The NHS ten-year plan sets out a bold, long-term direction for healthcare in England. But its implementation lands at a time of significant upheaval: the abolition of NHS England as a distinct organisation; a 50% cut to running costs across both NHS England and integrated care boards (ICBs); worsening provider deficits; and growing uncertainty about the future of community pharmacy and general practice contractual models and primary care networks (PCNs).
For pharmacy, this represents both a threat and an opportunity. Medicines remain the second largest area of NHS expenditure after workforce. Our profession — with clinical insight, close community accessibility and unique risk awareness — is perfectly positioned to help shape a more effective, affordable and patient-focused NHS. However, we will only do so if we step forward decisively and lead. Right now, our leadership infrastructure and professional culture isn’t ready.
Without visible, inspirational and strategic pharmacy leadership, system decisions about medicines — from access and affordability to innovation and deprescribing — risk being made without the necessary expertise. This not only jeopardises patient safety but may drive inefficient resource allocation at a time when every pound and every minute counts. The absence of strong professional leadership also risks reinforcing a narrow view of what pharmacy offers. If we aren’t present in system redesign, our role will remain defined by historic delivery models, not future potential. The cost of inaction is not just organisational — it’s clinical.
Championing all sectors
Two deep-rooted challenges hold us back. The first is professional risk aversion. Our training centres on identifying and managing risk — from spotting prescribing errors to preventing dispensing harm. This has created a professional culture that prizes caution and control. While this makes us feel safe, it also makes us slower to adapt, less comfortable with ambiguity, and hesitant to take bold strategic positions. Other professions move more quickly into influence; we perfect the plan.
We need a new kind of leadership — visible, strategic, collaborative and unashamedly ambitious
The second is fragmented leadership. Pharmacy has grown into a highly diverse profession across hospitals, primary care, community pharmacy, academia and commissioning. However, our leadership bodies have not evolved fast enough to unify that diversity into a coherent voice. For too long, internal divisions and sectoral silos have diluted our influence and left national stakeholders unclear on who speaks for pharmacy. That lack of cohesion has also meant that some of our leadership discourse has focused inward — on identity and legacy — rather than on forward-facing, system-shaping ambition. We need a new kind of leadership — visible, strategic, collaborative and unashamedly ambitious.
At a national level, the development of the Royal College of Pharmacy offers a rare and vital opportunity. For this new body to succeed, it must clearly articulate its purpose and ambition — not only to pharmacy professionals, but to wider system leaders and the government. It must break free of the limitations of its predecessor and become the single most credible and authoritative voice on medicines in the UK.
That means championing the full breadth of pharmacy practice across all sectors, not just focusing on community pharmacy alone. As services evolve — particularly in areas such as chronic disease management, prevention, neighbourhood health and independent prescribing — the royal college must evolve with them. Failure to do so risks alienating much of the workforce and limiting its relevance.
Alongside this, the UK Pharmacy Professional Leadership Advisory Board (UKPPLAB) plays an important, but transitional, role. In truth, if the Royal Pharmaceutical Society (RPS) had stepped into its strategic leadership space earlier, UKPPLAB might never have been necessary. One of the reasons I sought election to the RPS board was to help push us in that direction. As the Royal College of Pharmacy takes shape and builds confidence, I hope UKPPLAB concludes that its purpose has been fulfilled — a burning platform to reignite leadership momentum.
All pharmacists have a role to play
Leadership doesn’t just happen nationally. At system level, pharmacy professionals must take the initiative. ICBs, trusts, provider collaboratives, PCNs, clinical networks — all of these are spaces where pharmacy needs to be present, persuasive and solution-focused. This includes provider-based pharmacy leaders, clinical specialists, community pharmacists and those leading medicines optimisation in commissioning teams.
The leadership behaviours we need now include the ability to influence without dominance, the insight to choose battles strategically, and a willingness to let go of infighting, even where professional differences exist. Perhaps most critically, we need to be prepared to support — not tear down — those who step forward to lead.
When we speak as experts — calmly, credibly, and collaboratively — people listen
Some may argue that pharmacy’s voice has been overlooked for so long that trying to influence now is futile. Others may feel that stepping forward risks drawing attention or scrutiny at a time of cuts. But in my experience, the opposite is true.
As chair of the ICB Chief Pharmacist Network, I’ve seen first-hand how constructively the system responds when we speak clearly and pragmatically. Earlier in 2025, our network wrote jointly to Claire Fuller, Penny Dash and Jim Mackey on the NHS England leadership team. We didn’t ask for protection — we offered ideas, we set out how pharmacy could help the NHS meet its challenges. The result? Open doors, not closed ones.
It was a clear lesson: when we speak as experts — calmly, credibly, and collaboratively — people listen. They value pharmacy’s ability to spot risk and design around it. They trust us when we engage proportionately, not defensively. But influence doesn’t come from asking for it — it comes from earning it.
Every pharmacy professional — from the newest foundation trainee to the most senior consultant — has a role to play in this leadership journey. That might mean stepping into system meetings, even when they feel unfamiliar; explaining medicines strategy in ways others can understand; designing new models of care, rather than waiting to be asked; and supporting professional bodies to evolve, rather than criticising from the sidelines. Leadership is not just about hierarchy or title. It’s about voice, intent and action.
If we want pharmacy to shape the future of the NHS, we can no longer wait to be invited. The door is already open. What we need now is the courage to walk through it — together, and with purpose.
Conflicts of interest
Ewan Maule is an elected member of the Royal Pharmaceutical Society English Pharmacy Board and chair of the ICB Chief Pharmacist Network. No external writing assistance was used in the production of this article.
