What happened
The mechanics of the deal explain how a trade agreement translates into a mortality projection. From April 2026 the government raised NICE's cost-effectiveness threshold for approving new medicines from £20,000–£30,000 per quality-adjusted life year (QALY) to £25,000–£35,000, and cut the rebate rate pharmaceutical companies pay back to the NHS under the VPAG scheme from 23% to 14.5%. Both changes mean the NHS pays more per medicine and claws back less from manufacturers than before.
The government committed to raising NHS spending on new medicines from 0.3% of GDP in 2026 to 0.6% by 2036 — a doubling. The BMJ analysis models what happens if that increased spending is not matched by new funding: the money has to come from somewhere else in a fixed NHS budget, and historically that has meant other treatments, staffing, and preventative care absorb the cut. Because that displaced spending affects a much larger number of patients with common chronic conditions than the smaller number who benefit from the new medicines themselves, the net effect nationally is a projected increase in mortality — even though the deal's headline framing was about securing patient access to innovative treatments and protecting UK pharmaceutical exports from Trump-era tariffs.
The government has not, as of the analysis's publication, committed the additional funding that would be needed to avoid these displacement effects.