The SMC is an independent organisation that advises the NHS Health Boards about medicines in Scotland.
What the SMC does
The SMC aims to make sure that people have the same access to treatment wherever they live in Scotland. It assesses how well each new medicine works and how cost effective it is. It looks at new medicines as they are licensed and decides:
- which patients would benefit from them
- whether they should be available on the NHS in Scotland
The SMC is part of Healthcare Improvement Scotland (HIS), which was set up in 2010. HIS supports the Scottish Government's healthcare strategy by developing guidance for clinical practice and supports the improvement of healthcare.
The Scottish Intercollegiate Guidelines Network is also part of HIS. It develops evidence based guidelines on how particular conditions, including cancer, should be treated.
How the SMC works
When a new drug is licensed, the SMC asks the manufacturer for details about it. A licence means that the medicine works and is safe for a particular illness. But it does not necessarily mean that it is good value or works better than current treatments
Where the SMC gets advice from
When making decisions, the SMC asks for advice from:
- health professionals from the NHS Boards in Scotland
- patient representatives
- health service managers
- pharmacists and members of the Association of the British Pharmaceutical Industry (ABPI)
How the SMC makes decisions
The SMC makes its decisions based on:
- evidence about how well the drug works
- cost effectiveness, including the quality-of-life-adjusted-year (QALY)
- contributions from patient organisations, health professionals, experts and other interested parties
A QALY is a tool that takes into account how a treatment affects the quantity and quality of life. Quantity of life means how long someone lives for. And quality of life is more about how the treatment affects you. Quality of life includes:
- how well you are
- whether you can work
- whether you can care for yourself
Reviewing cancer treatments
The SMC aims to review new medicines as soon as possible. It might start the process even before the medicine has been marketed. It actively checks which drugs are likely to be licensed and contacts the drug companies at an early stage. It aims to assess each new medicine before it becomes available or at least within 3 months of licensing.
The whole process usually takes about 18 weeks.
New Drugs Committee (NDC)
First, the SMC makes a draft assessment. Then it passes the assessment on to the New Drugs Committee (NDC) which looks at all the scientific evidence. The NDC is made up of health professionals.
The assessment is taken to the monthly SMC meeting. At this meeting, the whole committee considers all the issues. It hears from patient organisations and looks at the cost effectiveness of the new medicine.
Within 4 weeks of making a decision, the SMC publishes it in a Detailed Advice Document (DAD). This is available on their website.
Using the SMC’s advice
Once the SMC makes a decision, the NHS boards in Scotland take this into account when they decide which medicines are available in their area. But they don’t have to follow the SMC decision.
Doctors can use their clinical judgement to make a decision based on an individual patient’s situation. In reality, doctors usually follow the SMC's advice.
Talk to your doctor if you haven’t been offered a particular treatment that the SMC recommended. You can ask why they have not offered it to you. If you aren’t happy with their explanation you can contact your local NHS board.
An independent review panel can look at the data again if the SMC decides not to recommend a medicine for use in Scotland. The panel might come to a different decision. The manufacturer can also send in new data and the SMC will consider the medicine again.
Getting drugs before an SMC decision
Once a drug is licensed, doctors can legally prescribe it. But NHS Scotland expects doctors to wait for the SMC to assess a new medicine before they prescribe it. Because the SMC tries to assess all new medicines before they are available, this is rarely a problem.
How the SMC works with NICE
The National Institute for Health and Care Excellence (NICE) decides which drugs and treatments should be available on the NHS in England. NICE also publishes guidelines on the treatment of conditions including cancer.
NICE and the SMC are separate. But the multiple technology appraisals (MTAs) that NICE produce may apply in both areas. HIS reviews the MTAs and decides if they should apply in Scotland.