Category Archives: Government

Community pharmacy settlement brings stability, but long-term challenges remain

As a former Pharmacy Minister, I watch the annual community pharmacy contract negotiations with interest because I know how important they are. This year’s settlement is notable for one reason above many in that it was agreed! That may sound like a low bar, but in today’s NHS it is anything but.

At a time when ministers find themselves in dispute with almost every part of the health workforce, the fact that Government and Community Pharmacy England have reached an agreement matters.

Negotiation remains preferable to imposition. It provides stability, certainty and, perhaps most importantly, a platform for future reform. The settlement itself is better than many in the sector (including me) were expecting. Indeed, compared with the rest of primary care, community pharmacy has secured one of the stronger funding settlements available anywhere in the NHS.

Minister Stephen Kinnock deserve praise for recognising that pharmacies cannot carry on indefinitely with rising costs. The increase in funding, the uplift in retained medicines margin and the write-off of historic over-delivery all sit on the positive side of the ledger.

But we should be honest about what this settlement is – and what it is not.

It is not a recovery plan. The uncomfortable truth is that a decade long funding gap – which I absolutely take my share of responsibility for – has not been closed. The additional investment announced for 2026/27 is largely consumed by increased activity levels and of course inflation. This matters because while the settlement should help stabilise the sector, I suspect it will not halt pharmacy closures.

There is another challenge too. I have great respect for Community Pharmacy England but there will come a point where it must decide whether it believes a deal is acceptable or not.

Last year, and now this, we hear of an agreement reached quickly followed by explanations setting out why the agreement is not good enough. I understand why this occurs, but it is not a position that can be sustained indefinitely and many in the sector will feel that. Ministers won’t much care so long as it’s done and they will come to rely on that.

At some point, the sector, government and negotiators alike need true alignment on what success actually looks like. The government’s clear priority in this settlement is independent prescribing. As a manifesto commitment and a central part of the neighbourhood health agenda, it is easy to see why ministers are keen to deliver here.

The principle is absolutely right. For years I have argued that community pharmacy is one of the NHS’ most underused assets. Everyone should want pharmacists diagnosing, prescribing and managing more patients – ‘hospital to community’ as they say.

My concern is whether the funding stamped on this settlement will be enough to deliver independent prescribing at a meaningful scale. Training people is vital. Creating the capacity, infrastructure and incentives to make independent prescribing a systemic part of community pharmacy practice is another challenge.

My verdict? This is a better deal than many anticipated and best in class in primary care. It provides some level of stability and demonstrates that constructive negotiation is still possible with this government.

But stability is not transformation.

The question facing us all is whether the settlement represents the first step towards a realised clinical future for community pharmacy – or merely another year spent managing decline, albeit a little more slowly.

This article from Steve Brine also appears at the Chemist + Druggist online magazine.

Burnham’s Gamble: The Contest That Could Decide Britain’s Next Prime Minister

Andy Burnham’s intention to make a return to parliament has been clear for a number of years, despite assurances – until recently – that he was focused on his role as mayor of Greater Manchester. Following disastrous local election results for Labour and subsequent calls from Labour MPs for Keir Starmer to resign, Burnham’s opportunity has finally arrived. Josh Simons MP resigned earlier this month to allow Burnham to stand for election in the constituency of Makerfield. Unlike the Gorton and Denton by-election earlier this year — where Burnham sought to run but was blocked by the Labour Party’s National Executive Committee — the NEC has allowed Burnham to stand, and the Prime Minister has made no apparent attempt to prevent it. This shift reflects the severe weakening of Starmer’s authority amongst the Parliamentary Labour Party, with almost 100 Labour MPs calling for his resignation in the aftermath of the local elections.

This is a hugely consequential by-election that is highly likely to determine the future of this Labour government. If Burnham wins, he is widely expected to challenge Starmer for the leadership of the Labour Party and his position as prime minister. If he loses, questions around Starmer’s leadership are likely to persist, though the path forward becomes far less clear. Other prominent figures, such as former health secretary, Wes Streeting, or former deputy prime minister, Angela Rayner, are likely to emerge as challengers, but in that scenario Starmer could remain in office for longer despite his weakened position.

The main challenger to Labour in Makerfield is Nigel Farage’s Reform UK. Reform UK’s candidate Robert Kenyon is a local plumber who contested the constituency for Reform UK at the 2024 general election. The contrast between the two candidates is stark: Andy Burnham has spent almost his entire working life in frontline politics and is widely seen as having leadership ambitions, while Kenyon is positioning himself as a local, political outsider. While Reform UK may have hoped that Kenyon’s local profile would resonate with voters, particularly when contrasted with Burnham’s national political ambitions, it is Burnham’s strong personal popularity as mayor of Greater Manchester that is likely to bolster his performance. If Labour had selected any other candidate, Reform UK would almost certainly win this by-election as Makerfield is the 29th most easily winnable seat for Reform UK, based on the swing required from the 2024 general election for the party to win the seat.

With Burnham in the running, the result is expected to be extremely close between Labour and Reform UK. The first constituency poll shows Burnham leading Reform by just three percentage points, underlining how competitive the race is going to be. The outcome may ultimately depend on where smaller-party voters choose to lend their support, if they choose to do so at all. Labour will hope to attract tactical backing from voters who would otherwise support the Liberal Democrats or the Green Party, while Reform UK will seek to consolidate support on the right from voters considering Restore Britain. The growing momentum behind Restore Britain’s campaign also threatens to split the right wing vote if would be Reform UK voters switch their vote to Restore Britain, which could deny Reform UK a victory. Restore Britain was established as a right-wing challenge to Reform UK by former Reform UK MP Rupert Lowe, who left the party following a dispute with Nigel Farage over policy. Currently, the Liberal Democrats and the Green Party are collectively polling at 7%. The same figure as Restore Britain. This means even relatively small shifts through tactical voting could determine the outcome of the by-election contest.

Another factor that may shift the result is the media scrutiny surrounding Kenyon’s social media posts and the numerous Reform UK councillors that have stood down since the local elections on 7 May. If these issues resonate with voters, it could become a significant issue in the campaign and may bolster Labour’s chances in this highly competitive election.

The key issues on which the by-election is being fought have also presented risks for Burnham’s campaign. Burnham has already started to change tack on several policy issues in a bid to make himself more attractive to voters in the Makerfield constituency. For example, in an attempt to neutralise Reform UK’s attacks on his previous position that the UK should rejoin the EU, Burnham has stated that he will not reopen the Brexit debate. He has also agreed to maintain the government’s existing fiscal rules, despite having previously questioned them. . For businesses and investors, this points towards the possibility that a Burnham government may pursue a policy agenda that is broadly similar to the current government than Burnham would like to explicitly admit. These U-turns in fundamental policy areas may risk Burnham appearing the same as Starmer: a politician that changes their stance at the first sign of opposition. If Reform UK can capitalise on this, it may undermine Burnham’s attempt to present himself as a fundamentally different kind of Labour leader and weaken the electoral advantage that currently makes him such a significant political threat to both Starmer and Farage.

If Burnham achieves victory in a seat that would almost certainly be won by Reform UK against any other Labour candidate, it will be politically significant beyond the by-election itself. A win would allow Burnham to argue that he has the electoral appeal needed to reverse Reform UK’s lead in the national opinion polls and could persuade Labour MPs that he can address many of the government’s political and electoral problems. If Burnham wins, this makes it likely that he would be able to gain nominations from the 81 MPs required to trigger a leadership challenge, with many Labour MPs potentially concluding that he is the person who is most capable of stopping Reform UK from winning the next general election. With polling of Labour members showing that Burnham would beat any other contender for leader, this may mean that success in the by-election paves a path for Burnham to be the next Prime Minister. If Burnham fails to be elected, however, those same polls show that Starmer would beat a number of other candidates in a head-to-head election for the Labour leadership, including Wes Streeting.

The importance of this by-election cannot be overstated. It creates the conditions for Burnham to become Prime Minister, but also for Starmer to remain in position, having seen off other potential challengers.   It is vital for businesses and investors to begin thinking now about how a future Burnham-led government may affect them and to consider how existing policy agendas could continue to be developed by a weakened Starmer administration.

If you would like to talk more about the outcome of the by-election or the potential of a Burnham-led government, please email jacob.walsh@gkstrategy.com.

Treasury to Treatment: James Murray Appointed Health Secretary

As predicted, England has a new Health Secretary – James Murray.

Above all else, he deserves the goodwill that comes with inheriting one of the best jobs in government.

The Department of Health and Social Care is unlike any other brief. It combines immense public affection for the NHS with relentless operational pressure, difficult fiscal realities and an almost impossible expectation that Ministers can ‘fix’ deep-rooted problems decades in the making.

So my advice to James above all else would be this; you inherit a Ten Year Plan (and numerous other strategies) so don’t waste time and try the patience of the sector by re-writing them.

Focus on operationalising them and give your civil servants (as well as Jim Mackie who I suspect will be feeling deflated right now) a very clear steer from day one on your top three policy areas. Not the infamous three ‘shifts’ – they’re the means to the end – but the areas they know you personally will never drift from.

James takes office with a formidable in-tray. NHS waiting lists still high and a media (as well as a sector) that is sceptical recent falls weren’t more about politics than clinical reality.

Access to primary care continues to define the ‘retail offer’ in health, while care reform of course remains the great unresolved question of British domestic policy.

Not to mention a Ten Year Workforce Plan that remains illusive, medicine shortages (which I predict will grow as an issue in 2026) and rising demand because we are living longer, but often not healthier, lives.

And hanging over all of this is perhaps the biggest challenge of all; how we finally move from a sickness service to a genuine health service.

That is why the NHS Modernisation Bill he inherits matters. Much of the early discussion around it has understandably focused on the proposed Single Patient Record — a potentially transformative attempt to join up fragmented patient information across the NHS.

Done properly, this could save lives, reduce duplication, improve productivity and finally give clinicians the information they need at the point of care. Done badly, it risks becoming another expensive digital programme which loses public trust before it delivers meaningful change. The new Secretary of State will need Number 10 (whoever occupies it) to back him fully when the going gets tough.

But the Bill goes wider than that. It is likely to include measures aimed at modernising NHS structures, expanding the use of technology and AI, improving data sharing, reforming procurement and accelerating innovation adoption. And that’s before Labour MPs, increasingly keen to reject incrementalism, get their hands on amendments come the Bill Committee stage.

The challenge, of course, is delivery. Every Health Secretary arrives in office promising reform. Most discover the system is better at absorbing change than enabling it.

The NHS is enormous, complex and deeply institutionalised. Structural reform alone rarely changes outcomes unless accompanied by cultural change, workforce support and political honesty about priorities.

And that brings me to Wes Streeting. I know how hard it is to leave that Department so it can’t have been easy.

Politics is often too tribal to acknowledge effort when people leave office or move on from major briefs. But it is right to recognise the energy, seriousness and determination Wes brought to the health debate.

Whatever one’s politics, he helped force difficult conversations into the open — about productivity, reform, prevention and the need for the NHS to modernise if it is to remain sustainable.

Wes deserves credit for that as well as the HIV Plan, the Men’s Health Strategy and some lesser noticed progress around things like the Rare Diseases Plan or England (finally) testing newborns for Spinal Muscular Atrophy as a result of his work with Jessy from Little Mix.

The new Health Secretary will quickly discover there are a thousand competing voices telling him what matters most.

My hope is that, amid the noise, he keeps sight of a simple truth: the future sustainability of the NHS will depend not only on how we treat illness, but on how seriously we take the business of creating a healthier society in every sense of the word. We should all wish him nothing but success.

Steve Brine, consultant, podcaster, trustee, former MP for Winchester & Chair of the Health Select Committee

Prevention is the new cure podcast – all things health and politics

Keir Starmer’s Nightmare – a look ahead to the May 7 elections

The UK is facing unprecedented electoral times. For the first time in British history, a party other than Labour or the Conservative Party has led in the polls for over 12 months. A governing party has never fallen in the opinion polls as fast or as heavily as the current Labour government. Fewer than two in five people say they would vote for Labour or the Conservatives, which has never happened before. To help us make sense of these seismic changes, esteemed political scientist and elections expert Sir John Curtice joined GK Strategy and our guests to explain the fundamental shifts that have taken place in electoral behaviour in the UK, and to unpack what this means for the upcoming elections on May 7.

On May 7, millions of people across the United Kingdom will go to the polls to vote in this important set of elections. Around 5000 seats across 136 local councils in England, which includes all the London borough councils, are up for grabs. Outside of England, Scotland and Wales will have parliamentary elections which will determine what party will run the devolved governments in Edinburgh and Cardiff. These elections are the biggest set of elections between now and the next general election, and the results will inevitably have a significant impact on politics and the standings of the current party leaders.

Curtice explained that British electoral attitudes have become highly fragmented, with the underlying shift being visible in the breakdown of traditional voting predictors. Historically, working-class and younger voters tended to support Labour, while middle- and upper-class and older voters leaned Conservative. However, his analysis of the 2024 general election showed that these relationships have largely collapsed. In their place, voting behaviour is increasingly structured around social values: whether individuals are socially liberal, and view diversity as something to be promoted, or socially conservative, and favouring greater cultural homogeneity.

This shift first became apparent during the Brexit referendum. While there was a relatively even split between economically left- and right-wing voters on whether to remain in or leave the EU, social attitudes were far more polarised: social liberals overwhelmingly supported Remain, while social conservatives backed Leave. Curtice argued that Brexit crystallised this realignment in British politics, with social values now serving as the strongest predictor of voting behaviour.

Looking to the elections on May 7 and the fate of the two main parties, Curtice laid out a grim picture for them both. He warned that the pro-Brexit coalition which delivered Boris Johnson’s victory in 2019 has now fractured, leaving the Conservative vote split almost evenly between Leave and Remain supporters. For Labour, the picture that Curtice painted is arguably worse, with its 2024 coalition fragmenting across the Green Party, Reform UK, and the Liberal Democrats. Curtice argued that the driving factor behind this is that both the Green party and Reform UK have firmly chosen a side on the socially liberal–socially conservative divide, allowing them to reap the electoral rewards of modern Britain’s voting behaviour.

May 7 looks to be a dark night for Labour and the Conservative Party, with Curtice stating the night will either be “bad, very bad, or existential” for them both. Polling day could result in what Curtice described as “Keir Starmer’s Nightmare”: Labour coming third in Wales and Scotland, losing to Reform UK in working class councils, and the Green Party beating them in London. While he acknowledged the considerable uncertainty around the elections and their outcomes, Curtice argued that the two-party system is effectively dead. In its place, the first-past-the-post system that once enabled the Conservatives and Labour to dominate is now contributing to their decline. Sir John aptly captured it: “those who live by the sword can die by the sword.”

GK Strategy are experts in helping businesses and investors understand, navigate and influence the ever-changing political landscape. If you would like to talk about the impact of the local elections or the political landscape more generally, please contact scott@gkstrategy.com.