Inconsistent leadership, a lack of understanding of people’s experiences of taking medicines and an ‘almost complete absence of useable data’ are some of the endemic problems identified in a highly critical report by MSPs.

The report by the Scottish Parliament’s health and sport committee into the supply and demand for medicines in Scotland outlines a raft of areas of ‘huge concern’.

Little effort is to taken to understand what patients think about the medicines they take, the MSPs say, which affects the system ‘at every stage’.

Gathering such information would be ‘the single most beneficial action to result from this inquiry’, they say.

Other issues include GP practices not prescribing effectively, community pharmacists being overlooked, and Integration Joint Boards described as “notable by their absence” from any efforts to try to achieve more cost and clinically effective use of medicines.

Committee convener Lewis Macdonald said the report highlights the need for “a much greater focus on outcomes for patients.”

He said: “The failure to adapt, improve and modernise the current system goes beyond the supply and demand for medicines”.

Nearly 17% of NHS net spending in 2017-18 was on drugs, the equivalent of around £1.8bn.

Prescribers ‘instinctively reach for the prescribing pad’

Prescribers are ‘instinctively reaching for the prescription pad’, according to MSPs, rather than taking the time to discuss medicines with patients in any meaningful way.

They are also critical that long-term prescriptions are not being reviewed, resulting in ‘at best waste and at worst harm to the patient’.

The committee calls for an overhaul of the Scottish Government’s contract with GPs, given its failure to address what it describes as a ‘stark’ power imbalance between patients and prescribers.

This is despite a new contract being renegotiated and implemented, with some controversy, in 2018.

MSPs say an approach which pays GPs from the public purse with no monitoring or evaluation of their actions is not acceptable.

‘Dismal failure’ when it comes to IT

The committee says it is ‘extremely disappointed that once again all roads lead to the dismal failure’ of the NHS in Scotland to implement a comprehensive IT system that would maximise the use of patient data to improve services.

Referring to the evidence gathered by the committee, the report states: ‘Comments on patients' surprise at how badly information is handled, particularly at junctions of care, were casually made, once again exposing attitudes not focused on patient care.

‘Worse still, where a lack of patient focus was acknowledged, this was not followed by a solution or plan to take action, but simply left hanging for us to add to the list of issues with medicine management.’

The head of the association of the British Pharmaceutical Industry, Alison Culpan, told the committee that better data collection would stop opportunities to deliver personalised medicine – where treatment can be tailored to patients depending on how they are predicted to respond to specific medicines – from being squandered.

Community pharmacy overlooked

The committee report says that although the role of community pharmacists is clear when it comes to dispensing medicines, a lack of structure and understanding surrounding their relationships with patients and other health services means their potential contribution to managing medicines is wasted.

In order to deal with the changes brought about by the pandemic, pharmacists had some wishes granted immediately that they had been making for years, including read-only access to patients’ records.

Speaking to healthandcare.scot last month, Royal Pharmaceutical Society Scotland board representative Jonathan Burton said pharmacists must now be allowed to add information to patient records to make best use of their expertise in managing medicines.

 

“We found the lack of care taken to understand people's experience of taking medicines impacted the system at every stage," Convener Lewis Macdonald said.

"The almost complete absence of data collection, or data sharing across the health service before the current covid-19 crisis, or analysis of a medicine’s impact on patients, is staggering. Quite simply, patients deserve a better system than this.

“Our evidence has made clear once again the profound failings of current health IT systems. These need to be completely overhauled so that data can be gathered, analysed and shared in a systematic way across the NHS.

“The scale of this task is undoubtedly great, but it is essential to quickly deliver a fit for purpose system which would improve patient outcomes, increase efficiency and reduce costs.”

A Scottish Government spokesperson said:

“As the report notes, the Scottish Government has made progress in the collection and use of data to improve patient outcomes, particularly for cancer treatment and in Primary Care. This approach has been driven by senior clinicians, pharmacists, patients and senior leaders in the health service and we look forward to future developments in this area.

“The Scottish Government will work with the committee and a range of stakeholders in taking forward further improvements to the systems that support the supply and demand for medicines and ensuring the best outcomes for the NHS and patients.”

 

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