A single national formulary for Scotland and prescribing restrictions have been mooted as ways to reduce medicines waste in an enquiry by the Health & Sport committee into the supply and demand for medicines.
Opening the debate about a single national formulary for Scotland, Dr Ewan Bell of Healthcare Improvement Scotland described a single formulary as “a good idea in principle, but there has been a challenge in delivering on it”. Challenges include the risk of a loss of ownership of local formulary decision-making. He said “[This] might clinically disengage… healthcare professionals… who develop the formularies locally.”
Adding to the concerns, Dr Scott Jamieson, from the Royal College of General Practitioners, noted that Scottish primary care services, including in rural areas such as Shetland or Benbecula, have evolved to offer different services depending on the local need. He said: “Every level has different services to support that formulary, and it is all intertwined—it is not a distinct thing. The issue is not that an SNF is not a positive thing. As a GP, I would find it quite restrictive to have lists of things that we could and could not prescribe. There would also be unintended consequences with regard to how the patient feels about that.”
Turning the conversation to prescribing restrictions Dr Jamieson told the committee that prescription volumes for medicines also available over the counter was “radically” declining: as an example, he cited a 20-25 per cent reduction in prescriptions for paracetamol use Explaining, he said: “I suspect that patients are having more realistic value conversations about why they are on particular medicines. [The] reduction in paracetamol use is absolutely not through GPs proactively telling patients that they cannot have paracetamol on prescription.”
Matt Barclay of Community Pharmacy Scotland added: “Giving the clinician the freedom to make the clinical decision that is in the best interests of the patient in front of them is always the right thing.”