Human Medicines (Amendments Relating to Hub and Spoke Dispensing etc.) Regulations 2025

Considered in Grand Committee

Moved by

That the Grand Committee do consider the Human Medicines (Amendments Relating to Hub and Spoke Dispensing etc.) Regulations 2025.

My Lords, as I know we all acknowledge, community pharmacies play a vital role in our healthcare system by ensuring that patients have access to medicines and acting as an easily accessible “front door” to the NHS. They dispense around 1.1 billion NHS medicines every single year.

Traditionally, all dispensing processes have been done in a single pharmacy or by a dispensing doctor. In hub-and-spoke dispensing, routine tasks such as sourcing, preparing, assembling and labelling medicines are carried out at a central “hub”, which is separate from the “spoke” pharmacy where the prescription is received. Hubs often make use of automated processes to realise economies of scale and to increase efficiencies. Such arrangements already exist in the UK, but the Medicines Act 1968 restricts their use to community pharmacies that are part of the same legal entity. Not all pharmacy businesses are able to invest in their own hub-and-spoke model, as compared with the larger pharmacy chains.

The Government are committed to supporting the community pharmacy sector and to cutting the red tape that frustrates it. The proposed changes have been a long time coming. If approved today, as I hope they will be, they will allow all pharmacies, including small independents, and dispensing doctors to utilise hub-and-spoke arrangements if they choose to do so.

Staff in hub-and-spoke arrangements report a calmer, more focused environment—I think we would all welcome that. In hubs, there are fewer disruptions and the use of automation reduces the risk of dispensing errors. At spokes, staff have more time for complex cases and patient care, making better use of their skills—something that the Government aim to support. The legislative changes we are debating will help all pharmacies and dispensing doctors realise these benefits, instead of limiting them to a few.

My Lords, I broadly support these regulations. I hope that my noble friend the Minister will not mind my intervening briefly to ask a couple of questions; I have no wish to detain the Committee.

Obviously, I understand that community pharmacies have been playing an increasingly expanded clinical role in treating minor illnesses and improving medicines’ safety and optimisation. To improve the efficiency of dispensing, these regulations will help support community pharmacies in taking on a more clinical role. The purpose of these regulations, which is to free up smaller pharmacies and enable them to undertake hub-and-spoke models, is, I am sure, a good one. First, does my noble friend the Minister have any idea of how welcome this will be to smaller pharmacies? Is it expected that a great deal of them will undertake these new arrangements outwith the previous restriction on being in the same legal entity?

Secondly, having recently been to my local pharmacy and having talked to the pharmacists there, I was struck by the strain that they are under, both in terms of their workload and financially. Am I right in thinking that this hub-and-spoke model, which will be made more widely available, will in some way help smaller pharmacies deal financially with the situations that they face? Am I wrong in thinking that there is a financial dimension to this? If there is, I would be very grateful for any reply that the Minister can give, but, in summary, these regulations are a step in the right direction.

My Lords, I am most grateful to the Minister for the comprehensive way in which she introduced this instrument, including how it corresponds with all the documentation that we have. I am glad to see that it applies to Wales; we have many small pharmacies with cross-border flow and many roads going across the border, so this SI will make things much easier.

Like the noble Viscount, Lord Stansgate, I have some questions. I hope that at least some of them will be answered; some of them may need time. One of my concerns is about how the finances of this will work, because pharmacies depend on a dispensing fee. Who will get the fee? Will that be down to local negotiation? Will the fee be split?

However, the principle of freeing up time for the pharmacist to undertake more clinical duties is to be welcomed. They are often the first point of call for patients now. They often know the patient. They spot the person who looks less well and can advise them appropriately. They can also advise on drug side-effects, if a person goes into the pharmacist and asks about new symptoms that they might have.

However, I wondered where the liability sits if there is an error. If I understood right, it would sit with the hub if it were in what is dispensed, but there may be a difference in liability for information given to the patient. One hopes this will never happen, but some of those governance issues need to be thought through in detail.

I note that the pharmacists are already taking impressive extended roles in some areas. For example, there is a scheme in Bristol where pharmacists are taking blood for PSA assessment and reaching a population who would not otherwise present for screening for cancers. If we have pharmacists doing more health screening that would certainly free up GP time. Again, pharmacists will need to be remunerated for that.

My Lords, I thank the Minister for outlining the purpose behind and need for these regulations.

On these Liberal Democrat Benches, we are of course open to innovation and efficiency in our healthcare system. We recognise the potential for modernising practices to streamline operations, to reduce burdens and, ultimately, to try to improve the delivery of medicines to patients. However, for something as sensitive and fundamental as dispensing medicines, the devil, as always, lies in the detail—as the noble Viscount, Lord Stansgate, and the noble Baroness, Lady Finlay of Llandaff, pointed out—so we must scrutinise these proposed changes with the utmost care.

The concept of hub-and-spoke dispensing, where a central facility prepares medicines in bulk for distribution to local pharmacies, is presented as a measure to free up valuable pharmacy time. The stated aim is to allow community pharmacists to engage more directly in clinical services, to provide vital advice, to manage long-term conditions and to offer preventive care. We wholeheartedly support this ambition; indeed, the Liberal Democrats have long championed the expansion of pharmacists’ clinical role as a cornerstone of accessible primary care. However, we must ask: will these regulations genuinely deliver on that promise, or do they instead risk creating a two-tier system, undermining our vital community pharmacies and, potentially, creating issues with patients being unable to get their drugs from their local community pharmacists?

I will set out our concerns. First, our primary concern is about the impact on the landscape of community pharmacies and patient access. As the National Pharmacy Association has pointed out, although large pharmacy chains may have the capital and infrastructure to invest in sophisticated hub facilities, enabling them to centralise dispensing, what about our independent local pharmacies, which are often at the heart of our communities, particularly in rural or deprived areas?

If the assumption is that hubs will be the large pharmacists, then page 22 of the impact assessment very clearly points out that the Government are not clear what sort of fee structure might emerge—for example, an annual fee or a fee per item. That is important, because if the hub also has pharmacies as part of its spoke and other pharmacies as part of its non-hub—namely, independent pharmacies—then we must ask: will the fee structure be the same or could there be a differential fee structure that gives competitive advantage to the smaller spoke that is part of the larger hub chain? That is an important point to tease out, so I hope the Minister can clarify that point.

Will these regulations inadvertently create an uneven playing field, putting unsustainable pressure on smaller businesses that lack the resources to adopt such models? We fear that this could lead to the closure of cherished local pharmacies, diminishing physical access to essential services and reducing patient choice, especially for the elderly, those with limited mobility or individuals who rely on familiarisation and trusted face-to-face interaction.

Secondly, we must consider the crucial matter of patient safety and the preservation of clinical expertise. The dispensing of medicines is not merely a logistical exercise but a complex, professional act demanding precision, clinical judgment and direct patient interaction. When this process is fragmented, with the initial dispensing removed from the point of patient collection, what robust mechanisms will be put in place to prevent errors and verify the correct medication for the correct patient? That is particularly important for complex prescriptions or for those requiring immediate consultation. We need absolute assurance that the pursuit of efficiency will not, even inadvertently, erode the critical layers of human oversight and professional accountability that safeguard patients. Furthermore, if the role of the spoke pharmacist is reduced to little more than a collection point, how do we ensure that their skills remain honed and their capacity for vital clinical intervention is maintained rather than diminished?

We on these Benches are supportive of the general thrust, but it is imperative that we get this right. The future of pharmacy must be one where professionals are empowered to do more for patients, not less. If the spoke becomes just a system of distribution and collection, this cannot come at the expense of local access, the viability of independent business or, more critically, patient safety.

I have a few questions for the Minister on these regulations. First, what specific and quantifiable measures have the Government put in place, beyond mere guidance, to actively support independent and small community pharmacies to invest in and adapt to the hub-and-spoke model, thereby preventing market consolidation and ensuring equitable patient access to the diverse range of local pharmacy services, especially in areas where alternative provision is scarce? Secondly, beyond theoretical assurances, what new rigorous and independent audit and real-world data collection mechanisms will the Government implement to continuously monitor the impact of hub-and-spoke dispensing on medication error rates and, crucially, on the quality and frequency of patient counselling at the point of collection, ensuring that the clinical role of the community pharmacy is tangibly preserved and enhanced, rather than being inadvertently diminished by these regulations?

As I say, we are generally supportive, but these regulations raise genuine concerns and questions that need to be teased out. We must ensure that, in our drive for efficiency, we do not inadvertently dismantle the very fabric of local healthcare that our local community pharmacists provide and compromise the safety interests of our citizens.

My Lords, I thank the Minister for introducing this statutory instrument in her usual succinct way and all noble Lords who spoke in this debate. We on these very efficient Benches—so efficient that we have only one person here today, which is very good for productivity—recognise the Government’s intention to modernise pharmacy through the introduction of hub-and-spoke arrangements and to increase efficiency and free up pharmacies to focus more on patient care, finally getting away from the 1945 model that we have been stuck with where patients try to get an appointment with their GP in the morning and, if they are fortunate enough to see them, get triaged off to a pharmacist or to secondary care. This is much more efficient, and we welcome it.

I also welcome what many other noble Lords have said about more diagnosis and testing occurring at the level of the pharmacy. As we saw, one of the silver linings of Covid was the fact that people got more used to home testing. If we can see more home testing and more pharmacy testing out in the community, maybe we can reach those communities that we have found very hard to reach until now. We thought about this lots when I was in government; all Governments think about how to reach those hard-to-reach communities.

That said, while the aim is understandable and commendable, we have some concerns. First, the Government have chosen to proceed with only one model—the patient-spoke-hub-spoke-patient model—rather than the two models proposed by the previous Conservative Government, the other of which was patient-spoke-hub-patient. We see this as a significant narrowing of options, particularly when the consultation revealed a divided response from stakeholders. As the noble Lord, Lord Scriven, said, while large pharmacies were very much in favour of the model that the Government ended up choosing, many smaller and independent pharmacies remained opposed, as well as patients and providers who may have benefited from the second model, where patients are dispensed to directly.

My Lords, I thank noble Lords on all sides of the Committee for their helpful contributions to today’s debate. I get a sense of support for where we are going and questions about how it will happen, which I completely accept. This instrument is part of a package of measures to relieve pressure in community pharmacy and improve patient care and the ability of the NHS to serve patients, particularly in a community setting—one of the main pillars of change for our NHS fit for the future. It builds on legislation that is already in place to enable pharmacies to increase efficiency by dispensing medicines in their original packs. Pharmacy technicians are now able to act under patient group directions to supply medicines, and the Government will shortly bring forward legislation to enable them to be authorised to do more in the pharmacy.

My noble friend Lord Stansgate raised a number of issues; he asked how it has been received and raised the financial sustainability and attraction of these measures. I reiterate that the changes being introduced are enabling. They are purely voluntary. It is entirely up to pharmacists, which are independent businesses—it is important to remember that—to decide whether they feel that engaging one, two or several hubs is going to be beneficial to their business model. It is up to them to decide.