Hub and Spoke Gareth Jones
Hub and Spoke • What is in the DH Hub and Spoke proposal? • NPA Hub and Spoke T&F Group
DH proposal • Amend s10(1) of the Medicines Act 1968 • Enable inter-company Hub and Spoke arrangements • “create a level playing field”
DH proposal • Part of the DH narrative on efficiencies – referred to repeatedly at recent Parliamentary meeting by the Minister and Chief Pharmaceutical Officer
DH proposal – “impact assessment” • 45% of medicines will be dispensed in hub and spoke arrangements within 3 years • 10% reduction in pharmacist labour costs in spokes
DH proposal – “impact assessment” • For every job lost in the spoke, 0.4WTE will be created in the hub
DH proposal – “impact assessment” • Capital investment costs excluded from the calculations
NPA Hub and Spoke T&F Group • Manchester University literature review • Over 400 members responded to survey • Visit to an automated hub • Interview 20 experts • Legal opinion from a QC • Members of group from NPA, PSNC and PV
Benefits • Capacity – Some opportunity to support capacity release to deliver other services – No evidence that there are cash savings within pharmacies
More efficient? • Can not reduce staffing in a typical independent – you can redeploy capacity • Reducing staff can be counterproductive and potentially less safe • Hub service fee • Replication of process – Accuracy check in spoke – FMD check in spoke
More efficient? • Ineligible lines • Barriers – Lack of original pack dispensing – Low level of repeat dispensing • Reduce stock levels? • Resilience? • Can MDS packs be done within inter- company Hub and Spoke?
Safer? • Misleading to portray this as a case of humans versus machines • Existing error rate is low • FMD authentication process may deliver the safety benefit without automated dispensing • New opportunities for error
Impact on competition & procurement • Risk of a duopoly due to barriers to entry – DTP / restricted wholesaler schemes – Investment – Infrastructure • Risk to short-liners – Reducing amount of business open to short- liners, challenge to reach critical mass • Risk to the tax-payer
Barriers • EU Falsified Medicines Directive • Accuracy check requirement • DTP/limited wholesaler schemes • Lack of competition between hubs
Enablers • Original pack dispensing • Electronic Repeat Dispensing • New service commitment, eg, Pharmacy First • Public specification for hubs
Enablers • Fair contractual arrangements • GPhC recognition of the additional risks involved within inter-company hub and spoke
Conclusion • The inter-company hub and spoke idea is integral to the Ridge/Cavendish view of the world • DH document shows a complete lack of understanding of the issues • This politically driven proposal, as currently framed, can not deliver the promised level playing field
Conclusion • DH needs to go back to the drawing board • Please respond to the consultation, which closes on 17 th May 2016
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