What is your background?
I graduated in pharmacy from Heriot-Watt University. My pre-registration training was a joint post between industry and hospital. Following that, I did a PhD in medicinal chemistry at the University of Strathclyde. I then decided that I didn’t want to stay in academia; I wanted to go back to hospital practice, so I took a post that allowed me to do a part-time masters in clinical pharmacy.
After that, I worked in hospital practice in aseptic dispensing/surgery before progressing to become clinical pharmacy manager and providing a clinical service for ICU. Through these roles I developed my interest in antimicrobials and, some years later, I became one of the first antimicrobial pharmacists in Scotland.
I worked in that role for a few years, and then had a brief spell as a clinical effectiveness pharmacist before coming into my current role as project lead for the Scottish Antimicrobial Prescribing Group (SAPG).
I have also been chair of the UK Clinical Pharmacy Association (UKCPA) Pharmacy Infection Network for the last three years, and I’m standing down from that at the end of this month. One of the reasons I decided to apply for the Royal Pharmaceutical Society (RPS) role as chair of the Antimicrobial Expert Advisory Group (AEAG) was that it seemed a natural progression from working primarily with hospital pharmacists in UKCPA to the RPS group, which includes pharmacists from all sectors.
What has the AEAG achieved to date, and where do you hope to take the group next?
The previous chair, Harpal Dhillon, was from an industry background and he developed important links to the work that’s going on in developing new antimicrobials. With me taking over, we may look at a slight change in direction — my main focus will be around education. All of us in the group are keen to see pharmacists from all sectors becoming involved in antimicrobial stewardship (AMS). It is essential that all pharmacists have an awareness of AMS and can take action when required to promote the rational use of antibiotics.
I have already had a discussion with Christine Bond, who is chair of the new Science and Research board, and she’s very keen for us to work with them on progressing the AMS recommendations of
New Medicines, Better Medicines, Better Use of Medicines.
Has recent campaigning been effective in raising awareness of pharmacists’ role in AMS?
I think it has. The difficulty is that it’s reached the people who are keen to know, but it’s probably not reached everyone: there’s still a lot more to do. We’ve got the tools to support pharmacy teams, but embedding them in practice is challenging.
We have community pharmacists in the expert group, and that will be helpful in informing how we reach community pharmacists — I think that’s the key. Community pharmacies are a good way to reach the public, as they have a very high footfall and provide easy access to professional advice.
In Scotland we have had two public health campaigns in all community pharmacies focused on raising awareness about prudent use of antibiotics, and we plan to continue with those. The infrastructure in England, particularly, is more difficult in terms of doing something like that.
The RPS and the UKCPA have an ongoing collaboration to provide educational opportunities and together we will be delivering a study day for pharmacists and pharmacy technicians from all sectors to help build their confidence around antimicrobial stewardship. We hope to replicate the study day in the other UK nations, and could potentially offer it at a regional level too.
How does Scotland compare with the rest of the UK in managing AMR?
In Scotland we’re fortunate in that we are a small country: we have fourteen regional health boards who work effectively together. In terms of stewardship, we’re also fortunate in that the SAPG was established in response to a policy document, and alongside that was the formation of regional antimicrobial management teams. We have these teams in all our health boards, and that provides a very good network.
In terms of pharmacists, we also have two very good networks: The Association of Scottish Antimicrobial Pharmacists (ASAP), who are primarily hospital-based pharmacists, and The Scottish Prescribing Advisors Association (SPAA) who are primary care pharmacists and have a remit for all areas of prescribing. We have some of their members on SAPG, so we have been able to use these networks to take forward our workplan. The RPS in Scotland also has close links with these associations and with SAPG. I think that’s probably been the envy of some other UK nations who haven’t had these structures to date. But things are moving in the other nations, too.
Is enough happening globally to address antimicrobial resistance?
There is a lot of effort around the world, through various avenues, on antimicrobial stewardship. There has been a lot of action around AMR as a result of work by Dame Sally Davies, the English Chief Medical Officer. She has championed this area, and travels the world to share her vision working with the United Nations and the World Health Organization.
In some of the developing nations, there are no resources to tackle AMR, and even basic infrastructure is poor — things like poor sanitation are not helping the issue of resistance, and so we need to support the various global efforts.
What advice would you give pharmacists who want to support antimicrobial stewardship?
One of the key things that you can do is become familiar with your local guidelines for antibiotic treatment. No matter where you are in the country, there will be a local guideline and, I think, pharmacists in some sectors may not be aware of it. These guidelines can help pharmacists when they are reviewing prescriptions to check that patients are receiving the correct treatment. Pharmacists are also ideally placed to provide advice to patients presenting with symptoms of common infections, the majority of which do not require antibiotics, to support self-care.
I would also encourage pharmacists to visit the RPS’ online stewardship resources — there is lots of information there to support and develop their practice.