The quarterly medicines leakage report every ICB should want in 2026/27

The quarterly medicines leakage report every ICB should want in 2026/27

generic or off patent prescribing. It might mean delayed uptake of best value biological medicines. It might mean contract or framework non compliance. It might mean premium priced generics, slow response to shortages, oversupply, avoidable waste or failure to spread an agreed pathway change across a cluster. Different systems will find different categories. The important point is that leakage is operationally actionable. Most ICBs do not need more dashboards for this. They need a better synthesis. A good quarterly medicines leakage report would have six sections.

quarter, realised value to date, and the most material unresolved blockers. This gives the board level answer quickly.

one number: price inefficiency, non adoption of best value products, supply risk substitutions, formulary or pathway drift, and other locally relevant categories. The purpose is not perfect taxonomy. The purpose is to make the sources of value loss visible enough to manage.

ranked by likely value, confidence and delivery complexity. Not every opportunity belongs here. Some should be ruled out because the data is weak, the clinical case is poor or the implementation burden is disproportionate. That triage is part of good commissioning.

blocked? This is the section that turns a finance discussion into a management discussion. If a value opportunity is blocked because of clinical capacity, pathway redesign, homecare issues or local politics, the report should say so.

target date? What are the dependencies? What is the current risk rating? This matters even more as ICB footprints change, because larger organisations can otherwise fall into the trap of assuming that agreement in principle equals delivery in practice.

most important discipline of all. It prevents gross opportunity estimates from being mistaken for delivered benefit and improves the system’s ability to predict future value honestly. Why quarterly? Because annual review is too slow for an area that moves with product entry, shortages, pricing shifts and implementation cycles, while monthly board level reporting is often too noisy and detailed. Quarterly is frequent enough to drive action and strategic enough to support decision making. The deeper reason an ICB should want this report is that it operationalises strategic commissioning. It gives finance, pharmacy, procurement, clinical and provider leaders a shared view of what matters now. It reduces duplication across places and organisations. It creates a “do once” structure for the new era of clusters and larger footprints. And it gives the system a way to prove that medicines optimisation is not an abstract aspiration but a managed route to better value. Without something like this, strategic commissioning risks collapsing into three unhelpful habits. One is endless exploration: lots of data, little decision. Another is episodic heroics: value gets captured when one exceptional pharmacist, finance lead or procurement specialist drives it through manually, but the model is not repeatable. The third is narrative inflation: big claimed opportunities, weak realised value tracking. A quarterly medicines leakage report is not glamorous. It is simply the sort of management tool that serious commissioners use when they want to move from policy language to operational grip. And that is what the new ICB era requires. If strategic commissioning really is becoming the central purpose of ICBs, then medicines is one of the first places where that purpose should become visible. Not in another slide deck. In a report that shows what the system is losing, what it has chosen to do about it, and what it has actually delivered.