The gap in market access vs market adoption is widening in the NHS, as national approval and formulary decisions speed up while uptake still depends on local organisations choosing to change how they work.
Pharma and medtech teams that plan for adoption as early as they plan for access give their products the best chance of reaching patients once approved.
The time it takes for a new medicine to reach the NHS is shrinking. Since April 2026, NICE and the Medicines and Healthcare products Regulatory Agency (MHRA) have been able to publish licensing and value decisions side by side, closing the 90-day gap that used to separate them and bringing patient access forward by three to six months. The Single National Formulary will add to that effect: from December 2026 it begins replacing local formularies in 13 Integrated Care Boards (ICBs), with the rest of England following by July 2027, so that a product recommended by NICE becomes available on the same terms in every area.
For patients, availability is only the starting point. A medicine or device reaches them when a GP practice, Federation or Hospital Trust decides to build it into a pathway, and each of those organisations weighs the clinical capacity it will need, the safety and data governance duties it will take on and the funding before it agrees. National reform is concentrating access into a small number of decisions made once for the whole country, while adoption is still negotiated locally, one organisation at a time, meaning a growing share of the work in a successful launch now happens after a product has been approved.
Reforms that followed the 10 Year Health Plan have changed the route to access:
Listing under the Single National Formulary becomes a single national decision, so a product is either available across England or absent from the formulary altogether. Once it is listed, prescribers everywhere can use it, and the effort of encouraging them to do so shifts to adoption.
In principle, the NHS guarantees funding for NICE-recommended medicines: commissioners must make a medicine with a positive technology appraisal available within 90 days of guidance being published, without local funding or formulary restrictions. In practice, the funding duty secures the medicine, and whether patients receive it depends on the services around it. Tirzepatide for obesity shows how wide that gap can be. NICE estimated that around 3.4 million people in England could be eligible, but because the services needed to prescribe and support treatment could not absorb that demand, NHS England was given up to 12 years to roll it out, with around 220,000 people expected to have access in the first three. NHS England’s Innovation Scorecard, which tracks the use of NICE-approved medicines and technologies across the country, exists because uptake varies from one area to the next despite the same guidance applying everywhere.
The same pattern runs through innovation more widely. The King’s Fund’s May 2026 analysis of medtech and the NHS found that many pilots lack clear plans for scaling, success measures or decision points, leaving “cliff edges” for innovators once initial funding ends. In its words:
“The NHS is not short of pilots; it is short of intentional pilot strategies.”
NHS adoption is spread across several layers, each with its own decision-makers:
The change in the ICB role moves more of the initiative to Providers. Strategic commissioners concentrate on long-term population health and expect Providers to bring forward the service changes they want to make, so the people who run services, from GP partners to Trust operational leads, have become the main audience for any conversation about adoption.
General practice is where most long-term condition care is delivered, and its capacity is stretched. In August 2026, each fully qualified full-time equivalent GP in England was responsible for an average of 2,160 patients, 11.5% more than in 2015, while the number of fully qualified GPs had fallen slightly over the same period. Practices delivered around 28.8 million standard appointments that month.
Any product that adds activity competes for that capacity. A medicine that needs dose titration or regular monitoring, a device that requires training before it can be used, or a case-finding search that identifies hundreds of eligible patients all create appointments that someone has to deliver. Practices can see the clinical benefit and still decide they cannot take on the work, which is why the effect on capacity often settles a product’s future before its clinical value is weighed. Proposals that reduce workload, or bring the capacity to absorb it, are the ones that get a hearing.
Responsibility for a new digital technology is shared between the company that makes it and the organisation that deploys it. Under the NHS clinical safety standards, manufacturers must provide a clinical safety case and hazard log under DCB0129, while the deploying organisation, whether a GP practice, Federation or Trust, has its own duty under DCB0160 to assess whether the product is safe in its own setting, with its own workflows, staff and patients. That duty applies however complete the supplier’s own documentation is. Where a product processes patient data, the organisation acting as data controller must also complete a data protection impact assessment (DPIA) under UK GDPR before it goes live.
For a practice or Federation with limited management support, that work takes time, and it sits with the people who will be accountable if something goes wrong. Evidence of safety elsewhere helps, but boards approve tools they are confident are safe in their own setting. Companies that make the local assessment easier shorten the route to a decision.
Savings and costs often land in different budgets. A medicine switch can save money from an ICB’s prescribing budget while adding workload to general practice, and a new primary care pathway can reduce hospital activity without returning any of that saving to the practices doing the extra work. ICB medicines optimisation incentive schemes, which link practice action plans to the system’s prescribing savings plan, are one way of aligning the incentive with the work, and they show how much the structure of the incentive shapes what practices choose to do.
System finances add a further test. The NHS Medium Term Planning Framework (MTPF) requires every ICB and provider to deliver a 2% year-on-year improvement in productivity and to reach break-even without deficit support by the end of the planning period. A proposal that improves outcomes but adds cost or activity has to show how it contributes to that productivity requirement in terms an ICB can include in its own plan. The King’s Fund also notes that local transformation funding is often divided into pots too small for meaningful innovation, which helps explain why promising pilots end when their initial funding does.
The evidence points to a set of practical steps for pharma and medtech teams:
Funded delivery capacity shows how these elements fit together. When NHS Black Country ICB commissioned dedicated immunisation facilitators to run multilingual recall across 110 practices, the facilitators took on the outreach that practices had no time for, while practices kept their vaccination income and their clinicians gave every vaccine. The programme delivered more than 100,000 immunisations and has since been extended to a further ICB, making the move from local pilot to wider commissioning that many projects struggle to achieve.
National reform has shortened the distance between licensing and access, and the Single National Formulary will make that access consistent across England. As a result, the commercial challenge for pharma and medtech has moved further down the pathway. In the balance between market access and market adoption, adoption now carries most of the launch risk, because clinical capacity, governance duties and funding determine whether patients receive a product that is already available to them.
Companies that map the patient pathways their product will enter, and evaluate the value it adds once adopted, from the appointments it saves to the outcomes it improves, are more likely to launch successfully than those that plan for access alone. Making that case in the terms the system is measured on, and helping to provide the capacity the change requires, gives NHS teams a proposal they can say yes to.
CHASE works with pharmaceutical and medtech companies and the NHS to improve patient access to care through outsourced field teams, NHS-Industry Partnerships and market insights. Our team can help you map the patient pathways in your priority areas, assess the value your product can add once adopted, and design partnerships that support it.
Get in touch with our team to find out more about how we can help.
Market access is the point at which a product is licensed, recommended by NICE and listed on the formulary, so the NHS can use it. Market adoption is whether GP practices, Federations and Trusts build it into their pathways, which depends on clinical capacity, governance duties and funding.
NICE and the MHRA can now publish licensing and value decisions together, bringing access forward by three to six months. The Single National Formulary replaces local formularies through 2026 and 2027, and value-based procurement guidance for medtech caps whole life cost at 40% of tender weighting.
The main barriers are stretched clinical capacity in general practice, safety and data governance duties that sit with the adopting organisation, and funding arrangements where savings and costs fall in different budgets. Pilots without clear success measures or a route to recurrent funding also tend to end when initial funding does.
Commissioners must fund NICE-recommended medicines within 90 days, but funding makes a treatment an option and leaves its use to local services. Uptake depends on whether practices and Trusts have the capacity, governance and incentives to build it into their pathways, which NHS England’s Innovation Scorecard tracks.
Companies can start adoption planning alongside access, make their case in terms of system productivity, and prepare the safety and data documentation deploying organisations need. Designing pilots with success measures and a route to recurrent funding helps projects move into routine use.
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