Prime Minister Andy Burnham’s renewed focus on devolution signals a potential shift in how healthcare services, including community pharmacy, are managed across the UK. Following his election victory in June 2026, Burnham, a former mayor of Greater Manchester, has championed the transfer of power and resources from central government to regional and local authorities. This approach, exemplified by Greater Manchester’s health and social care devolution since 2014, could lead to more tailored, responsive healthcare solutions, but also raises questions about national consistency and funding.

The Greater Manchester Model: A Blueprint for Devolution

Greater Manchester’s journey with devolution began in 2014, granting the region significant control over services like housing, transport, education, and policing. A key development occurred in 2016 when health and social care responsibilities, including a substantial £6 billion annual budget and a £450 million sustainability fund, were devolved. This unique model, as described by researchers, empowered local leaders to adopt a more integrated approach to public health.

Since taking charge of the health budget, Greater Manchester has implemented various initiatives targeting issues such as smoking, alcohol-related harm, childhood tooth decay, and unemployment among those with health conditions. Notable successes include expanded at-home and community HIV testing and a malnutrition program for the elderly, which reportedly increased case identification by 50% and reduced general practice spending on supplements by £300,000 over three years.

Community Pharmacy’s Role in Devolved Healthcare

Pharmacist Luvjit Kandula, director of strategy and pharmacy transformation at Community Pharmacy Greater Manchester, highlighted the early recognition of community pharmacy’s vital role in improving health outcomes within the devolved structure. “When people talked about primary care, they were normally referring to general practice only. And that’s something we recognised very early on in Greater Manchester,” Kandula stated.

To ensure all primary care providers—GPs, dentists, pharmacists, and optometrists—had a voice, the Greater Manchester Primary Care Provider Board was established. This collaborative body, operating for a decade, has fostered stronger working relationships and provided a unified platform for primary care. “The advantage of devolution is that it set up a culture of partnership working and there was an openness to be inclusive,” Kandula explained.

This collaborative environment has led to primary care providers, including community pharmacies, being commissioned to deliver specific programs. For instance, a £2 million investment in 2024 to address winter pressures allowed for the expansion of the minor ailment service within pharmacy. Kandula noted that devolution offers the “flexibility to develop services that reflect local population needs,” allowing for adaptation beyond national frameworks.

Evidence of Success and Emerging Concerns

Research supports the positive impact of Greater Manchester’s devolved model. A 2024 study comparing the region with the rest of England between 2016 and 2020 found significant improvements. These included an 11.1% decrease in alcohol-related hospital admissions and a 14.4% reduction in violence-related hospital admissions. Same-day GP appointments rose by 1.8%, and unplanned A&E re-attendances fell by 2.7%. Adult social care saw a 17.6% improvement in both effectiveness and satisfaction.

Researchers concluded that devolved control enabled more flexible resource allocation, prioritizing targeted areas. In contrast, areas managed by NHS England often saw funds used primarily to cover provider deficits. The introduction of Integrated Care Systems (ICSs) in 2022 across England aimed to mirror some aspects of this integrated approach, bringing together various health and social care organizations.

However, challenges remain. A study published in the Journal of Public Health (July 2026) indicated that despite policy emphasis on prevention, treatment-centered activities often remained the priority in Greater Manchester. Christopher White, senior lecturer at Wrexham University and co-author of the study, suggested that initial planning for devolution may have neglected prevention, with a tendency to revert to established norms due to implementation fears. He noted that, in practice, “practice did not veer too far away from NHS policy and strategy for other areas of the UK.” Furthermore, research in the International Journal of Health Policy and Management (September 2025) found that while overall health and care spending increased, the focus was on addressing existing pressures rather than boosting prevention services.

National Consistency vs. Local Needs: The Debate

Organizations representing community pharmacy have voiced concerns about potential inconsistencies if devolution leads to a fragmented service landscape. Community Pharmacy England (CPE) stresses the need for continued national direction to ensure a coherent roadmap for the sector. Janet Morrison, CEO of CPE, stated, “The current contractual framework is complex, and it is likely that the overall direction for community pharmacy will need to continue to be nationally commissioned if there is to be a coherent roadmap for the future.” She acknowledged the ongoing debate regarding national versus local commissioning, emphasizing the need for a national framework, potentially including National Enhanced Services, to guarantee consistency and quality, warning against a “postcode lottery” of services.

The Company Chemists’ Association (CCA) echoed these sentiments. Malcolm Harrison, CEO of the CCA, believes devolution can “unlock more agile and responsive ways of delivering care for local populations,” with community pharmacies ideally positioned to contribute. However, he cautioned that devolution “must not result in unwarranted variation or a postcode lottery in the services patients can access.” Both Morrison and Harrison underscored the importance of sustainable funding, regardless of whether commissioning is national or local, for pharmacies to continue serving patients and the NHS effectively.

The Path Forward: Relationships and Sustainable Funding

Kandula emphasizes that devolved powers are merely enablers of change. True transformation requires fostering a culture of strong relationships and partnerships between health services, public services, and local leaders. “It’s not as simple as the power got devolved and then overnight everything changed,” she remarked. “It’s basically creating a culture of relationships and partnerships and understanding… and incentivising them to be included and work together around shared outcomes.” She concluded, “Your power is built through your relationships and your partnerships. That’s what’s going to bring the outcome, the productivity, the efficiency, and it’s not this siloed, kind of pushing-back-responsibility-on-each-other approach.”

Ultimately, the success of devolution for community pharmacy hinges on balancing local responsiveness with national standards, ensuring equitable access to high-quality care, and securing robust, sustainable funding for the sector.