Independent Review of Medicines Homecare in Scotland: review report and recommendations

Appendix 1: NHS Medicines Homecare Review Terms of Reference

NHS Scotland Medicines Homecare Review

Terms of Reference

The Medicines Homecare Review aims to evaluate the approaches to supply of secondary care-initiated medicines and associated care to patients in the community in Scotland. The review will span six months, commencing in summer 2023 and aims to ensure timely access to critical medicines and enhance patient experience.

Terms of reference

The project aims to review approaches to supply secondary care-initiated medicines and associated care to patients in the community in Scotland and will:

• Describe the current landscape in how patients currently receive secondary care-initiated medicines and associated care in the community in Scotland. This will cover hospital pharmacy, community pharmacy, medicines homecare including manufacturer-commissioned patient support programmes (PSPs), the extent of their use and how services are designed around these models of medicines supply.
• Identify the benefits and challenges associated with each of these approaches. This will include:
  • Person centred care, and patient preference.
  • Quality of pharmaceutical care
  • Ease of patient access to medicines
  • Sustainability and value of supply routes
  • Geographical equity in service provision
  • Operational efficiency
  • Resilience and business continuity planning
  • Environmental sustainability
  • Challenges to scalability
  • The influence of pharmaceutical industry
• Undertake horizon scanning to identify trends that could impact on demand for these services in the future. This will include potential changes to the medicines pipeline, and potential changes to VAT rules.
• Consider if there are lessons that can be learnt from approaches in other countries.
• Provide recommendations for the future.

Process

In view of this the review will explore and seek evidence regarding the following:

• Challenges and prevalence of issues pertaining to homecare medicines services.
• The impact of these issues on individuals, clinicians, and the wider NHS.
• The contractual arrangements for homecare medicines services and who ensures high standards.
• The methods and effectiveness of verifying a provider’s ability to meet quality and safety standards.
• The robustness, effectiveness, and accessibility of relevant performance indicators.
• Comments on the information available to the public and relevant professionals.
• Potential barriers to new providers entering the market.
• The efficacy of enforcement mechanisms where services fail to meet required standards.
• Potential future uses for medicines homecare services.
• Factors affecting a provider’s ability to deliver effective, reliable services and potential remedies for these issues.
• Recognised or alternative medicines supply models from both within Scotland and internationally
• Feasibility and scalability of these alternative models in the Scottish healthcare context

Output

The collected evidence will be utilised to create a report, to be presented to the Chief Pharmaceutical Officer. The report will detail key findings and conclusions, as well as recommendations on the future direction of medicines homecare services in Scotland.

Timescales

The review will commence in August 2023 culminating in a final report by March 2024.