Proposed models of hub and spoke dispensing across legal entities could cause ‘further complications’ in an already ‘broken medicines market’, the Royal Pharmaceutical Society (RPS) has warned.

RPS president Professor Claire Anderson told The Pharmacist that the organisation was ‘apprehensive’ that hub and spoke dispensing across different legal entities ‘could cause further complications’ when pharmacy teams were already facing ‘ongoing pressure’ regarding shortages.

And she said that ‘the current broken medicines market’ was ‘exacerbating medicines shortages’.

‘This is why we support calls for a widescale review of medicines supply chains,’ Professor Anderson said.

The government’s planned changes to hub and spoke legislation would see pharmacies from different legal entities able to use a central ‘hub’ for the assembly and supply of medicines – either to the ‘spoke’ pharmacy or direct to the patient.

The proposed changes would also enable spokes to transfer medicine to the hub, although the government said it expected this would not come into use until both hub and spoke ‘feel that they have sufficiently robust procedures in place to manage possible risks and issues’.

During the government’s consultation on this issue, concerns were raised that allowing spoke to hub supply ‘could encourage hoarding of medicine within the supply chain with the expectation of supplying one another in future’, or could lead to hubs ‘skimming’ from spokes – such as requesting medicinal product from spokes to stockpile or sell on.

But the government said in its consultation response that it would ‘not be possible for pharmacies to sell large quantities of stock to wholesalers because any transfer of medicines from the spoke to the hub under the hub and spoke models can only be done in the context of dispensing an individual prescription to a specific patient’.

Concerns were also raised in the consultation that arrangements by local governments to hold stockpiles of medicines for their local populations or to divert stock to a particular part of the UK in the case of shortages ‘could be adversely affected by any flow of medicines between the hub and spoke, especially where the hub is in another area or another country’.

Particular concerns were raised around Northern Ireland, but the government said that many of these had been addressed by the Windsor Framework, which was agreed after the consultation period.

And it said that posting medicines to Northern Ireland from Great Britain already occurred under distance selling pharmacies (DSPs), so this was ‘not a new development’.

It also confirmed that UK pharmacies would not be able to use any hubs located in British Overseas Territories.

And while the government said some respondents to the consultation ‘were concerned about a possible impact on the price of medicine’, there were ‘no new concerns raised about the general availability of medicine, over and above existing concerns in the market already about shortages, which are due to a wide range of factors’.

The RPS also raised concerns that patients might be confused by the proposed labelling requirements, which could see either the hub or the spoke named on the patient prescription.

'Whilst we welcome the opportunity for independent contractors to be brought into parity with group pharmacies in the same legal entities, implementing this must ensure that patients and the public have the transparency and knowledge of where their medications and personal data are being sent and supplied from,' Professor Anderson said.