Medicines at a pharmacy - Image credit: Julien Behal/PA

Medicines system in Scotland ‘does not have a focus on patients’, committee finds

The system for prescribing medicines in Scotland “does not have a focus on patients”, a Holyrood committee inquiry has found.

The Health and Sport Committee’s report describes a system “burdened by market forces, public sector administrative bureaucracy and under resourcing, inconsistent leadership and a lack of comprehensive, strategic thinking and imagination, allied to an almost complete absence of useable data.”

The committee particularly criticised the failure of the NHS to introduce appropriate IT systems.

“We are extremely disappointed that once again all roads lead to the dismal failure of the NHS in Scotland to implement comprehensive IT systems which maximise the use of patient data to provide a better service,” the reports says.

Committee members are calling for an overhaul of the system to allow for collection and analysis of data that would ensure the best possible outcomes for patients and cost savings for the NHS.

MSPs found a “lack of care” to understand patients’ experience of taking medicines and a lack of follow up to ensure that medicines were effective or even being used.

Prescribers were “instinctively reaching for the prescription pad” and not taking the time to discuss medicines with patients, nor were the principals of realistic medicine, in which patients and clinicians share decision making about their care, being followed.

The limited monitoring and evaluation of GPs as external contractors is also called into question by the committee.

The committee also highlighted a failure of senior leadership to take on the challenge of transforming the system.

The report makes clear the committee’s frustration that those charged with solving these problems, instead bemoaned the system’s myriad failings without seeking to address them.

They have called on senior leaders across the health service to show the leadership needed to bring forward strategies and solutions to tackle these issues urgently.

The committee also wants to see community pharmacists play a far greater role in patient care, saying a lack of formal structure means their skills and knowledge often go to waste, but the report expresses concern that discussions by community pharmacists with patients on the effectiveness of medicine were “at best recorded on Post-it Notes and at worst disappearing without record.”

The report makes a total of 129 recommendations for change in the system for managing the supply and demand for medicines.

Committee convener Lewis Macdonald said: “The failure to adapt, improve and modernise the current system goes beyond the supply and demand for medicines.

“We found the lack of care taken to understand people's experience of taking medicines impacted the system at every stage.

“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.”

He added: “Again and again throughout this inquiry we have seen that the default position of medical professionals is to reach for their prescription pad rather than consider lifestyle-focused alternatives to medicines, and this cannot continue.

“Our report last year detailed the value of social prescribing but it’s clear that despite its many benefits, it is still considered a second-class option, if it is considered at all.