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Twelve stockings of the NHS – gifts, curiosities and mixed blessings for pharma

Every December, the NHS and the life sciences sector find themselves in the same strange seasonal mood: exhausted; oddly reflective and quietly aware that the coming year will bring yet another wave of reforms, ambitions and constraints.

So, in the festive spirit, here is a Christmas stocktake: the twelve stockings the NHS hands to pharma this year. Some contain gifts. Some contain coal. Most contain something in between.

In theory, the new Strategic Commissioning Framework is one of the most genuinely constructive reforms of recent years. It’s the NHS saying: we know we need a longer attention span.

For pharma, it’s an unexpectedly stabilising force. It creates clearer strategic priorities, a more rational basis for engagement and permission for multiyear cross-sectoral partnerships.

It’s not perfect – ICS capacity varies wildly – but it signals a system that wants to behave strategically rather than reactively. Take note: HSJ is closely monitoring this story and the details of exactly who’s in charge of what, when, can be rather unclear.

NICE’s ‘faster in, faster out’ model sits squarely between gift and coal. Accelerated appraisals mean companies can get UK access closer to global timelines – good for industry and patients.

But the flip side is that post-launch performance becomes the judge: where weak real-world data leads to tighter restrictions or removal. This stocking says: you can have speed but you must back it with evidence. Fair enough – but demanding.

This is perhaps the purest lump of coal in pharma’s stocking, though one with a logic the NHS can easily justify. The SNF centralises decision-making, removes regional variation and makes national cost control unavoidable.

For companies used to building regional momentum, it’s a cold wind. Yet there’s a silver lining: predictability. It could give rapid clarity on position faster than many European markets.

This one is an absolute gift – the sort that becomes more valuable once you start using it.

Neighbourhood health systems, with PCNs evolving into community-focused digitally enabled cross-sector teams, are naturally aligned with what pharma has been trying to do for years – identify local cohorts, support pathway redesign, demonstrate real outcomes and integrate medicines into wider models of care.

These teams are hungry for support, open to partnership and deeply pragmatic. They are, in our estimation, the NHS’s most quietly transformative space.

This is the NHS’s north star and addressing the three ‘Streeting Shifts’ is arguably the biggest long-term commercial opportunity for industry.

Prevention and digital-first community care create the infrastructure for condition management beyond hospitals; remote monitoring aligned with therapeutic pathways and new models for delivering outcomes at scale.

The caveat is capacity. The NHS knows what needs to happen but the workforce and operational headroom aren’t always there yet. Still, this stocking contains a key blueprint for the next decade of value creation.

The shift towards three-to-five-year ICS planning cycles in the medium-term framework gives pharma something priceless – the ability to design multiyear evidence generation and service transformation plans that aren’t derailed by annual resets.

For the first time in ages, pharma companies can align internal planning with NHS cycles.

The UK’s revamped clinical research landscape – accelerated start-up, population registries, community sites, ICS-led recruitment.

A stocking that’s unambiguously a gift if pharma can use it properly.

This is the philosophical core of where the NHS is heading. The old model – sell a medicine, hope for adoption – is giving way to one that demands disease management, patient support, pathway change and measurable population-level improvement.

It can be daunting but also liberating.

Outcomes create room to show value far beyond the molecule – on staff, time, capacity, easing backlogs, creating headroom, reducing inequality, creating system value and more.

This is the great paradox: ICSs centralise some things (money, governance, FRPs) while decentralising others (delivery, neighbourhood care, local partnerships).

The result is a system where variation is back – not in policy but in implementation capacity and appetite.

This is a stocking full of opportunity and bruised shins. Navigate local priorities well and you can create powerful exemplars; fail to and you’ll hear ‘not this year’ in dozens of flavours.

The NHS’s push on inequalities is morally essential and commercially significant. It creates clear goals: earlier diagnosis in underserved groups, structured follow-up, targeted condition management and population-specific outcomes.

This gives pharma a legitimate rationale for upstream investment and community-focused interventions – but it demands rigour.

You can’t claim impact without evidence. Quietly, this might be one of the most important stockings on the list.

The days of influencing a handful of commissioners and calling it done are over. Today’s stakeholder map is sprawling: ICS execs; place directors; PCN clinical directors; community providers; HINs, acute alliances; digital governance leads; equality and population health teams.

The good news is that there are more entry points. The bad news is the complexity. Master this map and the engagement landscape becomes far richer than the old CCG era ever allowed.

The innovation architecture – HINs, national programmes, ICS priorities, commercial teams, NIHR networks, community diagnostics, innovation zones – is finally maturing.

What once felt like scattered pilots now resembles something more coherent. Not always fast, not always aligned, but increasingly structured.

This stocking contains the most forward-facing opportunity of all: a system that is learning to scale innovation, not just admire it.

This year’s NHS–pharma Christmas outlook is neither rosy nor bleak. It’s balanced, thoughtful and occasionally contradictory – in other words, recognisably British.

Pharma enters 2025 with opportunities that are more strategic, more local and more outcomes-driven than ever before, alongside constraints that are sharper and more transparent.

The trick is simple: stop selling into the system you wish existed; start partnering with the system that actually does.

Twelve stockings, twelve signals. Plenty to unwrap – and more than enough to work with during 2026.

Oli Hudson is Content Director at hsjinformation.co.uk