Pharmacists can count on support from the Department of Health and Social Care (DHSC) in the event of post-Brexit medicines shortages if the UK leaves the EU without a deal, Dame Sally Davies, the chief medical officer for England, has told pharmacists.
Davies’s assurance came in her keynote speech at the Royal Pharmaceutical Society (RPS’s) Science and Research Summit, which was held at County Hall, London, on 8 February 2019. Although pharmacists would be on “the front line” of a difficult and “hair-raising” scenario, Davies said the DHSC needed to support pharmacists “to make sure you are working within the bounds of your professional accountability”.
Much of Davies’s speech was devoted to outlining the UK’s antimicrobial stewardship (AMS) strategy, in light of the recent announcement of the government’s 5-year action plan and 20-year vision to combat antimicrobial resistance. Antimicrobial usage in the UK decreased by 7.3% between 2014 and 2017, she said, and the strategy aims to reduce antimicrobial usage by 15% by 2024. Pharmacists’ role in stewardship is central, Davies said, adding that her “ideal” would be that when a GP writes a prescription for antimicrobials, they ask the patient to check first with their pharmacist to see if they really need the drugs.
The AMS theme continued in later sessions, with Alison Homes, director of the Health Protection Research Unit at the National Institute for Health Research (NIHR), saying that stewardship is about optimisation, not restriction. Up to 50% of all antimicrobials prescribed in hospitals may be inappropriate, she said, and post-operative surgical site infections are, globally, a major driver of antimicrobial use.
The summit took place the day before the EU-wide implementation of the Falsified Medicines Directive (FMD), and a session on counterfeit medicines, illegal substances and FMD was well attended. Bernard Naughton of the Oxford University Hospitals NHS Foundation Trust and a post-doctoral researcher at the SaÃ¯d Business School of the University of Oxford raised the concern — familiar to many pharmacists — that a no-deal Brexit may leave UK pharmacists without access to the European Medicines Verification System, the EU database at the heart of FMD. If the UK ends up without any system of medicines verification, it could, he said, become an attractive target for drug counterfeiters.
Less than 1% of medicines in the legitimate supply chain are falsified, Naughton said. At the moment, the problem lies mainly in online sales: globally, around 50% of medicines sold online are falsified. Mike Isles, executive director of The Alliance for Safe Online Pharmacies EU, told delegates that around 18% of medicines in the EU are purchased online and yet at any one time, around 30,000 websites are illegally selling medicines.
Isles is also director of the European Alliance for Access to Safe Medicines (EAASM) and he directed delegates towards Facts About Fake Medicines: a website produced by EAASM that gives patients information on how to safely purchase medicines online.
Isles said he would like to see the risks of fake medicines covered on each EU medical and pharmacy degree within five years.
In the same session, Cheryl Way, member of the RPS Welsh Pharmacy Board and National Pharmacy and Medicines Management Lead NHS Wales Informatics Service, presenting a Welsh perspective on FMD, said that the main issue in Wales had been integration of FMD compliance into automated dispensing systems. Information from suppliers of robotic systems had been “late in coming” she said. On a positive note, Way said that the Welsh hospital sector was well prepared: as of 21 January 2019, 100% of secondary care pharmacies had submitted their registrations to the UK National Medicines Verification System, and all Welsh hospital pharmacies were ready to go live on 9 February 2019.
In a discussion on healthy ageing and management of long-term conditions, Neil Watson, clinical director of pharmacy at Newcastle and codirector of Northern Alliance Advanced Therapies Treatment Centre, spoke about the challenge of providing advanced therapies such as CAR-T cell therapy and how this had “stressed the system”. But he encouraged pharmacists to get involved. He said: “These are medicines. They need to be prescribed, prepared and administered. There is a lot of commonality with what we do normally. You may not want to get involved in cellular therapies, but believe me, you need to.”
Mahendra Patel, a member of the RPS English Pharmacy Board with a special interest in diabetes, spoke about the importance of all hospitals having a multidisciplinary team — including a pharmacist — to ensure good diabetes care in hospital. He pointed out that 58,000 patients had an episode of severe hypoglycaemia in 2017.
In a session on illicit drugs, alcohol and mental health, Amira Guirguis, senior lecturer in pharmaceutical chemistry at the University of Hertfordshire, highlighted the growing problem of novel psychoactive substances or “legal highs”. Often, she said, these are sold under the guise of “food supplements” with claims that they can boost confidence or reduce anxiety. Guirguis directed pharmacists seeking more information to the RPS guidance produced in 2018.
The final keynote speech of the day was from Molly Stevens, professor of biomedical materials and regenerative medicine at Imperial College London. Stevens gave an overview of her research in the design of materials for tissue healing and early disease detection. In the former case, Stevens was particularly interested in exosomes: vesicles that are released from cells, and that can be loaded with micro RNA or drugs to aid in tissue rebuilding. Her group is, she said, doing a lot of work in this area with support from GSK and AstraZeneca.
Among work on early disease detection, Stevens described a current project using nanoparticles for early-stage, point-of-care detection of HIV, with the results read and displayed using a mobile phone. Currently being trialled in KwaZulu Natal, South Africa, this is, she said, the most sensitive point-of-care test in the world for early-stage HIV.
After her speech, Stevens was presented with the RPS’s Harrison Medal, awarded every second year to a mid-career scientist who has made an outstanding contribution to pharmaceutical science.
The day ended with the awarding of prizes for posters and oral presentations. Fiona McMillan, lead principal pharmacist in vocational training at NHS Education for Scotland, took the award for best practice research poster. The award for best science and clinical poster was won by Matthew Dryden, consultant and honourary senior lecturer at the Department of Microbiology and Infection, Hampshire Hospitals NHS Foundation Trust; Jonathan Cooke of Manchester Pharmacy School presented the poster on Dryden’s behalf. The award for best practice research oral presentation went to Cathy Geeson, NIHR clinical doctorial research fellow. The award for best presentation in the science and clinical category was won by Ankie Hazen, education supervisor for general practice pharmacists at the Centre for Postgraduate Pharmacy Education.