A Single National Formulary Could Transform Women's Health — If We Get It Right
By Charlotte Howden
When the Government reaffirmed its plans for a single national formulary in the renewed Women's Health Strategy—a policy first announced in the NHS 10-Year Plan—many people saw it as a technical NHS reform.
It isn't.
For women living with serious conditions like Hyperemesis Gravidarum (HG), it could fundamentally change whether treatment is accessible—or not.
Recently, I sat down with Neil Hardy, Chief Pharmacist for NHS Hampshire and Isle of Wight ICB, to discuss what the single national formulary could mean in practice for clinicians, pharmacists and patients.
One thing became clear very quickly: postcode prescribing still exists.
As Neil explained:
"The patient is the patient, the drug is the drug, and the condition is the condition."
And yet across England, access to medicines can still depend on geography. For women with Hyperemesis Gravidarum, that reality has had serious consequences.
When Access Depends on Your Postcode
During our discussion, we talked specifically about Xonvea—the only licensed medication in the UK specifically approved for nausea and vomiting in pregnancy. Historically, some NHS areas made the medication available, while neighbouring ICBs did not.
That meant a pregnant woman living five minutes one way could access treatment routinely, while another woman five minutes the other way could not. This is exactly the kind of inconsistency the single national formulary is designed to address.
Neil described the ambition clearly:
"If it is decided nationally that a medicine should be available, it should be adopted and patients should therefore have access to it."
For women's health, that matters enormously.
Why This Matters Beyond HG
The issue extends far beyond one condition. Women's health has historically suffered from fragmentation, variation and slow adoption of innovation.
Pregnancy is a particularly difficult area because prescribing decisions are often shaped by understandable caution. Many medicines used safely in pregnancy for decades are technically off-label, simply because formal licensing studies were never conducted in pregnant populations. That creates uncertainty for clinicians. It also creates delays for patients.
One of the most important parts of our conversation focused on the reality that pharmaceutical companies rarely invest heavily in pregnancy medicines unless there is confidence those medicines will actually be adopted once approved. That is why the national formulary matters. It sends a signal that innovation in women's health will not simply disappear into 300 separate local decision-making processes.
The Hidden Barrier: Shared Care
One of the most revealing parts of the interview was our discussion around shared care. Many women with HG describe the same experience: a hospital specialist prescribes medication, the GP declines to continue it, and the patient is left stuck between primary and secondary care.
I shared my own experience of being prescribed ondansetron in hospital, only to find my GP unwilling to continue prescribing it once I returned home. For someone vomiting dozens of times a day, travelling repeatedly to hospital simply to obtain medication is not realistic.
Neil made an important point here:
"If it's not easily available, then it's not available."
That sentence captures the reality of healthcare access perfectly. A treatment technically existing is not the same thing as patients being able to access it safely, quickly and consistently.
Pharmacy Has a Bigger Role Than We Realise
Another key theme was the evolving role of pharmacy. Community pharmacists are increasingly becoming frontline clinicians—diagnosing conditions, prescribing medicines and identifying red flags.
For HG, that presents a huge opportunity. Many women are still told severe pregnancy sickness is "normal". Early recognition and timely intervention remain inconsistent. Greater awareness among pharmacists and pharmacy teams could dramatically improve early signposting and escalation.
As Neil suggested, pharmacists do not necessarily need to become HG specialists overnight—but they do need confidence to recognise when pregnancy sickness has crossed into something more serious. That awareness alone could prevent significant harm.
Reform Alone Is Not Enough
The single national formulary will not solve every problem overnight. Implementation matters. Infrastructure matters. Clinical confidence matters. Electronic prescribing matters. Shared care pathways matter.
But for the first time in a long time, there is genuine momentum behind reducing variation in access to medicines across England. For women's health advocates, clinicians and patients alike, that should be welcomed. Because ultimately, access to treatment should never depend on which side of a county border—or hospital boundary—someone happens to live on.
And if we are serious about improving women's healthcare, consistency cannot remain optional.
Watch the full interview with Neil Hardy: