In its five-year pharmacy funding agreement, the Department of Health and Social Care (DH) said it would make two changes to the law. The first will “allow all pharmacies to benefit from more efficient hub-and-spoke dispensing”. The second is intended to accelerate a reduction in pharmacy numbers by encouraging pharmacies to close and merge branches.
The DH believes that automated hub-and-spoke dispensing will enable pharmacies to recoup through savings some of the money that has been taken away.
The Medicines Act 1968 currently allows anyone owning more than one pharmacy to dispense from a pharmacy ‘hub’ and supply from a branch, the ‘spoke’. There doesn’t seem to be any logic for restricting hub-and-spoke dispensing to multiples, so levelling the playing field for independents is a no-brainer. The real question is whether the economics stack up.
The DH doesn’t seem to have any idea about the financial implications of hub-and-spoke dispensing. No sums were included in the impact assessment used to justify the funding cuts in 2016. Before any contractors can take up hub-and-spoke dispensing, they will need to know what savings they can make and how much it will cost. Pharmacies will still have the cost of a pharmacist, and they will have to take into account redundancy payments for any dispensing staff laid off.
There appears to be grudging acceptance in community pharmacy circles that there isn’t enough money to support the approximately 11,600 pharmacies in England. Planned closures would be preferable to the risk that attrition results in closures where people are left without access to a pharmacy.
In 2016, the DH introduced a regulation designed to allow pharmacies to merge nearby branches and close one of them. However, many owners have been reluctant to use this regulation because of fears that someone else will apply for a new pharmacy contract, arguing that the closure would cause a gap in services.
The DH now says it will look to strengthen the “protections” for pharmacies that want to consolidate. This might involve preventing new applications within a specified distance from a pharmacy that has closed after a merger. It might also enable the closure of some 100-hour pharmacies, which are usually found in what the DH calls a “cluster”.
These issues have been controversial, but the tide can no longer be held back. Community pharmacy is going to have to adapt to meet the challenges the changes will bring.
David Reissner is chair of the Pharmacy Law and Ethics Association