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Confirmation of a 50% cut to headcounts at integrated care boards (ICBs) could “set NHS ambitions back”, Ewan Maule, chair of the ICB Chief Pharmacist Network, has warned.
Speaking at the NHS Providers’ annual conference, held in Manchester on 12 November 2025, health secretary Wes Streeting confirmed the overhaul, which was first announced in April 2025.
“ICBs will be tasked with transforming the NHS into a neighbourhood health service, with a greater focus on preventing illness. It will mean they will be leaner organisations, with half their current posts removed,” he said.
Streeting also confirmed that the functions of NHS England will be “brought back into the Department of Health and Social Care” within two years, adding that the structural changes will save the health service £1bn per year.
Ewan Maule, chair of the ICB Chief Pharmacist Network, told The Pharmaceutical Journal that the language used in the announcement was “disappointing and dismissive” of the expertise of ICB staff.
“These are not administrative roles, and they are not red tape or bureaucracy,” he said.
“They are clinical leaders, medicines experts and strategic commissioners ensuring that the NHS in England gets good value for the £20bn it spends every year on medicines.
“One of the unintended consequences of the reforms and the way they are being implemented will be that many operational and assurance functions currently held by ICBs or NHS England regional teams will need to be picked up elsewhere,” he added.
“In practice, this will mean providers having to work together much more collaboratively, particularly across care interfaces, to maintain safe and effective access to and use of medicines. This has the potential to detract from service provision and will require development of a different set of skills. Professional leadership will be critical during this change.”
“While many pharmacy staff will remain employed within ICBs, the disruption and distraction caused by these changes — landing right in the middle of winter, the NHS’s most pressured period — combined with the inevitable loss of organisational memory, are likely to set NHS ambitions back, at least for a period of time.”
The Royal Pharmaceutical Society (RPS) has also expressed concerns over the 50% cut to ICB headcounts.
Tase Oputu, chair of the RPS’s English Pharmacy Board, said that pharmacists and pharmacy teams are “essential to delivering the ambitions of the ten-year health plan”, warning that the cuts raise “profound concerns about the sustainability of our workforce, the wellbeing of medicines optimisation staff and ultimately, the safety and quality of patient care”.
“Pharmacists and their medicines optimisation teams within ICBs are integral to achieving medicines value and improving population health at a local level.”
“The government’s vision for ICBs to lead strategic commissioning is inseparable from the role of medicines optimisation, which ensures that every decision on medicines supports better outcomes, safety and cost effectiveness,” she said.
“Removing or diminishing this function risks eroding the very foundation that enables patients to receive the right medicines, at the right time, in the right way. These roles are not ‘unnecessary bureaucracy’ or ‘administrative posts’; they are essential to delivering system-wide efficiency and equity in care.”
Oputu added that as the NHS moves towards greater provider collaboration and localised decision-making, the medicines agenda “cannot be treated as an operational afterthought”.
“NHS England’s own medicines optimisation good practice guidance warns of ‘serious risks to patient care, system performance and financial sustainability’ without a strong strategic medicines optimisation function at ICB and system level,” she said.
“We urge decision-makers to recognise that cutting medicines optimisation capacity is not a saving; it is a false economy that jeopardises patient outcomes and the resilience of the NHS.”
Commenting on the structural changes to the NHS in England, Henry Gregg, chief executive of the National Pharmacy Association, said the organisation is “strongly in favour of diverting funding to the front line of care in our communities”.
“Despite a funding increase in the spring, pharmacies are still facing the legacy of historic underfunding that has closed thousands of pharmacies,” he said.
“There is a huge opportunity to increase healthcare for people in pharmacies on their doorstep with modest investment. That will ease pressure across the NHS, unlock GP and hospital appointments and make it easier for people to get fast treatment and health advice to prevent disease.”
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I agree with all the points about pharmacy being essential to ensuring medicines safety and cost effective medicines optimisation. I’d like to point out that ICBs have to reduce running costs by 50% not head counts of staff. Each ICB has its own target based on their cost saving plans and achievements and in some cases their running costs may not have to reduce by as much as 50% based on work they have already done. They have to deliver plans to bring deliver the required services at a specific cost per head of their ICB population. Some ICBs are clustering (working together not merging at this point) as they may be able to work more efficiently this way. It also does not mean that one ICB offsets the savings required by another, all have their own targets. It sounds complicated because it is- Ewan Maule rightly points out that people working in ICBs are specialists, experts and work hard to deliver safe and effective services with their providers and partners. Medicines optimisation surely does need to continue to be an essential part of the agenda.