You will have noticed that this has been a busy few weeks in health policy.
The resignation of Amanda Pritchard, chief executive of NHS England, (which had widely been thought probable, but not imminent) was followed by a range of other senior NHS England figures. The sheer number of departures being announced made the NHS England leadership feel like Heathrow in holiday season.
Also emerging around this time was the news of major cuts to NHS England on the horizon to reduce costs and duplication with the Department of Health and Social Care (DHSC). The initial speculation was that this would mean a loss of up to half of central staffing.
A farewell to arm’s length
However, few were anticipating that prime minister Sir Keir Starmer would announce that the arm’s length body that is NHS England was being abolished completely. Health secretary Wes Streeting’s statement to the House of Commons on 13 March 2025 gave further details: integrated care boards (ICBs), the local organisations charged with making the move to a more neighbourhood-based preventative health system, are to have their management budgets cut by a further 20%, on top of the previously announced 30%. ICBs are meant to be the local commissioning organisations in the NHS and replaced clinical commissioning groups (CCGs), which had previously replaced primary care trusts (PCTs).
In 2010, Conservative health secretary Andrew Lansley promised that he was ‘Liberating the NHS’ — in 2025, Streeting wants to recapture it. This is quite the U-turn, given that at the end of January, Streeting told Health Service Journal that he did not plan to abolish NHS England.
It is hard to avoid wondering what changed for Streeting in the subsequent five weeks, particularly given that less than two weeks ago he confirmed the appointment of Penny Dash as the new chair of NHS England.
Some voices suggest that the Treasury had a huge impact on this move, owing to its impatience with the NHS’s propensity to keep overspending. Others believe that Streeting became weary with NHS England’s lack of demonstrable enthusiasm for reforms.
While it is too early to be sure exactly what all of this will mean in practice, one thing is clear — the health secretary is back in full charge of the English NHS. Power, decision-making and blame are all now firmly re-centralised in the office that Streeting (for the time being) occupies.
What this means for pharmacy
On the face of it, the policy of a health system ‘triple shift’ (from treatment to prevention; hospital to neighbourhood; and analogue to digital) will not be changed. Nor will the priority to avoid any plans for overspending.
However, these changes will now be happening in a system undergoing another big structural shift, with many managers across the patch left uncertain about their jobs’ future.
So this may not be optimal timing for negotiations on the new community pharmacy contract. The National Pharmacy Association has warned that collective action, for which it has a strong members’ mandate, will start in April 2025 if no new funding is announced before then.
If the pharmacy profession decides that it needs to take action, then it must learn what worked well for the resident (formerly known as ‘junior’) doctors, who largely retained public support despite their industrial action going on for almost two years. The junior doctors had a very clear set of messages about the causes of their dispute, and they had a small and well-drilled group of their leaders doing all the communications and media appearances. They had, in short, fully learned all the lessons from their disastrous campaign against the new contract in 2016/2017.
It is unlikely the Department of Health and Social Care will have the bandwidth or desire for a difficult industrial dispute
The DHSC will have enough on its plate with the huge decentralisation of power caused by abolishing NHS England. It is unlikely it will have the bandwidth or desire for a difficult industrial dispute.
So, the profession needs to be smart in the asks of negotiations. The ‘triple shift’ largely moves in the direction of giving community pharmacy a permanently bigger role in delivering health services. Can the sector move into gaps in current provision, perhaps working co-operatively across a regional footprint, to improve medicines use reviews, health checks and disease registers?
Given the plans for ICBs to take on delegated responsibility for vaccination commissioning in April 2026, the regional footprint becomes of greater interest to the sector.
But there is, of course, a new element of jeopardy for ICBs, given the scale of management budget cuts they face (which come on top of a 30% cut in the past financial year). It is fair to question whether they will have the capacity and capability to act as the local strategic commissioners: the role that was envisaged for them.
In November 2024, Streeting told the NHS Providers conference: “The framework I’m setting out today is based on triple devolution: with power shifting out of the centre to integrated care boards (ICBs), to providers and, crucially, to patients. I want to lead an NHS where power is moved from the centre to the local and from the local to the citizen.”
The current and explicit change to a Streeting-led health service is the opposite of this.
In the same speech, Streeting went further: “I want ICBs to focus on their job as strategic commissioners and be responsible for one big thing: the development of a new neighbourhood health service. It will focus on building up community and primary care services with the explicit aim of keeping patients healthy and out of hospital, with care closer to home and in the home.”
Ambition is a wonderful thing, but there is a risk that ICBs are to be asked to make bricks without straw.
Andy Cowper is the editor of Health Policy Insight.
