Hub and spoke dispensing not necessarily safer or more cost effective, shows international evidence

25 Feb 2020

Newly published research by the National Pharmacy Association (NPA) reveals that large scale automated dispensing remains very limited globally, despite the technology being established for at least 15 years.

The NPA says that demonstrable cost benefit cases were not uncovered by the research, which looked into the experience of hub and spoke dispensing in the UK and abroad.

With the exception of the Netherlands, the large scale automated dispensing of original pack medicines to third party pharmacies is not operational in any global market. Where third party automated dispensing has had most traction its focus is on multi dose dispensing (more often called MDS in the UK).

The majority of independent studies identify a similar absence of definitive evidence in respect of patient safety. Whilst accuracy gains may be made in the part of the process that is automated, new processes are introduced pre and post automation.  These introduce new risks, and no studies that address the patient safety impact of the full end-to-end process have been conducted to date.

NPA Head of Corporate Affairs, Gareth Jones, said:

“Independent data and evidence does not clearly establish either an economic case or a health outcomes case for large scale automation. That doesn’t mean there is no future for hub and spoke, but it should give policy makers pause for thought.  It raises serious questions about the underlying case for investing in models that allow hub and spoke to operate between different companies.”

In light of the findings, the NPA believes the following factors should be considered:

Feasibility. At the present time, there do not appear to be any large scale pharmacy hubs in operation serving more than hundreds of third party pharmacies and thousands of patients.  Where automated volumes are greatest, they are concentrated on multiple chains, and also on loose pills counted into vials as opposed to original pack dispensing.

Economic. Several academic researchers have identified the absence of cost benefit cases in the automated dispensing scenarios they have researched.  It would therefore be welcome to see evidenced cost benefit cases.

Patient safety. Many claims for the patient safety benefits of large scale automation have been made.  A much more conservative tone is observed amongst academic researchers, who note the case may not be proven one way or the other. More rigorous independent research is required.

Read more about the Hub and Spoke research review here. Earlier this week, it was confirmed that NHS England, the Government and PSNC will seek to further enable the use of hub and spoke dispensing, as first indicated in the five year contractual deal.