There are 'virtually no financial efficiencies' for pharmacies offered by the Government's hub and spoke dispensing proposals, PSNC has suggested, warning that they are actually 'more likely to add cost' to the community pharmacy sector. 

This caution forms part of PSNC's response to the Government's consultation on whether the law should be changed to allow all community pharmacies to use hub and spoke dispensing models, where routine aspects of assembling prescriptions can take place on a large scale in a ‘hub’ that usually makes use of automated processes. 

Currently, it is only possible when the hub pharmacy forms part of the same retail business as the spoke pharmacy, meaning chain pharmacies are the main users of the model. 

The 12-week consultation, which closed on 8 June, sought views on the government’s plans to amend the Medicines Act 1968 and the Human Medicines Regulations 2012, which would allow hub and spoke dispensing across separate businesses. 

The DHSC has claimed it will ‘level the playing field’ between larger chains and smaller pharmacies. 

The government has proposed two separate hub and spoke dispensing models - one whereby a patient’s prescription is assembled by the hub and sent back to the spoke to make the supply (Model 1), and another in which the hub supplies the prescription directly to the patient (Model 2). 

There is also a proposal to allow dispensing doctors to access hubs, though they will not be able to function as a hub. 

PSNC has said it cannot support Model 2 because it 'raises patient safety issues'.

‘We are particularly concerned about the likely patient confusion, and safety issues this causes, if medicines are delivered to patients in an uncoordinated way from both the spoke pharmacy as well as one or more hubs, which is likely to happen under Model 2 for patients with co-morbidities or complex needs,’ it said. 

‘Receiving prescriptions, or different parts of the same prescription, from different sources is, at best, likely to cause increased patient queries, eroding time savings in the spokes, or more seriously lead to patient confusion and potential harm in patients taking their medicines properly.' 

PSNC said 'splitting responsibility for the patient' for a single dispensing process is 'inherently risky,' and that this patient safety risk is 'compounded where a patient receives multiple prescriptions in a given time period.’ 

‘Each party is reliant on the other to ensure patient safety is maintained,' PSNC said, 'and there will be a reduction of oversight and care of the patient by the spoke pharmacy.' 

There is a 'lack of clarity' for the patient or anybody acting on behalf of the patient, including other healthcare professionals, 'of who to turn to for advice or help if there is a crisis or problem,' PSNC said, and 'the ability of the spoke to intervene for patient safety reasons is reduced or lost.' 

PSNC also warned that supply from a hub 'reduces the opportunity to drive value through spokes in the provision of clinical services,' and pointed out that patients who want to use remote delivery from a hub are already able to get their medicines through Distance Selling Pharmacies. 

Other concerns raised about Model 2 by PSNC include that 'patient-facing activity may not be through the chosen, accessible spoke pharmacy,' compromising patient choice, and that there is the 'potential for gaps in supervision'. 

PSNC said: 'Only Model 1 is appropriate, with manageable risks relating to patient safety, and is a model that has the potential to allow the whole community pharmacy sector to benefit fairly. 

'PSNC supports Model 1 in the consultation since this effectively allows all community pharmacies to carry out hub and spoke dispensing that is currently permitted only within a single legal entity, a single retail pharmacy business.' 

However, it warned that 'there are virtually no financial efficiencies envisaged’ by either of the proposals, and, if used, ‘they are more likely to add cost to the community pharmacy sector.' 

It also said aspects of the proposed legislation are 'not clear' or are 'ambiguous' and require further consideration to 'ensure there are no unintended consequences.' 

PSNC said there should be no change to Section 220 of the HMRs and pharmacist supervision of supply prior to the envisaged consultation on skill mix later this year. 

As part of the Community Pharmacy Contractual Framework five-year deal (2019 to 2024), the government committed to pursuing legislative change to enable all community pharmacies to benefit from hub and spoke dispensing models, 'with the intention of supporting efficiencies for pharmacies and freeing up pharmacists and their teams for other tasks, such as providing clinical services to patients.' 

The Company Chemists’ Association has warned that there is not enough service income within pharmacy to warrant a network of hubs. 

The National Pharmacy Association has called on the Competition and Markets Authority to investigate the hub and spoke dispensing model in the UK, to ensure there is a ‘dynamic’ and ‘competitive’ market in place for pharmacies and other spokes. 

Former Royal Pharmaceutical Society president Ash Soni backed the idea of pharmacies operating in a group using a hub and spoke model in 2019, saying they were ‘the future’ for independents.