Every NHS patient in England deserves access to the right medicine, at the right time, wherever they live. Yet for common conditions, like diabetes, the NHS Alliance reports variation in the uptake of treatments across the NHS is more than 50%.

There is also an economic imperative as the pharmaceutical industry estimates that the UK economy would achieve £17.9 billion additional productivity gains through the increased uptake of innovative medicines.

That’s why, as set out in the 10 Year Health Plan for England, NHS England is leading the development of a Single National Formulary, or ‘SNF’ – which aims to reduce variation caused by local formularies and remove barriers that can delay access to clinically and cost-effective treatments.

In summary:

• The SNF will be a single, evidence-based source of prescribing guidance, delivered as a digital product integrated into clinical workflows.
• The SNF will drive rapid and equitable adoption of clinically and cost-effective innovations and secure taxpayer value.
• Its success will be measured by whether patients benefit from fairer access, faster uptake, and better outcomes.

To find out more about progress, and what patients, clinicians and pharmaceutical companies can expect over the next year and beyond, read on.

From complexity to consistency

The SNF is one of a package of policies that the Life Sciences Sector Plan sets out to “reduce friction in the system to optimise access and uptake of new medicines, so the most clinically and cost-effective can reach patients faster”.

Securing access to and uptake of medicines is a complex process. Once recommended by NICE, for medicines with a NICE technology appraisal, it then becomes the responsibility of the 26 NHS commissioners – Integrated Care Boards (ICBs) – to ensure the treatment is funded for eligible patients within three months.

All local formularies use categorisation to guide prescribing – for example, a colour may be used to indicate that a medicine should only be prescribed by a specialist. However, data found at least 51 different categories being used across England – creating a system that is not only complicated, but also inconsistent depending on where in the country a patient lives.

Early adopter sites

Early adopter sites will be the first to implement a new standardised categorisation system, and their experience will directly shape the national rollout.

Half of all 26 ICBs – including those operating under clustering arrangements – will transition over to the new categories by December 2026:

• North Central and Northwest London
• Northeast London
• Southeast London and Southwest London
• Greater Manchester
• Essex
• Norfolk and Suffolk
• Central East
• West Yorkshire
• Hampshire and Isle of Wight
• Humber and North Yorkshire
• Thames Valley
• Shropshire/Telford and Wrekin/Staffordshire and Stoke on Trent
• Coventry and Warwickshire/Herefordshire and Worcestershire

The remaining ICBs will adopt the new categorisation by July 2027.

Therapy areas

There are more than 70,000 medicines used in the UK and we must ensure the SNF is functional and practical in its design. The first 4 therapy areas that will be incorporated into the SNF as part of Phase 1 will be:

• chronic heart failure
• type 2 diabetes (adult)
• ophthalmology
• asthma

These conditions share large patient populations, significant public health and service burdens, and pathways with complex or inconsistent access to innovation.

The SNF is an entirely new policy initiative, so it is important we get started with therapeutic areas that:

• align with national strategies – including the 10 Year Health Plan for England
• have high-potential patient populations
• show existing prescribing variation
• are major causes of morbidity and mortality
• align with NICE’s workplan and priorities
• include pathway innovation – including genomic testing and upcoming disruptive technologies

The SNF will give clinicians consistent, accessible information in one place, embedded into prescribing systems and decision support tools, while maintaining clinical autonomy for individual prescribing decisions.

What happens next?

The next group of therapy areas will be considered before the end of 2026. This second group will include more complex areas where the SNF can act as a strategic enabler particularly around innovation, genomics, pathway transformation, service readiness and variation in access.

We plan to launch the first SNF digital product by July 2027, which will include 8 to 12 therapy areas. To support this, a national formulary committee will provide clinical and professional oversight of SNF decisions, working with NICE to translate national evidence into clear, clinically led formulary recommendations.

Through late 2027 to mid-2030, we will expand the SNF to cover additional therapeutic areas, evolving it into a comprehensive, single-source prescribing and decision-making tool. Throughout this period, we will continue to encourage feedback from patients, clinicians, local systems and industry to ensure the SNF delivers its intended benefits. 

Measuring success

The success of the SNF will ultimately be measured by whether patients benefit from fairer access to, faster uptake of, and better outcomes from medicines. We will also be tracking whether the SNF supports wider strategic changes in the NHS, including the transfer of care from hospital to community settings.

The SNF will be developed and implemented alongside existing commitments for rapid uptake of new biosimilar and generic medicines, as taxpayers would expect, and the government commitment for medicines investment to reach 0.6% of GDP over the next decade. Increasing pace and adoption of new medicines, through the SNF, must happen to meet that commitment, and to ensure every NHS patient in England gets access to the right medicine, at the right time, wherever they live.