The potential impacts of a 50% reduction in ICB pharmacy teams

In light of the government's commitment to reducing running costs in NHS England and integrated care boards (ICBs) by 50%, there is significant uncertainty for the workforce of around 18,000 people whose roles may be affected.

Community pharmacy is essential to the delivery of the 10 year health plan. Accessibility for local populations must improve. The public and healthcare professionals must embrace a digitally-integrated way of healthcare and prevention.

There is a strong appetite and opportunity to level-up the scope of clinical pharmacy within primary and community care. But, can this materialise with 50% fewer of the foundations underpinning this?

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ICB-based medicines optimisation teams have quietly built the architecture of pharmaceutical delivery in primary care, spanning years of experience and expertise. Pharmacists are generally known as patient-facing professionals. ICB Pharmacists and Pharmacy Technicians are uniquely positioned to understand population-facing care, while also influencing optimal investment in medicines at scale.

While the idea of redirecting £1bn back to frontline care would sound appealing to many, the speed and scale of change could also lead to risks and implications that may ultimately be felt by taxpayers.

To illustrate, maintaining the governance and oversight for a medicines budget of approximately £14bn nationally requires significant infrastructure, expertise and continuity. Current ICB pharmacy teams contribute in several ways, including:

• Influencing guidelines and policies to support medicines optimisation safety and quality
• Supporting development of whole pathways to access new medicines, i.e. following the release of NICE Technology Appraisals, which the NHS is legally obliged to fund
• Understanding national direction and contextualising for local population needs in order to inform local commissioning decisions
• Identifying and enabling cost-efficient prescribing at scale, making best use of taxpayers' money
• Centralised remote professional support for GP practices, with engagement to support ongoing development of localised pathways of care
• Maintaining financial balance in drugs budgets locally, ensuring finances can be redirected for commissioning according to local need
• Coordinating major MHRA or NatPSA alerts and medicines safety initiatives that protect local populations from potential harm
• Reducing medicines waste and supporting digital engagement in GP surgeries for good repeat prescription management
• Commissioning and management of centralised digital platforms to support cost-efficient prescribing and best practice
• Benchmarking and improvement of medicines use at scale, e.g. tackling opioid dependence

Reducing the workforce responsible for managing these activities significantly increases the risk of inefficiencies or financial pressures. These activities are made possible through the unique engagement of ICB pharmacy teams with system stakeholders, alongside their specialist skillset in managing substantial sums of taxpayers’ money and the associated risks.

A 50% reduction in workforce capacity will inevitably affect productivity and delivery. The extent and nature of this impact will depend on how responsibilities are redistributed and how systems adapt to meet local need.

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With the ongoing development of cluster relationships, careful consideration will be needed to ensure that medicines-related inequalities are not inadvertently widened. We must also consider where these niche accountabilities would be adopted within the NHS landscape.

While there is widespread support to cut the bureaucracy, remove unproductive layers of management, and give the frontline the best toolkit to deliver healthcare in the heart of our communities, we must also consider that these values are equally shared by the majority of the 18,000 jobs now at risk.

ICB Pharmacy Teams must come together to align their expertise and shared principles, but reducing the capacity to deliver improvements at scale risks severe loss of organisational memory and potential for poorer management of funding for medicines.

As ICB pharmacists and pharmacy technicians, we also practice with patients at the heart of what we do. We remain committed to driving safety, quality, service delivery and transformation for our local populations' benefit. The hope is that these teams are not conflated with perceptions of unnecessary bureaucracy, as the work undertaken by these teams directly supports patient safety, stewardship of public finances and system transformation.

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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.