The NHS in England is rarely far from a reorganisation, and typically bar a little remapping and funding shift, the impact on the pharmaceutical and medical device industries is limited. Once the noise dies down it feels more or less back to normal. The change we are experiencing now is different; high political stakes with a clear trajectory and national leaders coalesced behind it.

The commitment to change, essentially what has been laid out in the Government’s 10 Year Health Plan for England¹, is total. There will be transformation to care, how it is delivered and funded, from the systems that enable it through to the healthcare professionals providing it. Developing and implementing successful and sustainable commercial strategies will require curiosity, fresh perspectives and real-time insight. What’s often underplayed is that these changes don’t just affect strategy and engagement, they directly affect the roles, capabilities and team structures needed to succeed.

As you start implementing 2026 plans and soon begin planning for 2027, three key areas need consideration:

Organisations are changing, directly impacting who your customers are:

ICBs are reducing their size and role, Trusts are being bolstered and primary care is buddying up with all comers to create Neighbourhoods. Almost all healthcare technologies will be impacted by this as funding and decision chains are changing too. Accounts will evolve in how they arrange themselves and who delivers what. You may be used to engaging with certain organisations but their influence may wane in the new NHS, while others may emerge as key to your therapy areas.
The risk from structural shifts isn’t just misaligned targeting it’s investing in and deploying teams designed for a decision-making model that no longer exists.

Pathways are changing, impacting how patients access your medicine:

Shifting care out of hospital and focusing on prevention over treatment, two of the big shifts, are intended to drive major improvements in outcomes. Beyond simply tweaking pathways to improve clinic throughput, systems are looking to overhaul where and patients are seen, and by whom. Investing more in people not getting ill in the first place and therefore not needing treatment. Knowledge of pathways may need refreshing and understanding the nuance to derive opportunities within the change will add commercial advantage.Where access and value are increasingly determined at pathway or system level, traditional field role definitions and success measures may no longer fit.

Conversations are shifting, affecting how you need to engage:
Established knowledge, understanding and skillsets will need updating to deliver value to NHS customers. As they seek to drive transformational change they need partners who can go on that journey with them. Being able to talk population, value and pathway will become an expectation, above product and indication. The NHS is still learning its own trajectory and the language that goes with it, and industry has a role in helping shape the future state by being conversant in areas of emerging prominence.

Within this shift the question many organisations haven’t yet asked is whether they need to upskill existing teams, hire differently, or rethink role mix altogether.

The implication of all of this is that a strategic view is required of future resource requirements, both in number and skillset. The future NHS is deliberately designed to differ according to local needs, so adaptability within customer facing teams to respond to variation will become a superpower for agile companies. HACK works closely with current NHS decision-makers, providing an unrivalled perspective on evolving needs to inform strategic engagement decisions. We are delighted to be partnering with Evolve to shape a more adaptable, higher impact customer engagement model for the future. This is about optimising every spent on resourcing to amplify its impact.

Increasingly, the most effective conversations we’re having with pharma and medtech leaders bring strategy, engagement and resourcing into the same room. NHS insight helps clarify what needs to change; recruitment expertise helps translate that into who is needed to deliver it.

If you’re questioning whether your current engagement model or team design is still right for the NHS you’ll face in 2026–28, we’re increasingly having exploratory conversations with leaders grappling with exactly that.

¹FIT FOR THE FUTURE: 10 Year Health Plan for England. Department of Health and Social Care, 2025. Found at: https://www.gov.uk/government/publications/10-year-health-plan-for-england-fit-for-the-future (last accessed January 2026)