For 2026/27, ICB medicines optimisation work is shaped mainly by NHS England’s Medium Term Planning Framework, which asks ICBs to address problematic polypharmacy, prepare for a Single National Formulary and prioritise best-value medicines such as DOACs and SGLT-2 medicines. The 2024/25 national medicines optimisation opportunities remain the reference list, because NHS England has said that guidance will not be refreshed for 2026/27. This article sets out what those documents ask for and what they mean for the practices and PCNs that deliver much of the work.
How is the ICB role changing?
ICBs are moving to a strategic commissioning role. The 10 Year Health Plan, published in July 2025, set out that ICBs would become the strategic commissioners of local healthcare services, with their capability strengthened and commissioning support units closed. An NHS England board paper in May 2025 set out that ICBs would need to reduce their running costs by about 50% on average.
NHS England’s Strategic Commissioning Framework, published in November 2025, notes that clinical decisions such as referrals and prescribing drive how resources are used on an almost continuous basis. It gives ICBs a role in making sure those decisions rest on the best evidence and give value for money. In practice, ICB medicines optimisation teams set priorities, agree schemes and measure results, while much of the patient-level work takes place in GP practices and PCNs.
What does the Medium Term Planning Framework ask on medicines?
The Medium Term Planning Framework, published on 27 October 2025, covers 2026/27 to 2028/29 and contains several medicines asks:
- ICB five-year plans should support prevention goals that include reducing exposure to antibiotics and addressing problematic polypharmacy to reduce avoidable harm
- From April 2026, ICBs and providers are expected to plan for a Single National Formulary, prioritising efficiency savings in 2026/27 from best-value DOACs, SGLT-2 medicines and the wet AMD medical retinal treatment pathway
- ICBs should introduce prescribing-based services into community pharmacies during 2026/27 and make the most of the Discharge Medicines Service
- All primary care services should enable patients to request and manage their medicines online
The framework states that a Single National Formulary will be introduced within two years of its publication. For practices, the DOAC and SGLT-2 priorities are the most direct: both involve reviewing patients in the practice record and making changes where they are clinically right.
What happened to the national medicines optimisation opportunities?
The 2024/25 national medicines optimisation opportunities remain the reference list. In February 2026, NHS England confirmed that the guidance will not be updated for 2026/27, and described the 2024/25 opportunities as important topic areas that ICBs and partner organisations may pursue as improvement initiatives.
The 16 areas include addressing problematic polypharmacy, low-priority prescribing, identifying atrial fibrillation and using best-value DOACs, identifying hypertension, optimising inhaler use, valproate safety, lipid management, antimicrobial course length, chronic non-cancer pain management without opioids and inappropriate antidepressant prescribing. NHS England says the NHSBSA ePACT2 dashboard can still be used to track progress, with its metrics under review.
Where do practices and PCNs come in?
Practices and PCNs deliver most of these priorities, because the work happens in their clinical records. Finding the right patients, reviewing each one, agreeing changes with the patient and coding the outcome all take place in the practice system. ICBs often support this through local enhanced services and prescribing incentive schemes that reward practices for completed, clinically appropriate work.
Each ICB sets its own schemes, criteria and payment rules, so the detail varies from one area to the next. Our prescribing initiatives and schemes service covers how scheme work can be scoped, delivered and reported for a practice or PCN.
What does delivering an ICB priority look like at practice level?
Delivering an ICB priority at practice level follows a set order of steps:
- Read the ICB’s scheme criteria and agree a protocol with the practice’s clinical lead
- Run searches to find the eligible patients
- Review each patient clinically, including their other medicines and conditions
- Discuss any change with the patient and make it only where clinically right
- Code the outcome in the practice record
- Report results to the practice or PCN, and to the ICB where the scheme asks for it
The clinical review is the step that matters most. A best-value switch or a polypharmacy change is a decision for the individual patient, and a good programme records why a change was made or why the patient stayed on their current treatment.
How can a managed clinical pharmacy service help?
A managed service can help practices and PCNs deliver ICB medicines priorities as defined projects. Examples include polypharmacy review cohorts, best-value DOAC and SGLT-2 programmes, high-risk drug monitoring sweeps and incentive scheme work. The practice or PCN commissions and directs the work, and the service delivers it in the practice’s own clinical system.
85% of our pharmacists are independent prescribers, so agreed changes can be made within each prescriber’s competence and the practice’s protocol. Our page on medicines support for ICB priorities describes the workstreams in more detail.
What we see in practice
ICB schemes are often delivered one practice at a time, and the same method can be repeated. A Derbyshire practice claimed £2,960 through an ICB enhanced service for anticoagulant switches: of 65 patients screened, 37 were switched where clinically right. We then ran the same model in a second ICB area. At network scale, a Norfolk and Waveney PCN received 1,000 structured medication reviews between October and March.
We have supported 375+ GP practices and 88+ PCNs, with practices and PCNs in 23 ICB areas across all seven NHS regions. Our case studies set out the detail.
Related reading
- Medicines optimisation support for ICBs and PCNs: delivering it at scale
- Pharmacists working at scale across PCNs and federations
- GP federations and integrated neighbourhood teams: how medicines work is organised
Working through this year’s ICB medicines priorities? Send us an enquiry and we will reply within one working day.
Frequently asked questions
Is there a national medicines optimisation opportunities list for 2026/27?
The 2024/25 list remains the reference point. NHS England confirmed in February 2026 that the guidance will not be updated for 2026/27.
Does every ICB run the same medicines schemes?
Each ICB sets its own schemes, criteria and payments, guided by national priorities such as those in the Medium Term Planning Framework.
Is a best-value DOAC switch right for every patient?
Each switch is a clinical decision for the individual patient. A good programme reviews every patient and records the reason for any change, or for keeping current treatment.
Can a PCN deliver an ICB priority across all its practices at once?
Yes. A PCN can run one protocol across every member practice, with results reported per practice and for the network.
How is scheme work reported?
Results are reported to the practice or PCN in an agreed format, and to the ICB where the scheme asks for it.
