Hub and spoke debate rolls on

Hub and spoke is coming and you ignore it at your peril, John D’Arcy warned independents at Numark’s recent conference in Cape Town – but opinion in the sector remains deeply divided.

Numark has reignited the hub and spoke debate, saying it could create the capacity for independent pharmacists to provide more professional services and improve patient outcomes.

Speaking at the Numark conference in Cape Town, managing director John D’Arcy accepted that it is an emotive subject but said it is important to debate the issue.

“We could have ducked it [here] but that would not be good leadership, nor would it be good for independent pharmacy. Trust me, hub and spoke is coming. We ignore it at our peril. Let’s have the debate.”

A combination of rising prescription volumes and outdated supervision requirements is making pharmacy’s practice model unworkable, he said. Money is tight in the NHS and the Government is looking to make efficiencies and also wants greater value from pharmacy.

“Pharmacy urgently needs to wrap a value proposition around supply that focuses on patient outcomes and delivers value for money for the NHS. However, it is critically important that pharmacy retains the supply function because that provides the nexus to the patient through which pharmacists can add value.”

There is no doubt that the Government sees hub and spoke as a way of creating efficiencies and cost savings, Mr D’Arcy told delegates. However, he emphasised that face-to-face contact between patient and pharmacist is the best solution, which is why it is key that pharmacists are the ‘spokes’ in such a system.

“The NHS has a problem with access and most patients want direct contact with a pharmacist, especially as they get older,” he said.

Hub and spoke could provide the headroom for pharmacists to provide more services, for instance by taking care of repeat prescriptions in the hub, delivered back to pharmacies [in the spokes] for supply to patients, he said. However, it should not be used solely as a means of driving cost out of the system.

“Hub and spoke is not like distance selling because patients need the interaction with pharmacists.” If it becomes the norm in any way, Numark will be there with a solution for its members, he said.

Dangerous idea

The NPA was quick to respond to Mr D’Arcy’s comments. In a statement sent to Pharmacy Magazine, it said: “Context is important. In the current political climate, support for hub and spoke gives succour to those elements in Government that wish to hollow out the community pharmacy network on flawed cost grounds.

“It is easy to see why Phoenix and its associates would wish to re-ignite interest in hub and spoke. It is an opportunity for the big three wholesalers to dominate the market even more than they do now, which cannot be in the interests of independent pharmacies.

“This is not a question of change versus no change. However, the independent sector should move forward along a road built on solid foundations and be wary of slippery slopes.”

In its regular column in Pharmacy Magazine (March issue), the NPA describes hub and spoke as “a dangerous idea”. The reality is that pharmacies could be fatally undermined by a dangerous experiment, says NPA board member Mike Hewitson. “We can’t risk the established, trusted service model of community pharmacy – namely convenient, face-to-face care from healthcare professionals, locally responsive and community based.”

Trust me, hub and spoke is coming. We ignore it at our peril

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