Infographic: 2022 unwrapped

January: Antivirals

2022 kicked off on a positive note as new antiviral Paxlovid (nirmatrelvir and ritonavir; Pfizer) was recommended for patients with COVID-19.

Paxlovid became the first-line treatment choice, followed by remdesivir, with molnupiravir pushed down to a third-line option. But the limited supply, short treatment window and small number of patient groups eligible to receive antivirals gave rise to concerns about whether they could really turn the tide on the pandemic.

By the end of the year, draft guidance from the National Institute for Health and Care Excellence recommended Paxlovid but not molnupiravir or remdesivir as options for treating COVID-19 in adults on the grounds that they were not cost-effective.

February: Diabetes guidance

Guidance that would impact one of the largest patient groups in the UK was published.

The National Institute for Health and Care Excellence recommended a change in treatment for patients with type 2 diabetes mellitus.

The new guidance came on the back of a plethora of cardiovascular outcome trial data in recent years and meant that people with type 2 diabetes mellitus, who also have cardiovascular disease or are at high risk of developing it, were offered a SGLT2 inhibitor in addition to metformin earlier in their treatment.

In February, the Pharmaceutical Services Negotiating Committee appointed Janet Morrison as its new chief executive, who went on to negotiate the final two years of the community pharmacy contract in England. These negotiations led to the introduction of a national contraception management service and the expansion of the NHS Community Pharmacist Consultation Service to include referrals from emergency care, but the shelving of plans for an English version of ‘Pharmacy First’.

March: Pharmacy closures

An analysis by The Pharmaceutical Journal revealed that pharmacy closures have slowed significantly, halving in 2021 compared with 2020.

However, data revealed that the number of pharmacies in England is at its lowest level since 2015/2016 because of financial pressures on the sector.

Andrew Lane, chair of the National Pharmacy Association, said that no comfort can be taken from the figures, since the trajectory is still downwards, and there will be more closures to come without a fresh injection of funds.

In March, NHS England appointed Tony Avery, a GP based in Nottingham, as its first national clinical director for prescribing. Avery’s focus is to ensure prescribing reflects the needs of the diverse population in England, improves health outcomes and protects the environment.

April: Medicines shortages

With issues having rumbled along for more than three years, HRT shortages hit the headlines.

Pharmacists were given powers to limit dispensing of some types of HRT to three months to try to improve shortages. The news came following an exclusive story in The Pharmaceutical Journal, which revealed that shortages are being “exacerbated” by some patients being given prescriptions for a 12-month supply.

As part of the government’s response to HRT shortages, the health secretary appointed Madelaine McTernan, former director general of the COVID-19 vaccine taskforce, as ‘HRT tsar’ in April, with the promise of leaving “no stone unturned in our national mission to boost supply of HRT”.

Although HRT was perhaps the most widely reported medicines shortage in 2022, it was by no means the only one. Our reporting also covered shortages of alendronic acid, thrombolytic drugs, aripiprazole, paroxetine and Gaviscon and, in the summer, we reported results from our annual salary and job satisfaction survey, which showed that 54% of UK-based pharmacists said medicines shortages had put patients at risk in the past six months.

May: Mpox

The first UK cases of a global mpox (formerly monkeypox) outbreak were identified on 6 May.

Cases peaked in mid-July and a national vaccination programme was set up for those most at risk.

Later in the year, the four UK governments published a rapid policy statement, which said that hospitalised patients with PCR-confirmed mpox are eligible for antiviral treatment with tecovirimat if they have severe or complicated disease.

Also in May, NHS England set up an independent commission to review pharmacy professional leadership “to guide, support and enable the transformational change” that is ongoing for the sector, chaired by Nigel Clarke. In October, the RPS proposed a single leadership body to credential pharmacists and pharmacy technicians. The commission promised to report its recommendations by December 2022.

June: Opioids

The Pharmaceutical Journal reported that what had been a steady rise in long-term opioid use in England over several years had accelerated rapidly during the COVID-19 pandemic.

Some experts put the rise down to fewer opportunities for face-to-face medicines reviews.

There was an accompanying increase in the number of patients taking long-term opioids admitted to hospital with respiratory depression, accidental overdose or confusion.

A deeper dive into the data revealed that, despite a slight fall in the number of opioids dispensed in the community in England overall, use of some opioids continues to increase.

July: Serotonin and depression

Findings from a review that concluded there is no consistent evidence of an association between serotonin and depression were picked up in the national media.

Headlines such as ‘Antidepressants study casts doubt on drugs taken by 8 million people’ sparked serious fears among patients that the condition has been over-medicalised for years.

The debate was reignited later in the year, when scientists claimed to have found the first direct evidence that people with depression have a reduced capacity for releasing serotonin in the brain, in a small brain imaging study.

Steve Barclay was appointed health minister in July following the resignation of Sajid Javid, only to lose the job to Therese Coffey two months later in a cabinet reshuffle, when Liz Truss took over the role of prime minister from Boris Johnson. Barclay was then reappointed as health minister when Rishi Sunak became prime minister in October. There was also no less than four pharmacy ministers in 2022.

August: Independent prescribing

There was major news on the independent prescribing front.

A Pharmaceutical Journal exclusive revealed that pathfinder sites will launch in every region of England from the beginning of 2023 — the first independent pharmacist prescribing service in community pharmacy to be fully funded by the NHS in England.

The development, described by David Webb, chief pharmaceutical officer for England, as a potentially “game-changing” expansion of the services the profession can provide on the NHS, aims to prepare for 2026, when all pharmacists will be able to independently prescribe at registration.

September: TikTok

After an investigation by The Pharmaceutical Journal, social media platform TikTok removed posts recommending prescription-only drugs to teenagers wanting to lose weight.

Our analysis of the top 100 most popular user posts under the #dietpills hashtag found that commonly prescribed drugs for epilepsy, alcohol addiction and migraine were being openly promoted.

Nearly a third (31%) of the 100 most popular posts were actively promoting the use of diet pills for weight loss and, of those, more than a quarter (26%) were promoting a specific named prescription-only medicine.

September also saw the death of Queen Elizabeth II and a period of national mourning followed. Queen Elizabeth II was patron of the Royal Pharmaceutical Society and a long-time supporter of the profession.

October: Pharmacogenomics

The Pharmaceutical Journal broke the news that the first-ever NHS pilot of routine genetic testing to guide drug choice in primary care will begin in early 2023.

If the pilots in north-west England are successful, there are plans for testing to become a national programme.

The new pilots aim to test the practicalities of how pharmacogenomic panel testing can be embedded in the NHS. Initial findings from a large international study, reported in The Pharmaceutical Journal later in the year, showed that adverse drug reactions could be reduced by nearly a third by using a pharmacogenomic panel approach.

Community pharmacy funding came to the fore once again in October, following a government report that showed community pharmacies in England have seen a real-terms funding cut over the past five years.

November: Strike action

A wave of ballots on strike action rippled through the NHS, with nurses and ambulance staff in England both voting to strike before Christmas in a dispute over pay.

Hospital pharmacists in England and Wales were balloted on industrial action in mid-November ahead of possible strike action in January 2023.

December: Strep A

Problems with access to antibiotics for children came to a head after an early start to the strep A season led to at least 16 children dying from the infection.

Following reports from pharmacists of worsening supply problems for antibiotic oral suspensions, including penicillin, amoxicillin and azithromycin, NHS guidance advised clinicians to encourage children “to swallow oral solid dose forms” of antibiotics where possible, instead of using oral suspensions.

Speaking to the BBC’s Today programme on 9 December 2022, Kamila Hawthorne, chair of the Royal College of General Practitioners, called for community pharmacists to be able to dispense alternative formulations of antibiotics, or substitute them, if the prescribed form is unavailable.

Less than a week later, pharmacists were given emergency powers to supply alternatives for eight phenoxymethylpenicillin products under serious shortage protocols issued across the UK. The government also banned export or hoarding of four different antibiotics and the Competition and Markets Authority began investigating price increases for antibiotics used to treat strep A.

We hope you enjoyed our review of 2022. If you’d like to hear our predictions for 2023, listen to this month’s episode of the PJ Pod.