These commentaries by John Macgill represent his opinions only and not those of any Ettrickburn client.

Medicines shortage – a new prescription for an old problem

Ettrickburn commentary - Labour's plans to radically shake-up the pharma industry (part 2)

Ettrickburn commentary - Labour's plans to radically shake-up the pharma industry (part 1)

Cost of medicines falling

Three Nations Three Practices

Community Pharmacy Eliminating Hepatitis C

Homeless People make Glasgow

Heart Failure – we can get treatment right for everyone

Bundles of Safety

Community Pharmacy’s Leader in Scotland

CPO: On the Road to Achieving Excellence

Pharmacy technicians may become prescribers

Profile: Dr Norman Lannigan OBE

Profile: Jonathan Burton MBE

Profile: Clare Morrison MBE

Deep Dive Pharmacy

Mind the Gap - Diagnostic Skills for Pharamacists

Bundles of Safety

Supporting Excellence - Alison Strath Interview

2018 Pharmacy Forum Agenda Launched

Which Referendum to Choose

Three Perspectives on Pharmacy and Mental Health

Pharmacy and the New GP Contract

Bordering on Problematic

Recognised by the Queen and her community

VACANCY Reporter/Researcher: Health and Care Policy in Scotland

Prescribing in Mental Illness – A Practice Pharmacist’s Perspective

What Matters to You? Communication in Pharmacy

Prescribing in Mental Illness – A Patient’s Perspective

Focusing the Vision: Dr Rose Marie Parr on the new strategy for Scottish pharmacy

All the things that could go wrong - looking ahead to the SNP conference

Ask Once, Get Help Fast? Pharmacy and Mental Health

Automation and Delegation in Pharmacy: Understanding the Moving Parts

Pharmacy First in Forth Valley One Year On

Initiatives Highlight Potential of Community Pharmacy

Trying to concentrate on the day job

Health and the Local Elections – a strange silence

The Pharmacist Will See You Now – The Growth of GP Pharmacy

Montgomery’s Review – Dr Brian Montgomery answers questions on access to new medicines in Scotland

An afternoon with SMC

Pharmacists at SMC

SMC – are drug firms voting with their feet?

Radical Surgery on the Horizon for Scotland’s NHS

The Future’s Bright – in General Practice

Community Pharmacy in a Changing Environment

Disclosing payments to doctors – has Sir Malcolm done the pharma industry a favour?

Health and Care in the First Minister’s Programme for Government

CMO: Scotland’s pharmacists “absolutely ideally placed” to practice Realistic Medicine

Profile: Maree Todd – MSP and Pharmacist

Scottish Parliament Health Committee Work Programme

Scotland’s new NHS – a Summer of Speculation

Scotland’s New Health Committee

Two million voices in Scotland – is integration the big opportunity to listen?

Medicines – levelling the playing field

Key appointment raises the bar for health & social care partnerships

What did our new MSPs do before?

SMC says no then NICE says yes – three times

SNP promises single formulary and a review of Scotland’s NHS

More Generous than the CDF – but less transparent

Comparison of Funds: New Medicines v Cancer Drugs

Bonfire of the Boards? SNP signals NHS Review

A tribute to five retiring MSPs

New Medicines Review - Health Committee sends findings to Government

Medicines New & Old in the Scottish Cancer Strategy

Great Ambitions, Slow Progress – New Models of Care in Scotland

Scottish Minsters Demand Up-Front Medicine Price Negotiation

Opportunity and Disappointment: MSPs Investigate New Medicines Access

Scottish NHS Strategy calls for 'Realistic Medicine'

The Scottish Model of Value for Medicines: Taking Everything into Consideration

When SMC Says No: An Access to Medicines Lottery

Reviewing the Review: Access to New Medicines in Scotland

A day of psephology and kidology

Insulting the Lifesavers

Worthy of Mention – Health and Science in the Honours List

News Silence from North of the Border

A Christmas PPRS Present from Pharma

Friday, October 28, 2016: Radical Surgery on the Horizon for Scotland’s NHS

The Week in Scotland

Published on PubAffairs - See all this week’s reports at

The week had started much like any other in recent post-Brexit referendum history, with the Prime Minister and First Minister agreeing to disagree.

Nicola Sturgeon had joined her Welsh and Northern Irish counterparts in Downing Street for talks with Theresa May[i]. Mrs May cautioned her visitors against ‘undermining’ Brexit negotiations. Ms Sturgeon afterwards expressed her frustration that the trip down to London had failed to yield any greater insight into the thinking of the UK government.

“Brexit might mean Brexit,” said the First Minister, “but the Prime Minister could not tell us exactly what that platitude means in practice.”

As the week went on, the rhetoric from SNP politicians on the issue hardened from talk not of ‘hard’ or ‘soft’ Brexit, but of ‘hard right Brexiteers’ driving Scotland towards a destination that it hasn’t chosen.

And so it could have continued, had it not been for Caroline Gardner, Auditor General for Scotland. She published the findings of her much anticipated (by those of us who focus on these things) annual check-up of Scotland’s NHS[ii].

In simple terms, the NHS in Scotland is operating beyond its means. A budget of £12.2 billion, an increase of 2.7 per cent, isn’t enough to meet demands. Scotland’s NHS Boards are finding it difficult to balance the books. The workforce is ageing and recruiting new people is challenging.

All problems for the NHS are fertile ground for Scotland’s opposition parties because, for many of the nine years since the SNP came to power at Holyrood, Nicola Sturgeon was the Health Secretary. Opposition leaders duly weighed in at First Minister’s Question Time[iii]. Scottish Conservative leader Ruth Davidson accused the First Minister of adopting ‘sticking plaster solutions’. Her Labour counterpart, Kezia Dugdale, talked of a ‘grim diagnosis’.

The Auditor General, in common with all the parties at Holyrood, accepts that the big strategy to shift the balance of care from hospitals to communities is the right one for a sustainable NHS. This has seen the creation this year of 31 integrated health and social care partnerships bringing together NHS primary and community services with the social care provision of councils.

Ms Gardner’s main recommendation is that there now needs to be a clear written implementation plan for this process, with clear measures and goals.

Ms Sturgeon responded by revealing that ‘a single delivery framework’ will be published by the end of the year – fulfilling a manifesto[iv] promise to review the structure of the NHS and trigger what may be the biggest shake-up since the creation of NHS Boards in 2001.

While some NHS leaders have been predicting a gentle and unthreatening continuation of the administrative evolution brought about by the creation of the partnerships, others believe that a ‘bonfire of the boards’ is on the cards, the 14 local NHS boards being merged to create a handful of regional hospital organisations or possibly a single national body – rendering entire layers of NHS management surplus to requirements.

Which is, of course, quite a risky strategy for a government with its eye on its longed-for prize of Scottish independence. If you are intending to seek their backing in a new referendum, is it wise to upset 165,000 employees, countless patients and the wider Scottish public, by messing too much with the NHS?

Talks with Theresa May

annual check-up of Scotland’s NHS 

First Minister’s Questions