Independents have “little appetite” for hub and spoke dispensing models, according to Numark.

In its response to the government consultation on Human Medicines Regulations 2012, Numark said that its members’ use of hub and spoke would be predicated on three factors:

• ‘Cost effectiveness’
• No resultant loss of prescriptions where the hub forms a direct relationship with the patient
• Resilience in delivering a service at least as good as the one they already provide.

Members were particularly concerned about a hub’s ability to get hold of sufficient stock, given that 85 per cent of branded medicines are only available through either ‘direct to pharmacy’ or ‘a reduced wholesaler’ model. A multitude of hubs was likely to add to the current complexity of supply routes and make it harder for pharmacists to acquire stock and so comply with their NHS terms of service. It was also likely to lead to market distortion with resultant competition issues that could have a particularly negative impact on the independent sector.

To suggest, as the government did, that large-scale hub pharmacies had the capability to “increase efficiency and lower operating costs significantly”, was a “significant overstatement”, given the limited amount known about the use of hub and spoke in practice, said Numark.

In its response, the NPA raised concerns about how the model would operate across the devolved nations of the UK. For example, if hubs were in a different devolved nation to spokes, NHS funding would be drawn away from contractors in the spokes’ country via hub service fees, said the NPA. This would impact on current NHS contractual arrangements in the devolved countries and could affect pharmaceutical care and the sustainability of health provision in the devolved nations.

“The concept of hub and spoke is built on the electronic transfer of prescriptions – a technology not yet available in Northern Ireland”. And in Scotland, the hard copy prescription was essential for electronic transfer to take place, adding to the already complex process of dispensing and assembly of prescriptions. If pharmacies in Northern Ireland wanted to access a hub located in England, the system would fall under the remit of both the General Pharmaceutical Society and the Pharmaceutical Society of Northern Ireland.

The Healthcare Distribution Association (formerly the British Association of Pharmaceutical Wholesalers) described estimates of 45 per cent of medicines being dispensed through hub and spoke as “on the high side”. It also warned the proposed legislative changes could open medicines distribution to new providers who might not be required to match the high quality and safety standards of the MHRA-endorsed HDA Gold Standard of Good Distribution Practice.