By Rob Darracott

For many, how the NHS is structured feels irrelevant for the jobs they do day by day. However, as Adam Irvine says, this reorganisation “feels a little different”. He’s upbeat about the opportunities that might flow from bringing together an array of health and care bodies with a focus on tackling inequalities and improving population health. I hope there are others who share his view and who also have the right relationships on the ground – this shift has been a long time coming. 

The ambitions for Integrated Care Systems (ICSs) were writ large at the NHS Confederation’s virtual conference last month. There’s plenty of food for thought in our report. I was particularly struck by Louise Patten’s comments that ICSs represent “the fundamental shift towards collaboration as the driving force towards improvement,” and Imelda Redmond’s wish to build on the learnings from Covid by “looking around to see what our assets are... and distributing power to where the best decisions can be made”.

Our update on the saga community pharmacy representation in England is rapidly turning into, makes for more sober reading. More than 18 months have passed since Professor David Wright’s review was commissioned, and we’re now at the design principles stage. Importantly, these address governance, cost and equity for contractors in any new configuration of what the new PSNC and LPCs should deliver, but they seem to be missing a vital piece of context – the NHS. 

A major transformation of the system community pharmacy contractors work in may deliver a very different commissioning environment, so what kind of representation will community pharmacy need in 2022? What functions, at what level, will deliver on the opportunities people like Adam see coming out of the new system, place and neighbourhood configurations? 

For their part, speakers at the Confederation conference were alive to community pharmacy. “ICSs will need to develop the voice of pharmacists locally, and understand their roles and potential roles in supporting communities,” said one. But I’m struggling to see how you decide what representation you need where, nationally and locally, without a clear sense of the improved outcomes you are trying to achieve, and which will make the case to those who pay the bills.  

There’s a negative view about outgoing NHS chief executive Sir Simon Stevens in some pharmacy circles, but nobody can deny his health system management credentials. Sir Simon was talking about ICSs when he advised: “Don’t start with governance and management structures. Agree the outcomes and reverse engineer.” 

As community pharmacy contemplates organisational redesign just as the landscape around it is changing, he might just have a point.