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James Waldron: Where is the evidence for hub-and-spoke?

"Hub-and-spoke will not make up for a looming funding shortfall"

If hub-and-spoke isn't the panacea to pharmacy's woes, then patients may be in trouble

“It’ll be gone by June.” Of all the famously inaccurate predictions, Variety magazine’s verdict on the new fad of rock’n’roll music in 1955 is one of my favourites. Of course, with the gift of hindsight, many seemingly obvious forecasts of the future can turn out to be embarrassingly wrong, and journalists are no more immune to missteps than anyone else.

But when the government starts making seemingly wrong-footed predictions, it’s time to get concerned. Because when those in power give their visions of the future, it’s more than just talk – it’s the basis for action.

Take English chief pharmaceutical officer Keith Ridge’s assertion last September that hub-and-spoke dispensing will become capable of handling two-thirds of the country’s prescriptions. Whether or not you believe this is logistically possible, the government’s confidence that the model will allow pharmacies to “become more efficient and innovative” seems to underpin its brutal plans to “phase out establishment payments” for contractors, even if this results in up to a quarter of England’s pharmacies going out of business.

When we asked a team of pharmacy experts for their predictions of the coming year, it’s no surprise that dispensing hubs warranted a mention alongside the decriminalisation of dispensing errors, greater unity among pharmacy bodies and a lack of funding for services. But somehow I’m unsurprised that none of them predicted that, by the end of the year, all contractors will be profitably running their own automated dispensing hubs. Even Boots, which launched its own variation on the hub model back in 2014, seems distinctly lukewarm about its widescale use.

We live in a technological age, and have become used to expecting new developments in computing and robotics to solve the inconveniences of everyday life. Hub-and-spoke dispensing may have some logistical benefits, and can free up pharmacy teams to spend extra time with patients.

But, as those operating the model are keen to point out, it will not make up for a looming funding shortfall. In fact, there seems to be absolutely no evidence to suggest centralised dispensing hubs will be an effective cost-saving measure for independent pharmacies – even if the government is successful in amending the law so they can legally operate them.

And if hub-and-spoke doesn’t turn out to be the panacea to cure pharmacy’s financial woes, then my prediction is that both pharmacists and patients could be in serious trouble.

James Waldron is editor of C+D. Email him at [email protected] or contact him on Twitter at @CandDJamesW

How will your pharmacy cope with the phasing out of establishment payments?

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