• Executive Summary

• Introduction
  • Engagement
  • Structure of the report
  • Background

• Research and development
  • Real-world experience and clinical trials
  • Personalised medicine
    • Waste
    • Manufacturing technology
    • Preparedness for personalised medicine in the healthcare system
  • Research and Development - conclusions

• Licensing and acceptance for use in the NHS
  • Licensing
    • Licensing for more than one indication
      • Adaptive licensing
    • Evidence in support of licence applications
    • Licensing - conclusions
  • Access to new medicines
    • Scottish Medicines Consortium (SMC) assessments
      • Speed of assessment compared with the rest of the UK
      • Assessment of licensed medicines for cost effectiveness
      • Changes since the Montgomery Review - review of assessment methods
      • Changes since the Montgomery Review - Peer Approved Clinical System (PACS) Tier 2
        • Postcode lottery
        • Review of the implementation of PACS Tier 2
      • Changes since the Montgomery Review - Patient and Clinician Engagement (PACE)
      • Changes since the Montgomery Review - Clinical and cost effectiveness of new medicines
      • Changes since the Montgomery Review - access to end-of-life, orphan and ultra-orphan medicines
      • Changes since the Montgomery Review - interim acceptance
      • Value
      • Scottish Medicine Consortium horizon scanning
      • SMC assessment processes - conclusions
    • Patient Access Schemes
    • Interaction with the pharmaceutical industry
    • Access to new medicines - conclusions
  • Scrutiny of non-medicine interventions

• Purchase and Procurement
  • A. Achieving best value in procurement
  • B. International pricing markets
  • C. Wholesale Supply Chains
    • Shortages
  • D. Pricing - Branded Medicines
    • Voluntary Pricing and Access Scheme (VPAS)
      • Efficacy of the Voluntary Pricing and Access Scheme (VPAS)
      • Transparency in pricing around the UK
      • Rebate to Scotland and the New Medicines Fund
      • Voluntary Pricing and Access Scheme - conclusions
    • Pricing based on other considerations
      • Value and outcome based pricing
        • Support for value and outcome based pricing
        • Outcome based pricing and improved access to medicines
        • Collection of outcomes data to support value based pricing
        • Where outcomes differ from those anticipated
      • Multi-indication pricing
      • Pricing based on other considerations - conclusions
  • E. Pricing - generic medicine
    • Cost of generics - price increases
    • Cost of generics - UK Government price setting powers
  • F. Purchasing in Secondary Care
  • G. Purchasing in primary care
    • Community Pharmacy Procurement
      • Efficiency of Community Pharmacy Procurement
        • Community pharmacy procurement from wholesalers
        • Movement of prescriptions from secondary to primary care
      • Staff
      • Community pharmacy procurement versus central procurement
      • The Scottish Drugs Tariff
      • Financial Risk
      • Over the counter medicines
  • Purchasing and procurement - conclusions

• Prescribing
  • Freedom of the prescriber
    • Factors which may influence prescribing
      • A. The Quality and Outcomes Framework and the General Medical Services Contract (GMS Contract)
      • B. Formulary
        • Adding items to the formulary following SMC decisions
        • Value from a formulary with fewer options
        • Formulary compliance
        • Disinvestment/investment
        • Competition
        • Single National Formulary
        • The inclusion of non-medicines in a single national formulary (SNF)
      • C. Clinical Guidelines
    • Freedom of the prescriber - conclusions
  • Prescribing in primary care
    • Reviews of prescriptions
      • Comprehensive reviews of prescriptions are not routinely taking place
        • Reluctance to switch
        • Resources required to review prescriptions
        • The General Medical Services (GMS Contract)
      • Patients' Views
      • Other forms of support as part of reviews
      • Digitisation of reviews of medicines
      • Reviews of prescriptions - conclusions
    • Repeat prescribing
      • Medicines Care Review Service
      • Pharmacotherapy and repeat prescriptions
      • Delivery of repeat prescriptions
  • Prescribing in secondary care
    • Delaying discharge
    • Collection of prescribing data in secondary care
      • Hospital Electronic Prescribing and Administration System (HEPMA)
        • Challenges of introducing HEPMA
        • Procurement of HEPMA
        • Is there a role for HEPMA in the movement of records between primary, secondary care and social care?
        • Funding for HEPMA
        • Data Collection
        • Hospital Electronic Prescribing and Administration System (HEPMA) - conclusions
  • Non-pharmaceutical interventions
    • Assessment and governance of non-medicine prescribing
    • Medicines are not the only or even the most cost or clinically effective way forward
    • Communication with the public
    • GP knowledge
    • Non-pharmaceutical interventions - conclusions
  • Social prescribing
    • Culture change needed
    • Evidence on the benefits and outcomes of social prescribing
    • An instinct to prescribe medicines
    • A pill for every ill - patient expectation
    • New General Medical Services (GMS) Contract and support from other health professionals
    • Longer Appointment Times
    • Awareness of referral pathways and activities to prescribe
    • Inequality
    • Inquiry into Social Prescribing
    • Social Prescribing - conclusions
  • Realistic Medicine
  • Prescribing generics and biosimilars
    • Generic medicine
    • Biosimilars
    • Benefits of prescribing generic medicines and biosimilars
    • Governance of generic and biosimilar prescribing
  • Prescription charges
  • Prescribing non-licensed medicines
  • Polypharmacy
  • Non-medical prescribers
  • Prescribing - conclusions

• Dispensing
  • Community pharmacy contract
    • Minor Ailment Scheme and Pharmacy First
  • Pharmacy and the General Medical Services Contract
    • Community Pharmacy in GP surgeries - Pharmacotherapy
    • Relationship between pharmacist and the community
    • Impact on the pharmacy workforce
    • Skills and Training
  • Automation
  • Care Homes
    • Use of 'Just in Case' boxes
    • Stock of Medicines
    • Bulk prescribing in care homes
    • Other health care staff's presence in care homes
    • Scottish Government consideration of dispensing in care homes
  • Online Pharmacy

• Consumption
  • Waste
    • Adherence
      • Proposals to improve adherence
      • Discussions with patients on adherence
      • Use of technology and packaging to support adherence
      • Compliance aids
      • Environmental concerns
    • Medicines which have not been taken
      • Medicines which are prescribed but not picked up
      • Prescriptions which have been picked up but subsequently returned to the pharmacy unopened
      • Medicines which are dispensed but not taken
    • Over ordering by patients
    • Prescribing ineffective medicines
    • Errors and harm
  • Research into the causes of waste
  • Disposal of medicines
  • Waste - conclusions

• Data and IT
  • Sharing of medical records
  • Uniform IT and data systems
  • Data Scoping Taskforce and the Digital Health and Care Strategy
    • Scotland's Digital Health and Care Strategy
    • Data Ownership
  • Technology for the medicines of the future
  • Outcomes
    • Outcomes data for research, development, purchasing and procurement - Cancer Medicines Outcome Programme
    • Prescribing
    • Consumption
  • Data and IT - conclusions

• Glossary
  • Definition of terms
  • Acronyms

• Annexe A - Minutes of Meetings

• Annexe B
  • Official reports

• Annexe C