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If Wales can have one formulary, surely England can have one too. The way local formulary applications are done is that local formulary committees look at Scottish or Welsh decisions and then adjust them to "meet local population" needs (at vast waste to the taxpayer's money). We also need to tackle the disparities in local health authorities using international guidelines, which do not adhere to the same cost-effectiveness rules as NICE and might not be applicable to universal UK healthcare. (A good example is the triple inhalers prescribed like lollipops for COPD patients under GOLD guidelines, whilst being the least affordable intervention in the COPD pyramid and pharma companies benefiting from the market cartel pricing.)