Audit Committee, 27 Apr 2004

Meeting date: Tuesday, April 27, 2004

Official Report 300KB pdf

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“Supporting prescribing in general practice”

The next item is on the response to our report on the Audit Scotland report "Supporting prescribing in general practice—a progress report". I invite members' comments.

I read several times with interest the Health Department's response to our report on the Auditor General's report. The response contains much interesting information, but I have two primary concerns about it. First, I find it somewhat impenetrable, despite being familiar with much of the jargon and with the acronyms. I cannot work out whether it was by accident or by design that the response was blinding us with the science of the various activities, strategies, steering groups and the like that are in place. I do not believe that any of us question that an awful lot of activity and processes are going on around prescribing practice. Such work might well be bearing fruit, but I find it impossible to establish from the response whether that is the case. That remains the committee's key question on the issue.

I also cannot work out from the Executive's response how many patients in Scotland—the response uses the word patient sparingly—get access to repeat prescriptions through means other than the traditional visit to a general practitioner, and how many patients have systematic medicine reviews; nor can I work out what proportion of hospitals now have good linkages with primary care in terms of admission, discharge and exchange of information about medicines and so on. I cannot find such information in the response. I want to know much more about the impact that all the current activity—laudable though it may be—and planned activity is having and will have on the five million Scots who use the health service.

Secondly, I found it difficult to find anywhere in the response what the Executive's investment strategy is to ensure that its pilot initiatives will be rolled out. Paragraph 24 of the response states that systems would be developed nationally,

"taking account of affordability and relative priority for the use of resources."

That is not an unreasonable statement, but it is a pretty big one to make.

I could say more, because my highlighter pen went through much of the response. However, my two essential questions are: what impact is all the pilot activity having on patients and what is the investment strategy to support national implementation?

Annex A to the Health Department's e-pharmacy update letter gives the impression that the electronic transmission of prescriptions is being rolled out across Ayrshire and Arran, but that is certainly not the case. I was in a pharmacy yesterday that was using the original script. The ETP initiative has not been rolled out across the Ayrshire and Arran NHS Board area; if it is anywhere, it is still only in the pilot sites. I get the feeling that the Executive's response is just a lot of words without substance and I am unhappy about that. Susan Deacon is right to say that the response uses acronyms and all the rest of it but does not tell us what the patient gain is.

I looked in particular at complementary therapies and alternative approaches and their effectiveness and value for money. However, I am extremely disappointed by the Executive's response to those areas. There seems to be no thinking around comparing the different approaches.

I echo Rhona Brankin's concern about that. Much work has been done in complementary therapies and we should be pursuing that. It is clear from the experience of parts of the health service that such therapies have much to offer.

Does the Auditor General have any comments?

We do not have much to say at this point. Perhaps Barbara Hurst can offer a thought or two about what the Executive's response says about the significant issue of risk strategy.

In the detailed Health Department response—which contains, as Susan Deacon said, much information—the key issue for us was the risk assessment for the general medical services contract in the quality framework. We assure the committee that we regard the GMS contract as a risk and that we will deal with it as such in our audit process. We will bring back information on that. We want to ensure that the committee feels that we are addressing that key concern.

I presume that we should seek clarification from the Executive. There are four points. The first two, on input into practice and the investment strategy to support that, were made by Susan Deacon. The third point is where the roll-out has reached and what the time scales are. The fourth point, which was raised by Rhona Brankin and Robin Harper, was where we stand with complementary medicines and how they are factored in.

It would be useful to get specific information. The Executive's response states that

"Homeopathy is available on the NHS",

but I am not aware of it being available on the NHS throughout Scotland. It would be useful to get clarification on that point.

That is a valid suggestion. The clerks are fine with those actions.

I have a similar footnote. Can we ask the Executive to double check some of the statements that it has made and the assurances that it has given in the response? I know that this is not about prescribing per se—I have just spotted the caveat—but page 1 of the response states:

"All computerised GP practices have … access to laboratory results electronically."

The e-health strategy that has just been published states specifically that computerisation coverage currently is only 50 per cent. I am not saying that that statement is designed to mislead, but I found it slightly misleading and contradictory. It goes back to the question, "Can you just tell us in simple terms what the degree of coverage is now, and what you expect it to be next year and five years from now?" It would be useful to get clarification on that statement.

Similarly, statements have been made south of the border about specific targets and the progress that has been made on, for example, repeat dispensing schemes—which it is said will be nationwide by the end of this year—the coverage of medicines management schemes and pharmacist prescribing. I would be interested to know in simple terms what progress has been made on those tangible and important areas.

We will write to the Executive, thanking it for its response and asking it in a short but pointed letter to address the points that have been made, including the final matter raised by Susan Deacon about greater clarification.