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

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

Initiatives Highlight Potential of Community Pharmacy

Pharmacy First in Forth Valley One Year On

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

Wednesday, April 20, 2016: SNP promises single formulary and a review of Scotland’s NHS

She claimed it was the biggest manifesto launch ever seen in Scotland and, with some 1400 people queuing to get in to this morning’s event in Edinburgh, Nicola Sturgeon’s assessment was no doubt correct.

What the SNP manifesto signals, above all, is that the decision has been made to undertake the sort of review of Scotland’s NHS that so many of their ministers have been wanting to do since first coming to power.

The manifesto document[i] is actually two publications folded into one. The outer full colour summary magazine is awash with top-line statements and pictures of SNP people and Scottish landmarks.

The SNP’s big promises include that the NHS revenue budget will increase by £500 million more than inflation by the end of the coming parliament, which it says will mean funding increases by almost £2 billion in total.

Another big-ticket promise is to: ‘…reform the NHS to meet the challenge of an ageing population by investing an additional £1.3 billion in our health and social care partnerships, reforming primary care and increasing the numbers of GPs and nurses working in our communities.

It is the 44-page inner ‘Next Steps to a Better Scotland’ booklet that gives the meat of the party’s policies which, given the likelihood of the SNP being the next Scottish Government, gives the detail of where Scotland’s NHS is going to be going in the coming years.

As signalled by Health Secretary Shona Robison at the ALLIANCE hustings [my commentary on 6 April[ii]], there is to be a review of the structure of the Scottish NHS. The manifesto states:

‘Thirty-one new local integration bodies have been created to deliver adult health and social care. Scotland also has 22 health boards – 14 territorial and 8 special boards. In implementing the National Clinical Strategy, we will make sure the existing boundaries between health and integration bodies do not act as barriers to planning local services effectively.

‘The number, structure and regulation of health boards – and their relationships with local councils – will be reviewed, with a view to reducing unnecessary backroom duplication and removing structural impediments to better care.

‘We will develop how budgets are allocated, focussing on areas of clinical activity as well as geography and we will continue to shift the balance of care by increasing, in every year of the next parliament, the share of the NHS budget dedicated to mental health and to primary, community, and social care.’

The manifesto signals the creation of a Scottish major trauma network based on the four cities of Aberdeen, Dundee Edinburgh and Glasgow; the promise of new elective and diagnostic centres in Edinburgh, Livingston, Dundee, Aberdeen and Inverness; and a commitment to work more closely with the Royal College of Emergency Medicine on managing unscheduled and emergency care.

In Primary Care, the SNP is committing itself to shifting the balance of care (and its funding) to community settings, and increasing the number of GP surgeries offering a broad Community Health Service:

‘Our reforms will bring together a range of professionals in GP surgeries, including practice nurses, district nurses, mental health professionals, pharmacists, and allied health professionals. All GP practices will have access to an enhanced pharmacist, allowing GPs to focus more on the patients who require their assessment.’

Therapy area-specific promises include to implement the new Cancer Strategy and the Sexual Health and Blood Borne Virus Framework; to increase provision of insulin pumps to over 6,000, more than one in five of people with Type 1 diabetes in Scotland; and the SNP, in common with other parties, is putting added emphasis on improving services to people who are mentally unwell.

On medicines policy there is a nod to the current review of the work of the Scottish Medicines Consortium (SMC), and the announcement of a move to a single formulary for Scotland to replace the 14 local sets of guidance:

‘New medicines are now more readily available and we will continue to review the appraisal system, to ensure quick, safe and effective access to drugs. We will introduce the option of a pause in the medicines appraisal process to allow for negotiation and potentially avoid the need for reapplication.

‘A new single national formulary – guidance on drug prescribing – will also be introduced to ensure quick and equitable access to new medicines.’

One detail that is not addressed is who will be responsible for managing such a national formulary and what might be the balance of ownership, for instance, between SMC and NHS National Services Scotland’s National Procurement division.


[i] SNP Manifesto 2016

[ii] Commentary Bonfire of the Boards?