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Recent Reports
Aithisgean ùra
Committee Reports
Aithisgean Chomataidh
Research Briefings
Brathan-ullachaidh Rannsachadh
Feedback
Ais-eòlas
Published by The Scottish Parliamentary Corporate Body
Supply and demand for medicines
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Published: Tuesday 30 Jun 2020 (HSS052020R6)
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Overview
Report
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Overview
Report
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
Image: Journey of a medicine - from research and development to Scottish patients
Image: Background
Image: Research and development
Image: Licensing and acceptance for use in the NHS
Image: Scottish Medicines Consortium (SMC) assessments
Image: Changes since the Montgomery Review - interim acceptance
Image: Patient Access Schemes
Image: Purchase and Procurement
Image: G. Purchasing in primary care
Image: F. Purchasing in Secondary Care
Image: Freedom of the prescriber
Image: Prescribing in primary care
Image: Trends in hospital expenditure
Image: Trends in primary care expenditure
Image: Longer Appointment Times
Image: Realistic Medicine
Image: Generic medicine
Image: Dispensing
Image: Care Homes
Image: Bulk prescribing in care homes
Image: Waste
Image: Data and IT
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