Government set to ‘introduce’ hub-and-spoke legislation in 2025

Stephen Kinnock has recently announced that the government “is working towards introducing legislation to enable hub-and-spoke dispensing between different legal entities in 2025.” 

The minister confirmed these plans on 23 December in response to a written parliamentary question from Harriet Baldwin, the Shadow Minister for Business and Trade, regarding the Labour government’s plans to bring forward hub-and-spoke dispensing legislation.  

Kinnock stated that “this change will be enabled via amendments to both primary and secondary legislation,” stressing that the plans will be “subject to the usual parliamentary processes.” 

 

A decade of delays 

It was only in September that the legislation announced by the previous government was delayed seemingly indefinitely. Having initially been scheduled to come into effect in January 2025, the Department of Health and Social Care revealed to Community Pharmacy England  that, following the election of the new Labour government, it was “not in a position to implement these proposals from 1 January 2025, as previously intended.” 

The delay was met with mixed reviews, with some acknowledging the need for more time to effectively regulate universally implementing the models, and others criticising yet another delay to assisting community pharmacies in the UK.  

Company Chemists’ Association’s Chief Executive, Malcolm Harrison, emphasised how “disappointing” it was that commitments made to support pharmacies were “the subject of further delays,” 

Harry McQuillan, Chair of pharmacy chain Numark, said the delay was “disappointing, particularly for independent pharmacy owners who continue to be left without the same opportunities as those operating within the same legal entity.” However, McQuillan acknowledged the delay would give Numark more time to “carefully consider the full implications of extending hub-and-spoke to different pharmacy owners.” 

The previous government had equally delayed any legislation around the model, publishing its hub-and-spoke response more than two years after launching a consultation in March 2022, having previously held a consultation on the model in 2016. 

The continued delays were the subject of focus at a recent parliamentary debate calling for government investment and support for community pharmacies on 17 December – just 6 days before Kinnock’s announcement. 

Speaking at the debate, MP and pharmacist Sadik Al-Hassan shared he was “eager to see this government avoid the mistakes made during the past 14 years that have brought our sector to a crisis point”. He claimed this “can only be done by finally implementing the hub-and-spoke legislation, which was inexplicably shelved in September without warning or explanation.” 

“The hub-and-spoke model would allow smaller, independent community pharmacies to finally take advantage of the technologies larger chains have been utilising for decades, greatly increasing their efficiency and freeing up time previously spent on dispensing towards delivering clinical services to patients under an expanded Pharmacy First scheme.” 

Al-Hassan, who is also vice chair of the All-Party Parliamentary Group on Pharmacy added “we have a once in a generation opportunity to rewrite the story of pharmacy”. 

 

What exactly is being proposed? 

Currently, hub-and-spoke dispensing is only permitted between pharmacies within the same legal entity. The proposed legislation would allow for smaller independent pharmacies, who have previously been excluded, to benefit from the same model, as pharmacies belonging to different legal entities will be able to use hubs operated by other companies.  

While the current government have not yet outlined all the details surrounding the introduction, the previous government’s proposed models can be found on the Department of Health & Social Care website. 

 

Model One 

“The patient presents a prescription to the spoke. The spoke then sends the relevant information on to the hub so that they can carry out their agreed dispensing actions. The hub then sends these dispensed medicines back to the spoke, which may have further responsibilities to perform such as providing advice on the medicine to the patient, before supplying them to the patient.” 

Model Two 

“The same pathway is followed in that the patient presents a prescription to the spoke, which then sends the relevant information to the hub. The hub then assembles and prepares the medicine before supplying the completed order directly to the patient.” 

 What are the benefits of hub-and-spoke legislation? 

The idea is that this will create a level playing field between smaller pharmacies and larger chains, and that these changes will allow pharmacists to dispense medicines more efficiently, providing them with more time to engage with patients and deliver clinical services.  

When the legislation allowing for universal hub-and-spoke dispensing was first announced, Andrea Leadsom, the then Pharmacy Minister, said: “These proposals will level the playing field and enable our hard-working community pharmacies to benefit from centralised dispensing.” 

“It will also free up highly skilled pharmacists from back-office duties to deliver patient-facing services, including Pharmacy First and contraception consultations, supply medicines and provide advice.” 

Having implemented a hub-and-spoke model in 2023, Lo’s Pharmacy Group claimed in an interview with Pharmacy Business to have greatly benefited. Since implementation, the group “has freed up an average of four hours per day for their pharmacists working in branch.” 

“Errors have decreased due to the barcode technology and in terms of stock, the key has been less wastage. Instead of 39 pharmacies all having their own stockpile, we pull drug usage data to inform our stock holding and this results in a lower chance of wastage,” says Chris Lo of Lo’s Pharmacy Group. 

“Going forward as we grow in the number of pharmacies, we can scale our hub operation as needed. It is a crucial resource to help our pharmacies cope with an ever-increasing workload, with services like Pharmacy First now taking centre stage,” he added. 

 

Concerns from the sector 

The hub-and-spoke concept is not without its critics. When the government initially announced the delay in September, Gordon Hockey, Director of Legal at Community Pharmacy England, said: “Community Pharmacy England broadly supports the introduction of changes that would allow hub-and-spoke dispensing to occur between different legal entities, but they need to be introduced in a way that is safe for patients and does not lead to a proliferation of hubs that can dispense directly to patients, which would undermine market entry controls. Without controls on hubs, the community pharmacy market could be disrupted.” 

“We are also concerned that while hub-and-spoke dispensing may potentially release capacity in community pharmacies, there is no evidence that it will lead to financial savings for the sector. In addition, any activity saving will come at a cost, and given the critical state of pharmacy finances, pharmacy owners may not be able to invest in this at the moment.” 

While many welcome the government’s recent announcement, the sector is still looking for clarity around how the government will address key concerns surrounding the implementation, including patient safety and funding. 

Claire Anderson, president of the Royal Pharmaceutical Society, told The Pharmaceutical Journal on 3 January 2025: “We welcome clarity on plans to better enable community pharmacies to make use of hub-and-spoke dispensing.” 

“While this model could improve efficiency, it must prioritise patient safety and transparency. Patients must know where their medicines are supplied from and feel confident that data are protected.” 

Most significantly, there are concerns around how the patient–pharmacy relationship could be affected, and who would be held accountable if something went wrong. The previous government’s proposed Model Two in particular has been the subject of controversy within the sector.  

At the time that the previous models were proposed by the former government, the Royal Pharmaceutical Society raised safety concerns over medicines going directly from the hub to the patient, while Community Pharmacy Wales stated model two “has the potential to damage our market and has no place in Wales.” 

Other concerns include the large upfront costs of the model for smaller pharmacies. CCA’s Malcolm Harrison, despite generally advocating for the legislation to be rolled out, previously stated in 2022: “Given the huge upfront capital investment and ongoing operating costs of hub-and-spoke dispensing models, and the financial strain all pharmacy businesses are currently facing, we think it is unlikely the sector with be able to benefit from these changes.” 

“We support the Department’s intention to release clinical capacity in community pharmacy. Unfortunately, however, the proposed changes will not release any capacity unless the government’s funding for medicines supply is increased”. 

Writing in Chemist and Druggist in 2022, Ian Strachan, Pharmacy Owner and Board Member of the Independent Pharmacies Association (IPA) stated “The merits of hub-and-spoke dispensing are shrouded in misconception and a profound ignorance to the fundamentals of operating at the spoke.” 

“These challenges, to my mind, must be overcome if hub-and-spoke dispensing is to become the norm. Until they are, I will continue to raise questions and seek assurance that this is the appropriate model for the future of pharmacy.” 

Despite over 2 years passing since the former government’s initial proposal, much uncertainty remains, and many argue these challenges have still not been addressed. With Wes Streeting’s recent statement that he wants “a bigger role for community pharmacy as part of the shift from hospital to community,” conversations around how the government will address these concerns will come to the forefront of discussions, particularly regarding how this all aligns with the upcoming contract negotiations. 

CPE has stated that the DHSC will “continue to discuss the relevant issues” around hub-and-spoke-dispensing with the negotiator.