The Pharmacist spoke to Daniel Lee, chief executive of large-scale dispensing facility HubRx, ahead of incoming changes to hub and spoke legislation that will enable hub and spoke dispensing to operate across legal entities.

As founder and chief executive of Pharmacy2U, Daniel Lee built and ran some of the largest automated pharmacy facilities in the country.

Since leaving in 2019, he said he 'realised that the independent pharmacy sector was really missing out' on the opportunities of hub and spoke dispensing which had already been taken up by large multiples.

At the time, 'the legislation didn't allow for independent pharmacists to benefit in the same way' – including utilising the latest technology, better messaging, improved accuracy and building capacity that would allow community pharmacy to play a greater clinical role in the NHS, noted Mr Lee.

Anticipating a change in legislation that would allow hub and spoke dispensing to be used across legal entities, Mr Lee and his team built HubRx – 'an integrated, seamless, interoperable' dispensing facility within patient medication record (PMR) provider Rx Web. Mr Lee hopes in the future that other PMR suppliers will come on board as well.

With legislation change delayed, Mr Lee bought a chain of pharmacies to begin using the hub and spoke dispensing process with.

Outsourcing dispensing to this hub 'creates significant capacity within the branch for the teams to offer more clinical services', Mr Lee, chief executive of Hub Rx, told The Pharmacist in an interview last month.

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He suggested that hub and spoke dispensing is 'just one solution that pharmacists should look at' to help create capacity for both NHS and private clinical services.

And he advised contractors to also consider technology such as cost systems, stock control systems, HR systems, and clinic management systems.

Mr Lee said community pharmacists now had the opportunity 'to prove to government and to other stakeholders that we are clinicians first and foremost, not dispensers'.

'If we can take some of that volume off of you to allow you to concentrate on developing your clinical skills, that builds up your USP within your community, why wouldn't you do that?' Mr Lee said.

The cost of setting up an automated hub from scratch might be prohibitively expensive for some independents.

But Mr Lee said HubRx can be used by any contractor with no upfront cost, and a usage fee that is still to be determined, but will be around 70-80p, or roughly half of the dispensing fee contractors are paid by the NHS.

The HubRx automated dispensing facility –  which is 40,000 square foot – is operating at just 5% capacity, with space available to other independents who want to begin using it.

The HubRx automation facility holds 'a standard range' of stock, allowing each pharmacy branch to reduce their stock holding by around 50% and focus on one-off prescriptions or those more difficult to source.

When different pharmacy businesses join the facility, HubRx would purchase stock on behalf of its partner pharmacies.

'The more pharmacies that join HubRx, the more we'll be able to get better rates,'  Mr Lee said.

He clarified that HubRx does not add a margin to the drugs it buys, rather charging a standard use fee per item.

Automating dispensing at the hub had freed around 15 hours of pharmacist and staff time per branch, Mr Lee said.

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And he suggested pharmacies could decide whether to reduce their workforce as a result of this saving or invest in staff training and upskilling to deliver more clinical services.

'That's what we've done within our branches, and we've increased our clinical services no end,' he told The Pharmacist.

'All the pharmacists are being retrained to become independent prescribers. We're moving them to a place where they they have a sense of purpose. They're enjoying their role because it's more varied. They're not just stuck at the dispensing bench, swamped under pressure, feeling like they can't cope with the daily volume of workload.

'I can say as a pharmacist working in my family business, 25 years ago, it was the same, it hasn't changed.

'I speak to pharmacists day in day out who want to get away from the daily grind, but don't know how to how to do that.

'Using HubRx is not mandatory. We're not telling people that you have to do that. It's really for those that are really pressured, who are at the end of their tethers, they are touching capacity,' he said.

Speaking to concerns pharmacists may have about the safety of using a hub and spoke model, Mr Lee said the pharmacist in branch always does a clinical check on the first of a repeat prescription, and then would be prompted to re-check by an algorithm set by the pharmacist in branch – for instance, if there was a change in the prescription.

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'It is honestly super accurate, more accurate than within branch.

'It's just removing the basic sort of dispensing.'

In Mr Lee's branches, the hub manages around half of the dispensing, with more complex or individualised prescriptions – such as refrigerated or controlled drugs, split packs or dressings – to be done in store with more input from the pharmacist and the team.

Those that are automated are bagged and sent back to the pharmacy, while a text message is sent to the patient to alert them that their prescription is ready to pick up.