Discussing the future of strategic medicines optimisation

We recently hosted a roundtable discussion at Jesus College to discuss the future of strategic medicines optimisation. The discussion comes at a pivotal moment: NHS England and Integrated Care Boards (ICBs) are undergoing major restructuring, with organisations facing substantial reductions in running costs by the end of 2025.

To help implement this change, NHS leaders have published a blueprint which outlines the core functions of an ICB and suggests how they might evolve. The focus is clear: a shift toward more strategic, system-level ways of working. The challenge is how to implement this - serving larger populations with fewer staff.

The NHS blueprint emphasises a critical need to strengthen data intelligence capabilities across ICBs, including:

• Population health management – through predictive modelling and risk stratification
• Health inequalities analysis – by disaggregating data to surface disparities
• Epidemiological insight – to better understand disease causation, prevention, and optimal care
• Robust evaluation – using both qualitative and quantitative methods

The NHS’s ambition is that by enhancing these capabilities it will improve the NHS’s ability to identify priorities, allocate resources, and see the impact of their work on both clinical and financial outcomes.

At the Bennett Institute we have deep expertise in all of these domains, so there’s a great opportunity for collaboration between our team and the NHS in building smarter learning health systems. Through our work on OpenPrescribing over the last ten years, we have come into contact with most of the “Medicines Optimisation” teams that work locally advising clinicians in general practices on effective prescribing.

We therefore decided to convene a “policy roundtable” as part of our Bennett Institute’s policy insight work. We invited a small group of experts who care deeply about optimising medicines to deliver effective outcomes for patients. We hope that this will be a useful contribution to people tasked with implementing the new ways of working in the NHS.

What is strategic medicines optimisation?

Very briefly, strategic medicines optimisation describes the work, largely done by pharmacy professionals, to support general practices to control prescribing costs over time, using data.

It builds on decades of NHS experience in harnessing prescribing data to support safer and more cost-effective care. GP prescribing data has been gathered nationally and shared with a small number of named local NHS staff for review since at least the 1950s (Martin 1957). In the 90s, this data was taken by a small number of pharmacists to GP’s front doors to create a new class of NHS professionals, “pharmaceutical advisers”. Initially, pharmaceutical advisers justified their roles and salaries on an “invest to save” basis, by engaging with general practices to control prescribing costs. Many teams built on this work by improving prescribing safety and efficacy of medicines by changing prescribing practices. By the early 2000s, all Primary Care Trusts (PCTs, which became CCGs, and more recently ICBs) had invested in teams of pharmaceutical advisers, then known as medicines management teams, currently known as Medicines Optimisation teams. We are using a slight variation of the name, strategic medicines optimisation, to differentiate teams who work in ICBs from those who have moved to more patient-facing roles in general practice.

What we talked about

At the roundtable we had a lively and varied discussion with contributions from all participants. As the new operating model for the NHS emerges, both nationally and locally, we agreed there is an urgent need to define the types of work that ICB strategic medicines optimisation does: what functions they should grow, what they should evolve, what might be better delivered by different organisations, and what services should be stopped.

Alongside this, the group agreed that the strategic medicines optimisation profession needs some formal training to equip staff with the technical, clinical, and influencing skills required to deliver impact. We also see huge potential in shifting some analytical work from local to national level, enabling teams to spend less time replicating analytics and more time implementing.

Finally, the success of strategic medicines optimisation teams over many decades offers a powerful template for other areas, such as pathology and blood tests, where clear standards, strong data, and consistent delivery could drive similar improvements to medicines.

Next steps

We are rapidly developing our initial ideas into concrete actions, and will soon share a summary of our recommendations, to prompt further discussion. If you are an “architect” of the new NHS organisational model, and would like to discuss how medicines optimisation “fits in”, or receive a draft copy of our recommendations, please get in touch with Brian MacKenna.

We’ll also write a longer follow-up piece for publication, building on our previous work with NHS data analysts - bringing NHS data analysis into the 21st century. If you work in a medicine optimisation team and you’d like to contribute we’d love to hear from you, do get in touch. We’ll also convene more workshops at our annual Bennett Institute annual conference (planned for 10 - 11th December 2025 in Oxford, more information will follow shortly).

While NHS restructuring can bring challenges for staff, it also offers opportunities to implement ideal ways of working and integrate new expertise for a new era. We are confident that Medicines Optimisation teams will continue to play a vital role in ICBs providing invaluable clinical insight.

Thank you!

Finally, we would like to extend a massive thank you to everyone who participated in our roundtable: Ben Goldacre, Brian MacKenna, Richard Croker, Andrew Brown, Caroline Acuda, Ewan Maule, Laura Angus, Vanessa Burgess, Kenny Li, Charlie Thomas, David Webb, Catriona Ketiar, and Sajida Khatri. We know things are very busy in the NHS at the moment so we’re grateful for everyone who made the time to travel and contribute their valuable expertise.