JAN JONES Senior Pharmacist, Scottish Medicines Consortium (SMC) SMC before COVID


During the first months of 2020, SMc had just appointed a new chair - Dr Mark Macgregor - who is the Medical Director at the golden Jubilee national hospital, and had also appointed a new chair of the new Drugs committee, Dr Scott Muir, who is a consultant clinical Pharmacologist with nhS greater glasgow and clyde.


as the pandemic took a hold in Scotland, SMc was undertaking a continuing strategic review of its methodology, looking at:


• the introduction of the uK-wide VPaS scheme


• looking at the likely implications of the nIce review including the move to nIce covering all medicines


• exploring how to deal with uncertainty better


• examining how best to use broader datasets such as real- world data.


SMC during the height of the pandemic


When the nhS in Scotland was put on an emergency footing, SMc clinical staff were redeployed to frontline clinical duties, to direct response teams within health Boards and the Scottish government. Meanwhile, SMc members had to prioritise their ‘day job’ in their home boards.


SMc was closed to all new submissions from companies and all meetings were suspended. however, the european Medicines agency (eMa) continued its licensing activity throughout, and so a small team continued to work on assessment of the more than 30 existing submissions


Restarting SMC The high number of assessments


already in the system combined with a backlog of those that would have been submitted in the period from March until now, has led the SMc to temporarily change its standard processes to support effective recovery


new Drugs committee and Pace meetings resumed in June and July respectively, using an online platform and the full SMc met virtually for the first time in august.


going forward, Jan Jones said, SMc will prioritise and manage submissions for medicines where there is the greatest clinical need. at the same time, it will seek to minimise delay in access as a result of the pandemic. Of the medicines licensed during the period when SMc was suspended, priority would, she said, be given to those that, in the view of clinicians, deliver the greatest clinical benefit. It remains up to companies when they choose to submit a medicine following licensing.


SMc is aware, Jan said, that companies themselves have been disrupted by the pandemic, and so a fast track route has been introduced to give prompt advice for a small number of medicines following review by the SMc executive where there is a high level of confidence in their clinical and cost effectiveness.


Looking ahead


Jan concluded by saying that, throughout its entire history, the SMc has adapted its processes, generally in one direction: to become more complex. This has been entirely appropriate, she said, and is likely to continue. however, there is also a case for companies choosing a simpler approach for some medicines, and a shared desire from all parties to try to avoid the need for resubmissions.


‘Throughout its entire history, the SMC has adapted its processes, generally in one direction: to become more complex. This has been entirely appropriate, she said, and is likely to continue’


LINDSAY MCCLURE Associate Director, Medicines Pricing and Supply at NHS National Services Scotland


National Procurement (NP) nP is part of national Services Scotland and includes a dedicated pharmacy procurement team made up of pharmacists and procurement specialists. The team is involved in every stage of the product life cycle. It hosts the Patient access Scheme assessment group, tenders for the supply of generic and biosimilar medicines and supports their use, and runs tenders in areas of therapeutic competition. a major tender in rheumatology,


dermatology and gastroenterology biologics is planned for 2021.


The team leads the procurement of medical gas cylinders and liquid gas delivery systems which was a critical area of the cOVID-19 response, with health Boards reconfiguring theatres and wards into temporary Icus, and the need to install a system for bulk storage of liquid oxygen at the nhS Louisa Jordan hospital, with oxygen piped to every bedside. In addition, there was a surge in demand for cylinder oxygen to support transfers of very unwell people into hospitals from community assessment centres.


The impact of the pandemic as the pandemic took hold, there was an unprecedented increase in demand for intensive care unit medicines and palliative care medicines. In the case of propofol, IQVIa estimated that demand increased by almost 500 per cent in early april 2020 compared to the same time period in 2019.


There was also a surge in repeat prescription requests in primary care in March, with patients seeking to pick up their prescriptions early. There was also evidence of some prescribers issuing prescriptions for a longer period of time. naturally, all of this put a strain on supply.


In some therapy areas, there was a move to change treatment choices to reduce the need for people to go into hospital, such as a moving from intravenous medicines to those suitable for subcutaneous administration.


The demand created by trials of medicines with a potential to be useful in cOVID-19 had to be


managed in such a way that it did not affect their availability for people already prescribed them.


Supply was also affected by temporary suspensions of


manufacturing, export bans by other countries and staff absences in uK wholesalers. The response of governments, nhS, manufacturers and suppliers, Lindsay said, demonstrated ‘absolutely extraordinary teamwork’ at one of the most challenging and worrying times imaginable. as a result of the efforts of all concerned, the nhS in Scotland did not run out of stock.


Looking forward During the first wave of the pandemic, Lindsay said, monitoring arrangements were put in place at uK level to collect data from all major wholesalers, manufacturers of affected products and nhS teams to identify shortages and allocate medicines or ensure supplies of therapeutic alternatives. now, a new reporting solution is being implemented for the first time at a Scotland level to allow access to real-time information on medicines’ use and stocks, which will be a great asset in managing shortages in the future.


Work is being coordinated across the uK, Lindsay confirmed, to build a strategic stockpile of intensive care unit medicines, palliative care medicines and antibiotics and nP is looking at the feasibility of standardising the choice of critical care medicines.


Before cOVID, she said, different health boards were making different choices in terms of the formulation of medicines for use in intensive and critical care settings making it difficult to plan and procure.


Where previously consideration of supply chains in the medicines procurement process had often been limited to the number of wholesalers supplying the product, there would now be a need to consider whether there were changes that could support greater diversification of supply lines, such as the number of sources of active pharmaceutical ingredients used by a supplier.


ScOTTISh PharMacIST - 33


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