Context:
Integrated Care Boards (ICBs), once envisioned as the lynchpin of local NHS planning and commissioning, are facing unprecedented change. Yusuf — an ICS Chief Pharmacist and Director of Medicines Optimisation — delivered a clear message at the NeoNavitas Sub-National Access Conference: the NHS is undergoing yet another transformation, and the pace and implications for pharmaceutical engagement are accelerating.
1. Structural Shifts: The Role and Shape of ICBs is Changing
In one of the most impactful developments to date, NHS England has asked ICBs to explore further operational reductions — on top of an earlier 30% mandate, an additional 50% reduction in non-clinical costs is now being requested. This signals a wider rationalisation of NHS leadership and commissioning structures. Alongside this, a reduction of the number of ICBs is inevitable — from the current 42 — with a shift toward more regionally aligned models.
These changes are not abstract. They fundamentally alter who holds influence, how decisions are made, and what pharma must do to maintain access and relevance.
2. Locality Variation is Greater Than Ever
ICBs vary widely in their internal architecture. Some operate with centralised governance and decision-making, while others push accountability down to place or even neighbourhood level. For pharmaceutical companies, this means a ‘one-size-fits-all’ approach to NHS engagement no longer applies — if it ever did.
Yusuf highlighted the example of his own ICB, which operates with a clear line from a centralised Medicines Board through to subcommittees focused on delivery and finance. Others, particularly larger ICBs like Greater Manchester, may distribute power differently. Understanding the local structure — where decisions are made and by whom — is essential.
3. Redefining Value in Medicines
Perhaps the most important message of the session was the need to reframe how value is understood and communicated. Yusuf challenged the idea that value should be reduced to cost savings alone. Instead, he advocated for a broader definition — one that incorporates population wellbeing, reduced system burden, and improved patient functionality, such as returning to work or avoiding hospital admissions.
This evolving definition of value has direct implications for how pharmaceutical companies frame their value propositions. It’s not just about price — it’s about aligning with system-wide objectives like reducing inequality, supporting healthier communities, healthcare professional development and freeing up capacity.
4. Decision-Making is Multi-Layered and Fast Moving
Yusuf’s detailed mapping of his ICB’s governance infrastructure underscored the complexity of the medicines optimisation ecosystem. Committees at various levels — from local hospital DTCs to regional device groups — all play a role. As he pointed out, the right person to engage with today may not be the right person tomorrow.
This flux is amplified by the pressure on ICBs to reduce their size, redefine their remit, and operate more strategically. The implication for pharma is clear: organisations need either their own field-based teams with strong stakeholder access, or partners with the networks and local knowledge to navigate the system effectively.
5. Population Insight is a Prerequisite
A key piece of advice for industry was to come prepared with an understanding of the local population. Yusuf described the benefit of partnering with those who understand the specific demographic, economic and health profile of his ICB — and how that shapes commissioning decisions.
With health inequalities continuing to widen — even between neighbouring areas — pharma must be ready to tailor its narrative accordingly. A generic pitch will not resonate. Demonstrating how a therapy addresses the needs of that population, in that system, is the baseline for meaningful engagement.
Conclusion: An Urgent Call for Change
Yusuf’s presentation made one thing very clear — this is not business as usual. Structural reform, workforce pressures, budgetary strain, and an evolving view of value are reshaping the NHS from the ground up.
Pharmaceutical companies cannot afford to rely on outdated maps, static strategies, or top-down thinking. Success in this new era will require a deeper understanding of local systems, a broader definition of value, and more agile and tailored engagement.
At NeoNavitas, we help pharmaceutical companies do exactly that. Through real-time field insights, stakeholder mapping, and strategic support, we equip our partners to stay ahead of the curve and engage meaningfully in a system that’s constantly shifting.
If you’d like to learn more about how we can support your field access strategy in today’s NHS, get in touch with the NeoNavitas team.