more effiicient? Tell me how as a profession we can consider the Amazonisation of medicine supply? Pharmacy is the guardian of medicine supply and to commoditise it would be an insult to the profession. The evidence I've seen points to it being less efficient for the patient, more costly to the taxpayer in the long run, with an equal or worse risk level. A hub can't process an Rx there and then, or satisfy numerous emergency supply requests throughout the week and weekend, it also can't offer brand specific selections for patients. The hub will add a significant cost to the prescription journey and pharmacies will continue to require as promised a steady level remuneration to remain viable. Therefore for the taxpayer it's cutting off your nose to spite your face, so I think we need to be careful what we wish for. For the awkward process to work to any efficient level the hubs must remain very local to providers (Dutch model) and deliver multiple times per day, plus complete liability must also lie with the hub. Do the maths, will this be progress?

Steve Churton, Senior Management

"The evidence I've seen points to it being less efficient for the patient, more costly to the taxpayer in the long run, with an equal or worse risk level" - show me the evidence which supports this statement. 

"The hub will add a significant cost to the prescription journey" - again, show me the evidence which supports this statement.

It is very easy to construct a defensive position in support of the status quo, but not so easy to support such a position with anything other than speculative and clearly uninformed comments. There is plenty of evidence out there - based on practical "on the ground" experience - you just need to go and look for it if you are genuinely interested in learning more about the opportunity. Or alternatively you could just stand by and let others who are more open to the prospect of innovating do it for you - or to you! Patients need choice, pharmacists need choice and the profession needs choice. The changes proposed in the consultation will offer choice. It's completely up to you and others if they which to avail themselves of it. The distinct possibility is that many will take the view that the status quo is the only choice - and that would be a very dangerous position to take in my view. One thing is certain - NHS funding will only go in one direction over the next few years (we have already seen the start of this trajectory). Those who recognise this fact and decide to do things differently to improve the efficiency of a desperately inefficient process, will benefit themselves and their patients. Those who do not ......... !!

Philip Caton, Community pharmacist

So how do you give patients choice by threatening the very service that offers choice. Closing pharmacies is what this is all about. The reason there are too many pharmacies is the governments fault. successive governments btw. The current crew took too long to closed the loop hole on 100 hour pharmacies for example.

Successive governments have been ripping pharmacy off for years ever since cost plus went the journey. Our negotiators seem to be singularly unable to stand their ground on our behalf.

We are supposed to absorb losses due to clawbacks based on our turnover which take no account of the fact that DTP arrangements and single wholesaler agreements mean we operate at a loss because we are forced to supply against a prescription. Then they bring in the living wage and cut our funding and we're supposed to absorb that chuck in paternity leave and auto enrolment and it's getting really tight isn't it. A but you're a business and you must operate in the market. that would be fine if we could make a normal business profit and control our cost similarly. But the government pays what it pays and forces us to pay what it forces us to pay. That's a rigged market! So suggesting we surrender our practic e is fine if they allow us to make a profit - Bring back cost plus!!



Harry Tolly, Pharmacist

"""Those who recognise this fact and decide to do things differently to improve the efficiency of a desperately inefficient process  ... """"  Says Mr Churton !! ...........................................................................................................................................................


THE  ***MOST*** efficiency thing the NHS can do is give contracts to UK domiciled corporations that actually pay UK corporation tax AND take away contracts from those that do not.


Andy Beesley, Sales

Hello Steve. We have been involved in supporting the move to hubs across the UK consolidating work for compliance aids in one location for small and medium groups. The feedback we have had has been very encouraging as the Pharmacists willing to take this approach ARE reducing their costs while freeing up time at branch. We want to do this to encourage a change of focus for Pharmacy from dispensing volumes to health issues. I think this is in the interest of the future of Pharmacy, NHS cost reduction targets and more importantly the health of the nation. 

Gerry Diamond, Primary care pharmacist

Technically the final checker should put their initials on the completed bagged items so that they are responsible unless it is tampered with or 'reassembled'. bit of a minefield really. The upshot is that we are slowly heading towards mail order pharmacy just like the ostomy products, dispensed centrally dropped by courier.

Leon The Apothecary, Student

It makes me wonder why it can't just be sealed at point of final check. That way all that would need to be checked at the spoke would be that the seal is still intact. Or just go straight to the patient. I agree, we are moving to Amazon Prime NHS. 

Leon The Apothecary, Student

I'm very against the whole someone else picking a basket for you to label thing. One person can pick and label, it saves no time. Likewise I feel the process of a Hub is overcomplicated. Hub to Patient, instead of Hub to Spoke to Patient, sounds far simplier a process. 

Mike Hewitson, Superintendent Pharmacist

Hub to patient is centralised dispensing or put another way, internet pharmacy.

Leon The Apothecary, Student

Centralised Dispensing would be the most efficient compared to Hub and Spoke. It is a shame some morally questionable people have made Internet Pharmacy a dirty word.

Paul Miyagi, Information Technology

I don't think this government or any predecessors understand or have empathy for pharmacy workers and what they acheive with so little help , but having said that neither do the the bosses that run the multiples , the PSNC or the GPhC. 

Harry Tolly, Pharmacist

In another article, James Waldron revealed that PSNC has a new offer from the DoH. Why does Mr Hewitson not share details of this and what is the PSNC hiding in terms of stitching up the profession ?


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