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It gets complicated when the wider determinants of health such as housing, security and education are brought in. In pharmacy, it’s all about medicines optimisation, common ailments management and prevention, says Terry Maguire…

Our chief pharmacist invited a select group from community practice to a hotel outside Antrim on a dark and cold November evening.

We were there to discuss the design and implementation of a neighbourhood model of care. Copied and pasted from the NHS 10-year plan for England, community pharmacies are identified as a key partner in this new integrated service delivery model.

Championed by our health minister Mike Nesbitt, it represents a key plank of his ‘Reset Agenda’, his commitment to make care more accessible and efficient.

We politely sat through three short jargon-encrusted presentations before being asked for comment. A strange miasma of frustration emanated the room. Respecting our chief pharmaceutical officer (CPO) and the minister, who is really trying their best, most of us did wonder, silently, if this is the best both of them could do and if it was the most productive way for us to spend the evening.

Announced in September last year, this new model was expected to be designed by last month and implemented in April 2026 by a Department of Health (DoH) not known for its speed or efficiency.

Many in the room had been down this road before and some wore scars

Unlike our CPO, many in the room had been down this road before and some wore the scars. I spent over eight years on Belfast’s local commission group (LCG), ending up as chair in 2013 when the GPs decided they preferred a GP federation model and huffed off to form it, leaving the LCG model of care stillborn.

Transforming Your Care (TYC), a Northern Ireland health strategy which was published in 2011 called for this exact model but it was never delivered, so we were somewhat surprised that, in a hotel in Antrim in 2025, we were now being told that it is the new and exciting way forward.

Systems not Structures (the Bengoa Report), published in 2016, (some say TYC for slow learners) called for a similar model. It was a simple model of care; LCGs commission care and prevention services from integrated care partnerships (ICPs) that included community pharmacies, community groups, voluntary groups and GPs.

Funding would “shift left” from secondary care to sustain the model, justified because the new way of working would keep people out of hospital. But the model, never finding real traction with communities, was starved of funding that didn’t “shift left”, gained little political support and was largely ignored by trusts and GPs. 

The model struggled on until 2021, then the plug was pulled when the Health Board was dissolved and DoH took over direct responsibility for care delivery through a new structure called the Strategic Planning and Performance Group.

The Government seems to do this a lot; identify a problem, set up a review, publish the recommendations, deem it’s the best thing ever, half-heartedly attempt to implement with insufficient funding and then, having allowed it to fail, promptly disown it. Perhaps it’s just that the status quo has an impressive talent for maintaining itself.

Many in the room had worked in LCGs or ICPs and had heard it all before. The CPO was told so and, to her credit, she listened and seemed to understand our frustrations. If her department seriously wishes to implement care based around neighbourhoods (the same as the ICPs covering 115,000 residents), this will require a mechanism to co-ordinate the 25 or so community pharmacies that operate within these geographical units.

There will, of course, be overlap which also needs to be addressed. Commissioned services must be in place in the pharmacies are to deliver the care and prevention needed. Hoping that somehow pharmacists can magic this care out of nothing through sheer goodwill is for the birds. It’s this pie-in-the-sky thinking that helped wreck previous attempts to get this model in place.   

Over the life of LCGs and ICPs, there were some excellent examples of how the model might work and achieve good outcomes; supporting local communities to essentially look after their own health and be truly resilient.

It can get too complicated when the wider determinants of health are brought in such as housing, security and education. For pharmacy, we only work at three levels; medicine optimisation, common ailments management and prevention services.

With the right suite of commissioned services, we can, within neighbourhoods, provide effective care and support communities. In the Pharmacy First model (common ailments), for example, we need referral priority for patients needing to be seen by other healthcare professionals and we need a wider list of medicines so the need to do this becomes less. This would put an end to the 8am public scramble to get a GP appointment.

In the really important area of prevention, it comes down to four things; stop smoking, eat a better diet, take more exercise and reduce stress.

The Government might be excited by a model copied out of England but without proper funding (truly shifting left) and a real commitment to deliver, it is going the same way as its predecessor.

The one who can challenge the seeming intractability of the status quo is our health minister but I do wonder if he has it in him.

Terry Maguire is a leading community pharmacist in Northern Ireland.