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The 10-year plan for the NHS in England promises a single national formulary (SNF) within two years. Leela Barham investigates the idea

The 10 Year Health Plan puts forward the idea to have a SNF, offering limited details on what the idea means in practice. The aim is to speed up the adoption of clinically and cost-effective innovations as well as making that adoption “equitable”.

Ewan Maule, clinical director, and chief pharmacist of North East and North Cumbria NHS, chair of the ICB Chief Pharmacist Network (CPN) and Honorary Professor at Teesside University, in a Substack post on 14 July wrote that the plan had “quietly but boldly” made the proposal for a SNF. 

The ICB CPN had already called for a SNF in its model ICB medicines optimisation blueprint. He even went as far to write that “it’s potentially one of the biggest and most disruptive ideas in the plan”. 

Independent prescribing in community pharmacy, on the face of it, makes the SNF a relevant proposal for community pharmacy. Pharmacists are explicitly mentioned as being an audience for the SNF.

They, and other clinicians, will be “encouraged to use products ranked highly in the SNF, but will retain clinical autonomy as long as they prescribe in line with NICE guidance”.

There will be a new formulary oversight board for the SNF. That board will be “responsible for sequencing products included in the formulary based on clinical and cost effectiveness, supported by NICE.” 

Scotland’s SNF

Scotland is still working on its own SNF. The starting point was strong, as the Scottish government pointed to “a high degree of commonality in prescribing practice across 11 formularies” that were being used by the 14 health boards in Scotland.  

Maule tempered his enthusiasm for the English proposal by pointing to the Scottish experience. “Scotland has been trying for years and not made it happen,” he wrote. 

A regional approach

Given the starting point in Scotland was existing formularies the Scots have phased in the transition to a SNF by working at regional level. The government described it as “a regional collaborative consensus model” according to a freedom of information request from January 2024.

The reasoning was to ensure that health boards led on the development of the formulary and that it was underpinned by local clinical ownership. 

Will England take steps to make sure its SNF will also have local clinical ownership? There’s a danger that if not chosen well the formulary oversight board won’t deliver this, risking it being the SNF being seen as a central diktat. Maule wrote that success of the SNF in England will depend upon “who we involve”.

The regional approach in Scotland could perhaps prompt people to remember that England has had regional approaches to medicines too; whatever happened to the Regional Medicines Optimisation Committees (RMOCs)?

It takes time

The East region in Scotland began the work with the first regional medicines formulary, although just when that was isn’t clear.

The East region produced the adult version of the formulary in May 2023. In January 2024 it was still working on a paediatric one. Implementation added more time: P3pharmacy understands that launch of the formulary in the East region took 18 months. 

The West region took up the baton in January 2024. We understand work is still underway with the first chapters expected to launch at the end of 2025. The final sections of the formulary aren’t due until March 2027. 

Scotland’s experience makes the plan for England to have a SNF within two years ambitious at best. Or perhaps the trade-off for speed will be less local engagement? 

Monitoring while building 

P3pharmacy understands that health boards in Scotland are already monitoring prescribing practice against the formulary. England will have to monitor practice against the SNF so that it can be shown if the hopes of faster and equitable adoption of clinically and cost-effective medicines are met, not just talked about.

Perhaps this will prompt a look again at the NHS Innovation Scorecard and other prescribing data? Will England link up the work on the SNF with the “development of a local formulary national minimum dataset…to increase visibility of local variation in the implementation of NICE guidance…” as promised in the Voluntary Scheme for Branded Medicines, Pricing and Growth (VPAG)? The timeline for that work is mid 2027.

Improving margin distribution?

A SNF could offer benefits to the system, according to Maule. “The potential to streamline government, reduce variation, and support digital integration is huge. It could save countless hours of local committee work and unlock greater consistency in prescribing and access.”

It’s hard to predict what the SNF will mean for England in general, let alone community pharmacy in particular. That said, there could be an upside according to Suraj Shah, drug tariff and reimbursement manager at Community Pharmacy England.

Shah said: “In theory, a national formulary could help to tackle variations in local prescribing and reduce distortions to margin distribution.”