MEDICINES
Attendees at a meeting of the Scottish Medicines Consortium
THE SCOTTISH MEDICINES CONSORTIUM (SMC) HAS BEEN MEETING IN PUBLIC FOR OVER TWO YEARS, BUT COMMERCIAL CONFIDENTIALITY LIMITS HOW MUCH ANY OBSERVER CAN BE TOLD. IN THE LIGHT OF THE LATEST REVIEW OF ACCESS TO NEW MEDICINES IN SCOTLAND, JOHN MACGILL JOINED THE PUBLIC GALLERY AT A FULL MEETING OF THE SMC IN GLASGOW.
AN AFTERNOON WITH SMC
by John Macgill
he Scottish Medicines Consortium has been acting on behalf of the NHS in Scotland since 2001 to decide which new medicines should be routinely available to prescribers.
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What made it revolutionary was that it included representatives of the pharmaceutical industry from the start and, later, patient representatives. And
8 - SCOTTISH PHARMACIST
it was fast, often publishing advice months and years before other health technology appraisal bodies.
For more than eleven years, the SMC met in private. Then, following the recommendations of a review published by the Scottish Government in late 2013, the meetings were opened to the public.
‘The main benefit,’ according to an
SMC spokesman, ‘is that patient groups and members of the public are now able to observe the SMC Committee meetings to get a better idea of the work we do, and hear at first hand the range of complex issues that members discuss when arriving at these difficult decisions on new medicines.
‘SMC is now recognised as one of the most transparent health technology assessment agencies in the world as almost all of our committee’s discussions are held with the public present. Feedback from those observing our meetings between May 2014 and February 2016 showed 82 per cent of people felt they had a better understanding of how SMC works.’
The reality is that you may be able to attend, but you will not get the full picture when you go to watch SMC in action.
On being handed a sheaf of documents for medicines under discussion – which you must sign for and then give back at the end of the meeting – you quickly discover that large sections of each have been redacted. Indeed, the paperwork is
only a draft advice document for each medicine submitted by the SMC’s New Drugs Committee, which has already scrutinised the medicine and made a recommendation (that you cannot see) to the full committee.
In many ways, observers should be pleased that they, unlike the 30 SMC members, do not get the full submissions from the companies. These can run to over 100 pages each – a lot of reading when you also have a day job.
Medicines are considered one at a time following a strict sequence.
After any member of the SMC who declares a conflict of interest for the medicine has left the room, and up to two representatives of the submitting company have come to the table, the scrutiny begins.
First a member of the New Drugs Committee reads a short summary. Then a report from any PACE meeting that has been held is read out.
The review that led to meetings being public also saw the introduction of an additional step for some high cost medicines for end of life and very rare conditions: Patient and Clinician
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