In the second of the Gateway to Local Adoption series, Visions4Health caught up with Dr Graham Duce, ICB GP prescribing and clinical lead, to discuss his views on the role of medicines operations teams in the new ICB structures.
As Integrated Care Boards (ICBs) mature, one of the quieter but most significant changes is happening in medicines operations. While headlines focus on high-level restructuring, the real impact is felt in the leaner, stretched teams now tasked with delivering safe, cost-effective prescribing across increasingly vast geographic footprints and patient populations.
The remit of ICBs was meant to include more effective service commissioning, with streamlining of care, reduced duplication, and support population health to reduce health inequalities and improve outcomes. In theory, consolidating medicines optimisation teams and scaling back clinical leadership reduces overhead and improves efficiency. In practice, however, it’s more complex. Many medicines management teams are facing up to 50% staffing reductions as per NHS England recommendations, while covering larger footprints.
Additionally, with fewer clinicians at the table, strategic decisions – like formulary approvals – are becoming more remote and genericised. We’ve moved from local, nuanced discussion to centralised processes with minimal specialist input. Clinicians, once central to decision-making, now often find themselves spectators to conversations dominated by finance teams and generalist managers.
This risks creating a postcode lottery not of ‘formulary’, but of ‘implementation’. It’s one thing to approve a NICE-recommended medicine centrally; it’s quite another to embed it into diverse local pathways with insufficient resources. The fear is that new treatments will be approved on paper but stall in practice due to lack of operational support.
There is, however, hope. Primary Care Networks and GP Federations could become engines of local innovation, designing pathways that reflect real-world needs of their specific patient populations. However, they must be empowered, funded, and trusted to lead. Without that, I worry we are building an NHS that is efficient on spreadsheets but fragile in service delivery.
Ultimately, medicines operations are more than paperwork, they’re the backbone of safe, quality and equitable prescribing. As ICBs continue to evolve, we must ensure that those who understand the intricacies of implementation remain in the room because if we get this wrong, the cost won’t just be financial, it will be borne by patients.
Dr Graham Duce is a member of Visions4Health’s Healthcare System Council and an NHS GP and GP Partner in Cheshire, practicing since 2001. He has held leadership roles in Medicines Optimisation and Clinical Service Redesign across various NHS organisations, including Cheshire and Merseyside ICB. He has helped introduce new services like a first seizure pathway and contributes to the local formulary and new drug approvals. Graham chairs the GP prescribing meetings, co-authors the MMT newsletter, and develops clinical guidelines. His areas of interest include cardiovascular, respiratory, psychiatric, and dermatological care, with a focus on integrating digital technologies to support NHS delivery and patient care.
