Viewpoint: Make hub and spoke happen – before it’s too late

Just four months after promising a change to hub and spoke dispensing legislation for independent pharmacies, it was announced that more time was needed for the Government to brief new ministers before its implementation. I can’t say that I wasn’t disappointed by this decision. But I do understand it.

Although the time frame may have changed, the benefits that independents, the NHS and patients stand to gain from hub and spoke dispensing haven’t wavered. In fact, if anything, the case for its arrival in 2025 has only grown stronger. And here’s why. 

The latest Pharmacy Pressures Survey paints a depressing picture. It claims that half of pharmacy businesses are losing money and as little as two per cent remain profitable.  

Community pharmacy is in a tug of war. On one side, it has been given the chance to flex its clinical muscle and make more profit through service delivery. But on the other, it is being pulled to dispensing increasingly larger volumes of prescription items with low NHS reimbursement. It is a battle that many are losing, as our depleting numbers on the high street show. 

For community pharmacy to help take some of the pressure away from overburdened GP practices – especially as we enter the winter period – and for them to add the value they are fully capable of to the NHS, something needs to change. 

An important change

I passionately believe that enabling independents to access hub and spoke dispensing is one of several important changes that could be made for the benefit of pharmacies, patients and, indeed, the NHS. I don’t just say that as the founder of HubRx. I also say it as the owner of 37 pharmacies that provide the evidence of hub and spoke’s positive impact. 

This year, by using hub and spoke dispensing for 60-70 per cent of our repeat prescriptions, we have released up to 15 hours of total staff time each day within our pharmacies, which has helped us increase our clinical services by 400 per cent. We were able to exceed last year’s flu and Covid vaccination delivery in just the first three days of October. Without releasing our dispensing capacity that would not have been possible. 

Dispensing prescriptions is vital for the NHS and patients, but sadly it is no longer sustainable for community pharmacies. And as ever more pharmacies close due to the pressures they face, their neighbours are having to shoulder more and more of that prescription burden. This makes it near impossible for them to deliver clinical services in the numbers they need to turn a profit. 

Forty-three per cent of pharmacy owners say that the financial strain is limiting their ability to provide some advanced services such as the New Medicine Service or vaccinations. 

“Make hub and spoke dispensing happen – let us transform pharmacy”

Some pharmacies are even outsourcing the delivery of these services – which is great for the NHS and for patients, but it doesn’t help pharmacy realise the full revenue opportunity. 

Eighty-six per cent of pharmacies say dispensing prescriptions is now taking longer and 79 per cent feel it is reducing the amount of time they can spend with patients. As we head into winter, the pressures pharmacies face are only going to deepen. The change to legislation around hub and spoke dispensing for independents really needs to happen – even if not all the changes mooted are enabled. 

Most sensible approach

The planned legislation comprised two parts – model 1 and model 2, with model 1 delivering medicines back to the pharmacy and model 2 direct to the patient.

There is a groundswell of support that the Department of Health and Social Care should press ahead with model 1 first and implement this as soon as possible. This option delivers the key capability of capacity creation in the branch needed to transform community pharmacy. 

Further discussions should be had to refine the model 2 option to ensure control of entry is protected. That feels like the most sensible approach and could grant pharmacies operating within different retail pharmacy businesses the ability to use a hub, level the playing field and fully support the NHS with pharmacy as the front door.

As the Government asks for recommendations to help shape the NHS now and in the future, here is my note in the suggestion box. Make hub and spoke dispensing happen, let us transform pharmacy, but please do it before it is too late for community pharmacy and its patients.