My best wishes to all The Pharmaceutical Journal readers for a happy and healthy 2025.
The first health policy column of the year is being written the day after the government’s latest NHS reform relaunch, as news of hospitals and ambulance services being overwhelmed by winter pressures spreads. It is almost impressive how the NHS consistently manages to be taken by surprise by the wholly predictable annual event of winter.
Let’s be honest — there have been greater tidings of comfort and joy. However, we are where we are: in a not-unfamiliar mess at the start of the calendar year.
The government’s NHS reform relaunch focuses largely on elective care, albeit with a plethora of nods to moving care out of hospital settings, including a relaunch of the yet-to-be-perfected Pharmacy First service.
As The Pharmaceutical Journal reported on 7 January 2024, there was specific emphasis on Pharmacy First being used to cut long waits to access ear, nose and throat (ENT) services, “where around 30% of referrals currently made to secondary care could be provided in the community”.
The ‘Reforming elective care for patients’ plan, published by the Department of Health and Social Care (DHSC) and NHS England on 6 January 2025, has highlighted a case study of a community pharmacy-run hearing health programme in south west London, through which 20 pharmacies offered digital otoscopy, earwax removal and hearing checks. Results from the case study show that almost 70% of patients were able to complete their treatment as part of the programme and only 3% of completed appointments resulted in a recommendation for the patient to be referred to secondary care.
It is ironic that The Pharmaceutical Journal reported in April 2024 that this service was discontinued by the NHS South West London Integrated Care Board, owing to a lack of funding… but that is for another month.
Today, we will focus on the recommendation from the DHSC that NHS Agenda for Change staff should get a 2.8% pay rise for 2025/2026.
Tough economic climate
The DHSC’s written evidence to the NHS Pay Review Body, published in December 2024, emphasises that the “government is currently operating within an extremely challenging fiscal position”, which is not wrong.
The latest long-term borrowing news for the Treasury is disheartening, having highlighted that 30-year borrowing is at its highest cost level since 1998. This UK government bond sell-off reflects global trends, with global investors evidently fearing that the second Trump administration may pursue inflationary protectionist policies with its threatened tariffs on global imports.
All of this does not suggest that any great loosening of the government purse strings is imminent
In March 2025, the Independent Office for Budget Responsibility will issue its updated forecasts about the British economy’s performance. The forecasts will include a new estimate of the headroom that the government has against its fiscal plans.
However, all of this does not suggest that any great loosening of the government purse strings is imminent.
NHS England also recommended a 2.8% pay rise to the NHS Pay Review Body, based on the “likely NHS budget from discussions to date with DHSC” and the 2024 autumn budget.
“Every 0.5% increase above that costs around £700m, which is the equivalent to around 2% of elective activity (greater than 300,000 completed patient pathways),” NHS England added.
Pharmacists to be hit?
In July 2024, the government accepted the NHS Pay Review Body’s recommendation of a 5.5% pay uplift to NHS staff in England for 2024/2025. Unite the Union, which represents NHS staff and includes members of the Guild of Healthcare Pharmacists (GHP), announced in September 2024 that two-thirds of members had voted to accept the offer.
However, this time, Sharon Graham, general secretary of Unite, described the latest recommended pay uplift for 2025/2026 as an “insult”.
Graham said: “The NHS still desperately needs to attract more workers after 14 years of below-inflation pay increases.
“This latest below-inflation pay recommendation is an insult to dedicated NHS staff and further evidence that the [NHS] Pay Review Body is broken beyond repair. Unite has long been saying that NHS pay concerns must be resolved through direct negotiations with government.”
The GHP, which represents hospital pharmacists in England, was no happier. Rob Connah, president of the GHP, said: “The proposed pay recommendation of 2.8% does not address restorative pay for staff on Agenda for Change. Real-terms pay has been decimated for over ten years.
“People should consider recent increases in their outgoings — such as mortgages, rent, utilities and food bills — in addition to inflation and how 2.8% would compare to those.”
It is not helpful to the sector’s morale to have to consider the available trade-offs of either sucking up further low pay growth, or of looking at the possibility of taking industrial action against a relatively new government. The current public mood seems to be sour. Although the six-month-old government has lost opinion poll support at a striking rate, it is far from clear whether public sympathy would be with striking NHS workers.
The year ahead does not promise to be one of easy answers.
Andy Cowper is the editor of Health Policy Insight
