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Hub and spoke dispensing is expected to be able to take place from October.
Following a second consultation in 2022 and protracted discussions, in spring 2024 the last Government announced proposals to enable remote prescription assembly across different business entities. This was intended to align with the changes that enabled original pack dispensing to come into effect on January 1 this year. However, parliamentary approval was delayed by the general election and the new Government’s priorities for parliamentary activity.
Now, however, the Government has finally laid amendments to the regulations. Since pharmacies will likely be required to notify their integrated care board of their decision to take part in the dispensing model 28 days in advance, the earliest date from which they will be able to dispense remotely assembled prescriptions is probably October 29.
Model 1 gets the nod
The original proposals described two models:
Model 1 (spoke-hub-spoke): a spoke pharmacy sends a patient’s unassembled prescription or part-assembled prescription to a hub. The hub completes assembly of the prescription and returns it to the spoke (‘deemed retail sale’). The spoke supplies the prescription to the patient and provides advice on the medicine(s)
Model 2 (spoke-hub-patient): a spoke pharmacy sends a patient’s unassembled prescription or part-assembled prescription to a hub. The hub completes the assembly of the prescription and dispenses it directly to the patient (‘retail sale’). The spoke pharmacy may supply part of the prescription direct to the patient under a ‘parallel retail sale’.
The Government said that Model 2 would not be taken forward on the basis of potential patient safety and regulatory issues. So Model 1 it is.
Key points
- Both the hub and the spoke must be registered pharmacies, and thus regulated by the GPhC
- NHS fees and reimbursement will be paid to the spoke pharmacy, which will have to reimburse the hub for the medicines supplied plus a fee for the assembly and distribution costs. (How will that work and against what tariff/cost?)
- Spoke pharmacies will have to display a sign telling patients they utilise hub and spoke, and require formal arrangements between spoke-hub
- Hubs will not have to meet good distribution practice nor require a wholesale dealer’s licence
- Dispensing doctors are also considered as spokes under the proposals.
Initial reflections
The chosen model allows the spoke pharmacy to retain the patient relationship and the patient interaction, intervention and service opportunity.
It will result in a one-off reduction in stock investment at the spoke pharmacy, which helps cash flow. But is there a potential trust issue between spoke and hub on data protection/patient retention? There are also clinical governance challenges (perceived or real) for the spoke, which has not assembled the prescription:
- Potential professional confidence/trust issues for the responsible pharmacist
- Who is accountable or responsible, and will they be tempted to recheck items to ensure they are complete and accurate before handing them out and discussing with patients? This activity may lose elements of intended efficiency gain and released capacity.
Viewpoint: Make hub and spoke happen – before it’s too late
Broader unanswered questions
Even with the increased dispensing fee, the reimbursement system with retained margin under Category M and dispensing at a loss on many medicines, questions remain about the financial viability of this model for both hub and spoke.
According to Community Pharmacy England’s updated indicative income table for 2025/26, the average net income per item, including the single activity fee and any retained margin, is around £2.29 for a pharmacy doing 8,000 items per month. The idea of splitting a pharmacy’s net income is, at the very least, questionable as a business model.
Given that the spoke is reimbursed for medicines but does not hold them, how will Category M and Drug Tariff discount scales operate for both entities? How will this impact wholesaler discount thresholds? Then there are many additional questions about the model, including:
- How will it impact relationships between pharmacies, wholesalers and manufacturers?
- How will it impact patient perceptions of service experience, given likely additional lead times?
- What happens with out-of-stock or owing items?
- What is the pharmacy name on the item label?
- How does a spoke pharmacy track where the completed prescription is on its journey back from the hub?
- Who liaises with the patient’s surgery to request changes for medium/long-term supply issues?
- What are the implications for the already challenged medicines supply chain?
Numark: Where’s Labour’s economic model for hub and spoke law change?
Final thoughts
At the time of writing, the GPhC had yet to comment publicly on the proposals as part of its wider review of inspections. Other pharmacy organisations have generally welcomed the level playing field, but with the caveat that core funding must make it viable.
Should pharmacy businesses adopt the spoke-hub-spoke model, it would need to be financially viable.
Any released capacity would need to be utilised to generate profitable revenue to replace that given to the hub for the service provided. Whatever the decision, it will need to be part of a transformative business plan.
- Mike Holden FRPharmS FRSPH is managing director of MH Associates.
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