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Funding talks need to be more transparent if they are to be fully understood by thousands of pharmacy contractors directly affected by them, says Nick Kaye…

There’s a number in the hit musical Hamilton. “No-one really knows how the game is played,” says the song. “The art of the trade. How the sausage gets made.”

“We just assume that it happens. But no-one else is in the room where it happens.”

As I wrote this, Community Pharmacy England’s negotiating team were in a room where it happens (at least we think it’s where it happens) with the Department of Health and Social Care being consulted on the pharmacy contract for 2026-27. 

I have never been in that room but I’m going to imagine I’m there, as I am sure many of you do.

Having led the National Pharmacy Association’s action with an excellent team and all your support, which I believe helped secure the only rise in core funding for over a decade, my aim would be as clear as it was then – to get a better financial footing for our network.

That would mean making the greatest possible progress towards getting proper funding for our core work and maximising the opportunities for pharmacy, now and into the future.

So, the key question in true negotiations I would be asking myself is not only what we want but what the Government wants. And how can we use their aims to get the result we need? Fortunately, what the Government wants is clear. They laid it out in the 10-year plan for the NHS. Let’s remind ourselves what they said.

One of the biggest challenges to us all

Pharmacy will play a vital role in the neighbourhood health service, supporting minor ailments and long-term condition management, monitoring complex medication regimes and treating obesity, high blood pressure and high cholesterol.

Community pharmacy will offer more clinical services and expand independent prescribing, transitioning over the next five years from being mainly focused on dispensing medicines to becoming integral to the neighbourhood health service.

This is a really important point but it’s also one of the biggest challenges to us all.

They also want us to play a bigger role in wider prevention measures by expanding our role in administering vaccinations and screening for patients at risk of cardiovascular disease and diabetes.

Let’s take this knowledge and understanding. It’s our opportunity and, importantly, it’s our leverage as well. Experience tells us that, frustrating as it is, the Treasury dislikes paying for more of the same of what they think they had before, but all the new approaches in the 10-year plan have a real value for patients and for politicians.

So, in my view, there is absolutely a deal to be done. We are uniquely positioned deliver exactly what they want, crucially, if the funding is right, although it means change, which can be tough. But as a group, we are agile and can pivot to maximise opportunities that are presented to us.

I can hear some of you saying “what about dispensing?” It’s woefully underfunded and as a member of the World Pharmacy Council, we have put out a global report highlighting this.

In practical terms, if we can’t even buy aspirin at a decent price, why are we suggesting we should faff around with independent prescribing and services? But we should remember that dispensing is a cost to the government. Yes, it’s a necessary one, and the Treasury will instinctively want to keep that cost under control. We need to be seen as a value centre not a cost centre.

Use our professional expertise to reduce overprescribing

A cost centre is a target for efficiency and cost savings; a value centre drives further investment. Again, given proper funding, we can help deliver what the government needs. The NHS faces huge problems with spiralling demand for medicines, global shortages, an unstable world market.

We can use our professional expertise to manage demand, maximise value and reduce overprescribing to bear down on rising costs. We can invest in technology, if there’s investment from the NHS. We can manage substitution, long-term conditions and help guarantee supply.

These are the reasons to invest in our core dispensing services. But they are a justification for reform and funding based on the government’s needs and wants. On a personal level, I believe it’s important to get our issues on the public’s radar. Campaigning and calling out the problems we and our patients face is critical.

You’ll notice I’ve said nothing about retained margin or activity fees or services of which I believe does need looking at and is in need of reform. But I’d rather focus on outcomes where the risk is for the health system, and where the circles between outcomes for patients, outcomes for the NHS and outcomes for us as contractors converge. 

You’ll also notice that I’m not in the room where it happens. Even when I was NPA chair, I was never in the room or briefed, which affects sector-wide decisions on campaigning.

During the last settlement when I was NPA chair, I was briefed 30 minutes before everyone else! That’s a closed book to virtually all of us and it’s worth saying I believe this process needs to be more transparent if it is to be fully understood by the thousands of pharmacy contractors directly affected by it.

But one thing the song from Hamilton doesn’t mention is how to spot the room in which it actually happens.

In a system where the Department of Health and Social Care, the NHS and the Treasury hold much of the power, the room where it happens is probably a ministerial office, often months before consultations start.

It’s worth us all remembering that a lot of the heavy lifting happens within government and this is what we should all work together to campaign on and also to influence and listen to what the other side needs as well as what we need.

Whatever the outcome of the current process, we would do well to remember what our funders need to deliver. As the song says: “When you got skin in the game, you stay in the game. But you don’t get a win unless you play in the game.”

Nick Kaye is a National Pharmacy Association board member and pharmacist based in Newquay. These are his personal views.