Progress with England’s Single National Formulary after a year
Leela Barham looked at what had happened a year after the NHS 10-Year Plan, released in July 2025, included the commitment to move to a Single National Formulary (SNF) for medicines within the next two years in England.
“Move” turned into the keyword, with the expansion of the SNF into a comprehensive tool scheduled for mid-2030. More worrying, perhaps, is that an exclusive FOI reveals that there aren’t – yet – concrete plans on how to measure success.
SNF announced in July 2025
In July 2025 the government committed to “move to a Single National Formulary (SNF) for medicines within the next 2 years.” That was all the detail available in the 10-Year Plan for the NHS.
There’s been quite a bit of interest in the policy because the Life Sciences Sector Plan, also originally released in July 2025, said that the SNF would “remove bureaucratic delays to patient access, reduce unwarranted variation in prescribing, and free up healthcare staff administration time to focus on caring for patients.” Sounds good, right?
Progress update from NHS England in July 2026
Now that a year has come and gone since then, NHS England released a blog on the SNF. It was a chance to re-state what the SNF will be and do, with NHS England stating that, 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.
It was also linked to the government’s commitment for medicines investment to reach 0.6% of GDP over the next decade. The SNF is pitched to enable this because it will increase the pace and adoption of new medicines.
The blog also set out the timeline. The plan is for the first SNF digital product to be launched by July 2027, which will cover four therapy areas as part of Phase 1: chronic heart failure, type 2 diabetes (adult), ophthalmology, and asthma. That’s important because it technically meets the requirement for a “move” to the SNF within the next two years.
The blog adds that, through late 2027 to mid-2030, the SNF will be expanded into a “comprehensive, single-source prescribing and decision-making tool.”
Regional approach to implementation
The NHS England blog sets out the 13 integrated care boards that are early adopter sites that will be the first to implement a new standardised categorisation system by December 2026. That will shape the national rollout. They are:
- 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
All the other ICBs will roll out the categorisation by July 2027.
New categorisation: Change in name only… For now
NHS England is light on details for the SNF. But more has been emerging from early adopter sites.
Laura Angus, ICB chief pharmacy officer for Humber and North Yorkshire ICB posted on LinkedIn how they’re moving away from traffic lights to a word-based approach. Green will be known as “all settings”, red as “specialist only”. A video shows what this means in practice (check it out here).
She added that, “But the important thing is that, for now, the underlying classification of medicines isn’t changing.” She also wrote, “The real message is that this is a change in language, not a wholesale change in prescribing responsibilities.”
The post suggested that more change is coming. But exactly what change isn’t clear. Delivering on the ambitions of the SNF needs more than a change in labels on local formulary websites, although, the importance of everyone speaking the same language must not be downplayed as a sound starting point.
Reality check
Those working in the NHS and on formularies, no less, have suggested that the SNF is trying to solve the wrong problems. Sonali Sanghvi, Andrew Barron, and John Minshull have argued in an editorial for the Drug and Therapeutics Bulletin that the SNF will end up duplicating the work of NICE, that local formularies that exist can be fixed instead, that there is a need for a measurement infrastructure that can come from a better Innovation Scorecard and tools like OpenSAFELY, and more radically that ring fencing of funding for new medicines is needed. They conclude that the SNF risks becoming a policy distraction.
Ewan Maule - clinical director, North East and North Cumbria NHS, and chief pharmacist and Honorary Professor at Teesside University - prompted by a Pulse post on how GP practices are being ‘pressured’ into prescribing and monitoring weight-loss drugs without locally commissioned services, pointed out in a LinkedIn post: “If the single national formulary doesn’t think through the implementation implications of things like this, then, it won’t make a ha’peth of difference to access and unwarranted variation.” Yet, he does see promise with the SNF, if done right.
Community Pharmacy has also been critical of the policy. Oliver Picard, chair of the National Pharmacy Association (NPA), warned that the SNF could make medicine shortages worse at the Community Pharmacy and General Practice Conference in Birmingham, held 21st – 22nd June.
How will success be measured?
How will we know if the SNF works? There are statements about what success looks like from the Life Sciences Sector Plan. NHS England’s blog refers to success being seen in terms of “whether patients benefit from fairer access, faster uptake, and better outcomes,” but also points to tracking whether the SNF supports wider strategic changes in the NHS, including the transfer of care from hospital to community settings. That’s a lot to expect from one policy. It runs the risk of overpromising and underdelivering.
Beyond the warm words, just what will be measured? NHS England doesn’t know yet. NHS England was asked, “What measures of success of the Single National Formulary will be used in the future? And what data will they draw upon? And who will undertake the analysis?” in a Freedom of Information request.
NHS England responded: “NHS England does not currently hold the information in response to question 3 of your request, as the success metrics are still in development, as are how they will be measured, etc.”
That doesn’t inspire confidence after a year of policy development.
