ICB cuts risk losing local medicines supply intelligence

The ongoing impact of conflict in the Middle East has undoubtedly continued to compound disruption to medicines manufacturing and shipping routes, further exposing the fragility of our medicines supply chains in the UK.

Alongside economic instability, these pressures are no longer intermittent challenges for us, but a sustained and complex reality for pharmacy. National and international collaboration remains essential if we are to preserve and protect critical medicines supply.

However, much closer to home, there is an equally important, and possibly underappreciated risk emerging from NHS reorganisations.

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The clustering of Integrated Care Boards (ICBs), combined with significant workforce reductions, risks the erosion of one of the system's most valuable assets in managing shortages: local intelligence. Where we rely on systems to understand local population health needs and prescribing behaviours, there are also trusted relationships and informal networks that enable rapid and coordinated responses across many systems.

The question is whether this is recognised as a key interlinking factor in how medicines shortages may be managed in future? Even if a medicines shortage is driven by a global factor, areas are not always impacted uniformly.

ICB teams historically have a deeply developed nuanced understanding of their local systems, enabling them to quickly and pragmatically respond to supply disruptions. As pharmacy professionals, we cannot look at medicines shortages as a simple supply chain disruption in isolation.

Beyond this, ICBs historically hold the experience required to prioritise where prescribing guidelines and policies require re-alignment with national guidance, knowledge of local procurement routes, secondary care (hospital) intel, specific local population needs and financial balance for the tax payer's pocket. This local agility is critical when managing a fragile supply chain and making real-time decisions that will affect patient care at scale.

While the move towards standardised ways of working across larger geographies may appear logical from an efficiency and governance point of view, there is a real risk in attempting to impose uniformity too early.

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This rings particularly true in the context of newly formed clusters and significant workforce gaps. ICB capacity and continuity is already under strain - the insight required to manage further shortages effectively may prove difficult to rapidly rebuild once it is lost.

A wholesale ‘reset’ risks us losing our local intelligence faster than it can be replaced. Perhaps this can be managed by prioritising the preservation of local expertise, while gradually aligning new systems and processes that will add genuine value to healthcare for the future.

A balanced, hybrid model is needed: national coordination and oversight must continue to be complemented by local teams with the right amount of local intelligence, so they can continue to be best placed to interpret and respond to shortages in real time.

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Without this balance, we risk weakening our national efforts to manage medicine shortages at the very time when resilience is most needed.

Shveta Suri is Head of Pharmacy Productivity, Chesterfield, Derby and Derbyshire integrated care board. Shveta is part of our four strong editorial advisory board. She focuses on maintaining financial balance in primary care spend on medicines, with high-quality outcomes, leading the Derbyshire prescription service and medicines optimisation activity across GP practices in Chesterfield. She has more than 15 years experience across multiple sectors of pharmacy, including intermediate care and service development with an extensive background in quality improvement activities to improve patient outcomes and operational delivery. ChatGPT was used by the author in the structuring of this piece.