The Government's hub and spoke dispensing proposals show a 'fundamental lack of understanding of the role of pharmacists’ in safe and appropriate dispensing, the Pharmacists' Defence Association (PDA) has said.

The Government consultation on whether to allow all community pharmacies to use hub and spoke dispensing models, which the Department of Health and Social Care (DHSC) claims will  ‘level the playing field’ between larger chains and smaller pharmacies, ended earlier this month.

However, the PDA raised a raft of concerns in response to the proposals, and suggested the Government has failed to provide any evidence that there is any 'desire or appetite' from smaller pharmacy operators for the legislation.

It continued: ‘There appears to be significant concern within the independent pharmacy sector that these proposals will, when taken together with other policy measures, lead to a significant reduction in the viability of the existing independent pharmacy network and thus lead to reduced access to pharmacies and pharmacists.'

In hub and spoke dispensing models, routine aspects of assembling prescriptions can take place on a large scale in a ‘hub’ that usually makes use of automated processes.

Currently, this model is only possible when the hub pharmacy forms part of the same retail business as the spoke pharmacy, meaning chain pharmacies are the main users of the method.

The Government has proposed two separate hub and spoke dispensing models - one whereby a patient’s prescription is assembled by the hub and sent back to the spoke to make the supply, and another in which the hub supplies the prescription directly to the patient.

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

The PDA also warned that both models may not free up time for pharmacists but may generate ‘more pressure for a single-handed pharmacist to do even more low-level work, rather than provide services’ because there are ‘insufficient staff to carry out non-clinical work’.

It continued: 'Medicines are not usual items of commerce, and the safe supply to patients is a complex process with many risks at multiple points in the dispensing pathway.

The PDA also said the supply of medicines from the spoke to the hub 'should absolutely not be possible’ and should ‘only be possible in one direction – hub to spoke’, with only the spoke pharmacist carrying out clinical checks.

It warned that 'the integrity of a supply chain is crucial for safety and if hundreds of pharmacies supplied medicines to a hub the likelihood of some catastrophic error occurring increases’.

The PDA said the Government showed ‘a fundamental lack of understanding of the role of pharmacists’ by asking in the consultation whether to ‘allow flexibility’ and having the label carrying ‘the name and address of either the hub or the spoke’ depending on agreements.

It warned that the Government is 'seeking to reduce the supply of medicines to a commoditised, mechanical thought-free process, whereas in reality pharmacists perform a vital role in clinically checking each and every prescription prior to it being dispensed’.

The PDA criticised the 'continued lack of robust evidence to support the proposals,' and said safety data and the extent of usage of existing hub and spoke operations could have 'informed the discussion,' so 'decisions and outcomes arrived at would have been driven by evidence rather than pre-determined endpoints.'

It added: 'The PDA is not opposed to the introduction of hub and spoke on a larger scale than is currently utilised, if it is done so within governance structures and supports the professional role of the pharmacist in ensuring clinical appropriateness and the provision of pharmaceutical care, however the impact assessment needs to be based on factual information.'

The PDA has recommended that the proposals be referred to and considered in the round by the Competition and Markets Authority.

As part of the Community Pharmacy Contractual Framework five-year deal (2019 to 2024), the government committed to pursuing legislative change to enable all community pharmacies to benefit from hub and spoke dispensing models.

The Company Chemists’ Association has warned that there is not enough service income within pharmacy to warrant a network of hubs.

The National Pharmacy Association has called on the Competition and Markets Authority to investigate the hub and spoke dispensing model in the UK, to ensure there is a ‘dynamic’ and ‘competitive’ market in place for pharmacies and other spokes.

Former Royal Pharmaceutical Society president Ash Soni backed the idea of pharmacies operating in a group using a hub and spoke model in 2019, saying they were ‘the future’ for independents.