Once HEPMA is in place, we must look at how pharmacies link into it Prof Timoney adds.

Patients would be surprised about how little we know about pharmacy within hospitals, she adds.

Ms Caldwell says in some cases printouts of HEPMA have been provided to community pharmacy colleagues after a patient stay in hospital, which has helped them understand changes made to a patient's medication.

Mr Burton agrees that once pharmacists are more connected it will display the good work being done by the profession.

I support any move towards moving to outpatient community pharmacy dispensing, he adds.

Image source, bbc

SNP MSP Sandra White says patients waiting for drugs to go home and the pharmacy being closed seems like a "crazy, crazy system".

Prof Timoney says not every patient in hospital will see a pharmacist and it is junior doctors who write prescriptions and they know they need to get someone else into the bed and clerk them in as well.

Everything is running quite hot in the system and sometimes there are clogs due to the pace of what is going on in hospitals, she adds.

The professor says it is absolutely essential HEPMA is put in place across all hospitals in NHS Scotland.

What is HEPMA, external? It stands for Hospital Electronic Prescribing and Medicines Administration..

"We need to be using big data to drive improvements in our care."

Asked about delays in the prescribing process, Gail Caldwell says within NHS Greater Glasgow and Clyde it takes around three hours from receiving a prescription to ready the medicine.

For the patient this can feel not very person centred because it can leave them waiting for hours after they have been told they can go home, she explains.

In addition to the delay caused by ensuring the medicine is available and correct, there can also be additional waits because a prescription has not been dropped off by the doctor she adds.

She highlights a proposal with her health board which could see electronic immediate discharge letters sent to community pharmacists, which could see patients go to a local pharmacy nearer their homes rather than having to wait in hospitals.

Professor Angela Timoney from NHS Lothian says pharmacy technicians are working at the top of their licence.

Prof Timoney cites the workforce pressures being faced, but adds that is across the whole of the NHS.

Mr Burton points out: "We need to get our workforce planning right."

We do need a pipeline for pharmacy technicians he elucidates, adding there are great opportunities for them.

Prof Angela Timoney says there are good relationships between GPs and pharmacists, and generally GPs welcome conversations.

Mr Briggs asks whether it is recorded when a pharmacist questions or takes a different view from a GP.

Jonathan Burton explains this depends on the professional discretion of the pharmacist involved, though he accepts there is an issue with getting data.

Technical issues may simply require a post-it note, while other queries might be best done via phone he says.

Pharmacists will also speak to GPs whenever there are issues with medicine supply, he adds.

Image source, Getty Images

Tory MSP Miles Briggs asks if there is conflict between pharmacists and GPs over prescriptions.

"No, it's about reaching consensus with the patient," replies Mr Shimmins.

"As a community pharmacist you are not piggy in the middle your part of a triumvirate

"Conflict is rare, very rare."

Campbell Shimmins of Community Pharmacy Scotland says a patient has two weeks to come and collect a script.

Mr Shimmins explains this pertains to less than 2-3% of drugs.

Mr Burton explains with improvements in technology the ability to keep in touch with patients has improved, for example contacting them by text.

SNP MSP David Torrance asks about the recycling of unused and uncollected medicine.

Gail Caldwell explains there is a quality issue related to this because health professionals cannot ensure medicines are stored correctly when they are in patients' homes.

Medicines are reused in hospital settings because there are guaranteed standards she adds.

Jonathan Burton backs up this point. He adds systems are not sophisticated enough to keep track of every tablet, meaning a small amount of tablets from a bigger prescription which is not collected might not be tracked.

Image source, Thinkstock

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.

Jonathan Burton from the Royal Pharmaceutical Society in Scotland says during this inquiry we've heard how complex medicines are and how complex people are.

Mr Burton says to address this complexity pharmacists need the time to care.

In terms of community pharmacy and GP practices this means having time to talk to patients to build trust and avoid accepting the churn of medicines, he explains.

Mr Burton stresses the importance of IT, which can share problems quickly to help find solutions.

Prof Angela Timoney from NHS Lothian points to reductions in waste due to patients not taking medicines, adding her health board has met its targets on this for the six years she has been in post.

Campbell Shimmins of Community Pharmacy Scotland says regular checking with patients to ensure they are taking their medicines and what they are taking them for is standard pharmacy practice.

Recent changes will see patient-facing time increase to boost adherence and concordance, he adds.

Mr Shimmins says pharmacies are seeing less disposal uplifts.

Gail Caldwell from NHS Greater Glasgow and Clyde begins addressing the issue of drugs waste, talking about managed repeats where a pharmacist takes control of ordering a patient’s medicines.

Ms Caldwell cites risks around managed repeats which can generate waste and says a better system is managed care and review.

She explains managed care and review is a really important strategy for health boards.

Image source, Getty Images

The ‘supply and demand for medicines inquiry’ looks at the increasing cost of medicines for Scotland’s NHS.

The committee is seeking to find out how medicine usage can be improved and waste reduced, with estimates suggesting anywhere from 15% to 50% of prescriptions go to waste.

The growth in expenditure on drugs in Scotland is outstripping the growth in total NHS expenditure in both primary and secondary care:

Average year on year growth rate in hospital and primary care costs between 2012/13 and 2018/19:

• Hospital drug costs 6.6%
• All hospital costs 1.5%
• Primary care drug costs 3.6%
• All primary care costs 2.3%

Source: ISD Scotland, Health Costs Book, tables R600

The health committee is hearing from:

• Professor Angela Timoney from NHS Lothian
• Gail Caldwell from NHS Greater Glasgow and Clyde
• Campbell Shimmins of Community Pharmacy Scotland
• Jonathan Burton from the Royal Pharmaceutical Society in Scotland

Image source, Getty Images

The health committee will begin shortly to continue its inquiry into supply and demand for medicines.

The committee papers are available here. , external

Written submissions received on the topic are also available., external

Image source, PA Media

Welcome to BBC Scotland's Holyrood Live coverage of the Scottish Parliament on Tuesday 4 February 2020.

We begin with the health committee taking evidence as part of its inquiry into the supply and demand of medicines.

Topical questions takes place at the earlier time of 13:30. They are on NHS Lothian leadership and GDP figures.

Then MSPs debate the Non-Domestic Rates (Scotland) Bill, external for the final time, before voting on whether or not to pass it at decision time at 19:00.