Category Archives: Health

Palantir, politics and the future of NHS data

Drawing on his experience as a health minister and chair of the Health and Social Care Select Committee, GK’s strategic advisor Steve Brine examines the debate over Palantir’s role in the NHS and argues that evidence of patient benefit, delivery risks and credible alternatives should guide ministers’ decisions.

Senior Vice-President of Palantir UK Tom Watson is an old friend. We were in the Commons together for nine years and our paths crossed many times, not about health it must be said, but music, where we share a vision of creative sovereignty in the face of a powerful challenge from big tech.

Tom’s return to the political headlines was always likely to provoke a reaction but I was pleased to see him back; primarily because it means he once again had the all-clear in his battle with prostate cancer.

Back how? The former deputy leader of the Labour Party has joined American technology company Palantir as a senior vice-president. The appointment comes just as ministers approach a big decision about the company’s future role in the NHS.

Appearing recently on a BBC podcast, Tom warned against allowing what he called “mob rule” to determine government procurement decisions. His intervention was characteristically direct, but it raised a question that goes well beyond one company.

The bottom line is this: should our government allow political discomfort (justified or otherwise) with a supplier to override the practical interests of NHS patients?

At the heart of this debate is the NHS Federated Data Platform (FDP), a programme designed to connect information held across different parts of the health service, helping clinicians and managers make decisions about patient care, waiting lists and capacity.

In November 2023, a consortium led by Palantir secured a seven-year contract to deliver the FDP. Ministers now face a decision over a contractual break point in the early part of 2027.

Two parliamentary committees have recommended that the government take the option to break the contract and seek an alternative supplier.

And so, the search begins for compelling evidence that the existing arrangement is failing, or that a demonstrably better alternative exists, because in my experience the NHS cannot afford another technological false start.

Some NHS users have indeed complained about the technology itself. A British Medical Journal (BMJ) investigation published in July this year reported that NHS leaders had privately described aspects of the FDP as clunky and offering a poor user experience.

Having served as a health minister, and subsequently chaired the Health and Social Care Select Committee, I know how often the ambitions of NHS reform collide with the practical realities of delivery. The entire NHS Ten Year Plan is a case in point!

For decades, the NHS has struggled with fragmented information systems, inconsistent data and organisations unable to communicate with one another.

The consequences are not abstract. They mean operating theatres sitting underused while patients wait for treatment, unnecessary delays in discharging people from hospital, and clinicians spending time navigating disconnected systems.

The FDP was conceived to address precisely these challenges. It is not, as some commentary might suggest, a vast new database into which everyone’s medical records are poured. Rather, it provides a means of connecting and analysing information across existing systems, subject to governance and access controls.

The NHS does not need LESS intelligent use of data. It needs considerably MORE.

Indeed, the government’s wider ambitions for a modernised health service, including that Ten Year Plan, depend on greater use of artificial intelligence and a more joined-up approach to care.

Walking away from an established programme without a credible replacement risks repeating one of the NHS’s most frustrating habits: announcing transformation, beginning implementation and then changing direction.

Supporters of the FDP point to encouraging improvements. NHS England has reported increased theatre utilisation, more patients receiving procedures, improvements in cancer pathways and reductions in delayed hospital discharges.

But there is a necessary qualification.

Recent scrutiny, including by the Financial Times, has questioned whether some of the headline improvements can be directly attributed to the FDP. Some trusts have stopped using certain tools on the platform, and NHS England has acknowledged that improvements observed after the platform’s introduction do not automatically establish cause and effect.

That criticism deserves serious attention. But there is an important distinction between questioning the measurement of benefits and concluding that the technology has no value.

It is also striking that, unlike some previous NHS technology programmes, the FDP has not generated an overwhelming public backlash from the clinicians and operational staff expected to use it. There are complaints about usability and uneven adoption, certainly, but these sit alongside positive accounts from NHS organisations reporting practical improvements.

That is not proof of success, but neither is it the picture of an obviously failing system.

Incomplete evaluation is an argument for stronger scrutiny, not necessarily for abandoning a programme midway through implementation.

The politics of Palantir

Of course, much of the opposition to Palantir has little to do with such cold-eyed scrutiny of NHS operational performance.

The company’s American ownership, its co-founder Peter Thiel, and its work with defence, intelligence and immigration agencies have made it a lightning rod for political controversy.

These are matters on which people can hold sincerely different views, but we should be careful not to confuse opposition to a company’s activities elsewhere with evidence that its NHS contract is inappropriate or unsafe.

Palantir is not the owner of NHS patient data. It acts as a data processor, with NHS organisations retaining responsibility as data controllers.

The NHS relies extensively on international technology companies, pharmaceutical manufacturers, medical device suppliers and other private-sector partners. Their expertise is essential.

Surely the relevant test should be whether a supplier meets the necessary standards of security, effectiveness, accountability and value for money, not whether its founders hold political views with which some Labour MPs happen to disagree?

There are legitimate questions about supplier dependence and public trust, but they deserve to be distinguished from objections rooted primarily in political hostility towards the company.

Tom Watson’s intervention is interesting because it highlights an uncomfortable reality for government. Public procurement must operate within the law, but it must also serve the public interest.

In a recent conversation, someone described the FDP to me as a form of technological infrastructure that another supplier could, in theory, provide.

That is true, but it risks understating the complexity of what has been built. Palantir does not simply provide the cloud infrastructure on which the platform runs; its technology helps integrate data and supports the applications and operational workflows built around it.

There may well be credible alternatives, including other major international technology companies. But replacing the supplier is not necessarily the same as switching electricity providers. The government would need to establish what could be transferred, what would need rebuilding, how long that would take and at what cost.

And if the objective is greater technological sovereignty, replacing one American supplier with another hardly settles the argument.

Ministerial judgement

The government faces a difficult decision but, in my experience, the variables shift considerably when you’re making a political one rather than an operational one.

Palantir should be held rigorously to its contractual obligations, and the evidence of benefit must be strengthened. But – and this is my key point – the burden of proof should also apply to those advocating termination.

What would replace the existing platform? How quickly could an alternative supplier be brought in, and at what cost? What risks would that impose on patients, and would it deliver better results?

These are precisely the questions ministers must ask, and I am confident they are.

The wider lesson is that governments must resist the temptation to confuse a politically attractive announcement with successful public policy. Here I am less confident.

My instinct is that ministers should not exercise the February 2027 break clause unless the evidence presents a compelling case for doing so.

Ultimately, patients waiting for operations, cancer diagnoses or a safe discharge from hospital will not judge ministers by the ideological purity of their decisions.

They will judge them by whether the NHS is ‘fixed’.

View from the US: A Blue Wave is taking form

Erin Caddell of GK Strategy’s American partner Anchor Advisors examines the shifting US midterm landscape and the implications of a potential Democratic resurgence.

Like a surfer looking out at the ocean for the next big swell, US political observers are seeing signs of a gathering political “Blue Wave” – a potential shift in control of the House of Representatives and/or the Senate to Democrats in the midterm elections on 3 November. At this point, it is difficult to tell whether the wave will be big or small, and in the rapidly shifting seas of American politics, it could dissipate before it hits the shore. But US-focused investors and corporates should start paddling now to position themselves for the policy changes likely to occur.

As with most US political analysis these days, the midterm election outlook begins and ends with one man: President Trump. Arriving at the halfway point of the president’s term, midterms are often viewed as referenda on the incumbent administration’s progress. And with Trump dominating his party and the political debate as few have, midterm campaigns have been more focused on Trump than on the individual House and Senate candidates.

Here, the news is not good for Trump and the GOP. Continuing a trend we’ve noted in this column in recent months, Trump’s approval rating continues to grind lower due to high fuel prices driven by the unpopular US war with Iran, sticky inflation, and more recently, by a reacceleration of a trade war with Canada. An FT poll released on 6 September is indicative of the trend of recent US voter surveys: The poll of 1,914 registered voters found that 33% approved of Trump’s performance at the end of August, down from 39% in May. Equally troubling for the GOP, the survey found that independent voters’ approval of the president dropped from 32% in May to 26% in August.

Trump’s sagging popularity is being felt on the campaign trail. In the House, Republicans hold a slim majority of 218-214, meaning Democrats need to flip three seats to seize control. 270towin, an election forecaster, pegs 215 House seats as leaning Democratic, and 201 Republican equivalents, with 19 toss-ups in the 435-member body. Since 1946, the incumbent party has lost an average of 25 House seats in the midterms. Betting markets ascribe a 90% likelihood of a House flip in November.

In the fight for the Senate, with Republicans holding a 53-47 edge, Democrats need to win a net four seats to gain control (the Vice President breaks ties). The Democrat candidate is leading in the latest polls for GOP-held seats in Alaska, Maine, Iowa, North Carolina, Ohio and Texas, according to RealClearPolitics, though the margins are within a point or two in several, and a couple of Democrat-controlled Senate seats are also close. Betting markets peg odds of a Democratic Senate flip at 62-3%, up from 30% a year ago.

A lot can change in two months. But the data begs the question: What would it mean for US-focused investors and corporates for Democrats to win one or both houses of Congress in November? We focus here on two sectors: healthcare and renewable energy:

Healthcare. The healthcare and health insurance sectors have faced stiff headwinds throughout the second Trump Administration. The One Big Beautiful Bill (OBBB) – the centerpiece of the Republican legislative agenda in the first half of Trump’s second term – approved US$911 billion in spending cuts in the Medicaid health-insurance program for the poor over 10 years (some 15% of projected spending before the bill’s passage) and tightened eligibility requirements. Trump’s health secretary, Robert F. Kennedy Jr., has also pursued an anti-vaccine agenda that has hurt large pharmaceutical companies as well as primary-care physicians who administer vaccines to young children.

Democrats would not gain the ability to overturn administrative decisions even if the party wins the House or Senate in November. But through the appropriations process, a Democrat-led congressional chamber would dig out an old DC playbook: delay and live to fight another day. Democrats would attempt to delay the mandated spending cuts and tougher eligibility requirements for Medicaid recipients, many of which are not scheduled to come into effect until 2027. Democrats would also push back through budget tactics and oversight hearings against RFK Jr.’s moves to water down vaccine mandates and appoint anti-vaccine members of government health advisory panels. Beneficiaries could include hospitals (which receive substantial revenue from serving Medicaid recipients), Medicaid-focused insurers, primary-care physicians’ practices and drug manufacturers.

Renewable Energy. It is a worthwhile debate whether healthcare or renewable energy has been a bigger punching bag for Trump 2.0. We’ll give the nod to renewables, as not even health providers have been paid by the government not to provide their service. The Trump Administration has taken this unusual step, offering to pay more than US$2 billion to offshore wind developers sponsors to stop and invest in fossil-fuels projects instead. The Administration reported it approved new oil and gas leases on federal lands at a pace 55% greater in 2025 than in the last year of the Biden Administration in 2024. Yet the advantages of renewable development over fossil fuels – notably lower costs and faster speed to market – have meant that renewable production has still been growing despite the Trump Administration’s stance. The U.S. Energy Information Administration (EIA) reported that total U.S. energy production grew 3.4% y/y in 2025, with natural gas production increased by 4%. Renewable energy production rose 3%, equal to the growth in crude oil output, with both solar and wind setting new records (see below). Despite Trump’s constant anti-renewable, pro-fossil-fuels rhetoric, 61% of Republicans told Pew Research Center in 2025 they support more solar power (77% for all respondents), while 48% favor more wind (68% overall).

This bipartisan base of support could lead to improved market conditions for renewables firms under a Democrat House and/or Senate. As part of broader negotiations over the federal budget or on raising the debt limit, Democrats could push to restore tax credits for renewables projects passed during the Biden Administration in the Inflation Reduction Act (IRA) that the Trump Administration and the GOP-controlled Congress have reversed or limited thus far in Trump’s second term. Democrats would also use their investigative powers in Congress to scrutinise the payments the Trump Administration has made to halt offshore wind developments. Ultimately, market demand may lead policy: The new data centers necessary to power the AI boom are expected to increase total U.S. electricity demand by 5-10% by 2028, according to estimates by the University of California’s Lawrence Laboratory. As loyal Westminster Unwrapped readers know, the data-center boom has been met by a sudden public backlash across the U.S. (see our August 2026 note “Can’t buy me love: American public opinion turns against data centers – what’s next?”). But even if actual data-center construction is half that of projected, the U.S. will need significantly more renewables capacity to meet demand even if oil and gas development proceeds apace.

If Republicans rebound and hold both houses of Congress in November, the healthcare and renewables sectors would face a challenging policy landscape, but one no more hostile than the one they have managed through since January 2025. But a small blue wave could materially improve the operating environment for sectors out of favor thus far in Trump’s second White House stint, even better if a big one crashes to shore.

Digital health: Are we transforming the NHS or merely digitising what’s there?

Drawing on his experience as a health minister and chair of the Health and Social Care Select Committee, GK’s strategic advisor Steve Brine examines the government’s ambition to shift the NHS from analogue to digital, arguing that its success will depend on whether technology genuinely transforms care and reduces frontline pressures, rather than simply digitising how patients access them.

The Labour government has made ‘analogue to digital’ one of the defining ambitions of the10-Year Health Plan. It is difficult to argue with.

A next-generation NHS App, (finally) a Single Patient Record, greater use of AI and digitally enabled neighbourhood health all offer the prospect of a service that is easier to navigate, more personalised and – whisper it – more productive.

Given the pressures facing the NHS workforce and public finances, technology is no longer an interesting addition to health reform; it is central to whether much of that reform can actually be delivered. Jim Mackey, Chief Executive of NHS England, believes this to his core.

But there is an important question underneath all this ambition: how deliverable is it in practice, and are we moving further away or getting closer since the change of personnel in government?

For most people, their interaction with the NHS happens through primary care. That means the digital NHS will ultimately succeed or fail not in Whitehall, but in thousands of GP practices, pharmacies, optometrists and other community settings.

And therein lies both the opportunity and challenge.

Digital technology should help patients reach the right service first time, automate routine administration, enable better self-management and allow clinicians to concentrate their time on people with more complex needs. Used intelligently, it can support the other great shifts the government wants to achieve too: from hospital to community and from sickness to prevention.

But there is a danger that we confuse digitising access with transforming care.

Making it easier to contact the NHS is not necessarily the same thing as reducing pressure on it. If a new digital front door simply produces more follow-up work for already stretched primary-care teams, we have made demand more efficient without making the service more productive.

That distinction seems to me, as a former minister for primary care, to matter enormously.

The real opportunity is not simply to give patients a digital route to the same services they have always used. It is to use technology to change where they go and, sometimes, whether they need to see a healthcare professional at all.

During my tenure as the minister, Pharmacy First was born of exactly that thinking and I wrote about it in a recent column. It is hugely successful but that success should give us confidence to ask the next question: is Pharmacy First an analogue service in a digital age?

Its great strength is its simplicity. You have a problem, you walk into a pharmacy and speak to a professional, often without an appointment. We must not lose that.

But today we should be able to open the NHS App, describe our symptoms and be directed towards the right destination: self-care, GP, urgent care or community pharmacy. If pharmacy is appropriate, we should be able to see which pharmacies nearby offer the service and, ultimately, which have the capacity to see us.

‘Try your local pharmacy’ is mere signposting. ‘Your local pharmacy can help you this afternoon’ is a pathway.

The same principle applies much more widely.

A patient should not need to understand the organisational architecture of the NHS before accessing it. The question should increasingly be not how do I get a GP appointment? but what is the quickest and most appropriate way for the NHS to help me?

A genuinely intelligent digital front door should help make that distinction.

This is where the government’s digital ambitions and its neighbourhood health agenda ought to come together. Digital should be the connective tissue which allows care closer to home to work, not a separate technology programme running alongside it.

The NHS App may become increasingly sophisticated, but a brilliant consumer interface sitting on top of fragmented clinical systems does not constitute a digital health service. In short, the NHS does not only have a digital-access challenge; it has an integration challenge.

There is a workforce issue here also. Digital transformation cannot simply become another set of requirements imposed upon primary care. Every new platform, pathway or form of digital access changes somebody’s working day.

For a GP practice already managing intense demand, the compelling technology is not necessarily the one with the most impressive functionality. It is the one that removes duplication, reduces avoidable contacts, automates routine processes or releases clinical time.

Perhaps that suggests a simple test for every significant piece of NHS digital transformation should be; what workload does it REMOVE, not simply what functionality does it ADD?

There is an important patient dimension too. Digital by default cannot become digital only. Some patients will continue to need telephone or face-to-face access and, for those with frailty, multiple conditions or other complex needs, human navigation may become more rather than less important.

That is not an argument against digitalisation. In many ways, it is the argument for it. If technology can deal more effectively with straightforward transactions and help digitally confident patients navigate services themselves, scarce capacity can concentrate on those who need it most.

That, ultimately, is the prize.

Digital transformation should not be an IT programme imposed upon primary care. It should be service redesign undertaken WITH primary care. And the real measure of success will not be what happens on the screen, but whether technology changes for the better what happens behind it.

What does Andy Burnham’s social care announcement mean for providers?

On Tuesday 29 July, Prime Minister Andy Burnham, Louise Casey and Health Secretary Yvette Cooper outlined the government’s approach to adult social care reform. Burnham said it was ‘shameful’ that decades of political point-scoring had come at the expense of meaningful reform and argued that he is prepared to spend political capital to deliver lasting change. The prime minister used the speech to make three key announcements.

First, Burnham confirmed that Louise Casey’s independent review of adult social care will be accelerated by a year, with final recommendations now expected by summer 2027. He said Casey had been asked to consider how the government could deliver a National Care Service, arguing that social care should become more preventative, person-centred and better integrated with the NHS.

Second, Burnham announced a renewed focus on the social care workforce. Building on the government’s plans to introduce a Fair Pay Agreement for care workers from 2028/29, he said ministers would explore wider reforms to improve pay, training and career progression. He also proposed creating clearer pathways between social care and NHS roles to help professionalise the workforce and improve recruitment and retention.

Third, Burnham announced the launch of cross-party talks on social care reform involving the Conservatives and Liberal Democrats. He argued that lasting reform would require political consensus and described the discussions as the first test of his commitment to a less adversarial style of politics. Burnham said common ground must be found if policymakers are to address challenges that have remained unresolved for decades.

Both Andy Burnham and Louise Casey signalled that future reform would involve greater scrutiny of private providers. Casey argued that there remains an important role for a mixed market in adult social care, but criticised providers perceived to be “profiteering” from care services. Burnham echoed these concerns, arguing that some parts of the sector have prioritised profit and cost-cutting over the quality of care and outcomes for vulnerable people. However, Burnham has historically adopted a pragmatic rather than an ideological approach to public service reform. As health secretary in the Brown-led government, he recognised the role that independent providers could play in increasing NHS capacity and reducing waiting times where they delivered value for patients and taxpayers.

As a result, he is unlikely to pursue reforms that materially reduce the private sector’s role in adult social care. Given the significant share of care capacity and expertise provided by independent providers, the prime minister is likely to be mindful of avoiding reforms that could destabilise the market by causing market exits and place further pressure on already stretched services. Instead, providers should expect a greater focus on accountability and transparency, clearer standards to improve the quality and consistency of care, and enhanced scrutiny of how public funding and provider profits are used. The NHS Modernisation Bill currently going through the Commons is one key place to watch if any substantive change is to come forward.

On funding, Burnham argued that significant improvements could be achieved through more effective use of existing resources before tax rises are considered. He highlighted the costs associated with avoidable hospital admissions and delayed discharges caused by inadequate social care provision, suggesting that greater investment in prevention could deliver substantial savings across the wider health system. However, significant questions remain about the long-term funding model for a National Care Service. Reports suggest officials are exploring options ranging from social insurance-style contributions to inheritance-based levies, although ministers have stressed that no decisions will be taken until Casey’s review is complete and the new prime minister remains constrained to some extent by Labour’s 2024 manifesto commitments on tax.

Phil Hope, GK’s Strategic Adviser and former care services minister under Andy Burnham at the Department for Health, who was directly referenced in the prime minister’s speech said: ‘The prime minister was clear that he wants to build a broad consensus around social care reform and move the debate beyond the political point-scoring that has hindered progress in the past. Bringing forward the Louise Casey review to 2027 creates an opportunity for that conversation to take place away from the pressures of a forthcoming general election. While concerns about profiteering were raised, there was little detail on the scale of the issue or how ministers might address it, making this an area the Casey review is likely to explore further.’

Steve Brine, GK’s Strategic Advisor and former health minister as well as chair of the cross-party Health and Social Care Select Committee said: ‘It was a hugely impressive performance from Andy Burnham with what was more a political than a policy announcement but his authenticity on the subject is welcome and important. It was really about creating the political conditions for reform rather than announcing the detail, but that day will come – along with who pays – and that is the next big moment. Casey’s challenge is to define what ministers actually mean by ‘National Care Service’ – is it about standards, funding, eligibility – and for the PM it’s how will someone’s experience be different in two, three or five years’ time? That’s ultimately how people will judge success.’

Capital isn’t glamorous, but it’s where health reform succeeds or fails

Drawing on his experience as a Health Minister and Chair of the Health and Social Care Select Committee, GK’s strategic advisor Steve Brine argues the real challenge is delivering, not announcing, NHS infrastructure investment.

There is an old saying in politics that ministers like cutting ribbons more than fixing roofs. Reading the Government’s new 10-Year Capital Plan for Health and Social Care, I was reminded just how true that is.

Having served as a Health Minister and later as chair of the cross-party Health and Social Care Select Committee, I’ve learned that while politicians understandably focus on services, patients and waiting lists, none of those can be credibly improved without investing in the infrastructure that underpins them.

Estates, equipment and digital capability are not simply operational issues; capital isn’t glamorous – but it’s where health reform succeeds or fails

That is why I think this document matters, even if it contains fewer headline announcements than some may have wanted. It’s more of a capital investment framework than a capital spending announcement and while it is important because it starts to join together a series of previously announced commitments into one strategy, if you’re looking for lots of new money or major projects, you’ll likely be disappointed.

For investors, suppliers and those looking to support the transformation of health and care, this is best understood therefore as a statement of strategic direction. The Government is attempting to provide something the NHS has too often lacked: a long-term framework that links capital investment directly to service reform.

The themes will be familiar and re-enforce the view many of us held that the capital plan would essentially be the infrastructure companion to the 10-Year Health Plan which is now just over one year old.

Investment in neighbourhood health centres, modern diagnostic equipment (see my last piece), digital infrastructure, community facilities and the maintenance of the existing estate have all featured in previous announcements.

What is new is the attempt to bring those priorities together and explicitly align them with the Government’s ambition to shift care from hospitals into communities, from analogue to digital, and from sickness towards prevention.

As a minister, I learned very quickly that capital policy is health policy. You can’t expect clinicians to embrace new models of care if they are working in buildings designed before England last won the World Cup, nor can you promise a digital NHS without investing in the infrastructure that powers it. Too often, capital has been treated as something separate from healthcare delivery whereas in reality, it is one of its principal enablers.

That lesson stayed with me when I chaired the Health and Social Care Select Committee. Alongside colleagues on the Public Accounts Committee, we scrutinised the New Hospital Programme, asking not simply whether Boris Johnson’s ambitions were right, but whether they were deliverable.

That experience reinforced a rather obvious point: announcing infrastructure programmes is relatively straightforward; delivering them consistently over a decade, through changing political and economic circumstances, is considerably more challenging!

That is why I think investors should read this document with cautious optimism. The opportunities are clear. If the Government is serious about expanding community-based care, modernising diagnostics, digitising the NHS and addressing the maintenance backlog, there will inevitably be demand for expertise, technology, construction, data, equipment and innovative delivery models.

The direction of travel is now clearer than it has been for some time. The question not answered is pace. The plan sets out the destination far more clearly than the route to get there. There is relatively little detail about sequencing, procurement, prioritisation or delivery milestones.

History also provides a note of caution. During my time in government, I saw how easily capital budgets could come under pressure when day-to-day NHS spending became squeezed. Every government says it will protect long-term investment; not every government manages to do so.

And I note how one of the strongest themes is ‘repair first’ as large sums are earmarked for tackling the maintenance backlog, replacing obsolete equipment and of course removing RAAC. £6.75bn for hospital repairs over nine years and £2bn to remove reinforced autoclaved aerated concrete.

Overall, I see this as a welcome piece of strategic thinking. It provides a clearer signal than we have had for many years that infrastructure is no longer being viewed as an afterthought but as a prerequisite for NHS reform. For those looking to invest, that matters.

The real test, however, will not be whether the strategy is well written, but whether successive governments (including the new one about to start work) have the discipline to stick to it.

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.