Here we go again

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Here we go again

By Rob Darracott

It’s five and a half years since the Department of Health and Social Care abandoned proposals in its first consultation on the subject in the face of opposition by certain contractor groups. Rarely do trade bodies argue for an unlevel playing field, but their suspicion was tweaked by the inclusion of ‘hub and spoke’ in the infamous 2015 ‘pharmacy cuts’ letter.

The current proposal seeks to remove the legal barrier to independents, working among themselves or with others, to do the sort of things multiples are already doing. Streamlining the routine, mundane element of supply. Creating time and space in pharmacies for customer services. Maybe, yes, saving money by efficiency accruing through consolidation. 

Some of the arguments against levelling the playing field in 2016 were illogical. There was no business model for it for independents, we were assured. Independents would be at the mercy of distributors, which seemed to assume legislative change would impose change, rather than enable it. It’s what the Department of Health wants, so we’re agin it. 

It’s going to be harder to run those lines this time. That’s not stopped the NPA, however, which has been quick off the mark to suggest the Competition and Markets Authority take a view on the proposals’ potential impact on independents’ ‘buying margins’ and the likelihood of wholesalers achieving greater market power. Crystals balls might be helpful. And independent hubs are setting up; groups like HubRx, led by Daniel Lee, once of Pharmacy2U, certainly think they have a business model to interest people. 

Meanwhile, in the real world, large and small multiples have been investing in hub and spoke options for their businesses. The central fill models of Pharmacy2U, LloydsDirect and others, continue to take market share. Bigger independents are investing in robots and repeat prescription collection points, both technologies that make hub and spoke academic. 

The legal detail in all this feels like a bit of a sideshow, given the challenges facing the NHS. With household finances about to take a dive as energy costs rocket, what am I bid for a mental health crisis to add to the Brexit-heightened staffing problems, rising Covid cases, maternity safety scandals and the waiting list backlog? The NHS faces a financial squeeze that makes George Osborne’s austerity look like a walk in the park. 

Community pharmacy needs to respond to the hub and spoke consultation, of course. And it needs to do what it can to ensure the legislation delivers a genuinely level playing field that gives independents a real option for off-site assembly. But the case will be best made by focusing on the continuing benefit to patients of having a network of community pharmacies offering face to face contact with a health professional.

Hub and spoke was always, in my mind, one means to a more interesting end. You can also read that December 2015 letter as suggesting that greater efficiency in the dispensing process is necessary to create the space for the delivery of more clinical services. With a greater impact on patients. And better remunerated.

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