Supply and Demand of Medicines – Scottish Parliament Inquiry findings

02 Jul 2020

Report from the Scottish Parliament Health and Sport Committee into Supply and Demand of Medicines.

The report from the Scottish Parliament Health and Sport Committee Inquiry into the supply and demand for medicines was published on 30th June 2020. This follows an extensive inquiry starting late last year with a request for written responses to the Scottish Government committee followed by several weeks in early 2020 of verbal evidence from Scottish pharmacists.  The NPA response to the inquiry was submitted after discussing fully with members attending the November 2019 NPA Scottish forum. The aspects of medicine supply and demand for the Committee’s focus were purchasing, prescribing, dispensing and consumption of medicines.

 

The Committee recognise the value of community pharmacists in medicine supply and highlight the additional benefits that community pharmacy bring to the clinical and cost effectiveness of medicines.

 

The Committee report finds that overall the supply and demand for medicines in NHS Scotland to be “an incoherent system which fails to put patients first” and that the limited accountability of GPs, “is not acceptable”.

 

The report is a detailed lengthy summary of findings covering 195 pages and 129 recommendations which if accepted by Scottish Government will be significant to the progress of the Scottish Community Pharmacy contract. The Scottish Government express frustration at the valuable work taking place by community pharmacists which is not recorded and welcome the ambition of a greater role for pharmacists which they view as an area for immediate action. Throughout the report the need for more open discussion with patients about their medicines was identified. General Medical Services contract accountability, NHS Secondary Care systems, NHS information sharing and medicine waste policies all came under scrutiny.

 

NPA summary on medicine supply and demand:

The NPA responded to the inquiry, providing examples of where community pharmacists are integral to efficient medicine NHS supply and suggestions for future improvement.

In our response summary we concluded:

  • NPA Scottish members believe that the pharmacy network supplies medicines safely and cost effectively to patients for NHS Scotland.
  • NHS Board variation in prescribing trends can cause cost inefficiency and result in patient concern, whereas national formularies, prescriber guidance and digital improvements increase access to the most clinically appropriate and cost effective medicines.
  • Medicine manufacturer quota systems enforced on community pharmacies negatively impacts pharmacy workload and patient care.

What the Scottish Parliament committee found:

With Quota Systems:

The Committee recognised the inefficiencies caused by the Quota system and acknowledged the NPA statement that the quota system caused pharmacists additional workload and was “not intuitive nor responsive, inflexible and we believe inequitable”

Workforce:

As a matter of urgency the Committee will seek “from the Cabinet Secretary as to any action the Scottish Government can take to implement more flexible working and formalised career pathways for pharmacy staff” 

The Committee suggests that “procurement of medicines become part of the formalised training for pharmacy technicians”.

The committee request details of progress of the GP Pharmacotherapy service with regards to sufficient capacity of pharmacy staff.

Drug Tariff:

In response to NPA comment that the Scottish Drug Tariff “has a more timely response process to medicines shortages and the resultant price increases than the rest of the UK, although on rare occasions contractors may still be out of pocket for dispensing prescriptions to patients”. The committee recommend the NHS pay community pharmacy on the same payment terms as have been requested by wholesalers.

Automated Dispensing:

The committee would like detail on the evaluations of pilots and trials undertaken by both the Scottish Government and Health Boards of automated dispensing so far in Scotland

Online Pharmacies:

The committee “believe the profession is perhaps underestimating the potentially disruptive effect of online pharmacies. We ask what consideration the Scottish Government has given to the potential threat of online pharmacies and how it can future proof the contract and associated regulations to protect the network

Care Homes:

 

Medicine waste was recognised as an issue in care homes with the recommendation that pharmacists could have wider roles working in care homes.

Access to Shared Patient Records:

The report stated, “A comprehensive system of care should include information sharing across all parts of the system and everybody providing patients with medical care and advice should have the requisite details of the patient in order to make evidence-based judgements. This applies equally to all

Why the sharing of the Emergency Care Summary to community pharmacy only became suddenly available in the COVID-19 pandemic was questioned.

Medicine Waste:

Recommendation was made to Scottish Government to establish a means of collecting information on medicine use by patients

This Scottish Parliament report provides Scottish Government with wide recommendations covering all areas of medicines supply and demand in NHS Scotland which will have future implications for community pharmacy owners and community pharmacists along with GPs, and of course NHS Board scrutiny of their processes. Read the report, listen to the podcast or please contact Janice Oman, NPA Scotland Representation Manager to discuss further. J.oman@npa.co.uk