As health workers, we have to understand how our industry is structured and how hierarchies and money relations prevent us from developing the sector in the interest of workers, health users and patients. Trusts like NBT spend nearly 10% of their total budget (£77m in 2024) on drugs, all this money goes straight to profit-oriented multinational corporations. There is a lot of obvious criticism about the pharmaceutical industry, e.g. about the attempt of the major corporations to gain extra-profits by using the patent law, but there is little analysis of the inner-workings of the sector. We translated an older article, ‘Industry and Pharmaceutics’, that looks at the bigger picture, and we featured a report from a friend who works as a research nurse for medical trials. Below you can find the first part of a longer conversation with friends who work in hospital pharmacies and for pharmaceutical companies.
The current global moment in pharma
The development of the global pharmaceutical sector is highly political, last but not least because it produces massive revenues, £1.6 trillion in 2023, and because it is very concentrated in a few global corporations. The UK is an important developer, manufacturer and exporter of pharmaceutical products. With Brexit the government had hoped that the UK could become some kind of global pharma lab or a “global science and technology superpower”, being less restricted by EU research and testing regulations. Actually, having to negotiate separate trade agreements created major issues, for example with India, where a lot of the basic materials for UK pharma companies are produced, but also with the US, where a lot of UK pharmaceuticals are exported to and where President Trump has recently increased import tariffs. The pharma companies put a lot of pressure on the state to create more profitable investment conditions, for example through subsidies.
A trade war over profits
In October 2025, the media reported that the government agreed to raise the amount that the NHS can pay for new (drug) treatments by up to 25%. This would mean that the pharma-industry will get an additional £1bn over three years, with billions more promised over the coming decade. The Association of the British Pharmaceutical Industry wants the ‘clawback rate’ – at which pharma companies pay back a chunk of their UK revenues to the NHS – reduced from nearly 23% to single digits. With their concession, the government basically bowed to the blackmail from (multi-)national companies who announced to stop production and investment in the UK if they don’t get more profitable conditions. In September 2025, the US drugmaker Merck scrapped the construction of a £1bn London research centre and is laying off 125 scientists, while the UK company AstraZeneca paused a planned £200m expansion of its Cambridge research site, which had been expected to create 1,000 jobs. Earlier on in January 2025, AstraZeneca had already bottled plans to invest £450m in its vaccine manufacturing facility in Speke, Merseyside, after the government decided to reduce the subsidies from £90m to £40 million. Combined with a shelved lab of the drug corporation Eli Lilly in London, four pharma projects worth more than £1.8bn have been pulled or paused in the UK in 2025.
In their internal struggle over markets, the global companies blackmail governments: if you don’t guarantee us profits, we go somewhere else. At the same time, nation states start fighting over investments. Trump increased the import tariffs for pharma products, with the aim that foreign pharma companies should invest directly in the US. From history we know that what starts as ‘trade wars’ often ends up in real wars. At the same time the health sector is drawn deeper into the global process of militarisation.
For worker, health user and patient control over the pharma sector
If the NHS is supposed to cough up millions of pounds more for drugs and the pharma companies have to return less of their revenue, then we know who has to pay for it: NHS workers and working class health users and patients. At NBT and UHBW, Trust management say that they don’t have money to pay bank staff the same increase like everyone else. The detox unit was closed and staff at the sexual health clinic halved, because of a ‘lack of funding’. All this proves that ‘politics’ and political decisions affect us directly and that we have to start defending ourselves. Together with workers in the pharma industry, many of whom are now threatened with job cuts or attacks on their pay and condition, we have to fight for worker and health user / patient control over the sector. Medication should not be produced according to profit goals, but for treating humans the best way possible.
This is a larger struggle. If the pharma industry is left to the chaos of markets and the narrow interests of profits and share dividends, then we all suffer. Pharma companies will use the patent rights in order to defend monopolies and profits, which prevents billions of people on the planet from getting access to needed medication for easily treatable illnesses, such as malaria or tuberculosis. Necessary research, for example into new antibiotics, won’t happen, because it doesn’t promise a hefty profit margin. We need an international working class revolution to expropriate the pharma companies and run them under the control of science workers, health workers and patients.
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Introductions
E.
I have been working in community pharmacies and hospitals, in many positions both here and in Greece. Recently I started working with a contractor for many pharma companies as a medical advisor. I monitor all interactions the companies have with anyone, from doctors to the media, in relation to their medicines. I have to check if what the company says about their drugs is factually correct and ethical. For instance, the company can’t say that their medicines cure cancer, they have to say that they reduce the chance of dying within one year by a certain percentage. Why would the company spend money on this? They want to avoid getting sued. Thanks to their medical advisors they’re avoiding blame, for any mistakes, inaccuracies, or lies. In the end they can blame the medical advisor if they get in trouble and I could lose my job and license. For the job you need previous experience, a pharmacist degree and a related masters degree, plus to have some experience with clinical data and publications.
V.
For the last three years, I’ve been working as a clinical pharmacist in outpatient departments, in different trusts and different hospitals all over the country. Your role is to clinically assess the prescriptions that arrive, electronically or on paper, and to pass them on to dispensers. You should have access to the clinical notes and medical records of the patients in order to be able to do your clinical screening – but that is not always the case. You often have to call up doctors to find out details, which can be frustrating. I am the last one in the line and if I hand out the wrong medication it will have legal consequences. My job role also includes counseling to patients about how to take the medication and possible contraindications. And then there are logistical tasks, such as checking stock levels and relating to suppliers.
D.
I am doing an apprenticeship to become a pharmacy technician in a hospital. Pharmacy technicians have been present in pharmacies for a long time, but quite recently it has become a registered position. Now there’s a legal obligation to register with the GPHC, which is the General Pharmaceutical Council and the regulatory body for all pharmacy professions. I am currently mainly based in the dispensary, processing the prescriptions once they’ve been clinically screened by a pharmacist. In general there is a push for pharmacy technicians to be more ward based to take up a lot of the responsibilities of what pharmacists have been doing previously, like doing drug histories and drug reconciliations when patients are admitted or advising patients on medication that they are taking. Pharmacy technicians are also navigating the contracts with the particular suppliers and wholesalers. Legally there is this feudal structure that says that a pharmacist has to be present in order for anything to happen. That is slowly being undermined. In a community pharmacy, for instance, you can’t actually hand out any medication unless the pharmacist is there, whereas in the hospital now, this is not necessary anymore. The relationship between a pharmacy technician and a pharmacist is quite similar to how you would understand the relationship between a doctor and a nurse.
Main problems to do the job
E.
The problem is remote work and that you are seen as the department that stops information, and therefore sales, from going out. It’s quite fast paced and in terms of how much stuff you need to do and how soon you need to find the solution to a lot of problems. Working for a contractor company which is paid by pharma based on time spent, I am made to monitor my time spent at work down to the minute. For context, every five minutes of my work, the contractor can charge pharma up to £300. To keep my job, I have to submit 7 to 8 hours of billable time per day, with limits on how long I can spend on each job. This is extremely stressful and uncomfortable. Even a short chat with a colleague can set work back and cause a fight with the manager. There is a big fight between marketing, who want to increase sales, and medical, who want to make sure that the information about the medication is right. If sales reps want to take leaflets to pharmacies about a particular product, these leaflets have to be approved by us. Or what the company says at international meetings, to which they invite hundreds of doctors. I think it is worth mentioning here that for many companies, the balance of power between departments is leaning heavily towards sales, with many colleagues forced to approve inappropriate projects which may be seen as misleading or bribing prescribers, putting their job, licence and patients lives at risk.
V.
The majority of outpatient pharmacies are run by private companies, because NHS Trusts found difficulties and problems to run them themselves. Private companies try to minimize cost and that leads to us being understaffed most of the time. Clearly there are gaps between the rules of the General Pharmaceutical Council about how we should work and the actual way we have to work. For example we are supposed to take mental breaks regularly in addition to our normal break. You can rarely take these breaks. On the other hand we are often supposed to stay longer, because not all medication could be processed within your normal shift times. Obviously in this hectic environment, pharmacists don’t have time to think. That leads to a lot of errors. Private companies have moved from a patient-centred to a profit-centred business.
The other problem is that NHS Trusts frequently change the contracts for outpatient pharmacies, so companies come and go and this creates additional chaos. Outpatient pharmacies are profitable businesses – one hospital outpatient pharmacy makes the money of ten community pharmacies, also because they tend to sell more high-cost drugs. Private companies pay a lot of money for these contracts. Trusts outsource outpatient pharmacies, rather than inpatient ones, because outpatient staff don’t need to be so specialized. Pharmacists in inpatient pharmacies have done their clinical diploma, they know how to screen bloods, they know how to do blood tests. Most of them are prescribers as well. Private companies don’t want to deal with that, they want to be able to hire anyone, whether they have work experience or not. They also hire a lot of locum staff, people who come and go, self-employed pharmacists. This can create problems in outsourced outpatient pharmacies though. For example, if you ask ten pharmacists in our area what clinical screening is, they’re going to give you ten different answers. It’s so blurred. The companies left it blurry on purpose, so that they can move faster. Most pharmacists will do a more superficial clinical assessment, rather than a proper screening.
The fact that you now have two entities that have to cooperate – the Trust and the pharmacy company – creates additional problems. For example, over the last year we didn’t have a proper pharmacy manager in our location, which made communication with the Trust representatives difficult. The manager would normally sort out things with the Trust, for example when we run out of labels – we ended up putting stickers on with sellotape. Or it is difficult to contact healthcare professionals like doctors and nurses – we often rely on emails for communication. But we have a target of under 30 minutes within which a prescription should go out, in which case you have to try and call the respective NHS health professional, which is not easy. Doctors in this Trust make a lot of prescription mistakes and they rely on us to find them out. This gap is getting even bigger when you have to deal with an outsourced company.
D.
Some of our problems are technical, e.g. we have four different data systems. There is one with everyone who has a NHS number and their medical records, which is used for dispensing drugs and printing labels with instructions for the patients. The other one is managing the workload, where we enter all prescriptions that need processing etc.. There can then be discrepancies, e.g. between what is on the drug chart and what is on the computer system. The third one is a patient record system which deals with discharge letters or discharge medication. These entries have to be created by a doctor, then filled in by a pharmacist and then sent downstream to be checked and to be dispensed. Technicians generally do all the double-checking in our hospital pharmacy. And then finally, there is a data system called Care Flow that not everyone has access to. To have these four different systems means that you got all this information in several different places. On one hand there is a drive towards digitalisation, on the other hand the digital platforms are currently not integrated and data sharing is pretty disjointed. So you still have to deal with bits of paper here and there and then with dispersed digital information. That causes a lot of nonsense technological issues.
The other issue is related to this. We’re the last step in getting a patient out of the hospital. And obviously there’s this intense pressure to move patients out of hospital. I have some interaction with patients on wards when I go and do counseling on the anticoagulant medication or something. Many patients wait ages before they can go home and they are told that it’s the pharmacy everyone is waiting for. Actually it is often the case that the doctor hasn’t written the discharge letter properly and pharmacists are trying to contact the doctor. There’s often an unproductive back-and-forth between doctor and pharmacist, regarding responsibilities and so on. Then things come to us and we often have issues with the way pharmacists write things and have to wait for clarification, because we lack authority. It’s a frustrating chain of events that just end up getting passed back and forth.
And here technology comes in again. There are massive communication issues. Most hospitals have a bleep system, where you can page someone to call you back. At our trust they’ve just taken that away for pharmacy. So now we use exclusively Microsoft Teams which is a nightmare, as people often don’t respond. It’s just a constant build up of frustrations that boils over into tribalism. You want to message someone directly, but often you would have to message within a team chat, which could embarrass that person. You end up aggravating pharmacists because they haven’t responded to you.
Even within pharmacy it is not clear for people what each job role actually involves. I think in general pharmacists like the fact that there is the job role of a pharmacy technician, as they are moving towards prescribing and other ‘high skilled’ tasks and they can push off a lot of the drudgery. Rarely now will pharmacists do accuracy checking in in the dispensary, for example. Whereas before it would have always been a pharmacist, which is quite mind numbing work. But then it’s also cutting out a layer of pharmacists who don’t want to do the clinical diploma or prescribing courses. Now they are forced to get these qualifications otherwise they become redundant in the whole process. Pharmacists start at Band 6, but if you can pay someone at Band 4 to do all of the menial functions that pharmacists used to do, then you’re going to do that. So there will be sections of the pharmacist workforce that are pissed off by the expansion of the technician role – also the technicians themselves, as they now have to take on more tasks, like drug reconciliations and ordering. In GP pharmacies, pharmacy technicians make recommendations to doctors on what to prescribe. For the NHS, these changes have been relatively rapid. There is a union for pharmacists which could look at all of this, but it is more like a professional association, like the RCN or BMA in their early days, so they don’t do much. General unions don’t seem interested in these specific things. For example, trainee technicians now have to do”Medicines Management” as part of their course – which will come into conflict with already qualified technicians who’ve had to do a supplementary six months course to go from Band 4 to Band 5.
V.
In the outpatient pharmacies I haven’t worked with pharmacy technicians yet. I think that’s quite a new thing. The role has been around for 40 years, but they have only been registered since perhaps 2012. In our place we only have pharmacists and dispensers (Assistant Technical Officers ATOs), who are basically on the minimum wage – perhaps £1 more, if they are experienced. Plus there are admin staff who book deliveries and so on.
The cooperation between pharmacy, doctors, pharmaceutical industry and research
E.
I think the binding point of these various parts of the industry are actually the pharmaceutical companies. Normally, workers in a hospital won’t have much contact with research, unless they are engaged with clinical trials. If you work in a pharmaceutical company you won’t have much contact with the hospital world, unless you are in sales and try to convince prescribers to use the company’s medications. What I noticed about the cooperation between pharma and health is that it’s very profit focused. The goal of research, even in universities, doesn’t seem to be the improvement of patients’ lives, but commercialisation and finding a gap in the market. For example, I was at a medical congress a couple of years ago and people there were happy when they heard that the clinical trial of a competing company had failed. The clinical trial failing basically means that these patients who enrolled in the trial got no benefit from the medicine. So this is a very sad moment. So their reaction shows how alienated some of the people working in the pharma sector are from what they are actually supposed to do. For them, the real enemy is not the disease. The real enemy are the other companies selling competitor products. Some influential doctors also seem to be more interested in profit than their patients. I have seen the same doctor attending 4 different competing medicines’ company-sponsored meetings in a month to trade their influence for lucrative speaker fees.
Nowadays, developing a medicine has become more and more expensive and more and more complicated because of the oversaturation of targets – we can talk about that later. But often companies have to partner between themselves, or I have to partner with universities and come to commercial agreements in order to finally create the medicine. These conflicting interests between all these groups lead to a lot of problems. The access of patients to a specific medicine might be severely restricted due to the conflicting interests of all the individual private organizations. For example, one of the private partners might own the rights to less potent, competitor medicine in one region in which case they may choose not to distribute the newer drug in that area.
Our company mainly engages in manufacturing and distribution. Companies used to do research and developments. They had direct partnership with universities and did their own research in private institutes. This changed recently because it is getting harder and harder to actually make and sell a medicine. In the past, some companies could release 20 drugs per year and they had up to 400 medicines in various stages of clinical development. However, this is becoming more and more rare. So now it’s more like 1 or 2 medicines per year for big companies. So there is a lack of stability in their business, because they don’t have this guaranteed long-term sustainable profit any more. So what they do is outsource a lot. For example, they outsource the research. Now it’s mainly the universities and start-up research companies doing the research, The universities get commercialisation agreements with private companies. They also outsource the manufacturing to areas with cheaper labour. So, what they are basically doing is just the marketing and distribution of the medicines. In most of the companies I worked for, the marketing and sales were the biggest departments.
In our case, the final manufacturing process is in the UK, where the pills are formed and packaged. This is not common for UK companies. But all the ingredients and the actual molecule that goes into the pill, they usually come from Asia, mainly India and a bit less from China. Because of stability issues, it’s hard to transport medicine. They deteriorate fast and need specific temperature, humidity etE. Therefore, it makes logistical sense to have the final manufacturing for distribution in Europe itself, perhaps North Africa. Good distribution points are usually chosen, the south of England is one of them.
V.
Basically, we don’t have a lot of direct contact with the pharma industry. Sometimes we are aware of manufacturing issues, when certain medicine is not available and we run out of stock. We deal more with the medical side, with the doctors. Often we have to pass on messages from the pharma companies, e.g. that there are manufacturing delays, on to the doctors, which can be quite chaotic. Also because the inpatient pharmacy has their own distribution network, because unlike ours it is not outsourced. They have their own warehouse – the inpatient and outpatient pharmacies at the hospital are like two completely separate departments. There are no connections, except when we borrow stock from them, which happens daily and messes up our stock count and which obviously annoys the Trust pharmacy.
E.
In Greece, the pharma industry is very different. And not just in Greece, but also in other countries, especially those which are less economically and politically stable. There the cooperation between the pharma industry and the healthcare system is mostly about personal connections and bribes. For example, I know this doctor, who asked the pharma company to make him a nice gravestone at an upmarket graveyard for when he dies. In return he will prescribe their products. Right now in the UK, there is actually very strict regulation with legal and monetary repercussions when broken. For instance, you’re not allowed to book any hotel for medical conferences that have facilities like spa, pools or whatnot. Yeah. This is actually written down by the MHRA Blue Guide, which is the guide of how companies interact with the NHS. You can only pay up to 70 pounds per day for feeding doctors and you can only pay them a fee if they actually talk at the conference. Also they’re allowed to pay doctors directly. They can only pay the trust that they work for. The main way to circumvent it in the UK is basically to have a different affiliate do the shady work. So a company that has offices in the UK, but that also has a headquarter in the US, can use this, because then it’s technically a different company registered in the US – and the US rules are much more lax. And so what can happen is that the UK company can tell the US company, “we want to do nice things for this doctor, because he’s very influential for prescribing medicine”, and they do that for them. Of course some companies within the UK itself might be willing to take the risk and the legal or otherwise repercussions if the profits gained from illegal activities massively outweigh the risk. There are cases of this, especially with weight reduction medicines, which make enormous profits. It is also important to understand that the UK is a sort of bubble, with all these rules and regulations, where things seem to be a bit more transparent. France is similar. Most other parts of the world are like the wild west for these things.
In terms of medical and pharmaceutical research, what is happening now is because the MHRA is no longer bound to the EMA, they can diverge. So they can approve medicines separately from Europe. In the past, you could only prescribe a medicine in the UK if it was approved by the European Union. In 2024, the first medicines were first approved by the UK, but rejected in the European Union. So in that way the UK might become the lab of Europe, where things get tested first. The US is stricter when it comes to regulations for implants and devices, but relatively more lax when it comes to pharmaceutics. So for prescription medicine, whether in Europe or in the UK, the regulations are very, very strict. However, in both of these markets there is lack of regulation with regard to medical devices and testing. Supplements are also minimally regulated, much less so than in other regions. For example, in Russia, even supplements are considered medicine and require clinical trials. Here, you just need to verbally vouch that they contain what you say they contain, and that’s it. I think the regulatory terms “medical devices”, “supplements” etE. could maybe be just loopholes to avoid regulation. At the end of the day, all these are medicinal products.
D.
In terms of contact between my work and the pharma industry, I often speak to pharma sales agents on the phone. They get through to me and ask, ‘who’s the antimicrobial pharmacists, can you pass me on to them, blah, blah, blah.’ I mean, generally we just say, ‘can I take your number’ and then you throw it in the bin. The other point of contact is in clinical trials. At any one time, the hospital will be running over a hundred clinical medication-related trials simultaneously. And the way that works is it’s all done through consultants. A consultant has to sponsor a clinical trial and it will be under the consultant’s name. The incentive structure is quite interesting because the NHS has rules against a consultant getting paid directly by the company to run a triaD. So it’s done in terms of the NHS providing extra funding for your department. Through the trial funding you might be able to fund another nurse on the ward – it’s strange. They’re running these clinical trials. At the moment it’s 50:50 between commercial trials, which is like directly for a drug company and then trials for universities and similar ‘public’ institutions. But of course, there’s huge cooperation between the drug companies and the universities, as well. So there is a strange sort of mix there. And then there is a battle to get participants for the trial. They might set a target of 10,000 participants – and these are all set by the company. Trials directly through companies might involve monetary incentives, but not for those in hospitals. These trials are integrated into our work in healthcare, e.g. it’s nurses who recruit patients and organise the trials. For normal pharmacy colleagues these trials are quite exceptional. There might be some pharmacists who are much more involved on a research level, but not the general workforce. It’s perhaps different for diabetes nurses, a lot of that work will be like administering trials, even if they’re not in the clinical trials department.
Another thing worth mentioning is that in 2016, the NHS was reformed into these integrated care boards. There’s now a situation where the regional ICB has control over the formulary. So the formulary is basically a list of approved medications for particular conditions. It’s a prescribing guidance and framework and you have to justify it if you don’t adhere to it.
The ICBs are in charge of funding – all NHS England funding goes through the ICBs and then they allocate the funding on that basis. Part of that involves what drugs to buy. There’s like two criteria. One is evidence based medicine, the other one is cost effectiveness. Companies approach the ICBs because they want their drugs to go on the formulary. There is a concentration of bureaucratic power that then filters down, for example, a prescriber in general practice wants to give a certain medication, but the ICB says that can only be given in hospitals – they then have to refer them to the hospital, which delays treatment. One of the justification for the ICBs is supply chain resilience. The procurement and decision regarding formularies used to be done on individual trust level. It’s now being concentrated into the regional ICBs. So Bristol, North Somerset, Gloucestershire is one of them. If every hospital was using the same first line broad spectrum antibiotic then you have less resilience and more chances of running out of that medication. Because of the structure of procurement agreements between companies in the NHS, it would be a legal nightmare to quickly procure an alternative. ICBs also don’t deal with individual drug suppliers, but with three or four wholesalers, who also supply Boots and other private pharmacies. They then supply drugs from 50 to 60 companies, but they are all subsidiaries of the same 4 to 5 global companies.
Another interaction with the pharma industry relates to recalls of medication. Companies have agreed to carry out testing at regular intervals of a particular batch of drugs. If they detect a problem, they send a communication to the MHRA and then the work of dealing with that is delegated out to normal pharmacy workers. It is something that I would have to deal with. The company has essentially no responsibility beyond reporting it to the MHRA. It’s not the case that they send out people from their company who then carry out the recalls. For example, recently a patient literally found the wrong drug inside of a packet. It was a pregnancy hypertensive medication. Then we had to find every instance where this medication had been given to patients. We had to call over a 100 patients. It’s a huge amount of work that we are doing for the pharma industry. There are four levels of medical recalls and they are very common, we are talking about one every week.
Industrial disputes in the sector
E.
I haven’t heard of any disputes in pharma in the UK. People in the industry often worked in community pharmacies before, where they had more stress with customers, longer working hours and less pay. But I know in Greece there are big unions in pharma companies and in pharma warehouses.
V.
It’s run by the Communist Party. I was a member of it, it’s quite strong, but they focus on mass workplaces, while most pharmacies in Greece are run by individual owners. In the UK hospital and community pharmacies there are either a lot of migrant workers or British workers on locum contracts. That makes it difficult to struggle. Recent migrants cannot work locum, because they need a visa sponsorship. The British workers want to become self-employed. Even the migrant pharmacists just want to collect money and then open a business in other sectors. Obviously when they have this mentality, it is very difficult to form any kind of resistance. Many British pharmacists move from hospital to community, because there they automatically become managers. In hospital outpatients we deal with abuse every day and serious incidents every week.
D.
I heard about disputes in small community pharmacies, very personal disputes. It seems that the general demographic of the workforce is young women. A lot of community pharmacies are still run by older male pharmacists. That creates scope for disputes. In the hospital I haven’t heard about collective disputes. Just that there was no staff room. Apart from that there is the usual disdain for private companies that make a lot of money, like the drug companies. You’d be surprised how little some drugs cost, others are a couple of grand for a single dose. A lot of my colleagues don’t like to take medication, which I find interesting. And a lot of pharmacists don’t like to deal with patients.
