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Patient Interest Seminar 21st May

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Fact or Fiction? Medicines not accepted by SMC can not be prescribed by GPs ... Fact with some fiction GPs are independent contractors and can prescribe non ... – PowerPoint PPT presentation

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Title: Patient Interest Seminar 21st May


1
Patient Interest Seminar 21st May
  • Dr. Andrew Power
  • Vice Chair
  • New Drugs Sub group

2
Objectives
  • SMC processes
  • NDC SMC
  • Health Board Formulary processes
  • QALY tables

3
Scottish Medicines Consortium
4
Composition
  • SMC multidisciplinary (30)
  • Physicians, pharmacists, health economists
  • NHS executives/finance managers
  • Pharmaceutical industry nominees (ABPI)
  • Public partners (3)
  • PR, Scottish Government representatives
  • NDC - clinical/scientific (15)
  • Physicians, pharmacists, nurse, health
    economists, academics, industry nominees
  • Including Pharmacy Assessment Team and Health
    Economics Team

5
Safety, quality and efficacy
6
SMC Remit
  • National consortium of representatives of local
    drug and therapeutic committees
  • Provide advice to NHS Boards on
  • New medicines
  • New formulations of older medicines
  • Major new indications
  • Assess the need and clinical effectiveness
    including comparative efficacy
  • Assess the comparative cost-effectiveness
  • DO NOT assess safety

7
Assessment process
8
Scottish Medicines Consortium
  • Produce a Detailed Advice Document (DAD)
  • SMC may
  • Accept medicine for use in NHS Scotland
  • Accepted for use in NHS Scotland (with
    restrictions)
  • Not recommend for use in NHS Scotland
  • All advice can be found on the SMC website
    www.scottishmedicines.org.uk

9
Count and annual share of SMC decisions,
(excluding abbreviated and non-submissions)
10
QALYs
  • They are based on the number of years of life
    that would be added by the intervention. Each
    year in perfect health is assigned the value of
    1.0 down to a value of 0 for death.
  • If the extra years would not be lived in full
    health, for example if the patient would lose a
    limb, or be blind or be confined to a wheelchair,
    then the extra life-years are given a value
    between 0 and 1 to account for this.

11
Cost-Effectiveness vs. Effectiveness
  • DRUG B
  • 96 Cure Rate
  • 10 / patient
  • DRUG A
  • 90 Cure Rate
  • 1 / patient

With thanks to Dr. Andrew Walker, University of
Glasgow
12
Cost-Effectiveness vs. Effectiveness
  • DRUG B
  • 96 Cure Rate
  • 10 / patient
  • 96 cures / 1000
  • DRUG A
  • 90 Cure Rate
  • 1 / patient
  • 900 cures / 1000

13
(No Transcript)
14

15
Post SMC local formulary process
16
What is a formulary?
  • Generally, a list of medicine which the vast
    majority of prescribing should come from
  • May be a simple list
  • May include additional information and guidance
  • Can be applicable from anything from a single
    practice, to health board to country (e.g. BNF)
  • Formulary Management is the term given all
    processes linked to the Formulary including
    production, review and measurement of adherence

17
Why produce a Formulary?
  • Promote cost-effective drug use
  • Maximise given resources
  • Limited resources
  • Increasing pressures
  • Minimise risk
  • Maximise procurement

18
Fact or Fiction?
  • Medicines not accepted by SMC can not be
    prescribed by GPs
  • Fiction GP in general should follow SMC advice,
    but in exceptional cases may prescribe non-SMC
    medicines
  • In most health boards, GPs are able to appeal to
    have a medicine reconsidered for inclusion in the
    local formulary
  • Fact most health boards have an appeal process
    that GPs can access
  • GPs are independent contractors and do not have
    to stick to any agreed local formulary
  • Fact with some fiction GPs are independent
    contractors and can prescribe non-formulary
    medicines where they see fit, though they are
    requested to follow local formularies.
  • However, it should be noted that GPs are
    contracted to an NHS health board and widespread
    prescribing of medicines not accepted by SMC or
    non-Formulary without good reason could be deemed
    as inappropriate prescribing which may be
    considered a breach of contract.

19
ADTC
  • ADTC consider SMC advice for local implementation
  • Consider local needs of the population
  • Opinions of relevant local clinicians and groups
  • Consider what is on Formulary already
  • Generally, approximately 85 of medicines
    accepted by SMC will be added to the Formulary

20
Formulary adherence (GGC)
  • The Preferred List is a subset of about 350
    medicines covering conditions managed in Primary
    Care
  • Current average adherence for the year is 74
  • Adherence to the full formulary is unknown, but
    estimated at gt90

21
Objectives
  • SMC processes
  • NDC SMC
  • Health Board Formulary processes
  • QALY tables
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