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The Competition and Market Authority (CMA) has suggested regulatory levers to curb "potential competition risk" from hub and spoke dispensing. In its response to the hub and spoke dispensing consultation, led by the Department for Health and Social Care (DHSC) last week, the competition watchdog said that a pro-active approach to monitoring the effect of hub and spoke dispensing and subsequent early consideration of any competition concerns was likely to be more effective and potentially less costly than any "ex-post enforcement any ex-post enforcement or unpicking of subsequently embedded competition issues". The competition watchdog has made a few suggestions to identify and remove the barriers to competition that might emerge with the new business models entering the market. It has asked the department to enable a "more level playing field". "Smaller independent pharmacies should, have improved access to automation and new dispensing models," it said.

Two weeks prior to the closing of the hub and spoke consultation, issues around patient safety, costs and competition as well as practicalities such as what to do with uncollected medicines were discussed in a webinar on hub and spoke dispensing on Wednesday (May 26). The webinar was organised by Sigma Pharmaceuticals in association with the National Pharmacy Association (NPA). NPA director of corporate affairs Gareth Jones chaired the event and was joined by Sigma's Hatul Shah and Raj Haria as well as NPA vice chair Nick Kaye and NPA head of advice and support services Jasmine Shah. Kaye said: "There are still many 'unknown unknowns' with hub and spoke and the jury's still out on any potential benefits. I have lots of reservations about cost and it worries me how efficient this is for the business and the long term sustainability for the sector as a whole. Above all we need to think about the patient at the centre of all this and the potential confusion for them." Jasmine Shah felt patient safety was going to be the key in regards to whether the spoke and the hub would hold the ultimate responsibility and "who is going to take the accountability as far as patient care goes". She added: "It is most important that GPhC standards and NHS requirement are both met in identifying all the risks associated with the arrangement with hub and spoke and ensuring that (patient safety) measures are in place. Everything that needs to be looked at is by putting the patient at heart of the arrangement and seeing what is the safest way for them to receive care from both spoke and hub."