The DDA has warned that wholesalers could increase delivery prices if hub and spoke dispensing becomes more common.
In its response to the Department of Health consultation on relaxing the terms of hub and spoke dispensing in England, it says: “The way that the wholesalers work will change; [they] are likely to charge more to deliver to practices.” This will require extra funding for dispensing practices, said the DDA’s chief executive officer Matthew Isom.
Responding to the consultation, which proposes to allow hub and spoke dispensing between legal entities, and closes on May 17, the DDA says there must be a level playing field.
The current scope of the consultation excludes dispensing practices, despite dispensing practices having a 7% share of all NHS prescriptions. “This discriminates against rural patients and cannot be acceptable. If hub and spoke is to become the delivery model of choice, then a way must be found to include these providers of rural services”, Mr Isom notes.
Other concerns relate to the effect on the availability of medicines to patients in urgent situations and of providing tailored medicines advice. The response also reminds the DH of the documented earlier problems affecting supplies by Pharmacy 2U.
The assumed savings from implementing hub and spoke dispensing also take no account of the contractual minimum staffing levels in pharmacies. Mr Isom said: “We believe few, if any, small independent pharmacies will use hub and spoke, there being no obvious need or incentive to do so.” The DDA also documents a lack of robust published evidence to show the incremental safety of hub and spoke dispensing.
The consultation also includes proposals to add the prices of medicines to dispensing labels. The DDA’s response questions the safety of adding more, potentially confusing information to dispensing labels, and whether price information may deter patients, particularly, the elderly, from obtaining required medication. There are also cost implications for practices of implementing new dispensing IT, it notes.
On the specific question of labelling of medicines supplied under patient group directions and monitored dosage systems, the DDA says that pictures of medication should be included, where possible, to aid compliance. There should also be a warning that medicines become unlicensed, once they are stored outside the original pack.