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As NHS England prepares to be subsumed back into direct control by politicians, Saša Janković considers what it all means for pharmacy

On 13 March Sir Keir Starmer announced the government’s plan to abolish NHS England (NHSE) as an arm’s length body and to move its responsibilities into the Department of Health and Social Care (DHSC) over the next two years.

It is mooted to save £2 billion a year of taxpayers’ money and bring management back into “democratic control” at the heart of government. 

Reports estimate the combined overall size of the two bodies will shrink by about 50 per cent, with the number of job losses hovering at around the 10,000 mark.

In addition, England’s 42 local integrated care boards (ICBs) are set to experience a similar shift, having been told to cut their running costs in half by December 2025.

This restructuring follows recent announcements from several senior leaders that they are leaving NHSE, including chief executive Amanda Pritchard and national medical director Sir Stephen Powis, while the interim CEO for NHSE, Sir Jim Mackay and new NHSE chair Penny Dash take over.

Scrapping NHSE marks a reversal of the 2012 Lansley reforms under the last Conservative government when it was created to run the health service.

Health secretary Wes Streeting says it marks “the final nail in the coffin of the disastrous 2012 reorganisation, which led to the longest waiting times, lowest patient satisfaction and most expensive NHS in history”.

Streeting said these “major reforms” will “empower NHS staff and put patients first” by putting an end to “the duplication” resulting from two organisations doing the same job in a system currently holding staff back from delivering for patients. 

By “stripping back layers of red tape and bureaucracy”, he added that “more resources will be put back into the front line rather than being spent on unnecessary admin”. So, what might this mean for community pharmacy?

Pharmacy bodies respond

Noting that there has been “real progress in advancing the role of pharmacists across the NHS”, Royal Pharmaceutical Society England Pharmacy Board chair Tase Oputu says: “It is vital that planned reforms do not lose sight of this crucial ambition.

"Fully funded, well-supported pharmacy teams across all sectors are essential for delivering quality patient care [and] we have asked the government for more details on any proposed transition and its impact on pharmacy colleagues. 

“It’s crucial that pharmacy continues to have representation in the reorganised NHS and that negotiations for the community pharmacy contract remain secure.”

Independent Pharmacies Association (IPA) chief executive Leyla Hannbeck says that while “any reforms that reduce bureaucracy and streamline administration in the healthcare system are welcome, the test for these reforms will be whether cost savings can be channelled back into frontline patient care”. 

She stresses that “the focus of this government must be investing in the front door of healthcare and primary care services such as pharmacies”. 

 “A reorganisation of the NHS should prioritise this aim, not distract from it,”she adds.

The National Pharmacy Association (NPA) has said it will “work closely with whatever structures the government establishes to secure and improve the vital pharmacy services upon which millions of patients rely”, but NPA chair Nick Kaye has this warning: “Ministers have inherited a crisis in pharmacy and need to do everything they can to prevent further damage to pharmacy services. We hope these changes release much-needed funds for the frontline.”

At the Company Chemists Association (CCA) chief executive Malcolm Harrison has also made it clear that they “support the government’s stated aim of streamlining decision making and redirecting funding to frontline services, including community pharmacies”, but reiterated that: “After 10 years of cuts and pay freezes, pharmacies are in dire need of a funding uplift.”

Meanwhile, Community Pharmacy England (CPE) says it “will continue to make the case for community pharmacy by working closely with whatever new structures and teams the government deems appropriate in the future” and remains “fully focused on the current CPCF negotiations taking place with both NHSE and the DHSC.”

As the union which represents pharmacists wherever they practice or are employed the Pharmacists’ Defence Assocation’s (PDA) reach includes those working within the central and regional NHS England functions and ICBs, although it says it is “too early” for most individuals to know what the restructuring will mean for their particular role.

Pharmacists’ responses

Calling the restructure a “dramatic change in England’s approach to the health service, and a level of reform which has not been attempted before”, PDA director of pharmacy Jay Badenhorst expects the changes “will have an impact on all areas of pharmacy practice” – but many pharmacists remain cautious about promises of a brighter future ahead.

Daniel Lee, CEO of HubRx and Pharmacy+Health, hopes the words from the PM about ‘stripping back layers of red tape and bureaucracy’ by abolishing NHSE, is backed up with action, notably in a contract for community pharmacy that does indeed ‘shift money back to the frontline’ and in driving innovation by pushing forward at pace with Model 1 of the planned – and yet delayed – hub and spoke legislation change. 

“It would be a crime for NHSE to be disbanded only to be simply replaced by government departments who are also content to move at a glacial pace, and that billions of pounds of taxpayer money aren’t wasted on driving further inefficiencies and more delays,” he says. 

Lee believes it would be very easy to blame NHSE for all the mistakes that have been made at the expense of community pharmacy but says: “In reality I think the failings are a result of a systemic problem that spans across not only NHSE, but also the DHSC, and our industry’s representative bodies. 

“Instead of having a focus on driving action to support community pharmacy – and ultimately better deliver patient care – they’ve become navel gazers tied up in knots by their own red tape. 

“I can say this with confidence, having seen it in action as we’ve tried to hold the powers-that-be to account on the planned legislation change to enable more pharmacies the choice to use hub and spoke to free up capacity for repeat dispensing”, he says, calling it “a painful, unnecessarily protracted process” with very little transparency or communication. 

“Ultimately what we need in community pharmacy is stronger leadership and accountability, and for implementation to be considered swiftly.” 

Graham Phillips, director and superintendent pharmacist of iHeart Pharmacy Group, is hopeful that subsuming NHSE back into DHSC might result in “a more supportive approach to pharmacy” and is optimistic about Wes Streeting’s potential views on pharmacy, noting that the health secretary has written positively and in detail about pharmacy’s potential. 

He also believes the restructure could provide an opportunity to strengthen the role of the chief pharmacist, which he says currently lacks significant resources and influence within the NHS. 

“The first change should be to increase the pay grade to be more comparable with chief medical and nursing officers,”says Phillips.

“And then to expand the team supporting the chief pharmacist, which will elevate the role’s visibility and importance within the NHS. 

“The chief pharmacist should be seen as a significant player, not an afterthought, which would give the position more meaningful input into pharmacy-related policy and strategy and create a more holistic view of pharmacy’s contribution to healthcare.”

However, while Phillips thinks the restructure is generally good news for pharmacy and for patients, he adds: “CPE needs to keep up pressure to ensure real improvements, as the pharmacy sector cannot afford to wait two years for changes. Only time will tell.”

For Reena Barai, independent community pharmacist at SG Barai Pharmacy, the light at the end of the tunnel could come from Streeting’s acknowledgement that: “We need more doers and fewer checkers.” 

“We do need things to move at speed in order to meet the various priorities that this government has for this country in terms of the NHS, and the Prevention Agenda is a big one which I really feel community pharmacy is well placed to lead on,” she says.

“I would love to see whatever comes out of this change allowing more local decision making. So for example, in my area, we’ve got a high population of diabetic smokers and I’d love it if community pharmacies can get commissioned to target patients who are diabetics and smokers.

"If this restructuring is going to make things less ‘top down’ and more ‘bottom up’ it would allow pharmacies to do more.”