The Government is consulting again on hub and spoke. Pharmacists should make sure they have their say because we could be about to see some seismic changes in practice, says PM deputy editor Arthur Walsh

There is room for efficiency in any system. Some way of tweaking usual processes to make things run faster and more smoothly, while seeking to maintain the same level of service. In cash-strapped times, the mantra of efficiency looms ever larger in importance.

But who gets to decide what efficiency means in a given sector? What it looks like, how it is delivered and to what end? That’s the question facing UK pharmacies as the Government seeks once more to push through proposals that would enable every pharmacy in the country to use hub and spoke dispensing.

In a consultation document, the Government says its proposed changes to the Medicines Act and Human Medicines Regulations will free up pharmacists’ time for clinical services and face-to-face care, claiming that it may also improve safety by driving down error rates.

Step into the unknown 

It is not quite the same package that was rejected in 2016. For instance, this time the Government has made clear that dispensing hubs will need to be registered pharmacies and has said dispensing doctors will be allowed to act as spokes. 

Despite these tweaks, the core offer is pretty much the same, and has been met with similar puzzlement in many quarters. Freeing up time is a laudable aim but, for many, hub and spoke feels like a step into the unknown.

After decades of depending on their dispensing margin to keep their pharmacies running, some contractors worry about relinquishing this control to the hub – not to mention paying for the privilege (around £4,000 in set-up costs per pharmacy, according to Government estimates).

After all, it is not entirely clear how they would make up for any lost income. As one major pharmacy body puts it, there is “simply not enough service income within the current flat national funding envelope to warrant a network of hubs across the country”.

Perhaps surprisingly, this appraisal came from the Company Chemists’ Association, whose members are among the only pharmacy businesses to have used hub and spoke.

One independent contractor told me that while he is not opposed to change, and in fact sees potential benefits to having a level playing field, trust will be a major barrier.

This applies both to the big wholesalers, who may stand to consolidate their position at the expense of small pharmacy businesses, he says, and to the Government, which could turn around and make deeper funding cuts if it sees that pharmacies are dispensing more cheaply.

Concerns down the line

The Government stresses that the hub and spoke model will be optional and in its impact forecast says that by the 10-year point after any legislation changes it only expects a tenth of eligible pharmacies to have signed up.

This is a point I hear consistently from those who support the proposals, and it’s a very sensible one. If someone feels their business and patients could benefit from a new dispensing model, why should they be prevented from using it?

That’s difficult to argue with, yet I worry about possible outcomes down the line. Could a Government intent on a services-led future make such sweeping changes to community pharmacies’ contractual incentives that they are pushed into using a model they would never have chosen freely?

I admit this scenario rests on a few hypothetical developments, but nonetheless it is a concern I have heard from more than one contractor. 

Money is not the only worry. A pharmacy that currently has the ability to act flexibly when it has issues with one of its suppliers may face a crisis if its hub runs into trouble.

And, to my mind, the sticky question of who will shoulder the blame for any patient safety incidents has not yet been answered to any degree of satisfaction.

Whatever your views on the hub and spoke proposals, I would encourage you to respond to the Government consultation by the June 8 deadline. 

We may be about to see a seismic shift in community pharmacy practice – and anyone that stands to be affected should have their say.

The consultation can be found at gov.uk/government/consultations/hub-and-spoke-dispensing.