The National Genomic Test Directory specifies which genomic tests are commissioned by the National Health Service in England, the technology by which they are available, and the patients who will be eligible to access to a test. The Test Directory is copyrighted, controlled and maintained by NHS England. The Test Directory may only be amended following a robust and evidence-based process conducted and approved by NHS England which will occur on an annual basis. NHS England is currently working with the devolved nations to develop a clear and transparent systematic process for the future evaluation of new genomic tests, enabling an effective annual update process of the Test Directory. This will ensure continued value through the co-ordinated replacement of older tests with new and emerging approaches.