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He may have left Westminster but Steve Brine has kept up his ties with the pharmacy sector. He tells Arthur Walsh why real change hinges on political will 

The job title of ‘pharmacy minister’ is perhaps not the most prized in government, with some incumbents viewing the post – officially, minister of state for care – as a pitstop between the back benches and a plum job in, say, the Foreign Office.

Steve Brine, the Conservative MP for Winchester from 2010 until he stood down before last year’s general election, is a little different in this regard. 

Having held the position of primary care and public health minister (as it was then billed) from June 2017 to March 2019, Steve – currently an adviser to health tech companies and co-presenter of the podcast ‘Prevention is the New Cure’ – has kept a keen eye on developments in the pharmacy sector ever since. 

As chair of the health select committee from 2022 until standing down as an MP, he spearheaded a landmark report that spoke of pharmacy’s potential as well as the terrible pressures it faces. 

And even now after leaving parliament, he is a frequent commentator on sector affairs. “Why do I do that? Because I have a lot of friends in the sector. And I think they’re people whose heart is in the right place. I keep close interest in it because I genuinely think it is part of the way the NHS survives. 

“I hope this government will cherish them and go even further than they’ve gone in the current deal to make sure they survive.” 

He explains that when Theresa May offered him a ministerial post after the June 2017 election his priorities were clear. “Most people just want to be a minister – I didn’t want that,” he says. 

He told May: “I want to be the public health and cancer minister.” He didn’t have a clinical background, “but when you go into parliament, you bring your personal experiences”. 

Having lost his mother to breast cancer two weeks before his wedding, upon first entering parliament he chaired an all-party group dedicated to the disease. “I was therefore known for health and cancer issues.”

He worked under Jeremy Hunt – “probably my closest friend in politics” – who was a divisive figure but whom Steve believes should rank highly in any list of top-performing health secretaries due to his focus on patient safety. “I appreciate junior doctors would take a different view,” he adds wryly. 

He came to the department with some familiarity with primary care through his constituency work, but getting to know the provider network better he soon saw a “massive opportunity” – particularly in community pharmacy. 

Perhaps unsurprisingly, officials told him general practice was top of his worry list. Looking at that sector, he saw a workforce “that was burnt out, that was leaving”. 

Pharmacy was in strict contrast: “I had a workforce in pharmacy who were really very positive. They said, ‘We want to do more – we’re passionate about our mission, we’re trained health professionals and medicines specialists.’” 

He took great interest in the hypertension pilots in the North East of England and told civil servants: “I want us to supercharge primary care with pharmacy at the heart of it.” 

But persuading Number 10 was a real battle, he says. “It was hard enough to get the machine on board when you had a pharmacist’s son in Number 10, but at least Rishi Sunak launched Pharmacy First. With Theresa May’s government I was constantly trying to make the case for what I thought primary care could do.” 

Was pharmacy seen as an expense? “Well, it was another expense. They’d obviously reduced the pharmacy budget in order to meet the bounds and restrictions of austerity – an absolute non-negotiable.” 

We get on to the topic of pharmacy’s analogue to digital shift, which Steve says has been very bumpy. “The cherished place of read access [to patient records] has finally been realised but that’s nowhere near enough. Pharmacy is still working with one hand behind its back.” 

What is the main barrier? “Political will. Ultimately, everything is politics and everything is political.” He was working to get read access during his own time as minister and “making people see it as a priority was a challenge”. 

“There now needs to be some political will to drive through the full access to make sure that is happening. That’s a patient safety issue.” 

He doesn’t quite agree with me that pharmacy has often been overlooked by politicians. “Pharmacy had been very much looked at, but in the wrong way. Remember, I became a minister in 2017 off the back of the David Mowat cuts and the austerity years. The pharmacy sector was reeling, fuming – some would say it’s still fuming.” 

But he thought investing in the sector was a no-brainer: “If you wanted to achieve a shift from hospital to community – we had said as government we wanted it, we just phrased it differently [to Wes Streeting] – then you have to consider pharmacy to be part of that.” 

The early work on hypertension and minor ailments “sowed the seeds that would become Pharmacy First,” he says, adding that helping to lay this groundwork remains one of his proudest achievements in politics. 

Steve acknowledges that Pharmacy First is not “reaching anywhere near its potential” but says it’s “achieved a heck of a lot more than before I came to government – it didn’t exist”. Nonetheless, it is still “only just on the surface of the public consciousness” and for many the first port of call is still the GP. “We’ve got to try and change that mindset,” he insists. 

New deal ‘isn’t enough’ 

We speak the week after the news of the 2025-26 pharmacy contract launch. What state is the sector in now? After years of underfunding and rising closures, few seem happy with the settlement. 

He broadly agrees that it is insufficient but argues it is progress nonetheless. Referring to the select committee report, he says: “We had a whole raft of recommendations, one of which was that there needs to be a rise in the global sum and the single activity fee, all of which has happened in the funding deal.” 

He gives credit to Stephen Kinnock, the present pharmacy minister, who “battled” hard for these measures and the £193 million margin write-off – but dismisses his rhetoric around ‘undoing 14 years of damage’: “Not true. Plenty of good things happened in pharmacy.” 

But surely there is truth in the claim that the cuts did untold damage? “Yes, but the funding went down in the austerity years, and then went up again. There’s a psychological barrier to it going above £3 billion for the global sum, which is good. You can’t get away from that.” 

He says of the austerity years, “we can debate whether that was right or wrong – whether it was political and an economic necessity”.

And even with the new cash injection pharmacy is “still in a perilous state,” he believes: “I suspect the new deal will stem closures but not stop them. I suspect pharmacy owners and chains across the country are right now sitting down and working out whether they could continue to make it work under the deal that’s been agreed.” 

He rates Community Pharmacy England (CPE) chief Janet Morrison – “she’s doing her best”. He notes her comments that the CPE board “reluctantly” accepted the deal, which to him suggests “that they know it’s not enough and that they’re going to have to come back for more”. 

“They don’t want to start their relationship with the new government refusing the deal and having it imposed upon them,” he surmises.

“Their view is, better to be in the room and keep those relationships good and solid.”

Could another negotiating team have got a better deal out of the Government? “No. Ultimately, the department went into that negotiation with instructions from Treasury and would have been told very clearly what their red lines were. What they’ve done is move the pieces around within the deal and they’ve increased the global sum but something else will always give to make the global sum add up. 

“The only thing Stephen Kinnock did say was, we’ll have to wait and see what the spending review brings. That will be in June-July, around the time of the 10-year plan. I suppose – I hope – he’s saying there’s a submission going in from the department to continue the turnaround of pharmacy.” 

Right now, many pharmacists are “worried sick” about the rise in employment costs, says Steve. He takes a dim view of Labour’s two pharmacist MPs – Sadik Al-Hassan and Taiwo Owatemi – joining their colleagues in voting down a Liberal Democrat amendment to the fi nance bill that would have exempted pharmacies from paying the new rate of national insurance. 

“If you seek to represent pharmacy in parliament you really have to vote [that way].” He goes on: “It’s not about what you say in parliament, it’s about what you do. Those who now seek to represent pharmacy in parliament need to vote that way because the next rise is going to hurt.” 

The Labour argument was that taxation can’t be picked apart like that. Does Steve agree? “No. In a finance bill, anything can be done.”

And what about Steve’s own decision to vote with the Conservative whip against a Labour Opposition Day motion in November 2016 opposing huge cuts to the sector’s funding? 

“I didn’t represent the sector in November 2016,” he replies. “And of course, Opposition Days are partisan political knockabout whereas a finance bill when you’re in government changes the law.”

 Jury’s out on Labour 

As someone closely familiar with the workings of the Department of Health and Social Care, Steve has a unique perspective. I ask him to rate the government’s performance to date. 

“Labour are full of very good ambitions,” he replies. “I rate Wes as a person and as a politician. Do I rate Wes as a secretary of state? The jury’s out, because Wes hasn’t yet done anything.” 

With the abolition of NHS England (NHSE) Streeting will have much more control over policy than any health secretary since the Lansley reforms. 

“With that comes 100% of the power and 100% of the responsibility,” cautions Steve. He says Streeting’s ‘three shifts’ – from hospital to community, treatment to prevention and analogue to digital – are “absolutely right” but adds: “There’s nothing about those three shifts that any health minister in the last 30 years hadn’t said, including me.” 

Pharmacy is “beautifully placed” to support these ambitions, he thinks, but wonders if Labour’s 10-year plan will have enough meat on it to make them a reality – and whether the party has “the political will to drive them through.” 

He fears the plan will “underwhelm people,” adding that these endeavours tend to be full of topline ambitions and bare-bones on the details. 

“And I daresay pharmacy will be in the same place it’s often in: Wondering what its future looks like.

“I fear that health policy is more evolution than revolution. That sounds terribly sensible and British, but the thing about revolution is that at least you know where you want to get to. You want to storm the palace and change the government. 

“In an evolving health policy situation, it makes me wonder whether they really have any idea where they want to end up. I still think the jury is massively out on that.” 

There are the ongoing tumbleweeds regarding Labour’s manifesto pledge to launch a community pharmacy prescribing service, and other unanswered questions besides.

“The National Care Service in their manifesto, nobody has any idea what that looks like. They don’t know what they mean by it – or by neighbourhood health centres either, I think they’re working it out as they go along.”

Is that embarrassing for Labour? It’s par for the course, Steve replies. He is not uncharitable to Streeting – “a highly driven individual who grew up in a very difficult family situation” – and believes the health secretary when he says he wants to improve access. 

“That’s all very laudable. He’s also a fantastic communicator, which helps. Whether he can turn that into change on the ground remains to be seen.” 

The only path to success Steve sees is to take the power he is shoring up from the central NHS and devolve it back down to the Integrated Care Board (ICB) level. 

“If he does that, he could be a truly great health secretary. If he doesn’t, he could be another one who’s rearranged the deckchairs on the Titanic.” 

On the whole, he is sceptical about how the NHSE decision will play out. “I would bet you that a couple of months ago they didn’t have any idea they were going to scrap it.” 

He puts himself in the shoes of a Labour wonk: “What’s the biggest quango? It’s the NHS. We’ve already forced the chair out. We’ve effectively forced the chief executive out. The medical director’s retiring early, the chief financial and chief operating officers are leaving… You end up with a situation where by evolution you’ve got NHSE basically falling apart. 

“I wonder whether they understand the live systems that NHSE runs every day. Right now, they run live systems for patients – I just hope they have thought this through. It’s not just bureaucrats who are second guessing ministers on policy, which is what the narrative is. If you take bricks out of a wall and don’t have a plan, guess what happens? The wall falls on you. And that is my fear.”

“The much less reported story [than NHSE abolition] is that ICBs have been told to cut costs by 50 per cent, and they’re already running a massive deficit,” he says, adding:  “There’s only so many paper clips you can save. What you’re really going to have to do is merge smaller ICBs into larger ones.” 

Divide and conquer 

 

One of his ambitions as minister was to tackle infighting in primary care. “I always remember visiting a GP practice when I was a minister and there was a sign saying come here for your flu jab, not ‘insert pharmacy name’ down the road.” 

“It felt a bit like, it’s my toy and if I can’t have it no one can. That’s not good enough. That for me was the absolute embodiment of what had gone wrong. It shouldn’t be a competition between those providers, they’re all primary care.” 

As pharmacy minister he tried to tackle this mutual suspicion he says, explaining that ICBs and primary care networks (PCNs) were created in part to iron out some of these differences. 

However, they “have not worked out as Jeremy and I had hoped… PCNs are still heavily weighted in favour of GPs and ICBs are heavily weighted in favour of the acute sector”.

But he thinks local pharmaceutical committees should be at the heart of primary care: “They are every bit as primary care as GPs.” 

Asked if this reflects a failure on pharmacy’s part, he brings up the problem of infighting within the sector. “There is no question that when you want to pick up the phone to general practice, if you’re talking to the RCGP or the GP committee of the BMA that’s pretty much it.

“In pharmacy, you’ve got the NPA, CCA, CCPE, you’ve then got other smaller wannabe representative organisations with self-appointed leadership who all speak for pharmacy. 

“Government needs to hear one voice from one organisation because that’s how government works.” 

Otherwise, politicians “will always enjoy playing divide and conquer”.