The Evolving NHS – An ICS Chief Pharmacist’s Perspective

What does the evolving NHS landscape look like through the eyes of a Chief Pharmacist, and how are integrated care system (ICS) pharmacy teams responding?

In this Petauri Evidence NHS Whispers session, we put your questions to Yousaf Ahmad (Chief Pharmacist and Director of Medicines Optimisation, Frimley ICS), as he shares how he and his colleagues are responding to the changing NHS environment. From system pressures and financial constraints to prescribing priorities and service redesign, Yousaf explored how ICS pharmacy teams are adapting, and what this means for industry partners.

This episode was first broadcast as live webinar on: Friday 24th October 2025.

Learn more about this episode at https://petauri.com/insights/evolving-nhs-ics-chief-pharmacists-perspective/

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- [Presenter] Welcome to this Petauri Evidence webinar. At Petauri Evidence, we deliver market access and HEOR support, throughout the product lifecycle, to bring new treatments to patients across global markets. Follow us on LinkedIn for more great content from our team. We hope you enjoy the discussion.- Welcome, everyone, to our live Q and A session in this NHS Whispers webinar series. In this series, we've been following the evolving structure of the NHS, now shaped by the new 10 year plan, and exploring your questions around what these changes really mean, what's happening on the ground, and what you need to consider in the coming weeks, and months, in terms of your market access strategies. So I'm Charlotte Harding. I'm part of the UK market access team, here at Petauri Evidence, a global market access, and HEOR consultancy, within the Petauri platform. For those of you who may not know, we specialise in supporting bio-pharma companies across the full spectrum of market access strategy, with particular expertise in UK launches, and navigating NHS dynamics. Our work is informed by deep in-house expert experience, and enriched by our network of NHS partners, who provide valuable insights through advisory boards, strategic input, and feedback on value propositions and messaging. We're delighted to welcome our guest for today's session, Yousaf Ahmed, Chief Pharmacist and Director of Medicines Optimization at Frimley ICS, and we're looking forward to a lively, and insightful, discussion. So, welcome, Yousaf. Yousaf is an experienced pharmacy lead with over 20 years in NHS and international healthcare systems. He leads medicines, optimization, and strategy across Frimley ICS, and has worked in senior roles within acute care settings. He has represented pharmacy nationally through committee roles within the UK Clinical Pharmacy Association, the Royal Pharmaceutical Society, and as an advisor to NICE. Yousaf also sits on the governing council of the General Pharmaceutical Council, overseeing the regulation of pharmacy professionals and premises across the UK. He is passionate about workforce transformation, innovation in practice, and improving patient care through strategic pharmacy leadership. So just to remind you, there is a question box for you to submit any further questions to us throughout the session, so, please just check that you can see this, and we will come to these at the end, if we have time. So, I'm conscious that we have quite a lot to get through today. So thank you to everyone who submitted their questions in advance. But just before we dive in, Yousaf, how are things going in your world right now, and how are you doing?- Yeah, thanks, Charlotte, and thank you very much for the kind invitation to come and speak to lots of colleagues this morning, and I look forward to the chat. So, how am I? You know, weeks are flying by, if I was to be really honest with you, Charlotte, it's Friday already, and, you know, it's been a blur, and I felt like I've been going like one of those high speed trains through the week. There's lots of change in the NHS, and we'll talk about that today, as well as, there's a lot of anxiety, and stress, and worry, I think, with what people that are working. And also more importantly, from what I can say to colleagues, there's a lot of opportunity here, and we need to look at this restructure, reorganisation, and the policy documents that we're going to chat about, as an opportunity to do things differently going forward.- Yeah.- So yeah, I'm okay. But lots to do.- Okay, great, thanks, Yousaf. So in terms of the first question that we have for you today, so how do you see the current, sort of, structural changes within integrated care systems shaping the future of healthcare delivery in England? And, sort of, what will the ICS mergers lead to meaningful transformation, or are they kind of more of a structural reshuffle? What's your view on that?- Yes, a big question. It is a monumental change to how we do business in the NHS, this restructure. There's no two ways about it, I think. The current ecosystem has about 42 ICS systems, which range from populations as low as 500,000, all the way to two and a half million, 3 million.- Yeah.- So there is a lot of inconsistency. This restructure brings it down to around 25-ish, where the average number of populations are two and a half million to 3 million. So more consistency. But also a bit more clarity in some of the roles, and responsibilities, of integrated care systems. And we'll talk about that very shortly around strategic commissioning. So it's a monumental change, number one. Number two, it really focuses on the importance, this change, the importance of caring for people at the neighbourhood population level. What are we doing? How are we understanding our populations and neighbourhoods, and what we are doing to really intervene on seismic changes to their health? So it's going to focus on some of the real areas that ICSs ICBs, and NHS England, and the department, will need to focus on going forward. And thirdly, I think this, for me, presents, as I said, an opportunity but a challenge, to really make some transformational impact to healthcare delivery more long term. Within our system, we talk about generational change, and making sure that we invoke some sort of intervention that impacts people today, as well as tomorrow. I think with this restructure, the challenge and opportunity sits in being very clear in decision making, and being very clear on more impactful interventions. And we can talk about that shortly, I'm sure.- Yeah. So just in terms of the biggest challenges that ICBs have faced and sort of taking on specialist services previously managed by NHS England, what are your views on that?- Yeah, so delegated commissioning is really a shift of moving some of that autonomy and power from the centre to ICBs. We've seen that in some disciplines already, such as a pharmacy, optometry, and dentistry, the pod hub, where, you know, the market access, the commissioning of those particular contractors, moving to systems. That includes also the money involved, and the personnel that were sitting at centre, and that's been very interesting. Specialist services, spec com, again, another big body of people, and money, being delegated to systems, because of the structural changes is being a halt in the mechanics of that.- Okay, yeah.- So, I think, we are going to get there. What it will mean, I guess, that the key question is, Charlotte, what it'll mean is that individual systems, and regions, and we'll talk about regions shortly, I'm sure, individual systems, and regions, will have better autonomy in how the money that's used at spec com is spent within their patch.- Yeah.- So we may get more specificity on earlier access to innovative medicines, or, more importantly, bigger ability to shift services across the system or region. So I think more autonomy, more responsibility, and more influence in direct patient care.- Okay. And how would you say the NHS 10 year plan is influencing the prescribing of high cost drugs within community settings? And do you think there's any barriers that still exist in terms of prescribing these within the community?- Yeah, so if you look at medicines, again, I think you need to think about this question in a couple of different facets. If you look at the intention of what we believe strategic commissioning, when it comes to medicines, mean, you need to really be very clear what that means when it comes to medicines. The ICB blueprint, the 10 year plan, and other policy documents give us an idea on that. But, I think, over time, over the last six months, I think pharmacy leaders have been quite clear in understanding the strategic commissioning when it comes to medicines really focuses on long-term, population-based approach to planning, commissioning, and delivering medicines. So when we talk about value, for example, which I talk about quite often, it's about focusing on sustainability of medicines across the system, not just looking at the pound sign. So it is not a race to the bottom for the cheapest molecule, it's about how do we get the biggest bang for our buck? How do we use that value base in getting the most of the medicines that we have to spend on the medicines? It's also focusing on safety, and optimisation, in this wider sense. So how do we avoid harm in clinical risk, at the same time reduce unwanted variation, but still be amenable to change in the population? And the other kind of reported things is around supporting medicines in the wider agenda in health. And some of the things which are very new, which I have always believed in, but I think might be very new to many colleagues, is how does medicine support the wider ambitions of the government and healthcare? So how does it support economic growth? I.e. does it get people back to work, for example, living healthier lives, using healthcare facilities less, or just more appropriately? And, at the same time, how do we advance the notion of digital transformation? What does that mean for medicines in the wider scape? How do we facilitate the adoption of technologies, wearable technologies, app technologies to support more effective decision making when it comes to medicines? So all of these things, for me, are very crucial in understanding the wider strategic commissioning landscape when it comes to medicines. The question around how does a 10 year plan influence prescribing, I think it gives us a clear mandate to really move focus on looking at medicines in a different guise. So, as I said, it's not really just about how much spending we have, but how does medicines influence those other parts of the system? And what we talk about within Frimley is, what role does medicines play in, say, the urgent and emergency care agenda? What role does it play in the wider primary care agenda? What role does it play in neighbourhood health, you know? So I think it's about translating what we do in medicines into every part of the ecosystem of the ICS, and if you want to be really effective at delivering change with medicines, we need to be really effective articulating the narrative of how medicines can be an influencer, and enabler, to systems.- Yeah, no, thanks, Yousaf. That's very helpful and obviously makes a lot of sense. So, I'm just going to move on to our, sort of, next topic of conversation. So, looking ahead, how do you see the role of medicines optimization evolving within ICBs, particularly in relation to system-wide priorities? So you've sort of touched on this a little bit already, but, I guess, just in terms of what types of programmes do you think ICBs will prioritise to drive medicines optimization, and also how involved are you in decisions around medical devices, and diagnostics, and is that changing, and if so, how?- So, I'm really grateful. I think within that, in my system, we've got a strong narrative, and benefit around describing what medicines can do for the system. So, involved in decision making at all levels. I think I feel really privileged to have voice at the table. I guess the question is is how do we make that the norm across the country? How do we ensure medicines, and people that experts in medicines, have a voice around the table? I think medicines, and medicine devices, and diagnostics, I think they are very familiar with one another, and it's important that medicine professionals, pharmacy leadership, play a pivotal role in that decision making process when it comes to devices and diagnostics. So, I'm involved quite heavily at some of that conversation, both in the system, but also at region. I think region play a role at supporting systems in some of those non-medicine decision making, such as devices, which devices do we want to use, how effective are they? How do they support the pathway and where does medicines fit into that? Those are sort of the questions that I think many of the regional conversations are bringing people together are supporting some of those local decision making. I think, for me, medicines sit across multiple different specialties. So I'll give you an example. Like, recently we're looking at our, kind of, devices in the catheter stoma space. We've had real significant influence around what we want to do, which is traditionally not a medicine setting. Again, that gives you an example how different professionals come into that mix, and also in other areas, such as specialised commissioning, oncology medicines, biosimilars, but also areas which are associated, such as wound-care or gluten-free prescribing. I think there, for me, that whenever there is an association of medicines, they should be an expert within pharmacy medicines involved. One of the things I think without, we need to mention, particularly, is some of the elements that the 10 year plan,

and some of the policy talks about: 13:05

waste, polypharmacy, over-prescribing, which really are kind of core components in some of the future landscapes of health systems. And when you think about medicine. So how does that, what we do really well, in that space, in terms of pharmacy medicines, how do we translate that into, say, the kind of wider neighbourhood system? And the last thing I'll mention on this question is around workforce transformation. So I'm really passionate about this. There's the question is how do we take the specialists from their settings into the more community drived areas? And we've looked at that in some of the [] biosimilar space. How do we look at those specialists prescribing in other other settings and how do we deliver care, and, say, in a primary care setting that traditionally is delivered in secondary care? We are going to see more of that and I think that's the right way to go. And some of the national drive around neighbourhood health models, there's going to be a strong focus on, not only bringing the primary care neighbourhood together by bringing, say, the providers and secondary care into that landscape. So I think there's going to be interesting conversations around how do we effectively prescribe real high specialist medicines in line with other medicines that traditionally have never been thought of in that way? So there's a real coming together, both in terms of competence and skillset, but also the people that are involved. And that, for me, is exciting.- Yeah, no, thank you, Yousaf. I think, and that moves nicely into my next question, which is around, so where do you think the prescribing budgets will sit under the neighbourhood model, and how do you think that may affect local decision making?- Yeah, this is a very, very interesting question. So, I think there is a narrative, and that's been publicly, it's publicly aware, that systems have an operating cost target, i.e. their workforce head count. There's a mandate to reduce that, so. And it varies on size and complexity, some are 30, some are up to 50%. And it's under the proverbial denominator of 90 pound per head. Again, public knowledge. There is a mandate to provide services per population at no maximum of 90 per head. So, if you think about it, ICSs have to look at their operating model, the services that they commission, the different providers that they support in this space, in a particular defined financial construct. And when we look at medicines, which is one of the biggest budget lines for any chief financial officer, in their system, and, I can tell you, in some of the revised blueprints, medicine's budget will range from anywhere between 500 million to a billion pounds. And I think that'd be that average. So, if you think about it, there's something about where does that budget line sit, number one, and where do the people that help to support and manage that budget, where do they sit? And I think there's been a couple of different models that we've discussed, where we've looked at seeing what the pros and cons, the benefits, and the opportunities are, in moving this around. Could there be an opportunity for us to shift the management of that budget to, say, a provider in the new system? Is there an opportunity within that? Which includes moving, and shifting the people that manage that. In essence, having a more light touch approach from an ICS perspective, but more a heavy approach from a provider lens. That's an interesting model. And I think there's something around discussing the pros and cons of that. And there's another model where we look at retaining some of those core components of medicines optimization, such as formulary assessment, such as guideline production, such as strategic priority setting, that remains at the ICB. But in terms of the delivery, such as the operation part, how do we manifest the guideline into practice, working directly with individual practices, and people on the ground, moving that part of the picture outside to providers. Almost splitting that strategic and operational aspect, which currently sits within ICB on its own. So that's the second model where the object retains the ICS, but the teams are split. And the last model is looking at just solely strategic commissioning, i.e. pushing the entirety of the operational aspect to providers. That's quite tough because then there's a lot that rides in them. So those are going to three aspects that are in current discussion, and maybe systems are looking at that.- And do you have a preference on which model that you think would work best, in terms of what you're trying to achieve, or, yeah?(laughing) That might be a tricky one to answer, but what's your opinion on that?- I shifted my thinking, a good question, Charlotte. My thinking has more evolved as I learned more out of this past year. So what I thought initially is shifted. I'm currently toying with the idea is could it be that we shift the entirety out to provider and then, in that shift, have a commissioning agreement, a contract agreement, where the provider commissions the ICS to deliver that service. So in essence.- Okay, yeah.- Everything goes out, but then we still retain some degree of responsibility, and autonomy here. So I think, mainly, I'm kind of veering toward that, looking at the pros and cons. So we're delving deep into that. What does that mean? I think systems have to think very creatively where this big budget lines, where does this sit, and, secondly, what did they want to do when it comes to medicine's optimization restructure? And, this, it's a very important point, Charlotte. I've asked that question in exec meetings. What if there wasn't a medicines optimization team in the new ICB? What if there wasn't? And I have said, I think there could have been, I think it means a bigger impact to your prescribing budget. Vis-a-vis, I think you would be, I think there'll be 2, 3, 4, 5% overarching spend in your prescribing. But, in essence, you will spend 20 to 30 million pounds more on medicines if you don't have an appropriate medicines organisation team. I think there's a lot of truth in that. It wakes people up. I think it's my duty, as a pharmacy leader, to say these things to executive colleagues. But there's truth in that. The amount of money we spend in money medicines optimization team, you get a lot of bang for your buck. And I think that narrative is one of the crucial components, what I say to my colleagues that we need to articulate in this restructure, so executives understand the value the pharmacy medicines team bring.- Yeah, no, thank you, Yousaf. That's really helpful. Just before we move on,'cause I am conscious of time, if responsibilities do shift to neighbourhood teams, how do you think confidential pricing arrangements may be managed or protected? Just quickly.- I think there'd be more flexibility in having an array of confidential agreements. There'd be more flex in the system. It'd be more direct in terms of what we need for different populations if there was a shift over to it. What I'm really apprehensive about is the weight of our system, or the NHS, won't be leveraged enough to maximise some of those beneficial pricing arrangements.- Yeah.- There was something for me about leveraging our benefit, leveraging our weight, and driving more preferential pricing arrangements versus the ability to have them in the first place, and for them to be managed and protected. So there's pros and cons to that. I would love us to have the ability to do both, to work in a way where it's shifted out to neighbourhood and PCNs, but we support that in a way of having a more focused conversation, allowing to leverage that ability to drive more effective pricing arrangements. So, it's a worry, and a concern, but it's something I think we could do if we just work together at it.- Yeah, no, thank you.- There'd be more, Charlotte, there'd be more of them, I think. That's the thing I basically want to get across.- Yeah, no, thank you. That was obviously very insightful. So, just moving on. So, in your opinion, what defines a productive and collaborative relationship between healthcare professionals and pharmaceutical suppliers in your current system? So, what habits, or behaviours, do the best suppliers consistently demonstrate, what's your, overall view on what the pharmaceutical industry's role could be in terms of supporting healthcare delivery, and you in your job role as well?- Yeah, great question, Charlotte. I do appreciate. I think two things strike really evidently, a trust and ongoing relationship. I think for some of our industry partners, we've spent a lot of time, just a lot of time together, conversating, discussing, building that sort of relationship, and at the same time building that trust. So that for me is very important, that continual conversation, that's number one.- Yeah.- That ability to understand our pressures, and priorities, and to really look at scoping what industry partners can do to support that. So there's something for me about time spent, relationship built, and understanding priorities of our population. Those three components are absolutely crucial and essential. Why we've seen success in our system, with that relationship, is that we've had a really strong governance structure. So our policies and what keeps us safe. And we've got a clear structure for that. We've also been supported by relevant code of conduct, and also documents that've been produced nationally, by the NHS Confed, that really support that more convivial relationship with industry and NHS. So, I think, we've utilised some of those frameworks, and those mechanisms, and we do our policies. So we became more comfortable in having those conversations and working together. Also, what I found a blueprint that we worked really well in our system is that we've had a third party involved, so if there's an agreement in providing a different service, for example, it's been funded by industry, and they've commissioned a third party service provider who have engaged with us.- Yeah.- That threeway, kind of, threeway relationship has been really helpful in driving the comfort for us, in terms of working with industry, but also change.- Yeah.- And so, I find that is a very good proof. And the last thing I'll add, I know, Charlotte, time is short,(Charlotte laughing) is that as we look forward. As we look forward, this is vitally important. The 10 year plan makes it very clear we are unable, as an NHS, to do this alone. We're unable to do it alone. So this is opportunity for industry to really come in to showcase what they can add into the conversation to support the NHS to deliver on some of their priorities. And because there's going to be a more population localized-driven model, there's going to be lots of opportunities to work with systems at different levels, to really make some interventions that support the agenda of the industry partner, but also the agenda of the NHS. So this is a really opportune moment for us to really test some more further models and deliver on that.- And, just quickly, what types of engagement, or evidence sharing, do you find sort of most valuable?- I find information on what's coming around the corner, horizon-scanning.- Yeah.- Be it the molecules or other aspects, or horizon-scanning, and bringing that to me has been really helpful, because it helps to think our own thinking. The other thing is that our case studies, and other work, so we try our best, as always, to share stuff. But when industry comes to me to say we've done some work over here, this is what it's made, this is really, really helpful. So that's our case study. And the third thing is giving us some support in those areas which we are not great at. So from project management, data interrogation, and insights. Large data set review mining, translating some of our findings into what it means, you know, we have large elements of population health informatics helping us to actually translate what that means. And tracking some of our interventions. Really good things that industry do really well. We need some guidance and support on those.- Yeah, okay, thank you. I think we may have time to squeeze in one last question. So, this is just around the, kind of, single national formulary. So we've already had, at Petauri Evidence, a number of thoughtful conversations about how single national formulary might work, particularly from the perspective of some of your pharmacy colleagues. And if anyone listening would like a summary of any of those discussions, then, obviously, feel free to reach out,

and we'd be happy to share: 26:33

evidence@petauri.com. But, for today, thought we'd just focus on a couple of key question is what do you see, Yousaf, as the potential impact of moving to a single national formulary? And what would you identify as the top three benefits and risks associated with that?- Yeah, let's start with the benefits and risks. So, always, I believe in the sentiment that the single national formulary has been set out, the sentiments being reducing variation, improving access, supporting prescribing decisions, and supporting local prescribing formularies, shifting the care from hospital to community. So looking at how do we use, as I mentioned, specialised medicines in other settings. Reducing the capacity, well, hoping to support the capacity at releasing people that do the role right now into, say, direct patient care. And also around quality and safety, improving the consistency. So I've given you roughly sentiments, but those are, I would say, the five benefits to it. Some of the negative aspects, not being associated to the SNF is not being really apt for sensitivities around local population needs, or the various needs locally. Maybe producing prescriber constraint. So what is the prescribing clinician paradigm here? How do they feel? What improves or reduces their inability to prescribe? So, the prescribed aspect. And, thirdly, some of the red tape bureaucracy when it comes to producing a large formulary at a national level. Again, you can think about those as the negatives and the risks. So I think, overall, the sentiment is right. What I've been kind of feeding into the conversation here, both at a national level, but also with my peers, is that the single national formulary will not work if we just rewrite the BNF, or rewrite what our current formulary is. It's not going to work. It's not going to work. We need to have a more focused approach on what the single national formulary is. So I've been asked, "What does that mean?" So, one of my, kind of, concepts is do we focus the single national formulary on elements such as innovative new drugs coming in, new NICE TAs, do we focus it on high cost medicines? Do we focus it on, say, medtech, devices, app technology? I think if we have that as a real focus, it helps our systems to do what we do well. So the bulk of formulary work, but really helps us to target the area of high spend by having a clear line of, nationally, this is what we've agreed, and this is value for money. It hits the quality of safety agenda, but it's also focused on some of those high cost elements. So, I'm really intrigued, and excited that if we do the single national formulary focused on a particular subspecialty of medicines, I think it'll work really well. So it's something about, and again, we've had some communication from the national office around our formularies will still continue for a period of time until the single national formulary comes up online. And also it will include incorporating medtech in the future. So, I think, they've listened, and they know they can't just rehash a formulary from zero to a hundred. So they've got. I think it's going to be focused. I think that's right. It's going to involve areas which we're not very apt or fair in, right, such as MedTech, and it's going to support current formularies in place. So, I think, in the future for us, I still see we'll have a mechanism that we will do our formulary work, but it won't include as many people as it as it does today. Sorry, Charlotte, I know we are on time.- No, that's okay. I was just going to say, I think that brings us to the end of our session today. We obviously had a lot to get through, in quite a short timeframe, so, I'd just like to say thank you, again, to you, Yousaf, for an informative discussion, and also for taking the time out of your, probably, extremely busy day to be with us here today. And thank you to the audience for submitting your questions, which helped us plan for today. And also thank you for listening to our conversation. I appreciate we didn't get a chance to get through all of the questions. So if you kind of want to follow up on any of your questions then please do get in touch, and we can help signpost you to any of the right places if you want to continue the conversation further. So, thank you, again, and I hope everyone has a great rest of their day, and looks forward to the weekend. Thank you very much. And, yeah, thanks again, Yousaf.- [Presenter] Thank you for watching. If you'd like to find out more about how we can support your market access goals, get in touch today. For more market access insights, follow us on LinkedIn.