This report details the compliance of NHS boards in Scotland with the SGHD/CMO(2012)1. Twelve* NHS boards in Scotland responded, within tight timescales, to the request for data and subsequent requests to validate the data. This is to be commended.
All respondents had made a decision on all of the 23 medicines reviewed and the average percentage uptake of SMC accepted medicines on to the 12 boards' formularies was 74%. Of those not included, the most common reason given by the Area Drug and Therapeutic Committees (ADTCs) is that clinicians did not support formulary inclusion. Ten NHS boards used the CMO framework to categorise their decisions. In addition, 87% of all the decisions made by all NHS boards on all medicines were made within the required 90 days, with four boards making 100% of its decisions in 90 days.
In investigating the subsequent reporting of these local decisions, we identified that 70% of the NHS boards published their decisions within the required 14 days. Given the timing of the data collection exercise immediately after the introduction of the CMO, this suggests a relatively rapid adoption of the requirement to publish, with most NHS boards choosing to present their information as defined.
Using a series of search terms, we independently sought to determine how accessible the local ADTC decisions are. We identified that, although there appears to be an acceptance of the requirement to publish the decisions, the relevant websites or web pages are not as well signposted as they could be. This may reflect a need for wider tagging and better insight into how members of the public might choose to search.
This is the first time that it has been possible to report on the uptake of SMC medicines across NHS boards, the timeframe or these decisions and their publication. The principles of the CMO guidance have largely been accepted across NHSScotland; local decision making on new medicines is overall both timeous and publicised. Due to their specialist nature, the differences in local service provision for specialist conditions and the fact that an "equivalent"2 was already available on the formulary, justifiable variation in decisions made between NHS boards for the 23 medicines reviewed was demonstrated. Scope for improvement includes the consistent application of categories, improved accessibility of the information on the websites where decisions are posted, and a faster response rate for some ADTCs to make and publish the decisions.
A series of recommendations have been given to the Scottish Government and individual feedback has been provided to each NHS board.
* 12 boards responded, however two NHS boards follow the advice of mainland boards and therefore did not participate in the data collection exercise.
Email: VERONICA MOFFAT