NHS England (NHSE) has pointed to hub and spoke dispensing in its long-term workforce plan as a way to free up capacity within community pharmacy to deliver more clinical services.

The plan published last week said that modelling estimates that hub and spoke dispensing will increase 2% a year.

And it said that this would subsequently help to ‘reduce the time’ pharmacy teams spend on direct medicines supply and ‘release capacity across the community pharmacy workforce to support a greater focus on delivering clinical services’.

But Community Pharmacy England (CPE) said that as well as legislative change, ‘significant investment’ would also be needed to make hub and spoke dispensing ‘financially viable’ for the whole sector.

Alastair Buxton, director of NHS Services at CPE, said that while the plan referenced the benefit of the use of hub and spoke dispensing to free up capacity, the government would not only need to implement the ‘long promised legislation’ to allow that approach to be used across the whole sector, but ‘significant investment’ would also be required to make hub and spoke dispensing a ‘financially viable scenario for pharmacy owners’.

Proposals to allow hub and spoke dispensing by independent pharmacies

The Department of Health and Social Care (DHSC) is currently analysing responses to its 2022 consultation on whether hub and spoke dispensing models should be allowed to be used across different pharmacies.

As it stands, pharmacies can only use hub and spoke models if the spoke pharmacy forms part of the same retail business as the hub pharmacy.

But the new proposals would mean that hub and spoke dispensing could happen across separate businesses, which DHSC has claimed will ‘level the playing field’ between larger chains and smaller pharmacies.

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

DHSC said that changes to this law would mean independents could ‘group together’ to split the cost of setting up a hub, and free up time by being able to outsource elements of the dispensing process to other pharmacies, meaning they could concentrate on more ‘clinically focused tasks’.

The department added that the model may help with cost-saving, as ‘hub pharmacies with a higher volume of dispensing may be able to negotiate better deals with suppliers’.

These savings would then be ‘passed onto spoke pharmacies’ and ‘the spokes may also experience a cost-saving’, DHSC said.

Would hub and spoke dispensing deliver time and cost savings?

Pursuing legislative change to enable all community pharmacies to benefit from hub and spoke dispensing models was one of the efficiencies that the government committed to in the Community Pharmacy Contractual Framework (CPCF) five-year deal (2019 to 2024), with the aim of freeing up pharmacists and their teams for other tasks such as providing clinical services to patients.

Former Royal Pharmaceutical Society (RPS) president and now president of the National Association of Primary Care (NAPC) Ash Soni said at the time of the consultation that a co-operative hub and spoke model would be ‘the future’ for independents.

But CPE (then PSNC) warned in response to the consultation that the proposals would offer 'virtually no financial efficiencies' for pharmacies, adding that they were actually 'more likely to add cost' to the community pharmacy sector.

And the Pharmacists’ Defence Association (PDA) suggested that one of the proposed models of spoke-to-hub supply would increase the likelihood of ‘some catastrophic error’, risking patient safety.

Meanwhile, the Competition and Markets Authority (CMA) raised concerns that the proposals could lead to competition risks – therefore allowing for higher medicines prices – if the market developed in a way that meant that pharmacies’ access to medicines was through an increasingly limited number of hub suppliers.