The SMC; how they work and how we work with them

Kidney Cancer Scotland Health Professional, Maureen (Mo) Johnson (below), recently attended the Scottish Medicine Consortium (SMC) Patient Group Partners Meeting in Glasgow.

Along with about 25 other patient group representatives, Mo learned all how patient groups can inform the SMC process for new medicines use in Scotland. As a group they looked at issues like reaching underrepresented groups and how to make the SMC decision documents easy to understand.
Jennifer Laskey, who is the lead pharmacist for kidney and other urological cancers at the Beatson West of Scotland Cancer Centre, spoke with her other hat on She also works on a programme gathering real world evidence on people taking cancer medicines so doctors can make better choices about those treatments.
Peter McGrath was one of three public partners who are part of the SMC’s public involvement team. He talked about his experiences as a volunteer at the SMC and what he was involved in. Public partners are full voting members of the SMC committee which means, along with the other members, they read the submissions which can be a few hundred pages long! It was good to know that people with wider experience guide the decisions, too.
Below is our guide to the SMC and how they go about the process of new medicine approval.
Who decides which medicine should be prescribed to patients in Scotland?
An independent organisation called the Scottish Medicine Consortium (SMC) which is part of Healthcare Improvement Scotland.
What is the SMC?

The SMC is a committee that looks at a broad range of evidence about new medicines before deciding whether or not they can be accepted for routine use to patients in Scotland. The committee comprise of a panel of people who work in related industries, such as pharmacists, doctor, nurses, physiotherapists and other allied health professionals, as well as representatives from the local health boards across Scotland, pharmaceutical companies and patient groups. This means there is a wide range of views and experiences taken into consideration in the decision as to whether a new medicine should be prescribed in Scotland. The committee is supported by an operational team of pharmacists, administrators, health economists and public involvement advisers.
How do the new medicines get approved?

Firstly, when a medicine is licensed by the Medicines and Healthcare products Regulatory Agency or the European Medicines Agency, the pharmaceutical company that makes the specific drug will present a submission to the SMC for use on patients in Scotland. They will submit a great deal of in depth supporting information relating to research undertaken, about how the medicine works in the condition that it’s is to be used for, its side effects, how much it costs and how much it might save the NHS in the long term if recommended.
A subcommittee of the SMC called the New Drugs Committee (NDC), which has clinicians, pharmacists and people from pharmaceutical companies, also get together once a month to look at the technical information about the medicine.  They then report back to the pharmaceutical company with positive and negative feedback about their submission and detailed advice guidance is put together for the SMC committee. The SMC committee then meet to discuss and decide whether the medicine is good value for money and if it works better than other medicines available previously approved by the SMC for the particular group of patients
How are Kidney Cancer Scotland involved in new medicine submissions?
Kidney Cancer Scotland is a patient group partner who, along with other patient and carer groups, make up the Public Involvement Network.
We are invited to three parts of the new medicine appraisal;

1. To sit in a Patient and Clinician Engagement (PACE) meeting. This is sometimes called once the SMC has received the submission for the new medicine from the pharmaceutical company (after any issues highlighted by the NDC). We would represent the views of kidney cancer patients in Scotland
2. We write a ‘patient group submission’ which reflects the views of people living with kidney cancer and their carers. The submission asks questions about how people are affected by the condition and the impact of the new medicine on patients and their carers. Kidney Cancer Scotland collect that information by talking with patients, carers and their families.
3. Our health professional represents the patient group at the SMC meeting . This involves listening to the summary of the submission and commenting on its accuracy. Mo recently represented patients at the recent meeting about the newly recommended combination therapy, nivolumab and ipilimumab.

Kidney Cancer Scotland have been asked to  take part in the process of reviewing another treatment for those with metastatic kidney cancer (cancer that has spread to other organs). The medicine is called lenvatinib, and in this case it will be used in combination with the drug everolimus.  If approved, these will be prescribed after a medication that belongs to the targeted therapies group called ‘vascular endothelial growth factor’ (VEGF) hasn’t worked for the patient.
As a patient group partner, we have been asked to highlight  the challenges faced by people affected by kidney cancer and how this new medicine might help. If you’ve had experience of levantanib in a clinical trial, we would especially love to hear about those experiences.

If you would like to contribute to the submission by talking about your experiences of kidney cancer , please get in touch with our health professional Mo on 07741 648862, by email mj@kidneycancerscot.org or you can answer some or all of the following  questions by clicking here