NPA leads the debate on Hub and Spoke

The NPA has been leading the debate on hub and spoke dispensing models since the concept was first proposed by the government in 2015. The 2019-2024 funding settlement for community pharmacy in England is linked to efficiencies to be made through the hub and spoke dispensing model.

The Medicines and Medical Devices Act 2021 paves the way for regulatory changes by the government to allow inter-company hub and spoke dispensing, where a pharmacy outsources elements of its dispensing to a third party.

The NPA has always taken a balanced and evidence-based approach to the matter of hub and spoke dispensing models. We have conducted extensive research on the subject in the UK and around the world.

The NPA has consistently challenged claims that hub and spoke will deliver efficiencies and patient safety benefits. We remain concerned that hub and spoke will not deliver benefits to many independent pharmacies and could have unintended adverse consequences for the sector.

NPA hub & spoke task group report

In 2016, we convened a task and finish group which took evidence from 20 UK and international experts before publishing a report on this model. The report challenged many assumptions made by the then Department of Health about hub and spoke. It also set out enablers and barriers to the deployment of inter-company hub and spoke dispensing.

NPA international hub and spoke report

In 2020, the NPA published a report on hub and spoke dispensing models around the world.

This research revealed that the use of large-scale automated dispensing remains very limited globally, despite the technology being established for at least 15 years. The review did not find robust evidence to support the economic case for hub and spoke supply. The review found that the majority of independent studies identify an absence of definitive evidence in respect of patient safety benefits of large-scale automation.

 

NPA Hub & Spoke Roundtable

In February 2020, the NPA held a roundtable event at The King’s Fund in London to facilitate an informed debate about the potential benefits and risks of inter-company hub and spoke dispensing models.

The event was chaired by Richard Murray, Chief Executive of The King’s Fund, and participants included NPA members and representatives from community pharmacy, the NHS, government, regulators, the pharmaceutical industry and wholesale sector. Attendees discussed and explored the opportunities, risks, barriers and enablers of hub and spoke.

Following the event, we published a report of the roundtable discussion. The report concluded that:

  • Simply changing the law to enable inter-company hub and spoke dispensing will not create a level playing field for independent pharmacies and will not guarantee that the desired outcomes for the NHS, taxpayers and patients will be achieved.
  • There are many factors which need careful consideration and a holistic approach needs to be taken.

NPA parliamentary evidence

In June 2020, the NPA submitted evidence to the parliamentary Public Bill Committee regarding the Medicines and Medical Devices Bill. The Bill was progressing through Parliament at that time. Our evidence stated that:

  • The government needs to fully assess and consider the potential unintended consequences of hub and spoke dispensing, including the potential impacts on patient choice, availability of medicines in the UK, medicines prices and competition and choice in the pharmacy and pharmaceutical wholesale markets.
  • The government needs to base proposed regulatory changes to enable hub and spoke dispensing on robust evidence and in full consultation with all of the relevant stakeholders. It is a concern that the government has acknowledged in its own Impact Assessment of this Bill that the costs and benefits remain uncertain.