OBJECTIVES: Multiple sclerosis (MS) is an acquired chronic immune-mediated inflammatory condition of the central nervous system. It is the commonest cause of serious physical disability in adults of working age.  Inequalities in access to treatment and care for MS have been recognised within the UK and when the UK is compared with Europe eg. 69% of patients in Germany have access to disease modifying therapies versus 21% of patients in the UK.  Recent NICE guidance has been issued to tackle the inequalities in access to care for MS in England, however uptake of NICE Guidance is not uniform across the country, leading to delays and restrictions in access to treatment for patients in some areas.  This paper aims to assess the current variation in access to treatment for MS in England. METHODS: Prescribing of fingolimod for MS in England was examined using the NHS England Innovation Scorecard for Key Secondary Care Medicines per 100,000 population. Uptake of fingolimod across the 25 area teams was examined. RESULTS: Despite positive NICE guidance for fingolimod issued in April 2012 there are major differences in the uptake of fingolimod in England.  The highest uptake can be seen in the London area and in other area team geographies in the south.  Uptake in these areas is at least 3 fold and in some cases 7 fold greater than that seen in area team geographies in the North West.  Some of this variation may be explained by proximity to specialist care centres, however the existence of these centres does not explain the extent of the variation. CONCLUSIONS: Variations in access to treatment for MS in England persist despite NICE guidance and NHS reform aimed at addressing these inequalities.