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Lo's Pharmacy, a Yorkshire-based pharmacy chain is adopting a new approach to hub and spoke in a first of a kind model to be used in the UK. The pharmacy will centralise its repeat prescription dispensing service for original packs with the support of its medication wholesaler. The independent group, which has 25 NHS community pharmacies across Yorkshire, will install Centred Solution's Automated FLOWRx Hub product at its central dispensing facility in Wath-Upon-Dearne, South Yorkshire. But unlike other FLOWRx customers, who pick packs from a robotic dispensing system or internal warehouse, Lo's Pharmacy will receive patient-specific flow totes directly from their wholesaler which can then be processed by their hub. This workflow has not been used anywhere else in the country until now and it is a revolutionary approach to hub and spoke dispensing, showing what can be achieved when key players decide to collaborate. It further demonstrates that there are range of variations of hub and spoke models available and accessible to independent and multiple community pharmacies across the UK.

Paydens Pharmacy Group, one of the first multiple pharmacies to adopt hub and spoke model last year, revealed that the move has resulted in significant time savings in store. Centralising dispensing of repeat prescriptions relieves pressure in pharmacy branches and releases time to deliver revenue generating services, the group said. The group created a hub in Maidstone, Kent, to service its highest dispensing branches. The hub uses Centred Solution's FLOWRx Hub Auto to dispense their original pack repeat prescriptions. The group put in the first FLOWRx Hub production line in spring 2022 and then added in a second line in the autumn as they increased production and moved more stores to the hub and spoke model. The innovative solution interfaces with EMIS PMR, Omnicell's Robotic Dispensing System and Universal Logistics Management software as well as Victoria OS ordering software. The hub operation runs during the day Monday to Friday and produces an average of 33,289 packs per week for just under 9,000 patients, leaving plenty of scope to ramp up. The hub is currently dispensing 79.7% of repeat prescription original packs requested by the group's busiest stores.

While responding to the consultation on hub and spoke dispensing, trade unions for pharmacists have emphasised that the patient safety and care must be the priority in hub and spoke dispensing. The Royal Pharmaceutical Society (RPS) has welcomed the opportunity provided by a change in legislation to enable community pharmacies to make use of hub and spoke dispensing but reaffirmed that patient care must be at the heart of future changes. With regards to patient safety, the Pharmaceutical Services Negotiating Committee (PSNC) considers that only Model 1 is appropriate, with manageable risks related to patient safety, and is a model that has the potential to allow the whole sector to benefit fairly. In its response to the consultation on Hub and Spoke dispensing, PSNC highlighted that Model 2 in the consultation, a hub direct to patient supply of dispensed medicines, raises patient safety issues and it cannot be supported. RPS President Professor Claire Anderson said: "In all models, patients need to continue to have access to a pharmacist at the time of supply of medicines so they have the opportunity to discuss, ask questions or raise concerns, and receive appropriate information with counselling and advice.

With the government gearing up and pushing community pharmacies in England to adopt the hub and spoke dispensing model, stakeholders of the sector and industry leaders analyse the pros and cons related to the new concept. The model rose to prominence in 2015 in community pharmacy and the medicine supply chain in the UK, and has undergone a few consultations and reviews at the professional and governmental level since then. From a broader perspective, the industry agrees that the model will bring in efficiency to the system, much needed amid community pharmacy's flat funding settlement in England, at the same time highlighting some real challenges. The National Pharmacy Association (NPA) has so far released three reports on this matter and a review of the challenges and enablers of the hub and spoke in the UK in 2016. Besides, a review of international evidence and the report of a roundtable meeting was brought together in the supply chain with government and regulators in early 2020.

The Department of Health and Social Care (DHSC) has published its response to the 2016 hub and spoke consultation which has paved the way for a new discussion following engagement with community pharmacies and other stakeholders this year. The response showed that many respondents supported use of hub and spoke dispensing models in independent pharmacies, but expressed concerns about some practicalities related to it. Respondents raised concerns around "patient data, liability, implications for the supply chain, and risks to the existence of small community pharmacies." They also raised question about the speed of access to medicines in an emergency and security of data transfers between hubs and spokes, DHSC stated.

Talk of hub and spoke models has been rumbling on for as long as I can remember. The topic has once again hit the headlines as the government announced a fresh consultation for its proposed changes, calling on all interested parties to submit their views by 8th June. The argument for hub and spoke is to allow independents to have the same level playing field as the larger groups who have been operating this model for some time. The government also sees significant efficiency gains in centralisation, arguing this will free pharmacists time away from dispensing to focus on clinical services. The latest consultation advocates two models being created. In the first model, the dispensed medication is sent back to the spoke. In the second model, the completed medication can be sent out directly to the patient. The latter is a new concept which could open up new opportunities in how services are delivered. Pharmacies could effectively outsource the entire dispensing and delivery to housebound patients and care homes allowing pharmacies to take on new business without having to worry about logistics and geography.

The Company Chemists' Association (CCA) has called for an evidence-based approach to hub and spoke dispensing proposals, stating that it is vital to back the changes based on robust data and lived experience of pharmacy businesses. Community pharmacy contractors need to to respond to a Department of Health and Social Care initiated consultation on the hub-and-spoke dispensing models by June 8. Malcolm Harrison, CEO of the CCA, said: "I am very concerned by both the number and scale of the assumptions contained within the impact assessment, which are unlikely to come to fruition. "The impact Assessment also makes predictions on a yet un-born market, stretching 10 years into the future. Hub and spoke technologies do have the potential to enable new dispensing models in the future if new commissioning can support a change in operations. I would caution against firm predictions about likely benefits without stronger commitments to enablers of change."

HubRx has appointed Dr Sarah Passmore as superintendent pharmacist ahead of launching what the company called "the UK's first state-of-the-art automated pharmacy hub". Dr Passmore brings more than 20 years of pharmacy experience - having held key regulatory roles with Rowlands Pharmacy over a 11-year tenure, which also saw her involved in a number of pharmacy automation projects. Commenting on her appointment, Dr Passmore said: "As a pharmacist, who has spent more than 10 years working within community pharmacy, I'm excited by what a hub and spoke model for prescription dispensing can bring. "Pharmacists are highly trained in delivering clinical services to patients - and like me - it's often a part of their job that they thoroughly enjoy. The option of using hub and spoke to support dispensing prescriptions will give community pharmacists the gift of more time that can be spent helping patients. "I'm excited to join HubRx and for it to become the first state-of-the-art automated pharmacy hub designed for independent community pharmacists to launch in the UK."

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.

Speaking at the SIGMA Conference 2023, Dr Leyla Hannbeck, CEO of the Association of Independent Multiple Pharmacies (AIMp), spoke about the increasing number of prescriptions, lack of funding and other existing challenges. Leyla explained how the pharmacy sector is facing immense challenges which are disrupting the delivery of services as well as impacting its growth. She further spoke about the hub and spoke model, and how it is unable to solve the issues. "Community pharmacies are clogged with prescription volume, and this is preventing them from supporting the wider NHS as well as offering services," she said. She said that the prescription volumes have rocketed, while the number of pharmacies in England has declined from 11, 522 in the year 2021-22 to 11, 414 in 2022-23. When it comes to Company Chemists' Association (CCA) pharmacies, there has been a loss of 1055 branches from 2022 to 2023.

The Royal Pharmaceutical Society (RPS) has called its member to to express their views and fill out the Department of Health and Social Care's hub and spoke survey on the proposed model of dispensing. The Society has urged its members to fill out the survey before May 20. RPS president Claire Anderson said: "It is vital that RPS members have their say on issue that impact you in your roles. Currently only single legal entities can make use of this model of dispensing. "Our survey, which opened today, seeks your views and comments and will help to inform the RPS submission to this consultation." The consultation on the proposals to enable all community pharmacies to access hub and spoke dispensing published by the Department of Health and Social Care (DHSC) will run for three months and will close on June 8, 2022.

Bristol-based Titan PMR, a technology firm specialising in PMR systems for community pharmacies, is set to roll out an innovative platform named 'Titanverse,' that it claims will redefine pharmacy management, offering comprehensive solutions extending beyond prescription management. This new platform takes a versatile approach, efficiently managing all facets of pharmacy operations, from high-level management down to daily tasks, according to top company officials. "Our aim is to reshape pharmacies into genuine health hubs, providing advanced services and harnessing state-of-the-art technologies," said Tariq Muhammad, CEO of Titan PMR. "Titanverse, our latest offering, is positioned to ignite this transformation, revolutionising clinical services in the same way its predecessor revolutionised dispensing. With Titanverse, we have the vehicle to drive this vision forward, placing pharmacies at the forefront of primary care in the future." Titanverse adopts a Teams approach, catering to pharmacies with multiple locations or specific focuses. It furnishes real-time analytics and employs a color-coded rating system for swift performance evaluation. Moreover, the platform eases operations by enabling task delegation, encompassing clinical checks and dispensing, all while backing private services with adaptable templates and workflows.