Janine Barnes: ‘Pharmacists don’t need to be frightened of Parkinson’s disease’

Janine Barnes, a Fellow of the Royal Pharmaceutical Society, has devoted her career to improving the care of patients with Parkinson’s disease. She was recognised in the 2019 New Year’s Honours List with an MBE for her services to pharmacy. She spoke to The Pharmaceutical Journal about her work and what pharmacists can do, within multidisciplinary teams, to support people with Parkinson’s disease.

Can you tell us a bit about yourself? 

I work as a neurology specialist pharmacist for the Dudley Group NHS Foundation Trust. I specialise in Parkinson’s disease, including its clinical, educational and management aspects. I have a PhD in neuropharmacology and I looked at this disease as part of that.  

My neurology specialist pharmacist role was introduced in 2009 because we needed to increase the specialist Parkinson’s workforce on a local level. We found that people with Parkinson’s disease and multiple comorbidities, with complex medication regimes, were being overlooked and required pharmacy input. There were long waiting lists at that time for people with Parkinson’s to be reviewed by their consultant and more support was needed between their consultant appointments.  

What does your role involve? 

The neurology specialist pharmacist role is split into clinical, educational and medicines management aspects. I do weekly independent prescribing clinics in community locations and GP practices. I hold monthly secondary care clinics, looking at patients with comorbidities and complex medication regimes.  

I take the lead for the Parkinson’s disease education sessions for patients and carers, as well as education sessions for GPs and our specialist doctors within the Dudley Group NHS Foundation Trust. I also lecture and mentor undergraduates in pharmacy and medicine at the local universities, as well as having undergraduates shadow the Parkinson’s disease clinic.  

I am a member of the Midlands Therapeutics Review and Advisory Committee, a regional medicines management committee, and I’m also responsible for submitting medicines to the local formulary. I lead on medicines management for the community neurology team, which is part of Dudley Rehabilitation Service. This is a multidisciplinary team that consists of me, physiotherapists, specialist nurses, occupational therapists, speech and language therapists — lots of disciplines.  

That’s a broad team!  

It is! Lately we’ve started doing combined pharmacy and physiotherapy clinics. They seem to be going really well. There’s a lot of evidence from the National Institute for Health and Care Excellence (NICE) about the benefits of physiotherapy in Parkinson’s disease. It makes you think: maybe using physiotherapy we can keep the number of required medicines as low as possible. 

It’s great to promote pharmacy and to promote Parkinson’s disease treatment

We use the FRAX [Fracture Risk Assessment Tool] score, which looks at bone density — it’s a fracture risk assessment — and make recommendations or prescribe. If patients are found to be low in bone density, we can start looking at bisphosphonates, calcium and vitamin D. 

You were awarded an MBE in December 2018: how did that make you feel?  

It was a total surprise! It was for services to pharmacy and to Parkinson’s disease. I was absolutely delighted, really pleased, because it’s great to promote pharmacy and to promote Parkinson’s disease treatment. It’s nice to be able to explain to patients I see just what a pharmacist can do for them. I try to promote the role that we can provide as pharmacists. 

You’re the founder and chair of the Parkinson’s Disease Specialist Pharmacy Network. What’s your objective with this network and what have you done so far?  

The Parkinson’s Disease Specialist Pharmacy Network (PDSPN) launched the network in October 2018.  I do a lot of training sessions for local pharmacists from various clinical settings: community; hospital and GP surgeries. It had became apparent that there was a lot of interest in Parkinson’s disease: pharmacists wanted to know more, but there was a shortfall in knowledge.  

I presented at the Clinical Pharmacy Congress in 2018 and asked if anyone had any interest in joining a national network. About 350 people expressed interest straight away. 

The PDSPN has a written constitution and mission statement, and has had three steering committee meetings. It also includes technicians — we’ve got a technician on the steering committee. We’re planning a national conference in Birmingham on 10 October 2019, and we’d like to have the conference annually. 

I do a lot of presentations where I’m advocating pharmacists within the multidisciplinary team, but it’s staggering how few there are

We use the website of Parkinson’s UK, the research and support charity, as a web platform: we’re really lucky to have Parkinson’s UK supporting us. We hope to use this platform to tell people about drug shortages and anything new that comes out in the area.  

Our mission statement is to improve the lives of people affected by Parkinson’s disease, and to enable and inspire pharmacy teams — including technicians — to play an active role in Parkinson’s disease management across all clinical settings. 

I do a lot of presentations where I’m advocating pharmacists within the multidisciplinary team, but it’s staggering how few there are. When you go to these national conferences and ask delegates, “do you have a pharmacist in your team?”, they rarely do. 

You were the first pharmacist to be included in the National Institute for Health and Care Excellence guideline committee reviewing the management of Parkinson’s disease: how was your experience there?  

NICE’s Parkinson’s guidelines were published in 2006. Although there had been a few updates since then, there had never been a pharmacist on the committee, so it was nice to be on the 2017 review committee, to try to promote what we pharmacists can do. 

The main change in 2017 was using levodopa as first-line treatment for anyone with mobility problems; that was quite a dramatic change from the past.  

Then, when NICE interviewed potential committee members to review the cannabis guidelines, I thought, “that’s really topical and it would be good to have pharmacy input”. I was hoping they’d be looking at Parkinson’s disease as part of the review but it doesn’t look like they will, from the scoping exercise. But I’d hope, at least, that we can extrapolate what we find and use it in that population as well.  

What are your hopes for the next year?  

It would be nice to expand the PDSPN — to get people on board and get the membership up. The network’s biggest aim is to highlight Parkinson’s disease and show that pharmacists don’t need to be frightened of it. There is a bit of a myth with neurology that it’s difficult, but it isn’t. It’s just a case of getting pharmacists more au fait with it, and happy to be the first port of call for people with Parkinson’s.