Short-term savings, long-term costs: what cuts to medicines optimisation teams could mean for the NHS

In March 2025, then health secretary Wes Streeting announced a swathe of NHS reforms.

Among these was a mandate for integrated care boards (ICBs) to halve both their running costs, known as the ‘model ICB blueprint’, and their headcounts.

It is pharmacists who are feeling the brunt of these cuts in local medicines optimisation teams. Initially known as ‘pharmaceutical advisers’ in the 1990s, before evolving into medicines management teams in the 2000s, medicines optimisations teams have been present in the NHS since clinical commissioning groups formed in 2013.

ICB guidance states that these teams are tasked with enabling “the best possible outcomes for patients and value for the NHS and taxpayers by tackling — for example — problematic polypharmacy, antimicrobial resistance (AMR), variation in access to effective treatments, medicines sustainability and the safety of high-risk medicines”^​1​.

These are all increasingly urgent priorities for the NHS. 

In 2025, NHS England set a target to realise £1bn in medicines savings by 2029^​2​. However, latest data, published in November 2025, show expenditure is going in the wrong direction, with an estimated £21bn spent on medicines in 2024/2025 — a 5.3% increase on spend in 2023/2024^​3​. At the time, the NHS Business Services Authority said that it showed a “continuation of the rising trend in the amount spent across all areas of prescribing”^​3​. 

Meanwhile, giving evidence at a House of Lords Science and Technology Committee session on 24 June 2026, Jonathan Benger, chief executive of the National Institute for Health and Care Excellence (NICE), expressed concerns over the delay between NICE approval of a treatment and the NHS’s provision of that treatment to patients.

“There is a funding mandate that says that those medicines should be provided within 90 days of a positive NICE recommendation, and we know that that doesn’t happen universally,” Benger said.

A few days later, on 29 June 2026, a national AMR surveillance report published by the UK Health Security Agency (UKHSA) revealed an increase in cases of bacteraemia resistant to one or more critically important antibiotics by 13.1% from 2019 to 2024, reaching 20,484 episodes in 2024 — an average of nearly 400 resistant cases per week.

Where are cuts happening?

Despite the clear need for pharmacists focused on these issues at local levels, ICBs have confirmed to The Pharmaceutical Journal that they intend to reduce headcount within medicine optimisation teams.

“As part of the wider organisational changes being implemented across integrated care boards, the medicines optimisation team within NHS North East and North Cumbria ICB is undergoing changes to its structure and ways of working,” says Ewan Maule, director of medicines at North East and North Cumbria ICB.

“The team will see a reduction in headcount as part of the ICB’s overall workforce changes; however, the medicines optimisation function is not being merged with other teams and will continue to play an important role in supporting the safe, effective and cost-effective use of medicines across the health and care system.

“While some roles are changing, we remain committed to maintaining strong pharmacy leadership within the organisation. As part of this, we are currently recruiting to a new community pharmacy clinical lead role, which will help strengthen our engagement with community pharmacy and support the delivery of key clinical and strategic priorities across the system,” Maule adds.

As a result of the cost reduction targets, some ICBs are ‘clustering’ with others to save costs. The resulting mergers mean cuts to some medicines optimisation teams.

A spokesperson for NHS Dorset ICB says this is the case as it merges with NHS Somerset and NHS Bath and North East Somerset, Swindon and Wiltshire ICBs from April 2027. 

“After an extensive consultation, the medicines optimisation teams are being aligned with changes in roles and responsibilities focusing on strategic commissioning. This will result in the three legacy ICB teams being merged and more than a 50% cut in head count across the cluster ICBs,” they explain, going on to confirm that 24 posts from the medicines optimisation teams had either been cut from the clustering ICB organisations or been affected by the consultation.

Meanwhile, a spokesperson for NHS South Yorkshire ICB has also confirmed cuts to its medicines optimisation team. “Following an extensive period of consultation with staff, the ICB has now confirmed the outcome document for the organisational structures required to deliver the Model ICB Blueprint and meet the reduced operating cost budget of £30.6m (a 51% reduction). 

“This is reflected in the reduced size of the retained medicines optimisation team (sitting with the chief medical officer portfolio); they will be responsible for delivery of statutory requirements related to the safe and effective use of medicines.”

Four ICBs — Shropshire, Telford and Wrekin; Staffordshire and Stoke-on-Trent; Lancashire and South Cumbria; and Thames Valley — have confirmed they are still consulting on changes to their teams.

What does this mean?

Speaking at the Community Pharmacy and General Practice Conference in Birmingham, West Midlands, on 22 June 2026, Adrian Hayter, medical director in clinical policy at the Royal College of GPs said the changes to ICB medicine optimisation teams “will be at the detriment of managing our patients”.

“If we start to let go of those medicines optimisation teams, we’re not going to be able to collaborate, and we’re not going to improve the care and live within the resources that are allocated to us,” he explained, referring to collaboration between GPs and pharmacists. 

Accoring to Maule, the reduction in medicines optimisation teams will mean a change in ways of working, but also a loss in expertise. “The reduction in resourcing of medicines optimisation teams across ICBs will inevitably mean we need to work differently,” he explains.

“That is consistent with the direction of travel for ICBs as strategic commissioners: less direct delivery, and more focus on using data, clinical leadership, commissioning levers and system influence to improve outcomes, reduce variation and make best use of NHS resources.

“But we should also be honest about what is being lost. Across ICBs, medicines optimisation teams include incredibly valued and valuable colleagues, many with deep expertise, local relationships and organisational memory that cannot simply be replaced overnight. 

“Their contribution to patient safety, prescribing quality, access to medicines and financial sustainability has often been significant, even when it has not always been visible.”

Perception of teams

Also speaking at the Community Pharmacy and General Practice Conference, Danny Bartlett, clinical lead at Kent, Surrey and Sussex Primary Care School, and associate programme lead in postgraduate pharmacist prescribing at the University of Brighton, suggested that visibility of medicines optimisation teams has been part of the problem in leaving them vulnerable to cuts.

“I’ve had medicines optimisation teams at an ICB level allocated to my practices or primary care networks, and I’d go as far as to say that they’re hamstrung by the structures that created them,” he told delegates.

“They don’t have the ability to do two days a week in practice [and] one day a week of clinical leadership, where they can say, this is what I’m seeing on the ground, this is what my patient population needs.

“It’s the equivalent of the community pharmacy having the most qualified independent prescribing pharmacist, and then locking them in a stock room, and getting them to date check. Why are we not using all the skills of the pharmacists in medicines optimisation teams?”

Having seen how ICBs have restructured, he pointed out that medicines optimisation teams “didn’t make themselves unavoidable to be reduced, and we’ve seen them shrink loads”.

How should teams work in the future?

With the scale of the cutbacks in medicine optimisation teams still to be confirmed as many ICBs continue consulting their workforce, Maule says the challenge for ICBs now “is to preserve that expertise and influence in a different model”.

“ICB medicines optimisation teams will continue to act professionally and do an excellent job, but the nature of that job will change,” he says. 

“The future role will be less about doing everything directly, and more about shaping the conditions in which safe, effective and value-based medicines use happens across the whole system.”

Both he and Barlett have suggested embedding medicines optimisation pharmacists as clinical leaders.

“Imagine if you freed up one of their days — and it was funded through the ICB — and you said… go out to that practice and run a chronic disease clinic for them, but they [the practice] determine what they’re struggling with,” Bartlett said at the conference. 

“They might have had an asthma nurse retire, they might be struggling with their CVD data, and if you offer a day a week as a clinic, I guarantee you’re taking back messages to your medicines optimisation team in the ICB, with real intuitive things that you’re seeing on the ground.”

Maule adds: “Pharmacy leadership cannot sit only within ICB medicines optimisation teams. ICB chief pharmacists and medicines optimisation teams will continue to be valuable and vocal system leaders, but the next phase will require leadership from all parts of pharmacy: hospital, community, general practice, mental health, primary care networks, academia, industry and national bodies. 

“If more responsibility moves closer to providers and neighbourhood teams, pharmacy leaders in those settings will need to step forward too.”

It is a period of transition for medicines optimisation teams. As they are reduced or reconfigured in some areas, emerging models point towards more system-wide, collaborative approaches to delivering this work. As the NHS ten-year plan progresses and care is brought into neighbourhoods, perhaps medicines optimisation teams will be brought to the frontline, highlighting their value.

How these evolving structures operate in practice — and the extent to which they can maintain focus on quality, safety and value — will shape the future role of medicines optimisation across the NHS.