The ambition is grand and loud:
“world-leading access”, “faster adoption”, “global competitiveness”, “innovation at pace and scale.”

The UK government’s Life Sciences Sector Plan (LSSP) 2025, published in July 2025, sets a target for the UK to be among the top three fastest countries in Europe for patient access to medicines and medtech by 2030.

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However the very money that would make this possible is being quietly siphoned away before it even reaches the budgets that hold accountability for the system.

It’s like this:

Your partner gives you a shopping list. You normally spend £100 a week on food. To stop you raiding the middle aisle in Aldi for inflatable kayaks and cordless drills, they hand you £100 in cash.

Then they say that £100 now needs to cover two weeks. Fine — you’ve done the maths, vegetables are cheap, you can make this stretch.

But your partner then realises that switching to Aldi saves £20… so they take the £20 off you immediately, leaving £80 to do the same job.

Annoying, but manageable.

Then they tell you that with that £80, you’re also expected to host a steak dinner for the neighbours on Saturday night.

At that point you get the familiar tightening in your chest:

this isn’t going to work, and I’m the one who will be blamed when it doesn’t.

That’s essentially where we are. The introduction of generic dapagliflozin was hailed as delivering a potential £560m saving for the NHS. But here’s the kicker, that funding has already been removed from ICB allocations before the saving even materialised, and that ICBs hold the primary care prescribing budget.

A saving that could have given ICBs and therefore the providers the headroom to adopt the innovation and access that is being promised to pharma, and ultimately to our population, has been removed from before systems ever saw it. The resource vanished, but the expectations didn’t.

Now I get it, sometimes efficiency and innovation is driven by a carrot, and sometimes it’s driven by a stick. But I think this is different, and here’s why.

There’s a growing belief at the centre that because we’re all “one NHS”, you can simply tell the system to adopt innovative medicines faster. That same tone applies across lots of things at the moment, no doubt driven by the fact that the top team is made up of FT expats. Telling people you employ to do something is one thing (and of course that doesn’t always work as you’d intended - otherwise we wouldn’t have underperforming trusts). But people you don’t employ? That’s a whole different thing.

General practice and community pharmacists are independent contractors. Their contracts don’t align with these expectations. Community pharmacy, in particular, is still, incredibly, (under) funded almost entirely on dispensing volume. It is structurally misaligned with a world where innovation is driven by rooting out inefficiency and waste.

And when we try delegating budgets directly to prescribers to encourage “good prescribing”, we create rational behaviours that run completely against what we want: perverse incentives, defensive prescribing, local rationing, and delay as the safest option. And of course greater unwarranted variation - the great enemy when it comes to prescribing.

Enter the Single National Formulary — the tidy answer to a messy problem.

The SNF is being offered up as the key lever to drive uptake, complete with performance measures and system accountability.

But a national formulary cannot create financial headroom. It cannot redesign local pathways or commissioning models. It cannot align incentives across contracting models written in another era. We’re trying to solve structural misalignment with a publishing exercise and a big stick. And it’s a distraction.

The removal of £560m doesn’t happen in a vacuum. The economy is knackered and the government is trying to find a new way to dance around that particular handbag. The NHS is being ripped up and started again in the interests of ‘greater democratic accountability’ (and one man’s pursuit of the top job). In that context everyone wants to show how valuable they are, so everyone wants control and credit.

The gap between ambition and reality is widening. And I don’t think we are being honest with ourselves or our population about this.

And this is all landing at the worst possible time. People like me are currently writing next year’s plans while simultaneously dealing with:

• organisational chaos and distraction, including clustering, consultations and down-sizing

• 50% running-cost reductions, hollowing out the very teams expected to deliver innovation

• peak winter pressures

• political commentary that is, at best, insensitive and at worst, insulting to the people still holding the system together

It is very difficult to produce a credible plan for innovation uptake while your own organisation is being structurally dismantled and publicly criticised. It’s pretty difficult to just stay sane.

If the £560m from generic dapaglaflozin and the VPAG rebates are being removed so they can be ringfenced — visibly, transparently, meaningfully — into a national innovation fund that:

1. gives providers the resource to adopt new therapies safely and improves access to life changing and saving medicines,

2. demonstrates to industry that the UK is serious about delivery,

then brilliant. I’ll be delighted. But that requires openness. If this money is being pooled for innovation, then show it. Build confidence around it. I’ll be a cheerleader for it (but perhaps not in the uniform).

And maybe that’s exactly what is planned. Maybe I’m wrong, and this is part of a coherent, intelligent strategy. But right now, from where many of us sit, it doesn’t feel like that.

It feels like the vice is tightening, and me and my peers are left holding responsibility without the tools to meet it.

If we want faster adoption, we need a shared understanding of what it actually takes.

• The understanding and insight.

• The capacity.

• The contractual reform.

• The political courage.

You can’t performance-manage your way through a misalignment.

Photo by Edz Norton on Unsplash

So how to square this circle? It’s simple:

• Understand the behaviours you are incentivising

• Align the ambitions with the resources.

• Align the levers with the incentives.

• Align the responsibilities with the tools.

• And if national bodies are going to harvest savings upfront, show clearly and publicly how that money is being reinvested to drive the thing you’re asking systems to do.

Until then, we will keep trying to bridge the gap. But each year, that gap grows wider, and eventually it becomes unbridgeable. People give up.

And I suspect I’m not the only one who occasionally wonders what “giving up” might feel like.

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