Single national formulary and community care: a closer look at the 10-Year Health Plan
pharmafile | August 21, 2025 | Feature | Business Services, Market Access | Gateway to Local Adoption, NHS, Visions4Health
In the fourth of the Gateway to Local Adoption series, Visions4Health caught up with Frances Smith, Clinical Pharmacy Services Manager, Outpatients, to discuss her views on elements of the 10-Year Health Plan for England relating to patient access to medicines.
The newly-published 10-Year Health Plan sets out bold ambitions, but two proposals stand out for their potential to reshape how medicines are accessed: the creation of a single national formulary and the shift of services from hospital to community. Both offer opportunities but also raise some significant questions.
Let’s start with the single national formulary. On paper, having one consistent list of approved medicines across England sounds logical. A single formulary could bring consistency and perhaps even leverage better prices for the NHS, but it could also create vulnerabilities. If all providers are tied to a single brand or specific medication within a class, supply chain disruptions could have national consequences. In reality we already have the British National Formulary, and then local formularies determine what is actually available to patients in different regions. This variation can reflect local priorities, budgets or even drug availability. Limiting choice could frustrate clinicians, particularly where evidence or patient response supports alternatives. There is also the question of how a single national formulary would respond to rapidly evolving clinical evidence – would it be nimble enough to adapt?
The Plan’s push to move care out of hospitals and into community settings also needs careful consideration when dealing with high-cost or specialist medicines, for example biologic treatments in specialties such as rheumatology, gastroenterology and dermatology. The prescribing and governance systems are tightly linked to Acute Trusts. Even if consultations happen in off-site clinics, the medicines often come via hospital pharmacies or homecare services. If these clinics are run by non-acute community providers, prescribing could become more complex.
Commissioning processes like Blueteq approvals, pricing arrangements and governance requirements might not transfer smoothly into the Neighbourhood Health Service. Without careful integration, there’s a risk of delays, duplication, or reduced access.
Ultimately, these changes could improve equity and convenience for patients, but only if the system design addresses the logistical and governance realities. Otherwise, we risk trading local variation for national bottlenecks, or shifting care locations without ensuring the same safe, efficient access to medicines.
In short, ambition is good, but as with any prescription, the dose and delivery matter just as much as the drug.
Author
Frances Smith is a member of Visions4Health’s Healthcare System Council and an NHS Pharmacist in Cambridge. With over 15 years of experience, she has held leadership roles in Clinical Services covering a range of specialties including neurology, ophthalmology, diabetes, endocrinology, and more recently rheumatology, gastroenterology and dermatology. She is committed to delivering high-quality patient care as well as prioritising staff well-being. She is passionate about leadership and professional development within the pharmacy profession, aiming to expand pharmacists’ roles into outpatient services to develop collaborative services that utilise different skills and enhance patient care.
Visions4Health are UK market access experts and your gateway to local adoption at pace. To find out more about Visions4Health and its Healthcare System Council visit: visions4health.com
Related Content
Digital mental health technologies – a valuable tool in supporting people with depression and anxiety
The potential benefits of digital mental health technology for managing depression, anxiety and stress, together …
A community-first future: which pathways will get us there?
In the final Gateway to Local Adoption article of 2025, Visions4Health caught up with Julian …
The Pharma Files: with Dr Ewen Cameron, Chief Executive of West Suffolk NHS Foundation Trust
Pharmafile chats with Dr Ewen Cameron, Chief Executive of West Suffolk NHS Foundation Trust, about …
