Reimagining medicines optimisation: A call to action for reducing health inequalities

These discussions exposed an urgent need for reform in how medicines optimisation is approached. It is clear that without strategic intervention, inequalities in patient care will only widen, leading to a detrimental impact on public health outcomes. Here are some of the key takeaways from these events, as well as a proposed path forward for the NHS and industry leaders.

The disconnect between ideals and reality

One of the primary findings from the roundtable was the absence of measures around medical inequalities. Although a broad consensus exists on what ideal medicines optimisation should look like, the reality is starkly different. Decisions about financial budgeting and the delivery of patient services are often made by NHS leaders who lack a deep understanding of the integral role medicines play in a patient’s treatment pathway.

This misalignment has significant implications for patient care. The concept of medicine optimisation, which should be focused on enhancing patient outcomes, has been overshadowed by an emphasis on financial savings. As a result, rather than centring on personalised, patient-centric care, NHS systems have shifted their focus to cost-cutting and meeting top-level targets. This shift leads to inefficiencies and ultimately exacerbates health inequalities, particularly for patients who rely on personalised, long-term medication management.

Systemic challenges: Cost, supply, and workforce

Three core challenges in the current system were repeatedly highlighted during the discussions: cost, supply, and a workforce misaligned with patient needs.

1. Cost: It is commonly assumed that most systemic changes require significant funding. However, discussions revealed that not all change requires financial investment. What is needed is strong leadership, capable of steering stakeholders – including non-clinical leaders and community pharmacists – towards a model of care that focuses on prevention and long-term patient benefits, rather than short-term cost savings. Leaders must understand the broader role of medicines and refocus their efforts on interventions that will improve health outcomes for patients over time.
   
   For instance, Ewan Maule, clinical director for North East and North Cumbria Integrated Care Board, shared that many patients are disadvantaged because they do not know how to navigate the system. This presents an opportunity for healthcare professionals to reimagine their role – not just as dispensers of medication but as navigators and advocates for patients within a complex health system.
2. Supply: National shortages of medicines have become an increasing concern, contributing directly to health inequalities. Patients are often unable to access the medications they need, resulting in avoidable health complications. During the forum, Richard Condon, CEO of Aspire Pharma Ltd, pointed out that supply chain issues must be addressed at a systemic level. This means creating contingency plans for national shortages and investing in generics where possible to ensure a steady supply of essential medications. Aligning medicine procurement with patient needs, rather than solely with cost-saving measures, will help prevent disparities in access.
3. Workforce: Finally, there was widespread agreement that the workforce must be upskilled and refocused on patient-centric care. With more prescribing pharmacists entering the system in 2026, now is the time to invest in training and development that will shape the trajectory of patient care for the next decade. Raj Matharu, CEO of Community Pharmacy South East London, highlighted the importance of leadership in this area, emphasising that training and support must be provided to ensure that the workforce is equipped to meet future healthcare demands.
   
   Moreover, pharmacists and other healthcare professionals should be viewed as integral players in the broader health inequalities agenda. Their role extends beyond dispensing medications; they must champion preventive care and work collaboratively with other stakeholders to address social determinants of health.

The path forward: A call to action

The insights gathered from these discussions suggest that incremental tweaks to the current system are not enough. To reduce health inequalities and ensure that medicine optimisation fulfils its potential, the NHS and healthcare leaders must adopt a more holistic, patient-centric approach. Here are four key recommendations:

1. Rethink financial priorities: It is essential to move away from viewing medicines optimisation as a way to achieve short-term savings. Instead, the focus must shift to long-term patient outcomes. Leaders need to balance budgetary constraints with the recognition that early intervention, prevention, and personalised care will save costs in the long run by reducing hospital admissions and improving patient health.
2. Strengthen leadership and collaboration: Strong leadership is crucial for driving change. This includes bringing together a diverse range of stakeholders – from pharmacists to non-clinical leaders – who can provide a comprehensive understanding of patient care. Collaboration across sectors will be key to aligning treatment pathways with patient needs.
3. Address supply chain issues: Supply shortages are directly linked to health inequalities. The NHS must develop more resilient supply chains, diversify procurement strategies, and ensure that generics are available to prevent interruptions in patient care.
4. Invest in workforce development: The future of healthcare depends on a workforce that is skilled, adaptable and focused on patient outcomes. Training and development programmes for new and existing pharmacists will be essential in creating a system that prioritises patient care over cost-cutting. Equipping these professionals with the tools and skills to lead the way in medicine optimisation will be critical for the years to come.

Conclusion

The findings from the 2024 roundtable and the HSJ Medicines Forum paint a clear picture: medicines optimisation, as it is currently practised, is possibly contributing to health inequalities. It is now up to healthcare leaders to take decisive action. By shifting focus from cost savings to patient outcomes, strengthening leadership, addressing supply issues, and investing in workforce development, we can create a more equitable, patient-centric healthcare system.

This is not just a task for the NHS but a call to action for the entire healthcare ecosystem including the pharmaceutical industry to ensure that medicines optimisation works for all patients, not just those with the means or knowledge to navigate the system.

Call to action points for both the NHS and industry were formulated based on the meeting discussion and are detailed below. A white paper was developed following the roundtable event, summarising the discussion points which is available here. Clicking on this link will take you to an external website hosted by Aspire Pharma.