Dr Alan Macdonald from the Scottish Medicines Consortium rejects any suggestion that the process for new medicines is in any way not robust.

In 2016 Dr Brian Montgomery was asked to look at how changes made to the SMC's process in 2014 affected access to medicines for rare and end-of-life conditions.

Look at his Review of Access to New Medicines report here., external

As a result of the report the Scottish government agreed that expensive drugs used to treat rare conditions and cancers may be used on an interim basis so clinical effectiveness could be accessed.

The committee draws to a close.

Image source, Science Photo Library

Mr Briggs asks about the methadone programme.

Matt Barclay says pharmacies have a statutory duty to run this programme, which is evidence based and recognised at an international level.

He adds Community Pharmacy Scotland is working with health boards to look at additional services to support patients, such as dental care and needle exchange.

Image source, Getty Images

According to ISD, over the last ten years, the volume and cost of dispensed medicines and provision of pharmacy services within the community in Scotland has increased.

The total number of items dispensed, external increased by 20.5% from 85.8 million to 103.4 million items.

There was little change between 2016/17 and 2017/18 at an overall net cost of £1.3 billion, an increase of 25.7% over the last 10 years.

The following blog by the Scottish Parliament Information Centre (SPICe) has lots of useful info on this topic:

https://digitalpublications.parliament.scot/ResearchBriefings/Report/2020/1/16/Medicines-in-Scotland-1#, external

More details on the inquiry can be found here:

https://www.parliament.scot/parliamentarybusiness/CurrentCommittees/113038.aspx, external

Lib Dem MSP Alex Cole-Hamilton says it is vital the committee gets sight of any existing data.

Mr Cole-Hamilton asks about disinvestment in some products and whether there is a role for any national body to decide what should no longer be routinely used.

There is no national focus at the moment, but there are national groups that will focus on their own areas, replies Lindsay McClure.

Matt Barclay from Community Pharmacy Scotland says making medicine reviews routine is being looked at.

Tory MSP Brian Whittle asks about communication between various healthcare providers with regard to social prescribing.

Mr Barclay agrees more communication is needed to move away from what is seen as traditional medicine.

Dr Montgomery agrees the system is skewed towards pharmaceutical interventions, but there has been movement towards social prescribing.

He calls for a "pause" to ensure the right metrics and data are in place to make sure social prescribing is a worthwhile alternative.

Image source, GETTY IMAGES

The pharmaceutical industry is worth £1.7bn to Scotland's economy and directly employs more than 5,000 people across the country, a report has found.

The Fraser of Allander Institute (FAI) said the sector exported £462m worth of manufactured goods a year.

It also found it was the manufacturing sector's second biggest spender on research and development (R&D).

However, FAI said there was evidence to suggest business spending on such activity had fallen in recent years.

Matt Barclay from Community Pharmacy Scotland says the minute you have an element of social prescribing there can be more support for patients.

Social prescribing involves helping patients to improve their health, wellbeing and social welfare by connecting them to community services which might be run by councils or local charities.

Mr Briggs suggests there is a postcode lottery on access to medicines in some case.

Dr Macdonald says the existence of the SMC should work against any notion of a postcode lottery.

But the SMC does not have any involvement with the process of individual requests, external for drugs he explains and so he cannot comment on how each health board operates this.

Dr Montgomery says the creation of this process was designed to reduce differences between health boards but there is not yet the data to make conclusions about if it is working in practice.

Lindsay McClure from Medicines Pricing and Supply at the NHS National Services Scotland accepts there are supply chain and pricing challenges.

She says there is work to be done, but argues the system is working very well in terms of generic drugs.

Convener Lewis Macdonald asks if the price of medicines is competitive.

Ms McClure replies that is what the evidence is telling us.

Image source, Getty Images

SNP MSP Sandra White wonders how community pharmacy procurement can be improved, pointing to concerns the current model means them taking on financial risk.

Matt Barclay says procurement has become part of the day job for pharmacy teams which does take time away from the provision of care.

But pharmacies deal with it efficiently and patients do not wait any longer than they did previously for medicines, he adds.

With regards to financial risk, Mr Barclay says community pharmacy does need to be supported and he suggests there should be improvements to timescales as often pharmacies are having to pay for medicines before reimbursement.

Lindsay McClure says it is possible for authorities to share pricing information with one another, which creates a safeguard to ensure each home nation is not paying more for the same drugs.

Dr Montgomery says actions taken recently has provided more flexibility and direct access to some drugs.

Image source, bbc

Committee convener Lewis Macdonald asks about the centralisation of approvals for drugs and any erosion in the processes.

Dr Alan Macdonald from the Scottish Medicines Consortium says the first conclusion of Dr Montgomery's report was that this organisation had delivered in terms of access to cancer treatements.

Dr Macdonald absolutely refutes any view that the approvals process has weakened.

He says at no time has he ever thought that the process of the SMC has been carried out with anything other than rigour.

SMC's unique selling point is that it is the only body in this space looking independently at the evidence, he adds, saying it looks how much does a drug adds to the pre-existing therapies.

This part of the debate can be lost to the public, he points out.

Ms Harper highlights budgets are shifting from secondary to primary care.

Matt Barclay from Community Pharmacy Scotland says this can come with challenges for budgets, such as pharmacies needing to avoid overstocking.

The shape of medicine supply is changing and community pharmacies will have to adapt, he adds.

SNP MSP Emma Harper asks about the key drivers of growth in the medicines budget.

Lindsay McClure from the Medicines Pricing and Supply at the NHS National Services Scotland says her organisation will have to continue to work to control spend.

Dr Alan Macdonald from the Scottish Medicines Consortium explains it can be quite hard to get a single version of the truth as to how much prices are increasing, citing the complexity of the drivers.

Dr Brian Montgomery, author of the Review of Access to New Medicines, explains the options open to clinicians have increased, therefore driving up the budget.

Advances in medicine leads to greater pressure on the budget, he explains.

Image source, Thinkstocks

The focus of the committee’s inquiry is to look at the management of the medicines budget, including the clinical and cost effectiveness of prescribing.

The inquiry will encompass four distinct but related parts covering in effect the supply and demand for services:

• Purchasing (including procurement and medicine price regulation, a reserved area undertaken at a UK level)
• Prescribing (covering all licensed to write prescriptions)
• Dispensing (covering hospital, pharmacy and GP)
• Consumption (looking at effectiveness and wastage)

The inquiry will not cover advice on the clinical and cost-effectiveness of new medicines or whether new medicines should be routinely available for prescribing by the NHS in Scotland.

The health committee will shortly hear from:

• Dr Alan Macdonald from the Scottish Medicines Consortium, external
• Lindsay McClure from Medicines Pricing and Supply at the NHS National Services Scotland, external
• Matt Barclay from Community Pharmacy Scotland, external
• Dr Brian Montgomery, Author of the Review of Access to New Medicines, external

• Here's the committee papers, external
• Read all the written submissions received for this inquiry, external

SNP MSP Emma Harper says Channel 4's Dispatches showed secret meetings between US drug companies and UK government officials.

A documentary by Channel 4 Dispatches, external asserted that the price the NHS pays for US medicines could rise steeply in any future trade deal with the United States.

The programme reported that "drug pricing" had been discussed in six initial meetings between trade officials from the UK and the US, and that there had been "secret meetings" between the pharmaceutical companies and British civil servants.

Should we be seeking guarantees from the UK government on drug prices, asks Ms Harper.

Mr Smith, a former UK government trade negotiator, tells the committee describing them as secret talks is "a little bit of hyperbole", as he would be "absolutely amazed" if these talks had not been going on and US negotiating objectives had not been discussed.

It does underline these issues are on the table from the US side, he says.

Mr Stewart again raises the impact of a possible UK-US trade deal, wondering about issues relating to price, security of supply and patent control.

Alison Culpan says the signals from the UK are that medicines will not be on the table.

We already enjoy the benefits of US medicines come to Scotland and they go through the usual process, she adds.

Warwick Smith says there is some concern about intellectual property rights which could delay the launch of generic medicines in the UK compared with now.

Mr Stewart asks if there are any concerns about tariffs.

Alison Culpan says the Association of the British Pharmaceutical Industry is looking for a frictionless border so medicines can come straight in.

Ms Culpan says 45 million packs go out of the UK to Europe but 37 million come back in, so there is a hook there for co-operation between the EU and the UK.

"We should be looking for cooperation when it comes to the supply of medicines coming in."

There is a lot of work to be done, says Ms Culpan, but she cites work with the Scottish government to ensure medicines are not stuck at Dover, with drugs being flown in having been looked at.