Single national formulary must ‘maintain flexibility’ to support individual patients

A nationally-approved list of medications and medical products must strike a balance between national alignment and maintaining flexibility to support individual patients, pharmacy leaders have said.

The Royal College of Pharmacy warned that while a single national formulary (SNF) could reduce variation in prescribing across England it must not come at the expense of individualised patient care.

Its president Tase Oputu said: ‘A SNF has the potential to reduce variation in prescribing and access across England, supporting greater consistency and a more coherent national approach to medicines use.

‘However, it will be important to strike the right balance between national alignment and maintaining the flexibility clinicians need to support individual patient care.’

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Her comments come in response to NHS England announcing earlier this month it will begin testing a prototype of the SNF in June.

Formularies are lists of approved medicines deemed suitable for prescribing within a local area, often drawn up by groups of clinicians from both secondary and primary care.

In the 10-Year Health Plan the government pledged that it would move to a SNF for medicines within the next two year in a move designed to streamline procurement, accelerate the adoption of cost-effective innovations, and provide greater consistency across the country.

The plan said that a new formulary oversight board will be created, responsible for sequencing products included in the formulary based on clinical, and cost, effectiveness.

It added that local prescribers – such as pharmacists – will be encouraged to use the national formulary but will ‘retain clinical autonomy’ as long as they prescribe in line with National Institute for Health and Care Excellence (NICE) guidance.

However, while some pharmacy leaders welcomed the move to a SNF, they raised concerns over the medicine supply chain amid reports of drug shortages and record numbers of price concessions.

Ms Oputu said: ‘The NHS must also carefully consider medicines supply resilience and ensure the formulary is fully integrated into prescribing and dispensing systems to support safe, effective patient care.’

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Her concerns were echoed by the Company Chemists’ Association (CCA) which warned that any national formulary cannot succeed if the medicines supply chain remains underfunded.

A spokesperson for the organisation said: ‘We welcome the move towards a single national formulary, particularly if it helps reduce duplication, tackle variation across the country, and delivers for both primary and secondary care.

‘If implemented well, a single national formulary could positively impact the supply chain. Standardisation could help improve predictability in demand and help ease pressures pharmacy teams face when formularies change.

‘It is imperative to recognise that medicines are underfunded and that a single national formulary cannot succeed if the system continues to underfund medicines and medicines supply.’

However, National Pharmacy Association chair Olivier Picard said he was largely opposed to the establishment of a SNF because he feared it would reduce clinicians’ choice of available medicines.

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He said: ‘I am not convinced that a national formulary would [allow us to adapt to the current environment]. I think the current system offers a choice – if a drug is not available, we have an alternative.

‘Obviously, it needs to be re-prescribed by the doctor but there will always be hurdles, and I think those are hurdles that are easier to jump than not having any alternatives and having to wait for the government to make a decision to allow a different drug to be imported.’