The Scottish Government

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5. Action Plan: Scottish Medicines Consortium ( SMC)

The proposed primary role for SMC is to convene and service a group to fulfil the aspirations for a 'national clinical forum' as expressed in APP&P recommendations ¹². This group would include national stakeholder organisations and would collate and disseminate scientifically rigorous information on antimicrobial resistance trends and antimicrobial use on an ongoing regular basis to NHS.

This body, formed as a Consortium of NHS Boards, has an established record of providing regular monthly advice on all newly licensed medicines to NHS Boards on a clearly defined cycle and has participation from all relevant prescriber groups (currently with the sole exception of dentists). To achieve the additional task of convening a 'national clinical forum' will require the Scottish Medicines Consortium to set up a new subgroup, (the Antimicrobial Prescribing Group) within its existing structure. The subgroup will include input from clinicians, dentists, microbiologists and pharmacists in addition to the major stakeholder organisations. It would be appropriate for the Chairperson and deputy to be represented on the Scottish Medicines Consortium itself. As all NHS Boards currently have structures to deal with Scottish Medicines Consortium monthly advice, it seems appropriate for them to deal with additional material regarding antimicrobial prescribing information and antimicrobial resistance patterns, aligned with information on infection surveillance as required. The high standing of the Scottish Medicines Consortium amongst prescribers, NHS Boards and the general public, together with its previous interest in this area in producing APP&P identifies it as the ideal body to fulfil this crucial new function with maximal use of, and minimal disruption to, existing structures.

The Scottish Medicines Consortium, recognising the extensive work already done by Health Protection Scotland and the National Medicines Utilisation Unit in the area of antimicrobial resistance and antimicrobial usage, should task its Antimicrobial Prescribing Group to:

• collate and disseminate standardised local and national surveillance data on antimicrobial resistance and antimicrobial usage provided by HPS, NMUU and other agencies, ensuring compatibility wherever possible with the rest of the UK and other European countries
• relate information on patterns of antimicrobial resistance to antimicrobial prescribing in Scotland and UK, as part of national and international efforts to improve knowledge on how use of antimicrobials may contribute to the development of, and control of, antimicrobial resistance. The Scottish Government may wish to encourage submission of the resulting information to the European Centre of Disease Prevention and Control ( ECDC) and the European Surveillance of Antimicrobial Consumption ( ESAC) programme
• produce an annual national report which systematically details:
  • analysis and interpretation of data, including long term trends in antimicrobial resistance, for clinically important organisms
  • local and national antimicrobial usage
  • variations in practice and the reasons for them
• co-ordinate work undertaken by research units, HPS, the Scottish Microbiology Forum, and Antimicrobial Management Teams to explore and determine new risk factors and drivers for resistance patterns over time
• feed back to each NHS Board Antimicrobial Management Team their use of antimicrobials and incidence of antimicrobial resistance relative to other hospitals / NHS Boards
• collate national data on performance indicators as and when defined and agreed with key stakeholders (e.g. Scottish Government Health Directorates, NHS Quality Improvement Scotland, Health Protection Scotland, Scottish Microbiology Forum) and feed back the results to NHS Boards and Antimicrobial Management Teams.
• report at appropriate intervals on the usage patterns of agreed key antimicrobials in target infection groups across NHS Boards and encourage investigation of any apparently regional significant differences. Variations in the use of key antimicrobials could be a pointer to better clinical management and containment of spread of antimicrobial resistance
• provide a forum from which antimicrobial prescribing policies across Scotland can be co-ordinated and publicised in conjunction with NHS Board Antimicrobial Management Teams.

The importance of collating and reporting Scottish antimicrobial utilisation trends across Scotland is emphasised in the recommendations to the Scottish Executive (now the Scottish Executive) within the 2005 Audit Scotland report ²⁹.

Where unusual levels of antimicrobial resistance and/or antimicrobial utilisation are identified, further follow-up may be required by the appropriate body - e.g. HPS, NMUU and NHS Board Antimicrobial Management Teams - in conjunction with the Scottish Medicines Consortium where appropriate.

The Steering Group recognises that there will be resource implications to support these recommendations. These could be met, at least in part, by re-allocation of existing resources.

The location of the Antimicrobial Prescribing Group within the existing and proposed structures is shown in Figure 1.

Figure 1: Communication Structure

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