Equitable adoption of medicines in Scotland matters more than ever – let’s do more to achieve it

By Margaret Clark, Head of Access and Adoption Policy, Devolved Nations

The NHS and industry have always had shared a goal: to ensure patients can benefit from new treatments while helping ensure NHS resources are used effectively.

In Scotland, the Scottish Medicines Consortium (SMC) plays a vital role in this, providing robust, evidence-based assessments of innovative treatments to determine whether a new medicine is clinically and cost-effective. But the evidence increasingly shows that SMC approval is only part of the story.

Our latest report, Analysing the adoption of SMC-accepted medicines, highlights an ever more important challenge as healthcare delivery and innovation evolve.

The report found variation in how quickly and consistently SMC-accepted medicines are adopted across Scotland. Where this variation reflects avoidable barriers rather than clinical need, some patients may wait longer to benefit from medicines already assessed as effective and good value for money.

The report findings should be viewed in the context of the significant pressures facing NHS Scotland. While the report identifies variation in adoption, it does not explore the wider local factors that may contribute to these patterns. Instead, it highlights the growing complexity of introducing modern medicines into healthcare systems and the opportunity to better support implementation of SMC recommendations so patients can benefit more consistently.

Today's medicines are increasingly different from those that entered the NHS when I began my career. We are entering an era of genomically enabled medicines, advanced therapies, radioligand therapies (precision cancer treatments that combine a tumour-specific molecule (a ligand) with a radioactive particle (a radioisotope) to destroy cancer cells from the inside out) and potentially transformational treatments for conditions affecting large populations, including obesity, type 2 diabetes and Alzheimer's disease.

These innovations offer enormous promise, but they also need more than a positive SMC decision to reach patients. Adoption often depends on diagnostic testing, specialist workforce capacity, the right facilities and equipment, healthcare services being organised in new ways, and sustainable funding arrangements being established before patients can benefit and the value of medicines, which extends beyond the direct patient benefits to their families and carers, the healthcare system and the broader economy, can be realised.

This broader value is highlighted in the ABPI's Transforming Lives, Raising Productivity analysis, which estimates that increasing uptake of just four innovative medicine classes could enable 1.2 million more patients to receive treatment, deliver 429,000 additional years of life in good health and generate £17.9 billion in productivity gains for the UK economy. That is the virtuous cycle in action: improved patient outcomes, a more sustainable health service, and a stronger economy.

The relationship works in reverse as well.

Variation in implementation can lead to differences in the standard of care available across different parts of the country. The ABPI manifesto for investment, health and growth in Scotland highlights the importance of strengthening the journey from development and approval through to adoption, describing this as a key component of attracting future research investment and creating a virtuous cycle of innovation, improved health and economic growth.

Our latest report tries to move the conversation forward. Rather than simply identifying variation, it seeks to explore where variation is warranted or unwarranted and consider the underlying causes of unwarranted variation. The report suggests lessons we might learn from where adoption appears to be working well and provides recommendations for improvements.

As Scotland embarks on significant NHS reform, there is an opportunity to embed adoption and service readiness into the design of future healthcare structures. If we can strengthen the connection between horizon scanning, service planning, reimbursement and implementation, we can reduce avoidable delays and improve equitable access for patients across Scotland.

The science has never been more exciting. The opportunities to improve outcomes have never been greater. But innovation only delivers value when it reaches patients.

The next chapter in Scotland's medicines journey is not simply about assessing innovation - it is about adopting it.

By working together, we can ensure patients in Scotland benefit from the full value of medical innovation, wherever they live.