The Royal Pharmaceutical Society has said it broadly supports the introduction of a hub and spoke model across different legal entities but warned the second of two systems under consideration poses potential risks to patient safety.

Two dispensing models have been the subject of a consultation which closed last week; one where a patient’s prescription is assembled by the hub and sent back to the spoke to make the supply, and another in which the hub supplies the prescription directly to the patient.

In its response to the consultation, the RPS called for national guidance outlining what is included in the arrangements between hubs and spokes, with responsibilities and accountabilities clearly defined, while it said hubs needed to be inspected by the General Pharmaceutical Council “and rated in a similar way to community pharmacies and adhere to national minimum standards set by the regulator".

Pharmacy’s professional leadership body also expressed concerns about hubs supplying prescriptions directly to patients, particularly the absence of any interaction between a pharmacist and patient during the process where there is a change in a patient’s medicine, their condition or if they are taking high-risk medicines. 

“If a trigger is activated, then the person would need to be notified that they either pick up the medicine from the spoke where they can have a conversation with the pharmacist or they have a remote interaction with the pharmacist where this is appropriate,” the RPS said.

“There must also be the ability for the spoke to notify the hub that the medicine needs to come back to the pharmacy as they feel that there is a need to speak to the patient following a clinical check of the prescription. This would also need to be included in the process.”

The RPS stressed that all hub and spoke models must give patients access to a pharmacist once a medicine has been supplied so they can discuss the treatment and raise any concerns.

It also said the hub-to-patient model could “significantly” increase transportation costs as opposed to sending medicines back to one pharmacy while patients may be forced to wait longer than necessary for their medicines if hubs do not send anything out until they have received an entire batch of prescriptions.

The RPS said “robust business continuity processes” need to be in place in case a hub is out or action and spokes should be given the option of changing a hub if that hub is not meeting “national minimum standards” as set by the GPhC.

“There needs to be good electronic information flow between systems to ensure that accurate and timely information about prescriptions is passed from spokes to hubs and vice versa,” the RPS said.

It agreed that pharmacies should clearly display a notice telling patients they are employing a hub and spoke dispensing model and the names and addresses of hubs that are being used.

The RPS said that transparency will allow patients to take their prescriptions to another pharmacy if they are unhappy with the hub and spoke arrangement but said it was against any requirement for informed consent because “this would make the process too onerous/burdensome for the community pharmacy".

RPS president Claire Anderson said although “the choice provided by the new legislation is a positive outcome,” it was important that any model put forward provides “benefits for patients and across the sector".

“New national guidance must be developed to clarify arrangements between hub and spoke, and this must be backed up by minimum regulatory standards and clear communications for the public,” she 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. 

“Resilience of the medicines supply chain also needs to be considered if purchasing, dispensing and distribution of medicines happens via a handful of hubs.”