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*Personalised medicine initiatives in the UK In light of the increasing momentum towards personalised medicine and healthcare, driven by genomic science and a spectrum of technological and information tools [1], we discuss the challenges and impact of personalised approaches within the UK National Health Service (NHS). Various initiatives in the UK have attempted a shift from population-centred to individual-centred approaches and there have been some successful attempts to make healthcare systems more participatory and prevention-oriented. In the UK, personalised approaches have featured on policy agendas for some time. In 2009, the House of Lords report on Genomic Medicine noted that using genomics to enable stratified use of medicines holds ‘the greatest potential for the healthcare sector’ but also presents ‘one of the biggest translational challenges’ [2]. Stratified medicine initiatives, co-financed by industry and government, have encouraged the pharmaceutical industry to embrace personalised treatments and devices. In 2011, the Technology Strategy Board published a strategic vision for making the UK the world leader in development and adoption of stratified medicine. In 2012, the potential emergence of stratified medicine across the entire healthcare system fuelled by genomic information was a central theme of the governmental Human Genomics Strategy Group report [3]. Challenges for implementing personalised medicine in the UK Despite the high-level political endorsement, personalised medicine remains elusive and several challenges remain. These include establishing a robust evidence base, changing practice within existing health services, and facilitating an increasingly participatory approach. Some of these challenges were analysed in the PHG Foundation response to the Genomic Medicine report and its report on next-generation sequencing [4,5]. The Academy of Medical Sciences noted a further set of economic drivers for adopting personalised approaches [6]. Establishing the evidence base A personalised approach necessitates tests and interventions that target increasingly finely divided subgroups requiring a valid evidence base incorporating genomic data. Genomics may contribute to personalised medicine by allowing refined knowledge of a diagnostic group or a subgroup characterised by its response to a treatment . Demonstrating the clinical utility and cost-effectiveness of expensive complex technologies in genetic diseases, and that the replacement test is superior to existing interventions in efficacy, cost-effectiveness or discriminatory power, are necessary steps for implementation. Many molecular tests have failed to satisfy these requirements [7].

Personalised medicine in the UK: challenges of implementation and impact on healthcare system