Hi there, RPS members' names are published in the Long service of members list when it is their anniversary year of 50, 60 or 70 years of continuous membership. Sophie Willis, Senior Subeditor
Interesting debate. There is a qualification between technician and pharmacist in Ireland, pharmaceutical assistant. Its a closed register, no more being trained but they did an apprenticeship decades ago and as a result can cover a pharmacist day off each week and up to 2 weeks annual leave. The rest of the time they work alongside a pharmacist. They can only work in community. It would be a good compromise and Ireland has benefited from these healthcare professionals for decades and continues to do so. Ultimately healthcare professionals will seek good working conditions so may not solve multiples workforce problems.
I too am pleased to note the PJ's interest in genomics but since 99% of our genome in contained in the microbiome you risk missing 99% of the science and the clinical consequences. It is true to say "our genes are not our destiny" (epi-genetics) but it is equally the case (eg from studies of identical twins) that the microbiome plays a fundamental role
It’s very well explaining the supposed shortage but in fact there is not a shortage of pharmacists in the Uk, please look at the current Gphc register. It’s actually pharmacists choosing not to work in community due to workplace conditions and pay and lack of progression. Address that first and see how you can improve working conditions as that it the root cause of the so called shortage to which you refer to when in fact there isn’t a shortage, it’s just a shortage of pharmacists willing to work in community.
How many fake drugs were detected under the previous scheme ? How many packs were scanned ? How much of our time was wasted on it ? It is tragic the new scheme will be delayed ! Hopefully I will have retired before it appears . Next time the PSNC should demand a fee per pack for scanning .
The study acknowledges the limited conclusions that can be drawn from this - likely selection bias for people with negative views, with many complaining that the device was harder to use (variable depending on biosimilar) or pain at injection site. We don't have denominator for how many people were contacted - was it a silent majority?
Much was made by originator company of their product being citrate-free and therefore less painful to inject, yet for many years it had contained citrate. That must have had an impact on patient perceptions.
The pressure to deliver the switch and the top-down decisions about what biosimilars were allocated to each area didn't make things easier either. There certainly wasn't the time to bring in every patient for face-to-face discussions (as was common pre-Covid).
The lessons we can draw are limited, except to say that people who felt they had enough information were less likely to complain.
Completely agree James. We switched all our patients in gastro to the citrate containing first line biosimilar. Currently only 10% of our patients are using a non-citrate biosimilar or originator having switch back/forward again after failing to tolerate the citrate biosimilar post switch. It's clearly a relevant factor, but the numbers are completely out of step with those of this study, suggesting there is bias at play.
Why can’t they bring ranitidine back without the cancer Causing agent.? Famotidine which took its place is no where near as effective as ranitidine. Please bring back ranitidine it’s a brilliant antacid.
This is a personal account with no study, just how I treated my early stage of Covid. My husband was diagnosed with no real serious symptoms. This is in January 2022. I began to feel increasingly not well with extreme headache and other Covid symptoms and went to go get tested. I had noticed my daughters acne medication on our window sill, Doxycycline during this time and it needed refilling. Called it in for refilling on our (myself and daughter) way to get tested, symptoms of heaviness on my chest and very labored breathing got worse. My husband got the refill, I took it at 6:07 pm and 7:52 pm, felt 100% better in terms of my breathing and no pressure on my chest. I have often wondered what could have progressed into something with no real therapeutics at my Urgent Care and the Emergency Room with over 60+ in the waiting room. I have continued to Google Doxy with aspect to Covid 19 and have been increasing my stance that it is a therapeutic that should be used. For example, with the Lancet study, etc. I am a 53 year old female that could lose weight and am glad I had that antibiotic. I also used it with Vitamin C and Zinc.
I took a load of medication to Ukraine in 2001.(you can read about it in the Journal) This was to supply a dispensary in the west of the country- ie a non-urgent mission. It took extensive paper work just to get these medicines on board the bus we were using. Then we had to have paperwork for all the countries we passed through. When we got to the destination the medicines were held in quarantine for clearance by Ukrainian officials from Lviv. I realise that this is an emergency, but from my experiences medical aid from individuals is like as not going to be delayed, and the emergency might well have passed.Please, if you wish to help, send money.
I'm picking up a family from Western Ukraine later this week as I have a wheelchair access vehicle and I offered. They need Levo Thyroxine. It's not a problem for me to supply a small amount as my mother has a prescription. However is it appropriate or possible to access a larger amount to supply to the area? My contact say they are running out of this medication? Please let me know if possible. Thanks
As reported, there appears to be some conflation of a Pre-Payment Certificate (PPC) and the mechanism of eRD via the EPS.
The PPC is 'lodged' with the pharmacy.
I appreciate that the aim of a single charge for annual treatment is outwith the gift of EPS eRD - but this mechanism of supply makes sense in terms of reducing the touch-points the patient has to make in obtaining medication for a stable and persistent condition. We should be making life easier for patients.
I do hope the PPC scheme doesn't complicate issues for pharmacy teams.
But a simple solution would be to abolish prescriptions charges to align with other nations.
NICE 2021 has updated guidance on the recommended dosing or iron. There is now a recommendation that once daily oral iron (50-100mg elemental iron) is sufficient (not 100-200mg elemental iron as this paper suggests). This is due to hepcidin, which regulates iron uptake. Multiple daily dosing of iron increases the production of hepcidin, which reduces the amount of iron uptake. Hence, multiple daily dosing does not necessarily confer increased iron absorption but may lead to increased side effects.
This is taken from the updated NICE guidance:-
Traditionally oral iron salts were taken as split dose, two or three times a day. More recent data suggest that lower doses and more infrequent administration may be just as effective, while probably associated with lower rates of adverse effects.
The optimal drug, dosage and timing of oral iron for adults with iron deficiency anaemia are not clearly defined, and the effect of alternate day therapy on compliance and ultimate haematological response are unclear. Based on the available literature, a once daily dose of 50-100 mg of elemental iron (for example, one ferrous sulfate 200 mg tablet a day) taken in the fasting state may be the best compromise option for initial treatment.
For mental health medicines the Choice and Medication website portals have a series of leaflets on mental health medicines, also available in Arabic, Bengali, Hindi, Somali, Turkish, and Urdu.
really interesting article - very insightful and will support me in my clinical practice. I enjoyed learning about the holistic and individualised approach
The question is why the UK do not consider recruiting the refugee pharmacists who are already live in the UK for so many years and cannot get back to their job in any way due to the overcomplicated rules and regulations. I am one of these people and I know so many pharmacists as me. You already have good assets but unfortunately no one would help.
Sorry, I'm not clear on this, about 'new' applications since the new . . . Does this mean that there have been successful applications before all this 'new' framework? Are there any licensed devices/solutions 'out there'?
Charity status was considered by the RPSGB Council more than once in the past and rightly rejected for limiting the Society's ability to promote pharmacists and the profession. There is nothing that the Society cannot do now that would be achieved by College status, and much that could be lost.
I agree Nick on Charity and College status and don’t think they are the way forward but think the two issues are separate. See below. I am not convinced the Society is any nearer to operating as a body akin to Royal College than it was in 2010. In many ways things seem to have regressed somewhat. Take care
Follow the NICE guidelines and avoid unnecessary litigation. They do not see individual patients face to face and cannot make idicts on that basis. Let practitioners practice and politicians debate.
The article shares the RPS Assembly's thinking as to why conversion was not pursued, but considerably less detailed insight of the actual benefits that Royal Colleges enjoy. I wonder if colleagues who support college status can fill in the gaps?
Organisational transition is by its nature complex, but the pain of change alone is not a primary reason not to do something. I read that the RPS is not ready for this yet; what would tip the balance in favour of the college status?
Hi Lucy. Thanks for the query. By moderate consumption, I meant not more than the recommended limit, so 200mg per sitting and 400mg per day for non-pregnant adults.
As a former Transcom member who supported the idea of a Royal College I was interested to see Mr Bennett’s perspective on this recent decision taken it seems without membership debate. Sadly my notes were shredded years ago but I hope these thoughts may offer a way forward. From memory the old dual role RPSGB was deemed unfit for purpose and it was suggested the profession needed a professional body akin to a Royal College. NB not necessarily a Royal College per se. Transcom felt the RPS without its regulatory role could do that by engaging more with other pharmacy professional bodies.
I therefore reviewed how many of the Royal colleges ran to see what they offered and think I wrote to the PJ, but I cannot find anything I wrote before 2012 on the website. From memory I noted the following:-
They set standards for practice and qualifications beyond those needed for professional registration with the regulator. They worked with the regulator on ensuring these met service needs. They supported members though training, publications, examinations, libraries etc Students could join for free or nominal sums Membership level was focussed on training grades with fees often linked to salary growth to help younger members join and progress. Fellowship was the aim after 8- 10 years or so and there were clear routes to gain that membership level often linked to a NHS Consultancy or GP status that were open to all. Most provided free continuing membership/fellowship to those over 70 or 75 thereby retaining their expertise for future generations, and enabling them to continue within their social and professional networks. The Colleges were run by elected Fellows with input from some elected members and students.
I agree with the conclusion the new RPS does not need to try to become a Royal College. It could however move to operate much more like a Royal College than it does now.
Our Fellows system needs a radical rethink. When I became one around 1991 I wrote thanking the President and asked what I might do to help the profession, but got no answer I have no idea how many members or Fellows the Society has now but suggest the balance needs to change. I am long retired and have gradually become disengaged, I am not into social media so I’m not clear what the Society can do or is doing to identify develop or improve standards that employers or regulators want.
The Society might wish to commission research to see what employers and the regulator want from it and to investigate how Royal Colleges now work to see what can be done to mirror or improve as many of these roles and organisational arrangements as possible within the RPS without trying to become a College or Charity.
A couple more things came to kind. I mentioned Royal Colleges as did others in Transcom and I raised the idea of free membership for the over 70s to help retain expertise and give loyalty some reward. This caused a horrified reaction from RPSGB representatives, largely I think because of the enormous costs of providing and posting weekly Journals for nothing. Now that cost has gone, maybe it’s time to revisit that idea. Mr Bennett refers to no name change being sought. Transcom suggested the then RPSGB should be rebranded to lose “the unfit for purpose label” and the simplest solution was by dropping GB from the title. I think it would be worth contacting Nigel Clarke who chaired Transcom and then led GPhC to see if he can shed any light on what the Society might do going forward and for any thoughts on the past. Asking members might even be worth undertaking too.
‘….NDMA is classified as a probable human carcinogen, although available safety data does not show that ranitidine increases the risk of cancer, and any possible risk is likely to be low. However, according to the EMA, NDMA had been found in several ranitidine medicines “above levels considered acceptable”, and there are “unresolved questions” about the source of the impurity…’ How long will this take it’s been two years ?
To anyone who takes up this offer: Do NOT underestimate the demands of an Independent Prescriber course. If working full time ensure your employer agrees to time for undertaking the practical shadowing and observing parts of the requirement, if not indeed additional study time, as well as the course attendance requirement. If you're working part time, also make sure you have the availability in your "non-employed" time plus your study time from your employer to succeed in this very demanding course. But please don't let me put you off... the Independent Prescriber annotation is an opening to all sorts of new professional activities once qualified and competent in a clinical area.
This indicates complete white wash of the responsibility of the HSE in regards to the safety of health workers. This response not only dramatically reduces the confidence in the reporting system but also makes you wonder whether you should be working in the NHS or any other healthcare system if there is no concern about adverse outcomes to the staff that work there.
Graham I left this on the Chief Executives article on the Royal College decision. You may not have seen it. I’m on board with what you say and am so disappointed how the Society has progressed.
Howard McNulty 29/04/2022 As a former Transcom member who supported the idea of a Royal College I was interested to see Mr Bennett’s perspective on this recent decision taken it seems without membership debate. Sadly my notes were shredded years ago but I hope these thoughts may offer a way forward. From memory the old dual role RPSGB was deemed unfit for purpose and it was suggested the profession needed a professional body akin to a Royal College. NB not necessarily a Royal College per se. Transcom felt the RPS without its regulatory role could do that by engaging more with other pharmacy professional bodies.
I therefore reviewed how many of the Royal colleges ran to see what they offered and think I wrote to the PJ, but I cannot find anything I wrote before 2012 on the website. From memory I noted the following:-
They set standards for practice and qualifications beyond those needed for professional registration with the regulator. They worked with the regulator on ensuring these met service needs. They supported members though training, publications, examinations, libraries etc Students could join for free or nominal sums Membership level was focussed on training grades with fees often linked to salary growth to help younger members join and progress. Fellowship was the aim after 8- 10 years or so and there were clear routes to gain that membership level often linked to a NHS Consultancy or GP status that were open to all. Most provided free continuing membership/fellowship to those over 70 or 75 thereby retaining their expertise for future generations, and enabling them to continue within their social and professional networks. The Colleges were run by elected Fellows with input from some elected members and students.
I agree with the conclusion the new RPS does not need to try to become a Royal College. It could however move to operate much more like a Royal College than it does now.
Our Fellows system needs a radical rethink. When I became one around 1991 I wrote thanking the President and asked what I might do to help the profession, but got no answer I have no idea how many members or Fellows the Society has now but suggest the balance needs to change. I am long retired and have gradually become disengaged, I am not into social media so I’m not clear what the Society can do or is doing to identify develop or improve standards that employers or regulators want.
The Society might wish to commission research to see what employers and the regulator want from it and to investigate how Royal Colleges now work to see what can be done to mirror or improve as many of these roles and organisational arrangements as possible within the RPS without trying to become a College or Charity.
I note Chris' passing with great sadness. What a lovely tribute to him by his colleagues! I count myself as one of the "large number of staff he inspired with a love and enthusiasm for pharmacy". Whilst it is some years back, I still remember his quiet wisdom and gentle advice. RIP
Mike was my tutor at Chelsea College University of London where I studied for my B.Pharm. degree from 1968 to 71. I was so sad to read of his passing , but fascinated by his career after leaving Chelsea . I can totally concur with his wonderful warmth and help he gave me as a student. I too was invited to his home for a meal and he introduced me to the delights of Indian and Chinese cuisine! which was edifying to a naive young man from The Black Country! My sincere condolences to his family Malcolm Costley B.Pharm. M.R.Pharm.S.
The HSE might find it's hands tied in looking at both non-fatal and fatal cases of COVID, as unlawful killing merits a criminal rather than civil standard of proof.
Independent and dispassionate post-hoc assessment can offer perspective outside of the pressure cooker of the occupational environment. Regardless of the HSE, NHS organisations have a duty of care to their employees in real time and the Duck Test applies.
The length of consultation times is a question of parity more than anything else. 10 minutes is the minimum length supposed to be given to a GP appointment and in practice is the standard. In the face of unparalleled demand and a critical mass of undiagnosed morbidity I can't imagine GPs having a great deal of sympathy with requests for more time from other disciplines within their teams.
Resources, including time, are finite and will never be enough to deliver an equitable health service.
I wonder if there is any research on the number of housebound patients who would have the technology at home to be able to participate in a video call.
A truly inspiration man who had a significant influence on my career and the emphasis I have placed on management and leadership training - I mention him always when I speak to pharmacists about the importance of leadership. I wrote to him a few years ago to thank him and was delighted to receive a response. May you RIP 'Mr Barrett'.
Chris was deputy chief pharmacist at Westminster hospital, where I & three others Madeleine , Carolyn, Claire started our preregistration year. He inspired, encouraged and imbued a love of hospital work. Two of us ultimately became ward pharmacists at Westminster. My husband also worked with Chris’ in later years. It is with sadness that we have lost a major innovator to hospital pharmacy procedures.We will always be grateful to have known him.
clobetasone cream is a medication used on the skin to regale enlarging, tingling, and irritation. It can assist with skin issues, for example, skin inflammation, including contact dermatitis. psoriasis. You should always use the lowest strength corticosteroid that is effective for your skin condition for the fastest possible time. It should also not be used to treat: Acne.
tenofovir 300 mg is utilized alongside different drugs to treat mortal immunodeficiency disease in grown-ups and youngsters 2 years old and more chronic. It is additionally used to dine continuous HBV in grown-ups and children 2 years old and more seasoned gauging 22 pounds or more.
There is very high pressure everywhere in the primary care system so people need to move away from the familiar lines, 'to reduce GP pressure', or to 'support GPs'. This is about changing systems so eveyone can serve citizens efficiently when they are providing primary care services.
It was with great sadness that we learnt of the passing of Chris Barrett. I had the great fortune to spend my formative years under his mentorship at the London .His courtesy, sincerity and belief in his chosen profession were inspirational. Chris seconded me to the London Jewish Hospital where I was introduced to the nursing staff and found my wife; for which I remain eternally grateful. Fortunately we were able to correspond in his latter years and learnt of his many many interests. Our thoughts are with his children and grand children. Marie and Gary Boorman
Considering how bad job prospects are for a lot of pharmacists and how there is a shortage of doctors, Id say its mutually beneficial for pharmacists and the GMC. Whilst it is understandable that the last 2 years has had a heavy toll on healthcare worldwide, there ought to be more transparency from pharmacy and medical bodies, about this subject.
This is something which needs to be addressed and something I have been going on about for many years. I graduated in 2013 but have been unable to get a DMP/ DPP during all this time. I have requested support from multiple general practices and CCGs within a 30 mile radius since 2016 but all have turned me down (ghosting, nepotism or demaninding more money than what I was earning in a month for the "privilege" of shadowing them for 90 hours a week). THE GPhC and RPS really need to work together with IPSs and various bodies to come to some arrangement as it is ridiculous how thousands of pharmacists who can be great assets are being wasted
The worked solution to question three is incorrect as the price used in the question is £150/60 tablets and the price used in the solution video is £105/60 tablets.
I am happy NHS Education and the GPhC is working to help pharmacist who are keen to become Independent Prescribers in getting a DMP or DPP by incentivising this role. I have also asked few GPs and CCGs for support and the first question asked is about the incentive for them or the pratice. I am looking forward to a positive outcome in this ongoing development.
I am so very saddened on reading of the death of Sheila Beaumont. She had a wonderful way of making me feel most welcome when I relocated to work in East Sussex [between September 2005-February 2008]. Sheila was always looking to the future of pharmacy: Independent prescribing is the way forward! I fondly recall that Sheila was also an active member of the local Regional pharmacy group, CPPE tutor and active pharmacy delegate to many BPC conferences. Sheila you will be sorely missed. My heartfelt condolences to your family, friends, customers & colleagues.
I am saddened and shocked to read of Hillary Judd's death. I am fortunate that I interviewed with Hillary for an interesting pharmacist information job role in Exeter, Devon. Although unsuccessful, Hillary agreed to keep in touch via LinkedIn. And we chuckled about our shared connection as Pharmacy graduates of Aston University in Birmingham. I think Hillary would be delighted with the transformation of the Gosta Green campus! So, my heartfelt condolences to Hillary's family, friends & colleagues.
Why such an inertia? Red flag have been accumulating for long, from the bench, for more than a decade. Pharmacovigiliance is about drowsiness. https://www.bmj.com/content/377/bmj.o1531/rr
It is difficult to discern what a telephone help line would achieve for Rx drug addicts. It would have been no good for me, when I had a problem with prescription drugs. It’s difficult to get meaningful advice from a phone line , especially if the person in the other end has no idea of your circumstances. Once again it is people who have not been there dreaming up schemes for those who have. The BMA don’t want to support it because their members caused the problem in the first place and are unwilling to help. Even though I had a problem for 40 years and had fitness to practice issues, even I don’t know the answer. But I do know it’s not a phone line.
The idea of a helpline *has* come from those who have been through prescribed drug dependence and have struggled to get a) recognition of their withdrawal responses b) info on how to withdraw safely and c) support whilst doing so. A dedicated national helpline staffed by trained people could offer all of this.
Well, Bob, first off, people who have become physically dependent on a prescription medication is NOT an addict. There is a massive difference between addiction and physical dependency. Many people who become dependent have not been given informed consent by their doctors that dependency could occur. Many are left with absolutely no support (emotionally, financially, etc) and have no clue how to slowly and safely taper off their drugs because doctors are so incompetent they aren't educated on taper protocols. A helpline would help point these people in a direction of someone who can help them as well has offer emotionally support for having their lives destroyed by doctors who couldn't kindly inform them their medication could cause dependency. Many people end up physically dependent, NOT ADDICTED, and end up killing themselves because they have no clue how to taper and the drug has destroyed their nervous system. Many people physically dependent are going online to taper communities and forums to learn how to taper when it should be their doctors and governments job to help them, not complete strangers.
Chronic fatigue is something completely different to ME/CFS. This is written with the terms confused. The complex multisystem disease, ME/CFS, see NICE Guideline ME/CFS 2021, is marked out by the symptom Post Exertional Symptom Exacerbation which includes fatigue (understatement to the point of being absurd) as well as other symptoms. It is not defined by fatigue. Chronic fatigue on the other hand just means fatigue that has become chronic, it is a single symptom that can arises from any number of other conditions such as multiple sclerosis, arthritis or even depression. It seriously doesnt help when articles confuse the two, and causes even more harm when research cohorts confuse the two - the results end up useless and potentially even harmful. Please correct the title so it is clear which of these two things the article is about, is it about the disease ME/CFS as in the NICE Guideline, or is it about the symptom of something else,, chronic fatigue? Thanks
Thanks for your helpful comments on our feature. The feature aims to explore what is known about fatigue in general, and the specific impact of long COVID fatigue on research in this area. ME/CFS is pulled out as an example of a condition in which chronic fatigue is one of the symptoms to highlight and compare the struggles of people who have been living with fatigue for a long time, but the feature is not intended to be specifically about ME/CFS. I have amended the text to clarify this. Dawn Connelly Features editor The Pharmaceutical Journal
It's blatantly obvious you've never met anyone suffering from CFS/ME. As a sufferer myself, I can honestly say that PEM is NOT EVEN CLOSE to being the main symptom. I thought the article made it clear that the relation between CFS & the scope of the article refers to the symptom of fatigue...Which is BY FAR the main debilitating symptom of the condition. (not just in my opinion, but EVERY person I've ever heard talk about it. I'm a member of a Facebook support group where thousands of CFS sufferers post about their difficulties.)
The article even mentioned how many people aren't even aware they experience PEM. I myself have never considered it a symptom due to the unrelenting fatigue I'm already constantly battling.
You made it sound as if ME/CFS sufferers primarily experience fatigue post exertion. (Or even that exertion is REQUIRED for fatigue symptoms).... Which is not the case whatsoever. So, if anyone needs to watch out about spreading incorrect info, that's you my friend. The author of this clearly has a deep understanding of how CFS affects the lives of those burdened with this illness.
As this is primarily an article about about ME/CFS please could you consider making this clear in the title - as many health professionals do not understand that there is a major difference between having ME/CFS and having chronic fatigue
Chronic fatigue is a very common symptom that occurs in a wide range of medical and mental health conditions. It is not a distinct clinical entity
ME/CFS is a syndrome that includes activity-related fatigue and post-exterional malaise/symptom exacerbation among its key diagnostic features
The new NICE guideline sets out a very clear list of symptoms that are required to make a diagnosis of ME/CFS:
All of these symptoms should be present:
Debilitating fatigue that is worsened by activity, is not caused by excessive cognitive, physical, emotional or social exertion, and is not significantly relieved by rest.
Post-exertional malaise after activity in which the worsening of symptoms:
--- is often delayed in onset by hours or days
--- is disproportionate to the activity
--- has a prolonged recovery time that may last hours, days, weeks or longer.
Unrefreshing sleep or sleep disturbance (or both), which may include:
--- feeling exhausted, feeling flu-like and stiff on waking
--- broken or shallow sleep, altered sleep pattern or hypersomnia.
Cognitive difficulties (sometimes described as 'brain fog'), which may include problems finding words or numbers, difficulty in speaking, slowed responsiveness, short-term memory problems, and difficulty concentrating or multitasking.
Dr Charles Shepherd
Hon Medical Adviser MEA Member of the NICE guideline on ME/CFS committee from 2019 - 2021
Thanks for your helpful comments on our feature. The feature aims to explore what is known about fatigue in general, and the specific impact of long COVID fatigue on research in this area. ME/CFS is pulled out as an example of a condition in which chronic fatigue is one of the symptoms to highlight and compare the struggles of people who have been living with fatigue for a long time, but the feature is not intended to be specifically about ME/CFS. I have amended the text to clarify this. Dawn Connelly Features editor The Pharmaceutical Journal
I've already commented above to someone who left a similar comment, so if you don't mind pls read that as well.
It's really scary to me that PEM is such a huge factor to the medical "expert" community... So much so that it's considered a requirement for diagnosis.
As I mentioned above, I've never considered "exertion" to be much of a factor when considering my symptoms. Sure, when I have to go do things I'm worn down even more afterward, but even if I lay around for days trying to rest up I'm still going to be fatigued!! You could say that I'm only one person & insist most people would consider exertion to play a big role in symptoms, but based off countless posts I've read on the CFS/ME support group Facebook page that's not the case with them either!?!
The reason I'm so bothered by this is because it's just one more thing added to the confusion/misinformation surrounding this cursed illness. I'm aware that there's been a severe lack of funding for research which in turn resulted in very little studies being carried out. However the ones that have been done have obviously caused erroneous info to spread throughout the medical community. I'm going to assume that what was actually meant by post exertional malaise was really just trying to say that activity does not help the symptom of fatigue. Another thing that seems to be creating problems with research is how there's no distinction between severity levels. It doesn't seem right, in my opinion ,to group together people who are still able to work and function practically normally and those who can barely leave their bed. I'm not trying to be rude... It's just that this condition has completely stolen my life. I'm alive but I don't consider this living. I desperately yearn for real progress to be made regarding CFS but the way things stand currently (esp the lack of real understanding by doctors) gives me little hope. If only there were more truly insightful people, like the author of this article working to make progress concerning CFS/ME.
I’m very proud of the high antidepressant use in Norfolk. If you consider that maybe only 50% people with depression go to the GP, and few of those give enough clues to get accurately diagnosed, then Norfolk’s high use is probably only a small percentage of those appropriate for antidepressants. And, despite what NICE says, the evidence for psychological interventions is still poor (the use of waiting list controls instead of placebo is methodologically invalidating) and, although they may be flawed, antidepressants work in most people, are available at a moment’s notice and there’s no waiting list. I’d say the other areas are under-prescribing rather than those 3 areas over-prescribing.
Do these statistics reflect the way the death certificate is made out? In France, my wife died after "hitting the bottle" following the best part of a year in detoxification, but "alcohol addiction" did not feature on the certificate and I've been told it is rare there for any drug addiction to be listed, "cardiac failure" being the norm. Could this be the case elsewhere?
I was saddened to hear of the death of Isabel Bailey. As my onetime colleagues have said she was a pleasure to work with and someone who remained in the memory long after our cooperation had ended.
I too have happy memories of working with Sheila Beaumont at CPPE. She was she was always interesting to talk with, and provided wise counsel. My condolences to her family
Quote from email message sent to PCN Clinical Directors and PCN Lead Pharmacists from Medicines Value Team NHSEI on 7th July 2022:
'Neither the price at which the generic version of apixaban has been made available nor its limited supply justifies the NHS to change the existing commissioning recommendations that were issued in January 2022 and therefore, consistent with NICE guidance, we continue to recommend clinicians use edoxaban for new patients, where clinically appropriate.'
Concern re suitability of edoxaban for patients with CrCl > 95ml/min;
‘On the other side of the spectrum, a possibly decreased efficacy of edoxaban 60 mg OD compared with warfarin was observed in patients with a CrCl of >95 mL/min.31 Interestingly, as a result of these findings, further post hoc analyses revealed a similar effect also for Rivaroxaban188 and Apixaban.189’
from The 2018 European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation’
Obese patients. ISTH guidance is that unsuitability of DOACs in patients with BMI >40 weight >120kg applies to ALL DOACs:
see: Martin, K., Beyer-Westendorf, J., Davidson, B.L., Huisman, M.V., Sandset, P.M. and Moll, S., 2016. Use of the direct oral anticoagulants in obese patients: guidance from the SSC of the ISTH. Journal of Thrombosis and Haemostasis, 14(6), pp.1308-1313.
Colleagues may be interested in seeing how much antidepressants and other psychotropic drugs consumption in the UK compare to other 64 countries: https://www.the-lancet.com/journals/lanpsy/article/PIIS2215-0366(21)00292-3/fulltext
I am sorry to contradict because patients on antibiotic treatment for 5, 7, 10, or longterm are the ones who pollute the environment. All that you need is 3 dose to kill all the bacteria in our body, and no study to prove you need to prolong treatment. Using antiseptics, antibacterial soap, detergents and shampoo, kill sensitive bugs and help superbug and fungus thrive. Please stop polluting hospitals with plastic bins and expect to solve this problem of polluting environment.
A really interesting article, thank you for sharing. I'll be teaching Root Cause Analysis applied to medicines error on our PG diploma next month so this is a really useful, contemporary issue to weave in as an example. Could I please encourage some reflection around the terminology and language used though. Firstly, the supply issues are affecting patient adherence not concordance, the term concordance refers to the consultation between the HCP and the patient, not the medicines act. Secondly, whilst I wholly understand the frustrations here, I'd just urge a little reflection around the sentiment that the nurse 'decided' to give the medicines daily not weekly. Whilst I'm sure unintended entirely this holds an implicit accusatory judgement of wrong doing and even infers potential mallice on the nurses part. The nurse misunderstood, got confused, made a human error...for example would hold less accusatory judgement than 'decided'. A really small point but the language that we use with these things really does make quite a difference.
Thank you for your comprehensive article on a complex subject. May I point out however that abatacept, adalimumab and etanercept while good options for polyarticular juvenile idiopathic arthritis (pJIA) are neither useful nor licenced for systemic juvenile idiopathic arthritis (sJIA) as erroneously stated in table 2. Tocilizumab is correctly identified as useful to treat sJIA ( as well as being useful for pJIA) . Please see SPC of these meds for further information. Kind Regards Clare Nash ( Specialist Pharmacist, Paediatric Rheumatology, Sheffield Children's Hospital)
Thank you for this very comprehensive account of a complex subject. May I just point out that the drugs abatacept, adalimumab and etanercept while useful drugs for polyarthritic juvenile idiopathic arthritis (pJIA) are unsuitable for (and not licensed to treat) systemic juvenile idiopathic arthritis(sJIA) as claimed in table 2. Tocilizumab is however useful for sJIA Please see the relevant SPCs for further information. Kind Regards Clare Nash ( Specialist Pharmacist Paediatric Rheumatology Sheffield Children's Hospital)
Hi Clare. I am the Senior Editor at the PJ working on our learning and CPD provision. Thank you very much for highlighting this. I am looking into this with the authors of the piece and will make sure any necessary corrections are made.
My first concern is for the welfare of the 7 care home patients affected by the alendronate switch to risedronate. The harm potential of risedronate shouldn't be underestimated in this very vulnerable cohort. But why was the Mar-chart not checked by at least two nurses before administration? The different colour, shape, markings ought to have alerted that the pre-breakfast medicine had changed from before etc. Alas, "to err is human; to forgive, divine" [Alexander Pope, 1688 to 1744].
It's so insightful of the Pharmaceutical Journal to include insights from the three patients above. Overall, I too hope GSK would reconsider their decision to discontinue their much-needed seroxat (paroxetine) 20mg/10mL oral suspension.
Recruiting more pharmacists from abroad will not solve the problem it is merely plastering the issue. Perhaps you might need to understand why pharmacists are leaving community In their droves. You fail to mention the workplace conditions in community pharmacy and the rising workloads. It comes to as no surprise that many pharmacist are choosing to leave community and for lower pay but a better work life balance. Until you properly address these issues then you will find it very difficult to recruit and retain pharmacists.
I must take issue with some points made by the author of this article. Although there are no errors in what has been written, it is the omissions that concern me. Firstly, there is no mention that the primary target may not be the metatarsal joints. Secondly, there is an implication that the condition is almost always accompanied by painful swelling of joints and rubra. Any, or all of, these features may be absent. I have a patient who presented with painless swellings in the proximal metacarpal joints of several fingers in both hands. There was limited flexor and extensor movements, and there was no pain associated with these movements, and only two fingers could be fully extended. Blood tests ruled out osteo- and rheumatoid arthritis, and it was only when the patient was tested for blood oxalate that we could confirm a diagnosis of gout with tophi. The clinical example in the article is misleading by failing to mentioning painless presentation, not mentioning the metacarpal joints and that the deformities and that there may not be flare-ups, but still progressive.
Hello Henry. I am the senior editor for learning and research at the journal. Thanks very much for your comment. I have shared your feedback with the author of the article and will look at this closely with them. Thanks again.
David Ganderton was a very outstanding Fellow of the Society and his death war rants a special tribute of his life and work in pharmacy, which led to his OBE. Please prepare one and publish it in the PJ.
Pharmacists in England have, for some time, been able to create their own contribution (vaccination, emergency supply of prescription items, minor illness contributions, etc) to the patient's record and share this with GPs in both England and Wales, (I have no information about Scotland and Northern Ireland). This is 'write' access. What other information would pharmacists wish to share with the wider clinical community? Pharmacists in England also have access to the Summary Care Record, (and the Clinical Portal in Wales), which provides at least a level of 'read' access and is often all an admitting doctor can see when the patient turns up in Accident and Emergency. It would be useful to understand what level of 'read' access pharmacists feel they need to see. Most elements of any 'clinical record' (the hospital progress notes or the GP notes) are not 'shared' with anyone else, as they are largely unstructured and thus hard to share, store and make sense of once they are in a central repository. The Shared Medicines Record in Wales will provide access to up to date information about medicines for all clinicians (I use this term in its widest sense) who care for patients with medicines. Data about radiology or pathology results or pathology laboratory results would be included in the National Data Repository within Wales - and may be included in some ICS-level shared records in England - but are not always easily shared between hospitals and GPs within England, so I'm not sure that community pharmacists are any less well-off (in terms of access to data) than others. This doesn't make it right - merely adds an additional perspective. Data that is important to inform decision making is something that we should certainly press for, but we do need to specify what we wish to see (and why) to facilitate the provision of access. This isn't a 'censorship' issue - more a practical issue about identifying information that could (usefully) be made available. Structured information, such as laboratory results, are easier to share than 'clinical narrative' that is often recorded in 'the notes'. Data included in centralised 'shared records' could be made available to all relevant clinicians, but understanding what is really important will make it easier for those who are working to make this available.
“pharmacists have revealed that patients are being switched to edoxaban without being informed”
As a profession we have a duty to lead this discussion with the patient & take ownership of the process if they wish to proceed -in all settings PCN/GP & Community Pharmacy. If a patient presents with a first request or prescription then it would surely warrant a call or NMS depending on setting.
Excellent guideline from Helen Williams with PCPA, UKCPA & PCCS
This excellent survey highlights the need for ready to administer drugs to be made available from the pharmaceutical industry. Hospitals should be prepared to pay a small premium for the drugs presented in this way.
Agreed but there is also a need for regional / national hubs to be established within the NHS to produce batches of products which are not available from commercial sources. In addition to the question of whether the NHS is willing to pay a small premium for these products there is a need to establish a system to standardise these products to make them commercially viable to produce.
It’s easy to understand how clinicians have become used to a simplified “serotonin” explanation of how antidepressants work - the reality is complex and ambiguous and may sound less reassuring to patients. However, many people take medicines when they don’t understand how they work. Paracetamol for example. So, perhaps we should focus on finding out what the patient already knows about their medicine, what they want to know and what they’re concerned about. Then we can have an individualised (person centred) consultation and come to a shared decision about the optimal course of treatment for that patient.
Reform of the generic medicines procurement and supply system is essential for patients, the NHS and the future of our profession. It won’t be easy as change is difficult for everyone.
Whilst in the past most closures may have been relatively infrequent and for a matter of hours this is most certainly not my experience in my local area in recent times. Instead of the 7 days one particular Pharmacy was supposed to be open they were only open 3 and these were very much reduced hours. This situation was for weeks, it was further exacerbated by the fact that despite not being open prescriptions were still being downloaded and therefore increasing the workload in GP practices having to re-issue the prescriptions and then try to contact the Pharmacies when they were open to return the originals to the spine for cancellation, this will also have increased the workload in the Pharmacy at an already stressful time. I have to question how much the situation is trying to be downplayed.
Ravi Sharma has promised to take the results of the 2021 Workforce Wellbeing survey to 'governments across britain, the NHS and other stakeholders'. Much of the stress affecting pharmacy today is the result of the Society's own policies! Why isn't the Society working to reduce workload and stress by cutting its own ambitious itinery?
I think this article is a helpful summary, and tries to unpack some of the complexities surrounding this issue. I feel some of the responses by clinicians (not in this article!) have been slightly too defensive in saying "we don't use the chemical imbalance explanation with patients, so this is nothing new". I think if we are honest, it has previously been used quite commonly as a short-hand explanation (as Nina has mentioned in her comment). We need to reflect on that and refine our communication about antidepressant actions, understanding what each of our patients wants to know and what worries them. My other comment would be that a little more context about lead author Joanna Moncrieff would be relevant beyond describing her as a consultant psychiatrist. She's a prominent and longstanding critic of psychopharmacological approaches to treating mental illness, having published extensively in lay and scientific publications. I think that is relevant when reviewing this umbrella analysis and how it has been promoted.
The contents of medicines are surely only part of the story. What about the research on laboratory animals that is used to ensure safety, lack of toxicity, and effectiveness?
At last! I think this is the key to delivering clinical services in community pharmacies. It will mean that NHSE will hold the register and demand a level of service required to deliver the service and will be clinically rather than commercially focused.
Vaccination administration can become a key area of contribution to the health of the Nation by Pharmacists in general. The sooner aspirant pharmacists can become involved so much the better . It may be a suggestion worth considering and that is to involve Retired Pharmacists in this important and necessary role . John Edmunds
Understanding historical rivalries is key to understanding the situation we are in today. If they are put to one side it would be a monumental mistake. For example, the PIANA consultation was a total sham, with no indication at the time that it would effectively be a vote on the future of pharmacy. Now that we are living in that future we see the fruit of its misplaced agenda in terms of people leaving the profession, stalled recruitment, workplace pressure, overall dissatisfaction and policy outcomes that, I feel, are not representative of the majority of members. Of course, if our peers are delighted with the current direction of travel, it's no wonder that they want to sweep the past under the carpet. They are, in effect, creating new rivalries in which the wishes of the majority are, again, being swept aside.
What a great podcast! Recommended listening. Anticholinergic burden is important and often overlooked. Graham's team experience exactly mirrors what we found in East Lancashire - patients' quality of life improved with reduce drug burden. Clinicians inspired to deprescribe by witnessing positive patient outcomes. Good work!
This problem has existed for many, many years. It not only impacts patients but it's extremely stressful for pharmacists. Nobody has ever done anything about it that has made any real difference.
There are fundamental reasons that also need to be considered why an opportunity to move to GP practice can seem appealing when compared and contrasted with community pharmacy.
There is very little transparency at the RPS. I have tried on numerous occasions to voice my concerns to the English Pharmacy Board over many years - but the members can't be contacted, neither do they respond. I doubt if they even know that I have tried.
Assembly members make crucial decisions that the rest of us are unable to challenge. I have said on more than one occasion that they are 'cowards' since, once in the Assembly and EPB, they cut off all access to themselves and do what they like, completely unwilling to defend the decisions that they make or react to criticism. Ms Buckle insists that she is very happy to hear from members. Would she then publish contact details for herself, the EPB and the Assembly members in order for this to happen?
I note that she has been a locum - but has she any experience of long term pharmacy management? She speaks of wanting closer relationships with the PSNC (ie contractors) - but is she remotely interested in pharmacist employees?
I notice that she makes no mention of the intollerable pressures on pharmacy staff - partly due to what seems to be uncaring decisions made by herself and her colleagues and the PSNC which continue to cause great concern.
If there really is a desire to be an ambassador for the membership, please find out what the majority of members, who support the Society with their fees, really want - and please listen and respond.
Thank you for taking the time to both read and comment on this article.
The best way for the RPS to effectively respond to your questions on governance, policies or decision-making processes, is for you to contact 'commsteam@rpharms.com', where a member of the team will direct your inquiry to the most appropriate person at the RPS.
We are always grateful to hear from you, and the many other members for providing valuable insights that help us improve how we both represent and serve you, our members.
As a practicing employee community pharmacist, and a long-serving member of the RPS, I am acutely aware of the challenges facing our Profession at this time. We all need to pull together, support each other and continue to provide the excellent care to our patients for which we are increasingly recognised. And I can assure you, the RPS will continue to shout loudly on behalf of our Pharmacy Profession.
This is very unwise, if it was necessary to pick a medication for OAB as a P med they would be better picking an anti-muscarinic with a lower anti-cholinergic effect on cognition like solifenacin. Furthermore the idea of using the logic of raising self awareness is the oldest trick to replace the word increase market share.
Parkinson's disease is a neurodegenerative disorder marked by motor impairments caused by the damage of dopaminergic neurons in the substantia nigra and the formation of Lewy bodies. The specific cause of the sickness, however, is unclear. It affects the upper and lower extremities including facial muscles. An increase in the frequency of the disease over the last decade has necessitated greater research to develop advanced diagnostic tests and therapeutic regimens that would provide a lasting cure for Parkinson's disease.
It would have been interesting to have had more detail on the specific reasons why statins, antidepressants and PPIs were chosen for the pilot. Members of the public taking these drugs might be alarmed to know their genetics might be putting them at risk of side-effects and want to know more.
In my time as a proprietor pharmacist the idea of transferring to a GP practice was never even dreampt of let-a-lone seriously considered. What is the downside?
Dear Nicola. Many thanks indeed for your comment. I am the Senior Editor for Learning and Research at the PJ. I will write to you directly with a fuller response via email but wanted to assure you that the article went through our full editorial checks and was closely assessed before publication and that we treat questions around clinical validity and impartiality very seriously.
Dear Nicola, On behalf of all authors, I would like to thank you for bringing up such a valuable point. This case study was presented to us while the treatment was ongoing. The authors did not interfere in the treatment nor in the feedback provided. The patient and the caregiver signed a consent form provided by the PJ. For further discussion, please contact the corresponding author at: ljean@pccarx.co.uk or technicaluk@pccarx.com
A good point raised by Nicola Phillimore, although the declaration of interest by a manufacturer would not necessarily impact on the findings or quality of a piece of research or a clinical observation or case study.
However, in this instance I have concerns that the case study only represents a single case, has no control such as physiotherapy alone or physiotherapy with just the permeation-enhancing base, and the time delay of 10 months between pre-treatment and post-treatment neuropathic pain questionnaires in a condition which is likely to fluctuate over time. Those confounding factors make it impossible to draw any valid conclusions about the effect of the treatment.
Whilst the report is an interesting single patient observation, the publication as a CPD and learning article "case study" raises serious questions about the rigour and validity of the PJ editorial checks.
Dear Derek, On behalf of all authors, I would like to thank you for taking your time to provide feedback on our case study. CPRS is a complex condition and patients often struggle to manage their symptoms. This individual patient had a remarkable improvement in her condition, and we believe that this treatment option may be a benefit to other patients suffering from the same condition. Patient advised the physiotherapy sessions were made increasingly easier during the treatment period. For further discussion, please contact the corresponding author at: ljean@pccarx.co.uk or technicaluk@pccarx.com
I can totally relate to all of this. The Squiggly Careers podcast and books were a life line for me to accept and embrace the role changes that I've made throughout my pharmacy career. I would add, finding a sponsor who will champion and advocate for you is another great support in career development.
I was told that back in the early days of the NHS self-employed owner Pharmacists decide to threaten to hand in their NHS dispensing contracts because they were not happy with them. A large multiple Pharmacy company apparently refused to get involved and had the Owner Pharmacists gone ahead with their threat that would have left the Multiple with an open field. Thus, the owner Pharmacists backed down. So, my advice is not to strike, but to inform the Public that Pharmacists could strike as a last resort only and tell the Dept of Health that they need to address this problem as a matter of urgency for Pharmacists and Patients alike. The patients do not deserve another NHS profession to jump on the band waggon of strike action. A strike would harm patients and Pharmacists and the Dept of Health would not turn a hair
Please allow me to introduce myself as the Senior Editor for Research and Learning at the Pharmaceutical Journal. First of all, thank you for taking the time to submit comments and raise these questions with us. We very much welcome constructive discussion and scientific critique of our publishing and the opportunity it provides for improved accuracy and better insight for our readers.
In this instance we have shared your comments with the authors of the article and encouraged them to submit a written response to the specific questions you have raised. We accept that due to the real-world nature of the case presentation there were limitations that the reader needs to consider alongside the information provided, but we remain of the view that the article represents an interesting learning opportunity for our audience. As a case-presentation, we would also expect readers to appreciate that it represents a single data point drawn from clinical practice, and to factor this into their assessment of whether any conclusions can or should be drawn about this specific treatment strategy.
Having reflected on the discussion that the article has generated, we acknowledge that there are improvements that we can make to the way we present case-based articles of this type, in particular around how learning points are communicated, the limitations of the case study as a source of evidence and the need for the reader to critique appropriately. We have initiated a review of our relevant editorial processes and author guidelines and will implement these improvements for all case presentations subsequently published.
The link in the article is to the 2017 version of the standards. The link to the 2022 version is here: https://www.rpharms.com/Portals/0/RPS%20document%20library/Open%20access/Hospital%20Standards/RPS-Professional%20Standards%20for%20Hospital%20Pharmacy%20Services_2022FINAL.pdf
It is important to highlight to anyone using needle and syringe programmes in pharmacies to check their kits as they may not be engaged with drugs services. It is a balance to try to reach the most disengaged people and pharmacy teams have the privilege to be able to do that. I think the bottom line from this is, spread the word as much as you can. I have known people to use 1ml insulin syringes to withdraw naloxone when no needle was available (because it had been used). I have also heard of nasal administration of the IM solution. Not advocating either approaches, but just to illustrate the ability of people to be innovative in a crisis. What we need of course is more pharmacies supplying naloxone, that is important to have more even availability across the country and national commissioning would be ideal.
You were doing it for your country - it was an incredibly difficult time when we were all being called upon to work as we hadn't before and the fear and lack of clear guidance resulted in some people behaving badly towards healthcare professionals. Hope you have found counselling has helped this time and that you may be able to return to work if this feels right. It's brave of you to share your feelings and will help others who may not feel able to do so. Wishing you well
Really interesting! Have had several patients in my community pharmacy who have had issues with certain generic brands of tamoxifen, more than with most other drugs. Definitely worth someone researching properly.
I would not be wanting in any way to knock the desire of hospital staff working under heavy pressure not to continue with real terms pay cuts. However whilst pointing out that the Scottish Offer gives band 9 staff only a 2% rise, you could have mentioned that they are starting from over (if at top of scale of) £109,000. This is unlikely to garnish much sympathy with staff on a third of that.
An unbelievably brave account of a tragic situation. But your openness just might prompt someone to reach out for help and support sooner than they might have. The pharmacy profession often put others before themselves, but we need to realise that we need to be well, and functioning to help others. My best wishes to you, and I hope you find a positive future.
The news that Pharmacists and their teams can self refer to the NHS Practitioner Health Programme is excellent news and long overdue. I send my thanks to everyone who has worked to achieve this outcome, well done.
I can't believe the difference in placement tariffs. It is ridiculous. I know for a fact that based on this payment some GP practices will not host pharmacists if they could have a medical trainee at 6 times the payment. My practice wouldn't. It's a no-brainer isn't it? Why are pharmacists still so undervalued by the NHS?? Who is fighting our corner? How was this allowed to happen?
as a profession we can be very dismissive when patients tell us about these side effects. this is a good challenge from people within the profession that this is a lived experience and should be investigated further. do we need to change our testing protocols?
The article incorrectly asserts that "cannabis has two main species, Cannabis indica Lam and Cannabis sativa L.". Cannabis sativa L. is the one correct accepted species/taxon ; Cannabis indica Lam. is a heterotypic synonym – see https://powo.science.kew.org/taxon/urn:lsid:ipni.org:names:850879-1
Great to see your engagement. I agree, this is disputed territory! https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4604179/#!po=1.51515 Your point raising this will make an excellent pharmacy student project which I will task some undergraduates to dig into at next opportunity. The pertinent point of the study described was that prescribers selected any pharmaceutical grade, plant-derived, cannabinoid-containing oral product, which might have included CBD, d-9-THC, a combination of CBD/9-d-THC and other cannabinoids - rather than narrowing down.
It's laudable for the PSNC to request extra funding from the government for directing patients to community pharmacies. But this is not consistent with the regular "ask your pharmacist" campaign sponsored by the NPA which just finished a few weeks ago this year, for which we don't request additional remuneration. The profession would achieve more with a clear and coherent strategy from our representatives.
While it may be 'laudable' to request extra funding a major role for community pharmacists is to provide advice and support to members of the general public in respect of their health. Why else do some pharmacists choose to become community pharmacists?
As per current issues regarding cost of living crisis, increase in energy costs and work force issues. I am surprised that PSNC have not come out with a stronger mandate to actually ballot members on 1 day strike action in support of all the other health professions who have decided to strike. This would send a clear message to the Government regarding crisis faced in the Pharmacy sector.
Healthcare professionals have a duty to protect and promote breastfeeding. There are many specialist resources available that provide information on the safety of medications when breastfeeding, most of which are open-access. e.g. LactMed, SPS Safety in Breastfeeding, e-Lactancia. Hale's Medication & Mother's Milk is subscriber-only. UKDILAS can be contacted by healthcare professionals, and the Drugs in Breastmilk Information Service [see contact info in the body of the article] have a team of volunteer pharmacists responding to parents, breastfeeding supporters and healthcare professionals 365 days a year. Wendy Jones, the founder of the DiBM service, can be contacted via her website [https://breastfeeding-and-medication.co.uk/contact-me]
Parents who choose to breastfeed should be supported with their feeding choice by selecting an appropriate treatment or procedure where possible. Most parents can be supported with medication use while breastfeeding so #dontsaystoplookitup or contact one of the services listed above for expert support.
Amanda Da Costa The Breastfeeding Network's Drugs in Breastmilk Information Service Volunteer Pharmacist & Clinical Supervisor
With all the acknowledged advantages to mothers and babies of breastfeeding I have to say I have never read an article so negative about breastfeeding support for pharmacists. RCTs and large studies are not possible because of limited funding, even anecdotal reports suffer from publication bias as we never see the situations where the baby was not affected by the medication passing through breastmilk. There are several world wide expert sources of information based on the knowledge of the pharmacokinetics of medications passing through maternal milk - these have not even been acknowledged by the authors. UKDILAS is part of the UK Medicines Information Service and provides valuable individual data along with detailed factsheets. The Breastfeeding Newtork is run by volunteer pharmacists with a knowledge of drugs in breastmilk and breastfeeding in a service which has no funding. Women with complex medical conditions should be helped to make decisions based on evidence based information as supported by the MHRS consortium Safer Medicines in Breastfeeding and Medication. Outdated terms like fore milk and hind milk exemplify the concerns I have with this paper. I hope that fellow pharmacists will consult expert sources to enable them to support mothers who are breastfeeding and need medication. Dr Wendy Jones MBE Pharmacist with a special interest in breastfeeding and medication.
Has anyone heard of the effects UV light produced from backlit screens reducing the release of melatonin? It also happens with domestic energy-saving LED bulbs (including the daylight-mimicking ones). OK, it can be partly self-inflicted by young people but if you have ADHD then computer games are a good way to keep occupied. Please don't underrate melatonin. Don't forget that in clinical studies the overall effect may not be overwhelming but, as I'm sure most of you will know from your knowledge of clinical studies, the so-called 'curse of the mean' means significant effects in individuals can be obscured by lack of effect in others. Cannabis for some forms of epilepsy is a classic example. Each person is an individual they may get a significant effect on sleep latency and efficiency that is way better than the mean.
Whilst this article does raise the important issue of the data gap which exists for good quality published evidence for use of medicines during breastfeeding, we do not have to wait until this gap is filled before practical and evidence based advice can still be given.
Medication use is rarely a reason that breastfeeding cannot go ahead, and any risks can be managed. However, because of the data gap, advice and information sources can conflict with each other.
Nevertheless, my colleagues in their replies above, signpost to some very important information sources which are available to navigate this area, which includes the NHS UK Drugs in Lactation Advisory Service (part of the Specialist Pharmacy Service and the UK Medicines Information Network). The Specialist Pharmacy Service includes published advice from UKDILAS on their website and can be contacted regarding medicine use in breastfeeding (0300 770 8564). For more complex cases (including some of the scenarios mentioned in the article), UKDILAS can be contacted directly: https://www.sps.nhs.uk/breastfeeding-medicines-advice-service/
Laura Kearney Clinical Lead Pharmacist, UK Drugs In Lactation Advisory Service
Thank you for adding these information sources: others are pasted below.
Our papers highlight that the ‘evidence base’ on medicines and breastfeeding is weak: however excellent the compilation of the evidence, there are too few large studies with long-term follow-up [1]. Without these, we shall not know either how isolated the case reports of harm [2] are or which prescription medicines affect breastfeeding rates.
We argue that professionals should be proactive in supporting women prescribed long-term medicines to address the increased risk of ‘not breastfeeding’ and to check infants for any signs of sedation [3], irritability or poor feeding [4,5]. In some less affluent areas, many women simply stop breastfeeding, rather than engage with the excellent helplines available. Active monitoring should be tested in this context.
Sources of information include: • The British National Formulary (BNF) has information on product licensing https://bnf.nice.org.uk/ as do the Summaries of Product Characteristics Home - electronic medicines compendium (emc) • LACTMED: Drugs and lactation database (lactmed). In.: Bethesda (MD): National Library of Medicine (US); 2006. • Specialist Pharmacy Services (SPS) ‘MEDICINES INFORMATION GUIDELINES’ https://www.sps.nhs.uk/wp-content/uploads/2016/12/Resources-to-support-answering-medicines-related-questions-Feb-2019.pdf • SPS breastfeeding information https://www.sps.nhs.uk/home/guidance/safety-in-breastfeeding/ • UK Medicines Information, requires registration https://future.nhs.uk/UKMedsInfoNetwk/grouphome references 1. Jordan S, Bromley R, Damase-Michel C, et al. Breastfeeding, pregnancy, medicines, neurodevelopment, and population databases: the information desert. Int Breastfeed J. 2022;17. doi:10.1186/s13006-022-00494-5 2. Soussan C, Gouraud A, Portolan G, et al. Drug-induced adverse reactions via breastfeeding: a descriptive study in the French Pharmacovigilance Database. Eur J Clin Pharmacol. 2014;70:1361–6. doi:10.1007/s00228-014-1738-2 3. Lam J, Kelly L, Ciszkowski C, et al. Central Nervous System Depression of Neonates Breastfed by Mothers Receiving Oxycodone for Postpartum Analgesia. The Journal of Pediatrics. 2012;160:33-37.e2. doi:10.1016/j.jpeds.2011.06.050 4. Anderson P, Sauberan J. Modeling drug passage into human milk. Clin. Pharmacol. Ther. 2016;100:42–52. doi:10.1002/cpt.377 5. Merlob P, Schaefer C. Psychotropic drugs. In: Schaefer C, Peters P, Miller R, eds. Drugs During Pregnancy and Lactation . Elsevier 2015. 743–774.
Deeply saddened to read this. I came to know Gul as part of the Pharmacy and Public Health Forum. She had such passion for pharmacy and steadfast belief in the profession’s potential to improve public health. She expertly invited opinion, probed and challenged fairly. She remains an inspiration, a role model and will be sorely missed.
Incredibly sad to hear of Gul's passing. We worked closely together from 2009 on the Health Living Pharmacy work programme and her passion for pharmacy's role in public health could never be doubted. I last saw Gul at the end of September; she was not feeling herself but keen to celebrate the achievement of others. We had a big hug, which I will remember with affection and true to her essence, Gul was keen to push forward community pharmacy's role in prevention. Mental health, cardiovascular disease and lipid management high on her agenda. More importantly, Gul always had a kind word for everyone, keen to celebrate success in pharmacy but beyond all else was a proud mother, wife and daughter. Gul, you will be so sadly missed in pharmacy and by your family and friends x
Great article! However, increased adjudication is not met up with increased seats for OSPAP in the universities, resulting into too many students not getting admission and wasting time and money. To put things into perspective, only about 200 applicants could secure a seat in 4 different universities for the year 2023. This will create a backlog of about 500 applicants, with addition to, I think, 700 more applicants for the next year (2024). But the number of OSPAP -offering universities and the number of seats will remain the same.
I agree with Dharmendra Amin and Anne Parfitt-Rogers about paper copy of The PJ, but we are now living in a "digital word" and lots of publications are only available online. I MISS holding a hard copy in my hand and read it. Perhaps RPS will find a solution 🤷🏼♂️🤔!!! Any solutions RPS?
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Sincere condolences . Out thoughts and prayers are with you Tim. Rajni Patel & Usha Khanna .. Batch mates from Brighton . Please get in touch 07984462329
Sincere Condolances from Brighton colleagues, very sad to learn the news. Still, have happy memories and you will be missed hugely, Also from Ranjnikant Patel and others.
Please send me alert emails as before with information on CPS articles and up. to date news. The last email received from your end was back in September
Would have been nice to have had some response or private contact from Mr Bennett or someone in HQ to my comments, but like other responses submitted to other consultations or requests for ideas, nothing happens. I won’t bother any more. Happy New Year
Thorrun Gavind says that there has been a 'fantastic response' to the proposed Vision from the pharmacy profession. Would she be kind enough to publish the percentage of Society members who have supported it?
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Michael Dowdall - Executive Editor, Research & Learning
Drug shortages have been a problem for many, many years and cause enormous stress for pharmacists. From time to time the Pharmaceutical Society has claimed to be doing something about it but to little effect. Has the Society no influence over manufacturers? Does anybody care about the stress and inconvenience this is causing?
With much sadness and regret, I must write a few words about my research supervisor, colleague and friend, the late Professor Alan Tallentire. Alan's many academic and industrial achievements and accomplishments have already been enumerated In the Journal, nevertheless some personal reflections are appropriate. I had known Alan since 1968 when I was accepted to his team of radiobiology research students at the Pharmacy Department at Manchester University to work on radiosensitization of bacterial spores. I recall that on joining his small but select group as an enthusiastic young student raring to get started with my research, Alan's first priority was making sure I had suitable "digs" and financial support for tuition and subsistence. He was instrumental in helping me obtain a generous research grant from the Society.
Alan expected high academic standards from his students, and although highly critical of us in the lab, outside he was always most supportive and displayed pride in his students. He was keen that we present our research progress at academic meetings at every opportunity. I recall that within months after my arrival, he insisted that I should present my preliminary findings at a Spore Group Meeting in Harrogate.
He was also enthusiastic about his students acquiring teaching abilities and encouraged our participation as postgraduate tutors in pharmacy lab classes as well giving occasional lectures to the undergraduate pharmacy students. Alan not only taught me good scientific skills, but also how to write "good science", something I appreciate to this day. He was meticulous about good, clear and correct English usage and was highly critical of slovenly writing.
I often recall his high standards of "business" ethics (even in science) when it involved grants, stipends, travel grants and plagiarism. Alan was more than a research supervisor; in fact, he acted as a wonderful father figure to all his students.
Alan's many industrial contacts and his promotion of research within industrial pharmacy exemplify his not-living in an "ivory tower", yet he fought for high academic standards within the University setting, and was very much against the incorporation of non-academic subjects into the University's curricula (as was becoming fashionable in the early 70's). His scientific development of ISO Standard 11137 (a Standard for radiation dose setting for gamma-ray sterilization) is just one example of applying his research to the industrial setting. His founding of Air Dispersions after his retirement from academia is another.
Despite his crowded academic schedule, Alan was a keen sportsman. There was always time for a lunchtime game of squash or evening football game, a round of golf, as well as his unflinching support of Burnley (his home town) and England's cricket team.
Having moved to Israel after obtaining my Ph.D., we managed to keep in contact over the years - often when back in Manchester, I would visit him at the University or at Air Dispersions. As I continued in the same field both at the Hebrew University in Jerusalem and as an independent consultant on sterilization issues, we would both be invited from time to time as lecturers at International Atomic Energy Agency courses or meet at IAEA headquarters in Vienna. I last spoke to him a couple of years ago at an ISO zoom conference when we even managed to exchange a few jokes and reminiscences.
Alan was a most influential and sociable person, and would always find an excuse to take out his students for a beer, as well as inviting us all to his home. I fondly remember the annual dinners at his home supported by Lucy's culinary abilities.
My condolences are extended to his dear wife Lucy, and children Lawrence, Iain, David and Caroline and their families, to whom Alan was a wonderful husband and father. He will be sadly missed.
Geoffrey P Jacobs Dr Geoffrey P Jacobs Associates Consultants to the Pharmaceutical & Medical Device Industries POB 3304, Jerusalem 9103301, Israel Phones 972 2 6422227 0525509207 Fax: 972 2 6432372
Completely agree. Thanks for putting this critical piece out. I'm Ali, co-founder of Chorus Sleep - a non-pharmaceutical for insomnia. Another problem with melatonin (in addition to what you raised here) is the amounts found in over-the-counter supplements can vary DRAMATICALLY, so you don't know what you're getting. I like that you highlighted the importance of changing routine more than using supplements. We conduct a ton of research internally, and as I'm sure many people in this community know, the most impactful thing for improving sleep quality is keeping a consistent wake and bedtime schedule seven days a week.
It's also interesting to call out the rise in sleep problems since COVID. I'm not sure of the equivalent number for children, but for adults in the US - before COVID, it was estimated that 66% of adults had trouble sleeping each week, and now that number is estimated to be 86%. Clearly, the rise of stressors in our life, disruption to routine and cues our brain relies on for circadian rhythms (like working from home under fluorescent lights late into the night) is making our sleep worse, which is problematic for mental and physical health.
The combination of rising sleep challenges and insufficient solutions is becoming a more dire problem by the day. Thank you for writing about this important topic - education is a critical part of working together to solve it.
PS here is my LinkedIn if you ever want to connect directly: https://www.linkedin.com/in/ali-abramovitz-cook-69458459/
This is a good step for pharmacist Independent prescribers, the NHS and the general public who usually could have received appropriate treatment in the pharmacy for many conditions, but have to be sent to their doctors or NHS111 or walk-in centres for the same treatment (becos the pharmacist cannot prescribe the medication needed).
My question is: how does one receive funding for the course? Is it self funding or it is NHS funded? How does the program help Locum pharmacist to get a DPP? Thanks
I am not representing the course or provider in any context but in response to your first question about funding I see on the website materials somewhere it says that you can self- or NHS-fund the course. Your second question is of course one of the many difficulties practising Pharmacists are facing in accessing these courses in a supported way. There are huge barriers, as many of us know. Not least if you are full time and attempting to try to fit that course in around your working life. This is something that urgently needs to be addressed. Who wouldn't agree that proper support and protected time for most aspects of that course needs to be there and this needs to be addressed at a higher level now.
I applaud this excellent, heartfelt, and candid opinion piece about pharmacy professionals being undervalued and poorly utilised within Primary Care Networks (PCNs) in England. Sadly, I also hear this a lot in my various working arenas, especially when teaching on the national Academic Health Science Network’s (AHSN) Polypharmacy Action Learning sets, and have written often, with my colleagues and allies , about why medicines experts are a necessity, not a luxury, in general practice (1-3) As a former consultant pharmacist in acute medical care and medication safety who pivoted to work in primary care in a different NHS region, I would therefore offer the following succinct & pragmatic words of encouragement, about what can be a very harsh and tricky environment, and because, sadly, you can’t avoid personalities or politics in any job! 1 Be visible, have a medicines optimisation (MO) vision and share it often so pharmacy, medical, allied health professional, managerial teams are crystal clear what medicines experts can, and shouldn’t, do to improve patient care, improve medicines systems and safety, and save GPs time 2 Seek out respected GPs (ideally, but not necessarily, the prescribing lead) and managerial/administrative allies who have influence at a PCN board level as soon as possible once you are clear about the lay of the land. Use your patient honed communication skills to reach mutually beneficial outcomes 3 Ensure all pharmacy professionals document all clinical activities in patients’ clinical records and then agree what process and outcome data the PCN wants presented on a monthly or quarterly basis via a PCN wide medicines optimisation meeting 4 Set up the quarterly PCN wide medicines optimisation meeting chaired by the most respected prescriber but including all GP prescribing leads, senior pharmacy professionals, a community pharmacist lead plus Integrated Care Board (ICB) MO and PCN board representatives. Use national comparative MO data sets to help everyone see how well, or not so well, you fare compared with other PCNs in the ICB and understand / “buy into” the scale of sub-optimal medicines use 5 Go around obstructive practice / PCN personnel via 1, 2, 3, 4 6 Make sure you have agreed non-clinical sessions for thinking about, and dealing, with 1-5 7 Speak to other Additional Roles Reimbursement Scheme (ARRS) senior staff who may also have similar issues and can also help with 5 8 Ensure you have a personal mentor or coach outside your place of work and tap into any ICB wide pharmacy professional networks (What’s App groups and /or more formal groups) for reassurance, belief, and invigoration. If I can help further feel free to drop me a line @STEVECHEMIST on Twitter You have got this…….. Steve Williams Senior Clinical Pharmacist Poole Bay and Bournemouth PCN Founder / Owner of One Less Pill Ltd References 1 Williams SD, Hayes JM, Brad LD. Clinical pharmacists in general practice: a necessity not a luxury? British Journal of General Practice. Br J Gen Pract 2018; 68 (667): 85. DOI: https://doi.org/10.3399/bjgp18X694697
2 Williams SD, Hayes JM, Brad LD. Clinical pharmacists within primary care networks: a driver for collaborative general practice BJGP Life June 17th 2020 https://bjgplife.com/2020/06/17/clinical-pharmacists-within-primary-care-networks-another-driver-fo1 r-collaborative-general-practice/
3 Williams SD, Brad L, Jones D, Hayes J. Pharmacy professionals are part of the solution to reduce GPs’ workload BMJ 2021;373:n1176 https://doi.org/10.1136/bmj.n1176
Brilliant. Thanks for this article! I’m going to try and share it with our PCN Manager to help planning better use of our time. My PCN is receptive and interested, hopefully will be a positive outcome.
I totally agree with the article and have found private providers very often request off label high doses of transdermal oestrogen which the patient then expects primary care to issue. This causes a lot of conflict as we as a practice have decided against any off label prescribing
Sodium valproate preparations should be classified as "special containers" so they are never issued in white boxes and always have the manufacturers warning clearly visible.
In Scotland there has been a huge increase in the number of Community Pharmacy Urgent Supplies (CPUS) too. Surgeries are directing patients to the community pharmacy quite often inappropriately. They are not processing repeats quickly enough taking around 7 to 10 working days. I realise this is a service we provide but it is not a repeat prescription service. Patients have been quite aggressive if it is something we cannot do. Obviously we try and help when we can but pharmacy staff are at breaking point .
I agree. I looked at bioequivalence requirements a long time ago (2014) & was surprised to see the wide tolerances permitted (80% - 125%) between test & reference product. For narrow therapeutic index meds (decided on a case by case basis) between 90% - 111.11%. This was the Bioequivalence Guidance document published by CHMP/EMA in 2010. I haven't checked to see if this has been updated since, but IMHO the bioequivalence tolerances should be tighter.
Janice Barnes should perhaps understand Community Pharmacy remuneration and Drug Tariff before making a statement like "legally this brand will be dispensed by pharmacist" Community Pharmacists will only dispense what they get paid by NHS. Also, some PCN pharmacy advisors tend to muddy the waters by switching to "cheaper " brands to justify their existence of making savings. We notice that even in other clinical categories. Paresh Modasia
I stand by my comment that pharmacists must dispense a medication brand if specified by the prescriber on the patient's prescription. If the brand e.g., Sinemet is written on a prescription, the pharmacist must dispense Sinemet unless it is unavailable. If it is unavailable the pharmacist can • ask the GP to alter the prescription to a generic product which may be easier to source • signpost the patient to another pharmacy that has the branded product in stock • in some circumstances where there is an ongoing stock shortage problem, NHSE issues a Serious Shortage Protocol (SSP) then the pharmacist can dispense an alternative product against a branded Rx and endorse accordingly (SSP reference number, date, brand and price of product supplied). Whilst, I fully understand the current cost pressures and funding inequalities within community pharmacy, my role is to manage people with Parkinson's disease who have been stabilised on a specific brand of medication and a change of brand could have deleterious consequences on their symptom control. Janine (not Janice) Barnes
I completely agree with the remuneration issue you describe. However, I think Janine is stating that patients ask the prescriber to write the brand on the prescription rather than demand that the a brand is supplied against a generic prescription.
As a pharmacist I always have conversations with patients purchasing otc pain relief products containing codeine. Unfortunately, I could refuse to sell the product, but another pharmacy can still sell the product to the patient. There is no viable solution but to reclassify these products
If sodium valproate is classified as a special container then it will be dispensed in a full complete pack in the original packaging. Under current legislation I’m not sure how this could be achieved otherwise. At the moment with pack sizes as they are you have to split boxes to dispense the quantity ordered.
Nice to hear the word ‘causal’ being used in relation to clinically relevant adverse drug reactions- something which regulators & clinicians are sometimes reluctant to use.
Regardless of merits the new body might have, in terms of accountability could the PJ explain to whom the new body would be accountable? The Chief Pharmaceutical Officers are all appointed by individual UK nations (ignoring for the moment NI government problems), and are accountable to their respective governments. Is the creation of the new body something that all four nations will need to endorse, or from where else will it it derive its authority. Who will scrutinise its budgets and who will be responsible for ensuring its accounts are audited?
Very wise words once again from the last president of the dual purposed society (regulation and representation) who clearly has not lost site of the opportunity we had for a clinical leadership body. Do enough members want a clinical leadership body or will they wish to remain mired in a watered down PDA (which currently does a fine job of it’s own) pursuing perceived grievances and politically correct “right on” agendas rather than clinical leadership? There are some fine people on the representative boards but I wonder if there are enough to inspire others to stand? The annual embarrassment of “angry” members promising “Change “ usually directed at pharmacy employers has become cringeworthy. Most, whether elected or not, are seldom heard of again and that is worthy of reflection. Why do they stand and how do we encourage the motivated individuals who have so much to offer in truly leading the profession to stand.
As Mr Churton says, we have a big opportunity now. But will individual pharmacists grasp it? I hope so
Viral, congratulations on this amazing achievement. Your work has been an inspiration to your fellow colleagues, not only with the vaccine rollout, but with your broad portfolio of public health work which has enhanced the provision of public health services nationally and strengthened the reputation of the profession.
It's easier to collect the data on how many women of childbearing age are being prescribed valproate, but not so easy to draw the conclusion that they are not being informed about the risks. The only way to gain this level of insight is through clinical audit. Also with regard to women on valproate who have given birth, is there clinical audit to show whether they were informed about the risks or not before conceiving? How about those patients that choose not to complete the prevent form? I appreciate that more can be done, but need to be careful about assuming it is always due to a failure of healthcare professionals re informing the patient.
Even if the margin per pack calculated is correct (which I highly doubt), the government have not taken into account the spiraling costs of staff, utilities, fuel etc. More smoke & mirrors from this tory cabal.
OK, we are supposed to accept this tosh from an organisation that will not disclose the information it relies on in setting concession prices? Many concession prices are announced having been imposed. That means despite objections from PSNC and evidence from PSNC to the contrary. We cannot believe a word these people say and that has been the case for 6 years. It really is time they were called out by PSNC. “Profit”? Gross or net? Justify your findings.
Interesting that their working party includes no pharmacists. That may be a problem. And also their insistence of calling it sodium valproate throughout and not including the names valproic acid and semisodium valproate, which may confuse some people (service users and maybe one or two healthcare professionals and carers) and lead them not to make the connection.
This is a great initiative promoting further integration of care within the system. It would lead to better outcomes and a more effective, efficient and quality care for service users.
It's very interesting that when it becomes apparent that sodium valproate may have a reversible effect on male fertility the CHM advises that there should be greater scrutiny of the way valproate is prescribed and that further risk minimisation measures are required. Scandalous this situation has drag on for years effecting the lives of the pregnant women, the mother of the child and the child itself.
If a prescription dated February or March is not collected and paid for until after April 1st, will the certificate cover this or only prescriptions dated from April 1st?
Our research on the topic of CRP testing and its relevance in community pharmacy was published in PJ in May 2018. We identified the important benefits of CRP testing in terms of highly significantly reducing unnecessary GP appointments and antibiotic prescribing and presented the work at a number of conferences where our approach was applauded by Lord Jim O'Neill. Unfortunately, as you point out in this article political issues around funding prevented the scheme from being investigated on a larger scale. https://pharmaceutical-journal.com/article/research/point-of-care-c-reactive-protein-testing-in-community-pharmacy-to-deliver-appropriate-interventions-in-respiratory-tract-infections
Change is a must in modern times. Thoughts about social responsibility have been suppressed in the discussions but for a body with a Royal Charter is important. Reforming the profession as well as the NHS is a necessity as societal, professional and other changes force a review of relevance to the needs of the nation. The article and the report rightly highlight some major challenges for professional leadership bodies, particularly the engagement of younger members, credentialing and career development for pharmacy professionals, and having a more powerful advocate for the value of pharmacy services in improving patient care. To say RPS has been a bit lethargic in these areas is an understatement yet it should be remembered that other national contractor bodies have worked overtime to clip its wings. And, tge NHS itself could have helped. For example, why is CFCP driven by service specifications rather than professional standards? I think the profession would agree that changes are needed. But, my discussions with the members of the profession indicate a divided view about the process. More information about the process is needed for an informed collective view to be formed within the profession. I feel there is a need for position papers written by independent experts to inform and stimulate a debate. Perhaps, RPS and joint chairs would pause and take steps together to publish necessary position papers and allow the profession to discuss, debate and hopefully engage more meaningfully in the change process including the formation of proposed council. Whether a new or a reformed broom is needed requires a discussion but the process must be effective in the end and have general support of the profession.
Thank you to the authors for the important article which adds to the toolbox at the disposal of the Pharmacist and the duty of care to recognise nuances of thoughts, feelings and responses evoked by self-harm.
I read the case studies to be fictitious scenarios designed to illustrate the subtleties involved in recognising signs and the great impact that small adjustments can have on patient care and outcomes. If not fictitious, would it be possible to confirm that either of the two case studies represented a real scenario involving a real patient? Thank you.
Many thanks for your comment. I am the Senior Editor for Research and Learning who worked with the authors on this article. The case studies are based on a mix of the authors' professional experience combined with elements written to facilitate learning but were not purely based on a specific case or individual.
Is there not scope for the ICB to offer a new contract (in the vicinity of the closure) to provide NHS pharmaceutical services when there is a closure and the remaining local contractors cannot cope with the extra workload ?
Surely this is the rational way to ensure that local populations are not left disadvantaged because of commercial decisions made by corporate contractors who want to withdraw from providing NHS services in a locality.
It may well be the case that what may not be viable for a large corporate chain could be very viable for a small independent contractor.
Too complex 🙈 I am going to have to send patients back to GP for a separate script for HRT . Please can RPS & PSNC advise drs via NHSBSA to write separate scripts for 1 st April . Thank you
I think there is an error in the table where Sodium Chloride 0.18% and Glucose 4% is repeated twice, do the authors mean Sodium Chloride 0.45% with Glucose 5% but osmolarity would be different than quoted in the table. Also, in the paragraph under the table "Thyroid Function rests". I assume 'tests' would be more appropriate.
Is there a role of hypertonic saline? Especially when considering the acuity of hyponatraemia i.e. <48hours vs chronic.
Thank you for pointing out the typo's in the table, and elsewhere. This has been kindly addressed by Sophie and the team at the PJ.
With regard to your question about use of hypertonic saline, I think it was touched on in the article, albeit not in detail.
I would say it does not have a role in routine management of hyponatremia, especially in chronic hyponatremia (>48hrs) because of the risk of ODS. I would say never in the absence of close monitoring - hence why we have advocated it be done at least in a level 2 environment where those facilities are available.
However in severe hyponatremia presenting with neurological symptoms, typically acute rather than chronic (although it can be a rapid drop in pre-existing chronic hyponatremia), can be treated if there are adequate monitoring requirements to avoid the risk of over-correction. In these subset of patients, we would give infusions of 150mL 3% hypertonic saline (or equivalent) over 20 mins aiming for a 5mmol/L increase ideally within the first hour, and then not more than 10mmol/L in the first day. This use (i.e. the use of hypertonic saline) is advocated by the European guidelines - found here (https://eje.bioscientifica.com/view/journals/eje/170/3/G1.xml)
Thanks Renita, great article of a complicated subject. Case studies were great. Interesting NEJM released some RCT data from Canada regarding ODS is rare and sodium may not play as big a role as we think https://evidence.nejm.org/doi/full/10.1056/EVIDoa2200215. However, in practice I have seen the devastating effects of ODS and hypertonic saline always makes me worry....
Having chatted to you both outside my house in North Lancing just prior to the death of Carina you can imagine what a shock it was to read your sad announcement. She was a colleague and friend who will be sadly missed to both the family and the profession. My thoughts are with you.
This would be unlikely in a patient intending to buy over the counter remedy on an ad-had basis. Cyclizine IS still a -pharmacy medicine, although it laboured under a bad press for a few years. You may attract criticism for selling it in that, it would be akin to using a sledgehammer to crack a nut!
I am a long lost aquaintenance of my dear dear neighbour and hope to think a friend .I can truly say a piece of my heart is broken to learn of Victor's passing away in 2022.I can believe his achievements and love for his community.
I have always treasured one memory. When we were both kids growing up in Leeds Victor's father asked us to dig up the soil in his back garden. Well we decided , after reviewing options ,that a true achievement and more like a real brief was to transform the garden and add a feature of a 5 foot deep crater ,so we could both jump from the neighbours garage into the crater. We dug this crater from Morning until it was to dark to see.Needless to say Victor's father was not as pleased with the result as we were.Think Victor's mother and my mother probably saw the amusing aspect and recognised what we could both achieve.
All my heartfelt wishes to Victor's family and friends. I can see that his colleagues truly loved him and still do. He showed that families and communities are important to welfare .There is no doubt that he would love music.
Yours Stanislaw Antoni Smigielski BscHons Env Eng Long lost neighbour
I believe there is an error in the second paragraph of this article. Finerenone is a mineralocorticoid receptor ANTAGONIST, but the article states AGONIST.
I am the senior editor for research and learning at the PJ. We are currently looking into this with the authors of the article and respond in due course. Many thanks for your comment.
This is an excellent project showing how a simple intervention with collaborative working across the health social care interface can lead to better care for both patients and planet. Should be replicated nationwide....
Has any agency or research looked at the presence of nitrosamines in "food or health supplements"? Significant numbers of the public consume these too.
I agree with Mike Hannay's analysis of the proposals for a Government appointed PLC to oversee the leadership of the profession and share his concerns about the government's intentions Royal College status seems the best option but would be very difficult to acheive given that a Government recommendation to the Sovereign is required DVid Carrington
So at last England adopts a system that has demonstrated proven benefits in the devolved administrations as well as evaluating well in pilots ( I took part in one in 2019 which really proved it’s worth during the pandemic as so many GPs withdrew F2F services). But notable individuals including Sajid David as then health minister and particularly Thorrun Govind, chair of the English National Board have repeated the assertions that these are worthwhile schemes. And so, thankfully it’s come to pass. Particular thanks are due to Janet Morrison and her team at PSNC but I don’t think this could have happened without the support of David Webb, the new Chief Pharmaceutical Officer so I put on record my thanks to him.
So sorry to hear. Carina worked with us closely on medicines safety developing audits for PQS. Her work and impact on patient safety through community pharmacies across England will live on.
Wouldn’t it be nice if the various commentators and academics would consider that pharmacists actually have far more training on AMR and its consequences than any of the other prescribing professions? If you consider how many extra hours of pharmacology the average pharmacist graduate has studied it’s actually an insult to suggest otherwise. Allowing pharmacists to advise on clinically appropriate use of antibiotics is surely the safest way forward.
I also have reservations about this initiative. It will allow people to obtain antibiotics more easily which will encourage people to present earlier than waiting for a GP appointment. Patients do not always tell the truth about the length of time they have had a condition and they can access pharmacies easily. Perhaps target other initiatives for community pharmacy that don't involve antibiotics. We need fewer prescribers of this group, not more
So what you imply is that pharmacists are not capable of making clinically appropriate, professional decisions about peoples presenting symptoms. Nor will they be able to follow appropriate NICE guidelines on treatment protocols? I am offended if that is what you mean.
Pilot should also consider other primary care providers (Community Pharmacies) for future proofing concept of testing access through different clinical pathways.
I am saddened to hear of Don's passing. I worked with Don, and found him a kindred spirit when it came to technology. He would implementation various bits of code and programming to make like easier in the pharmacy. Immensely intellectual, and always had time for others, especially if the conversation was around technology.
This article appears to rely on the misguided contention that Government is intent on undermining the natural order of professional leadership within the profession. Nothing could be further from the truth. The CPhOs are naturally concerned to ensure that leadership of the profession is “fit for future” given the professional developments and increasingly clinical roles which members of the profession will discharge over the coming years to the benefit of their patients. Nothing more, nothing less. And certainly not the conspiratorial concerns expressed by Professor Hannay. The independently chaired transitional advisory PLC will be charged with developing and delivering what the profession believes is needed. I emphasise the word “profession”. Its deliberations and recommendations will be informed and shaped through wide ranging consultation with all interested parties, and should ultimately a Royal College be decided upon it will be established without impediment. Thankfully the recent RPS AGM motion in the authors name, which unbelievably called for the RPS to refrain from all involvement in the PLC, was resolutely defeated. It is perhaps instructive to point out that if the RPS had followed through on its remit to establish itself as the Royal College for the profession (a very clearly articulated “end game” when it was established in 2010) then quite probably we would not now be having this discussion. We have “lost” at least 5 years in not doing so, and we now need to move with pace and determination to establish what is required.
Very useful article. One of the key missing actions is transparency in the supply chain. It is still unclear how many API manufacturers supply those that assemble the finished products (FDF), and how many FDF manufacturers then supply different generic companies. Without this, it is difficult to predict the potential impact of disruption at each stage. In addition, there is a need to hold larger buffer stocks at each production stage to account for disruptions because pharmaceutical manufacturing is a long game over 5-6 months, and so increases in production will not be available quickly.
In terms of discussing personal issues which impact on work, confidentially, then please consider contacting Pharmacist Support.(PS) Listening friends who are volunteers with PS are pharmacists and an experienced source of support.
Hi PJ team. The NICE guidance actually says "including, but not limited to tiers 3 and 4", so from the outset it was viewed as something potentially suitable for Primary Care initiation.
I was very sad to read of David Cousins death. I first met him around 1980 when he came to work for me as a ‘Saturday pharmacist’ in the pharmacy I then ran on Canvey Island. He was a careful, conscientious pharmacist, someone with whom it was a pleasure to work. However he soon moved on, as did I and the next time I heard of him was in 1990 when I went at Orsett Hospital, where he had almost mythical status among those who had worked with him! We watched his career with interest, and it was no surprise that he achieved the heights he did. My deepest sympathies go to his wife and family.
Stating chickenpox is self limiting in adults suggests it is not a real problem. However in many cases it can be an extremely painful and unpleasant experience for many adults and Acyclovir would shorten the period of these symptoms. In my experience most patients do not receive this product in time. No figure for deaths in adults in the UK from chickenpox is available but the U.S estimates 100-150 deaths per annum.A vaccine in the Uk for those adults who have not had chickenpox would seem a worthwhile step forward.
Tribute to David Cousin: A Luminary in Pharmacy and Medicine Safety
It is with profound sadness that I learned of the passing of David Cousin, a figure of unparalleled stature within the world of pharmacy strategy and an extraordinary human being. As the president of the Royal Pharmaceutical Society of Great Britain (RPSGB) during our acquaintance, I was immersed in the mission to make Britain the safest place to take medicines. Our paths crossed during this pivotal time, and a shared fervour for medicine safety solidified our professional and personal bond.
Our frequent interactions were an exchange of passion and knowledge, from which I gleaned invaluable insights. David's presence was highly influential and impactful, marked by his steadfast leadership both nationally and internationally.
A memory that stands out vividly is of a gathering of global experts on medicine safety in Chicago. David's reputation preceded him there as well, with international colleagues expressing their immense respect and admiration for him. His natural wit and kindness added a distinctive charm to his personality, making him a cherished figure among peers and friends.
The pharmacy community, as well as his beloved family, has suffered a great loss. But David's legacy, deeply rooted in the realm of medicine safety, continues to thrive, influencing current and future generations in the field.
My heartfelt condolences extend to his wife, children, and extended family. David Cousin will be profoundly missed, yet his influence and memory will undeniably persist.
It was with great sadness that I learned of the death of David Cousins, a pharmacist whose legacy will live on for years to come. Our paths crossed often during his career. I was invited to be the external assessor on the interview panel when he was appointed Chief Pharmacist at Derby Royal Infirmary and many years later, I chaired the interview panel when he was appointed to the National Patient Safety Agency. History tells us that the right person was appointed on both occasions. His contribution to the advancement of hospital pharmacy practice and education and to the improvement in patient safety, through the development of policies and procedures, are recognised across the world. I offer my deepest sympathy to his wife and family.
I first met David while we were doing our pre-reg year in the South-West, with its famed 2-day residential courses. Even then, he was clearly head and shoulders above the rest of us and we could tell he was destined for greatness. Although our paths didn’t cross that often after that, we did speak at a few conferences together and were able to chat. I followed his career with interest and, whenever his name was mentioned, it was usually associated with the word “first” e.g. first to/first service to:first person. A remarkable man.
Although David was well known in the profession I didn't meet him until he joined the NPSA while I was at MHRA and we were both charged with implementing the findings of Organisation With A Memory - a report which sought to reduce the likelihood of medication errors happening in clinical practice. Patient safety was a passion we shared and it was an enormous privilege for me to work with David and to collaborate on the many guidelines he introduced over his years with NPSA. His work has had a lasting impact not just in the UK but across the international community. Patients across the world have much to thank David for and his legacy will be be a bedrock for future work in the area of safe medication practice. David and I also shared a love of music so our interactions also touched on the joy that our music brought to those around us. I am immensely saddened by his passing. My condolences and prayers go to his family. He will be missed by the profession but his influence will certainly continue. Rest in peace David.
I was shocked and saddened to hear of David's passing. David and myself were allocated adjacent benches for practical classes when we commenced at the School of Pharmacy, University of London in October 1972. So commenced a friendship that lasted in to the early stages of our careers in hospital pharmacy.
On graduation David returned to his native Devon and myself to Essex. He became frustrated with the limited career progression opportunities in the West Country. After mentioning this to Jeff Watling, then Area Pharmacist for South Essex, David was promptly installed as a Staff Pharmacist at Orsett Hospital, Grays, and Trina followed a few months later to take up a pharmacist technician post at Basildon Hospital.
David’s pioneering qualities soon became evident. He was in the first cohort of students to graduate from the University of London’s Masters in Clinical Pharmacy course based at Northwick Park Hospital. It was no surprise when David moved on to a Principal Pharmacist post at Derby Hospitals but before leaving Essex he was instrumental in founding the Essex Group of the Guild of Hospital Pharmacists (now Guild of Healthcare Pharmacists). His enthusiasm for pharmacy and life in general was always to the fore, and will be missed.
Soon after Keith Ridge the former CPhO announced the funding cuts in December 2015 I had a meeting with him. I asked him what he wanted his legacy to be. He had made no secret of his desire to force 3000 pharmacies to close and when asked which ones he wanted to close he said “the market will decide “. Well now it has. And Keith’s legacy is clear. A disaster for our profession. A disaster for patient safety. A disaster for patients and the public. A period of prolonged silence on behalf of the former CPhO would be welcome. But that’s probably about as likely as a period of silence from Boris Johnson
Whilst the news that the government is scrapping the plans to make 66 the cut off age for prescription levies is welcome, it really irritates me when the Prescription Charges Coalition claim that people with long term conditions are unable to collect their medication because they can't afford the prescription charges. They are, I feel, being more than a little disingenuous in this as they are, or should be, aware that anyone having to pay prescription charges can get relief from these by buying a pre-payment certificate. Pharmacists are not blameless in this. Anyone collecting more than three items on a regular basis who have to pay, should be counselled on how it would benefit them if they had a pre-payment certificate. The NHS provide these certificates to help people who have long term conditions which aren't eligible for free prescriptions. Yet when the news of raised prescription charges appears on TV, people will spring up claiming they won't be able to afford their medication, and their condition will get worse because of a lack of medication. Where are the pharmacists advising these people? Regards Bob Dunkley Retired Pharmacist
My belated but no less sincere congratulations to Jonathan on receiving this prestigious award. Beyond any doubt a worthy recipient in recognition of his significant contributions to pharmacy practice, an inspirational leader that has been a major influence in key developments in Scotland and beyond for many years. Long may he continue so to do.
As someone who does not specialise in neurology and has only heard the mainline narrative, this was a fantastic read. True food for thought, with excellent points well argued and which need wider and (ironically) more informed debate. Well done to the author.
My daughters small pharmacy chain spends hours weekly chasing medicines that are short in an effort to supply patient needs There is currently no additional income for the time spent on this
As a pharmacist involved in the pharmaceutical industry I understand the complex problems there are in the manufacturing process. Raw material shortage the more onerous requirements from the quality and compliance teams are currently very challenging This is just a sample of the issues for the manufacturing sector
The closure of smaller GMP manufacturing facilities for whatever reason in the Uk all have taken a toll I believe we need to find ways of ensuring we have a strong Uk sector and protect it
The consumer is now paying the price sadly
The regulators need to be part of the conversation team in an effort to improve supply
I was saddened to hear of David's death, one of the outstanding hospital pharmacists of his generation and a giant for others to emulate. David was an innovator, a firm believer in evidence as a basis for service development, a strong advocate for patient care at the centre of things, and a thoroughly nice guy… So much of what others were able to achieve was built upon the foundations provided by David. I will miss him and his common sense approach. I offer my deepest sympathy to his family and hope that the profession will continue to benefit from his leadership and example.
An excellent, thoughtful and analytical article that crystallises so many of the concerns I have felt as I've seen this approach unfold. Thank you for writing and publishing it Rachel.
John was the first CAPO of Tayside Health Board. He brought professionalism, an understanding of how Pharmacists could work together in Hospitals and the Community. He was much respected and a really lovely colleague.
A very useful guide which is up to date and will help to reduce unnecessary demands for antibiotic scripts SHENU BARCLAY LOCUM PHARMACISTGLOUCESTERSHIRE
Shortages and reimbursement mismatches have become all too common. Surely, it’s time the responsible authorities use their legislative powers to prevent some “market players” from “gaming” the system and harming the collective.
John Derrick Appleton died peacefully on 19th June 2023 just six months short of his hundredth birthday and six months after his wife of seventy five years. (He was John to his work colleagues but Derrick to his family). We first met in August 1978 when he gave me the greatest break in my career by appointing me as District Pharmaceutical Officer for Perth and Kinross at the age of twenty eight. Mr. Appleton, I could never bring myself to call him John, was the kindest boss I ever had. He gave me the freedom to make my own decisions but was always there with sound advice and a helping hand to rectify the consequences of the not so sensible ones.
A Yorkshireman through and through, he was for several years the Chief Pharmacist at St. James’s Hospital in Leeds before moving to Scotland as, up until 1974 and re-organisation of the NHS when he became Chief Administrative Pharmaceutical Officer (CAPO) for Tayside, the Regional Pharmaceutical Officer for Dundee and the East of Scotland, when he helped commission the new Ninewells Hospital in Dundee. John came from a generation of Hospital Pharmacists who were accustomed to having manufacturing as a primary activity and through hard work and cutting edge innovation, commissioned what is now Tayside Pharmaceuticals on the Ninewells Hospital site. At its opening it was the largest hospital pharmacy manufacturing facility in Europe. Sadly, in the early 1980s the role for which it was intended became unfashionable however following collaboration between NHS Tayside and NHS Greater Glasgow and Clyde and a £26m upgrade in 2019 it is still producing “specials” for the NHS and stands as a legacy to his vision of over fifty years ago.
He was an innovator in other ways, he encouraged the concept of Individual Patient Dispensing and clinical pharmacy when both were in their infancy and on his retirement in 1987 left a Pharmaceutical Service in Tayside that was at the cutting edge of professional practice.
John Appleton was one of a kind, he was passionate about the profession, a family man and, above all a gentleman who always encouraged, never belittled, and cared deeply about his fellow man. As a Yorkshireman he spoke his mind, but in a quiet unassuming way. This retired Pharmacist will be forever grateful for his support and friendship and will miss him sorely as will those others who had the privilege to know him and work with him.
In a world where we accept obesity to be a leading risk factor for cardiovascular disease and t2dm and many other conditions, why is the use of GLP1 agonists for weight loss use being criticised? I think it’s shortsighted. Patients with obesity who feel the need to pay privately to access drugs that could help them avoid long term conditions (not to mention improved mental health) are a massive cost-saving for the NHS and should not be made to feel that they are depriving other people of medication.
Retired, I am Deputy Chair of Healthwatch Shropshire which as an organisation which seeks to give voice to the seldom heard. We are aware of the difficulties some individuals face in accessing healthcare. Often these individuals are very reluctant to voice their concerns and it takes a long time to gain their trust. It is a deep seated problem, not only for those who seek to give exemplary healthcare but also those who fail to receive it.
Excellent article. The growth in private ADHD clinics is also driving this, but these can only thrive if the NHS isn’t willing or able to provide diagnosis and treatment.
It IS a good article but there's no consideration given to root cause analysis. WHY are we witnessing this massive growth not just in ADHD but in all forms of mental health problems. I've become fascinated by the link between diet and cardio metabolic health and the link between what we eat and brain function. Could it all be down to the role of the mitochondria? Prof Chris Palmer certainly thinks so and I can't recommend his book Brain Energy too highly
The increase is not only happening in the UK but also most part of the world. see: https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(22)00509-0/fulltext
Indeed not only ADHD treatment increase but also almost all psychotropic drugs in different part of the world. See: https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(21)00292-3/fulltext
It is probably a combination of better recognition, diagnosis and willingness to prescribe and take.
That's really helpful, Hermant. I would add that we should consider the investment in patient health as part of the calculation of cost effectiveness. If we avoid future NHS/healthcare interventions, and support people to maintain/gain quality of life, not only will that contribute to patient experience, it also contributes to the wider economic environment. For example, perhaps it can allow people to continue working, or return to work. When you state medications should be delivered in the 'right manner', I would expand that to say - " in a way that they can fit into their lifestyle, and obtain the maximum benefit from" - it's important they *can* adhere to treatment, as well. K
Worrying. So many things could and will go wrong. Throw in bad actors and the dangers could be immense. International regulation and expert overseeing is needed early days or sleepwalking into a real mess could ensue.
I have been contacted by my GP practice who have told me they are given Flu injections in September, but would not take bookings for the Covid boosters!
Should the position come that pharmacy technicians can undertake the roles currently delivered by pharmacists, then I would expect them to be renumerated at a similar rate, based on the responsibility and liability they would be undertaking. That would seem fair to me, and I would hope they wouldn't undervalue that position.
The best solution is finding another way other than doing OSPAP to evaluate overseas pharmacists as the way GPs are evaluated. If it is impossible, we should consider that there aren’t enough places in 4 universities providing OSPAP course and especially for pharmacists who are already living in the north ,Sunderland is only option to do OSPAP. If some universities like Durham and Newcastle can provide this course in the North it would be great. another problem is that the expiry date of adjudication letters is limited and it should be expanded for at least 5 years.
Firstly, I'd like to commend the entire editorial team for their hard work and efforts in putting together such a comprehensive article. The discussions and insights captured from the expert roundtable event around pharmacist prescribing are invaluable to our profession. I'd like to provide some clarifications on a couple of points attributed to me, to ensure there is no confusion amongst our esteemed colleagues:
On the topic of MDTs supporting newly qualified pharmacists, my perspective is not that it's an 'alternative' to relying on DPPs. DPPs are the bedrock of the prescribing learning in practice time through both direct, indirect and sometimes delegated supervision. The ‘MDT-collaborative’ approach to prescribing simply helps to orientate the experience, in terms of the types of objectives and activities that might be supervised during the training.
When discussing ‘MDT-collaborative’ prescribing as a concept, the intention was never to suggest that decision-making should be 'outsourced' to other members. The essence of my message is to emphasize the power of collective knowledge within the MDT, ensuring optimal patient care with each member contributing their expertise. A pharmacist prescribing at a foundation level can leverage the knowledge and skills of the team, to make a competent prescribing decision.
Building on this, regarding the 'scope of practice' for pharmacist trainees, my emphasis was on the importance of pharmacists feeling supported to make competent decisions. Instead of being limited to specific medicines or disease states (e.g., hypertension), a pharmacist’s scope is modulated by the level of support that they have around them. This is in alignment with the medical model for junior doctors.
I hope these clarifications provide a clear insight into my views and contributions during the event. Once again, thank you to the editorial team for their dedication and commitment to advancing our profession.
Really pleased to see RPS support this evidence based intervention. We know from international data that consumption rooms save lives and are economically cost effective in enabling engagement in treatment for HCV and HIV and prevention of drug related harm. I am proud of the RPS for taking this stand and endorsing a health approach to substance use issues.
I was delighted to read that Buproprion will be made available again later this year. A very good friend of mine was prescribed Zyban for Bipolar Disorder and the difference it made to her life was miraculous and it was devastating when it was withdrawn.
Is there a typo in this article? "Botulinum toxin is a neurotoxin that inhibits the release of acetylcysteine[36]." - should this read "acetylcholine" instead??
Many thanks for your comment. I am Senior Editor for Research & Learning at the PJ. We are currently investigating this with the author and will confirm if a correction to the article is necessary shortly.
This should come as no surprise to GPhC. Community Pharmacists repeatedly complain about the excessive workloads. GPhC take pride in announcing that pharmacists will be offering extra services with no consideration of the already excessive workload experienced in community. There are also many complaints about the poor staffing levels within pharmacies. GPhC simply say this is up to the employers to ensure staffing levels are adequate and that staff receive sufficient breaks. But employers are generally not interested and look at the bottom line and so continually cut staffing levels, not increase them. If you are already part-time and refuse to go full-time you are then faced with redundancy, but they say you can return as a locum for them the next day. (Yes illegal, yes reported to GPhC, no surprise GPhC not interested) That employer thankfully is rapidly dropping out of the UK market. . If GPhC supported its members better this crisis could easily have been averted.
Very sorry to learn that only 10-19% of smokers quit with vaping at 6 months. There is another important issue: having stopped smoking, do the ex-smokers continue to vape, and for how long. My anecdotal observation in community pharmacy practice in the 1990's, was that those prescribed NRT in forms that gave a substantial nicotine "hit" were more likely to continue using it long-term than those with "drip feed" NRT like shin patches. Nicotine itself is not harmless and is very addictive.
I am in Australia and have been on Paroxetine for approximately 20 years, originally prescribed for severe peri-menopausal symptoms. I have only recently become aware of the numerous negatives related to this product. I’m watching a BBC report on “Stopping Antidepressants “ , I am mortified to discover the discontinuation of the liquid form. I was hoping to withdraw from this medication safely. I am not an academic but I seriously can’t understand how a company can stop production of a product that is so essential to community health and well-being.
I also I'm on Seroxat the past 20 years, the liquid version being disconnected is absolutely insane, and uttering dangerous. Knowing how hard it is to come off this medication. I just cannot get my head around GSK pulling this from the market and not giving people stuck on it a second thought. Talk about playing with people's lifes, and not caring. I am absolutely disgusted by what they have done. I was on the liquid all these years and to learn it was being discontinued when it has seriously effected my wellbeing ever since. Surely to god people that are on this medication should be still able to access the liquid version.
I daren't get too excited until GSK confirms it themselves. Return date is still down as 'TBC' on their product supply page. I've emailed them directly but not heard anything yet.
They literally published the update in the Pharmaceutical Journal.
All such statements are thoroughly approved by a legal department beforehand – they're hardly likely to have made this announcement by accident... Trust that you'll have it again in 10 weeks' time! 😊
I have been taking bupropion (off licence) since 2016 for depression after my psychiatrist read that it has been used successfully with autistic patients. He decided to try this 12 months before I got my actual ASD diagnosis. The waiting list for the assessment was 6 years long- I am one of the many middle aged women who have finally been correctly diagnosed after a lifetime of misdiagnoses due to the belief that only boys were effected. Over the preceding 20 plus years, I had tried the majority of antidepressants with varying levels of short lived success. I was over the moon to find something that kept me stable. The past 12 months have been so stressful. Fortunately I have worked as a dispenser in the past and some of my ex colleagues had every locum they worked with scouring the shelves and drawers of all pharmacies they visited. I am grateful to each and every one as they have just about kept my rx filled whilst it has been unavailable. (Shout out to all locums everywhere! Thank you all for being there!) I had just about given up hope and had arranged meds review with psychiatrist. That appointment is today and I came here to remind myself why it had been stopped so that I could explain the issue. I cannot tell you how pleased I am to see the news that it is coming back!!
I read Dawn Connelly's article on esketamine with interest. DTB published an article on this medicine in 2020 (Esketamine for treatment-resistant depression. Drug and Therapeutics Bulletin 2020;58:183-188) and it appears that many of the issues we highlighted have yet to be resolved.
A couple of points are worth noting. Firstly, the results of the ESCAPE-TRD study are taken from a poster, which was reviewed by the RCPsych Academic Faculty rather than by the standard BJPsych Open peer review process. It is not clear if the full results have been published in a peer reviewed journal.
Secondly, the article includes comments from various healthcare professionals but does not include any declarations of competing interests for those healthcare professionals. Although readers can search the ABPI's Disclosure UK website (https://search.disclosureuk.org.uk/), I would urge the PJ to include declarations of competing interests for healthcare professionals who are quoted in its articles.
Readers may also be interested to see that the UK Government is currently consulting on "legislation to place a duty on manufacturers and commercial suppliers of medicines, devices and borderline substances to report details of the payments and other benefits they provide to healthcare professionals and organisations". I would urge readers to contribute to the consultation (https://consultations.dhsc.gov.uk/en/64d60a6e9708bb745e0cb76b). As Sydney Wolfe (founder of Public Citizen's Health Research Group) noted in an article in DTB (Wolfe S. Mandatory disclosure of all pharmaceutical and medical device companies’ payments to healthcare providers: learning from the USA. Drug and Therapeutics Bulletin 2022;60:52-55), "Unfortunately, the UK as well as many European countries lack laws mandating such disclosure. Mandatory disclosure, though not sufficient in itself, can pave the way for other necessary changes. Declaring conflicts is only the first step in dealing with this problem’, but ‘Disclosure is not enough. The ultimate solution is to eliminate all industry relationships from the practice of medicine’."
David Phizackerley Deputy Editor Drug and Therapeutics Bulletin BMJ Journals BMA House, Tavistock Square, London, WC1H 9JR
Thank you for your comment regarding the results of the ESCAPE-TRD study. Please be assured that your points around including declarations of competing interests in PJ articles are under consideration.
I am shocked and saddened to learn of the untimely death of Nina Barnett. She was a wonderfully empathetic person and a true professional. My sympathies to her family. Ian G Simpson MBE FRPharmS
I supplied the data in response to the FOIA inquiry on behalf of Sandwell and West Birmingham NHS Trust. In reply to the question "How many requests has your trust made to pharmaceutical companies for access to medicines offered through a company-led compassionate use of free of charge scheme each year between April 2014 and April 2023" we replied that we did not hold the data but in order to try and be helpful with the answer to the next question, "How many patients have received treatment with unlicensed medicines obtained this way each year between April 2014 and April 2023" I added the caveat "these are the number of patients who have received FOC, discounted, or compassionate-use medicines during the year regardless of their licensed status" as we could not distinguish between schemes put in place before licensing or after NICE approval.
This caveat has been completely ignored by the author of this article and it is disappointing to see the data misused in this way.
Thank you for highlighting the caveat on the data from Sandwell and West Birmingham NHS Trust. The article has now been updated to reflect this. If you have any further queries on the data please get in touch: carolyn.wickware@rpharms.com
I do not agree with extending the roles of pharmacy technicians or with the introduction of so-called 'physician associates' either.
There are undoubtedly a cost-cutting exercises going on but, apart from that, doctors should be doctors, pharmacists should be pharmacists and technicians should be technicians.
Peter, there’s no doubt that technicians are cheaper than pharmacists, and physician associates cheaper than medics.
However, focusing on pharmacy, another way of looking at it is that equipping organisations with pharmacists instead of technicians would be unaffordable and result in fewer staff on the floor. Technicians support the pharmacist infrastructure and allow pharmacists to work at the top of their skill set.
You want pharmacists to be pharmacists. I would argue that technicians afford us the freedom to be just that. I know I could not do my role effectively without technician support.
I’ve witnessed technician numbers and scope of practice expand over the course of my career, but this has not been at the expense of more pharmacists. On the contrary, both professions have grown together. We are reliant upon one another and this is no bad thing.
I agree with Stuart. Over the last few decades team working has become increasingly important for all healthcare professions, particularly multi-professional team working, as a result of the increase in scientific and clinical knowledge in all areas. Professional roles need to adapt and ‘being a pharmacist’ has certainly broadened from what it was when I first registered.
Key to developing roles and practice is good governance, ensuring that professions and individuals work within their competence and employing organisations use roles appropriately. This is essential to protect the public, the professionals and the organisations.
Equipping organisations with more pharmacists is exactly what is needed - rather than a re-appraisal of current roles.
I disagree with your opinion that the expansion of pharmacy practice has 'not been at the expense of more pharmacists'. There is, at present, a crisis of pharmacy recruitment and retention - proportionate, I would say, to the proliferation of new roles that nobody voted for or wanted in the first place, least of all the patient!
It was the so called physician associates who deliberately killed 7 babies, it was a nurse who was part of a regulated profession. So called commentators like yourself and your opinions reek of the classism and snobbery that everyone has come to expect from your ilk. Physician associates when given the correct support provide an excellent service, because you are too close minded you have never seen a physician associate and talk from ignorance. How many doctors and nurses are suspended from their roles due to deliberate and accidental fatalities. Bawa Garba, Harold shipman, Lucy Letby, Daniel Ubani. But you wouldn't know this just the word physician associate will trigger a snob
I am very sorry that you taken my comments to be a matter of class distinction. I apologise for giving you that impression. I assure you that that has never crossed my mind in any sphere of life at any time.
Many pharmacists, including myself, have qualified from working class backgrounds and are very grateful and respectful of the support offered by pharmacy technicians and others in their work.
you don't need to be upper class to be a snob. It is someone who looks down on others, called someone a " so called physician associate" is disrespectful, frequently pharmacists are called pill pushers and glorified shopkeeper how does that make you feel?
Please be assured that I have never 'looked down' on others and I have frequently decried 'status' in the profession. I became a pharmacist because I wanted to help people from whatever background or social class they happened to come from. I'd much rather be called a 'pill-pusher' than a 'clinical pharmacist'. I have no interest in boastfulness and pride - but I have just as much right to express an opinion about current issues as anybody else
Some look at their scope of practice, compare that to the scope of patient need, and somehow conclude they should just do what they did half a century ago
Others conclude that the skills of healthcare professionals should be stretched for patient benefit, to try address the gap between practice that is available and the practice that is required to service the patient need now.
Money is of course part of the solution to close that gap.
We do have to recognise though that PGDs are a highly regulated, thoughtful way of meeting the needs of a defined group of patients (that is their entire point). Adding pharmacy technicians to the long list of those regulated healthcare professions who can administer medications under a PGD is a pretty obvious step*.
And there is some really great news for the more conservative members of our society - pharmacy technicians would still be pharmacy technicians, just as prescribing pharmacists are still pharmacists, and doctors who also add to their skills (eg robotic surgery, informatics use, or law) are still doctors
PGDs can be used by * chiropodists and podiatrists * dental hygienists * dental therapists * dieticians * midwives * nurses * occupational therapists * optometrists * orthoptists * orthotists and prosthetists * paramedics * pharmacists * physiotherapists * radiographers * speech and language therapists
I am shocked to hear of Nina's sudden death. I have followed her work for many years, and had the pleasure of working alongside her through PRIMM. Her death is a huge loss to pharmacy and my thoughts rest with her family and colleagues. Dr Rachel Howard PhD MRPharmS IP
Barry, thank you for this heartfelt tribute. I am deeply saddened by Nina's death, and extend my sincere condolences to her family, friends and former colleagues. She was one of the most inspirational, grounded clinical pharmacist role models of our generation; an innovator, leader, and passionate ambassador for patient-centred care. Her contribution to the Consultant Pharmacists Group when the consultant role was in its infancy was invaluable, providing support, encouragement and dynamic leadership. Nina's love of her family, and her concern for the wellbeing of others (patients, professionals and more widely) were underpinned by her faith. May her memory be a blessing.
Patient need and patient benefit are adequately catered for under current arrangements. I see little need for the overlap of responsibilities (whether pharmacist, technician or physician associate) apart from role expansion.
What do the patients themselves want? Has anyone asked them?
Patients have indeed been asked in general, and the findings are a little at odds with the idea that patient need and benefit are adequately catered for under current arrangements
If you are specifically asking about the public view on the the item about whether pharmacy technicians should be permitted to fall under PGD regulations, that is of course the point of the consultation. You and I clearly have different views on this, I hope we each can live with the result
The fact that 'satisfaction with the NHS has fallen to the lowest level ever recorded' is testament to the fact that attempts to improve the service over the past two decades or so (by extending roles and services etc) have been a complete failure.
Continuing in the same vein by providing the public with what the profession wants rather than what the public wants is sure to fail as well.
A consultation is not a vote (although it is erroneously regarded as such by the profession) and is very unlikely to be representative of majority opinion.
Members of the Pharmacy Boards have such a poor level of support among the membership that they have virtually no mandate to make such wide ranging and important decisions either.
I would support a genuine majority vote if an election was conducted fairly with a significant response rate - otherwise I would suspect the outcome to be a 'fix'.
Equipping organisations with more pharmacists is exactly what is needed - rather than a re-appraisal of current roles.
I disagree with your opinion that the expansion of pharmacy practice has 'not been at the expense of more pharmacists'. There is, at present, a crisis of pharmacy recruitment and retention - proportionate, I would say, to the proliferation of new roles that nobody voted for or wanted in the first place, least of all the patient!
I think it's probably also worth a comment that since the esketamine was approved in 2019 (which we have used here) under SMC there's been this small issue of a global pandemic. We had some fo the mental health facilty reallocated to palliative care patints for a while. We were going what we could. Mental health referrals have gone through the roof since and staff who were told they needed to stretch for a period of time to get us through the COVID emergency are still waiting for when they can relax to a more reasonable level of activity.
Both the nasal spray and the ketamine injection require staffing and a bed for the person for a period of time and many hospital are running at poor staffing levels and over capacity on beds. I think it would be wrong to assume or suggestthat there isn't an appetite to treat people with these options but neither of these treatments are as simple as oral medication and are both costly in staff and facility requirements to facilitate in the context of a hugely over worked NHS where we are tasked to save the money that was spent over COVID.
I hope you don't mind me adding that Zero Suicide Alliance (https://zerosuicidealliance.com/) provide some excellent, free and concise training on how to engage with patients like those described in this article.
While this article will stimulate intellectual discussion of the position of the clinical pharmacist in a historical context, the current debate around Physician Associates means the title is likely to be inflammatory, and not in the spirit of the article - it feels like clickbait. This is the Pharmaceutical Journal, not Pulse magazine
The current controversy surrounding Physician Associates suggests we don’t need even allegorical muddying of roles between practitioners of pharmacy & medicine.
Can’t we just celebrate being super pharmacists & pharmacy technicians rather than trying to draw parallels with medics?
We owe it to our patients, their relatives, carers & to the public to be absolutely clear who they are seeing & speaking to.
In General Practice, where we have expanded teams over last 5 yrs to include a range of professions this role identification is absolutely vital - I’m proud to be a pharmacist, I’m not a medic.
1. If pharmacists want to embrace a clinical future, why don't they take a medical degree? I would be interested know your thoughts! 2. If pharmacy technicians want to be pharmacists, why don't they take a pharmacy degree? 3. Why should those pharmacists who want a clinical future effectively force it (& all the extra regulation and training requirements) onto those who don't? 4. The plethora of new clinical roles is one reason why pharmacists are experiencing so much workplace pressure. Is this justified? 5. There are so many people able to prescribe and give advice these days that medical practitioners must feel like they're losing overall control of their patients' health. Is this advisable? 6. Doctors should be doctors. Pharmacists should be pharmacists and technicians should be technicians. Overlap of responsibilities causes unnecessary confusion - all in the name of professional recognition rather than patient benefit.
When you have a family, and your working full time (sometimes more!), eight to ten hours a week, the kind of future you envisage for pharmacy is not as exciting as you make out!
In the interests of patient care and maintaining best practice, I think that it's important that clinicians (any healthcare professional) practice within their expertise. There is little to be gained from adding further confusion by using a new term such as 'pharmaceutical physician' - often my patients will call me 'doctor' in my consultations or when they want to book an appointment with me - they will say 'oh, you should have been a doctor', my response is usually along the lines of 'well, if I was, I wouldn't be an expert in medicines' which is essentially what they have found useful or helpful about the consultation or my intervention. So advancing the pharmacy profession is not about taking the place of a doctor but excelling in what we do best - managing all aspects of medicines (including prescribing and therapeutics).
Does the public not need to be clear what roles are required and who is trained to do what in their care pathways before finding boxes and titles for practitioners. Prof Anderson omits to mention consultant nurses who are undertaking medical roles too. Physician Associates roles are unclear to the public. RPS is focussed mostly on “clinical” and prescribing activities. There are many other roles for safe care provision. Managing resources, quality assurance, public health, manufacturing storage distribution compounding etc Should the many roles required in future not be identified first and allocated to those best trained to deal with them. It seems the public have no idea what these roles are and the team working required. There are dangers of black holes appearing where leadership and management is confused where roles are forgotten or taken on with inadequate training or quality assurance. What do doctors do in future as consultant nurses physician associates and pharmacists take roles over is key to the debate.
I was greatly saddened by this news and the sad loss of another member of the Square's Class of 70. Ralph was such a gentleman even in his youth - one of the genuine 'good guys'. RIP.
Doctors should be doctors. Pharmacists should be pharmacists and technicians should be technicians.
There are so many people prescribing these days that doctors must feel that they are losing control of patient care. That is not desirable or acceptable.
Clinical pharmacy has acheived more workplace pressure, more training, more regulation, more stress and more pharmacy closures. The pressure on pharmacists to acheive what they never had a chance to vote against is intolerable.
A pharmacist is a pharmacist - not a medic. Those intetested in clinical work should not force their ideas on every body else. They're welcome to the extra workload.
Clinical services have not stopped widespread closure of pharmacies nor have they demonstrably increased income - but they are a major cause of unacceptable stress and workload. The future relies on offering the public what it really needs - a safe, effective and efficient dispensing service!
Stuart paints a cogent if alarming picture of pharmacy’s future. However, pharmacy is different. A physician, surgeon, or indeed an accountant, surveyor or lawyer, gets paid for an expert service supplied to their client. Uniquely, a pharmacist supplies that expert service almost always in relation to a physical product, the medicine or drug. And either they, or someone delegated by them has to curate that product either by dispensing, storing, manipulating or in controlling its supply and preventing misuse. An entirely clinical pharmaceutical physician would not be in the business of curating the product. Indeed (and I have form here) this has all happened once before when the English apothecaries of 1650 had by 1850, abandoned pharmacy for general practice medicine, their curating role being taken by the chemists and druggists. If today’s pharmacists become pharmaceutical physicians, pharmacy technicians should indeed step into the curating role: which would make them pharmacists or perhaps even “apothecaries”, derived, from the Latin and Greek for a storekeeper.
I support Professor Anderson’s historical perspective. Sociologists’ interpretations of professionalization endeavours, including of pharmacists, fill libraries. They suggest that certain aspects may well be associated with the most intense jostling. I outline some “red flags” for those who prefer the status quo to continue. What title will the new generation of doctor have? It must be neither doctor nor pharmacist. A new name facilitates new behaviours of occupations. I suggest “medico". Other symbols also matter. For example, today’s optometrists, who use ophthalmoscopes, have battled with doctors for that right. Will tomorrow’s pharmacists wear stethoscopes? Hospital pharmacists already wear scrubs. I have eye-witnessed a junior doctor running to get a stethoscope. Fine — but before going to the canteen shared by all staff? Tomorrow’s technicians need at least a bachelor's degree. Their present qualification at registration is BTEC level 3: equivalent to three A levels. The gap between that level and the master's held by today’s pharmacists is too large; I included that point in my articles in the PJ in 2003-4. Pharmacists are losing interest in making medicines; biologists and chemists are replacing pharmacists, notably as QPs in industry. Is that in the best interests of patients? If a drug is required, diagnosis and advice is worthless if the patient cannot get the empirical medicine. Medicines are corporeal things; pharmacists have stuck like limpets to their entitlement to possess those artefacts. Somehow, tomorrow's pharmacists must maintain that privilege, just as some of today’s doctors retain their birthright to dispense. However, AI-enabled robotics may well change or remove the professions of pharmacists, pharmacy technicians and doctors, as we know them, within 5-10 years.
I’m all for levelling the funding across all systems, but this is a minimum of a £10k cost pressure for each trainee within NHS based placements. How this is a good move for the Long Term Workforce Plan is beyond me.
So would I like to know what suppliers are now supporting EPS. I know some of these trusts use Cleo (we are in a limited implementation with Cleo too at UHCW for UTCs only), but are other systems yet NHS acceptable?
We must also consider the environmental impact of homecare services. Medicine deliveries to individual patients by road across the UK from a centralised company does not appear sustainable.
I notice that 'pharmacies' can opt out, but not 'pharmacists'!
This is another role negotiated by the CPE but not approved by members of the profession.
No doubt, because of attractive remuneration, pharmacists will be pressurised by contractors to complete as many consultations as possible to earn maximum money (for the contractor). This has happened before in the case of Medicine Reviews.
In view of escalating workplace pressures, increased regulation, staff shortages, stress and illness, how is all this going to be acheived?
Another example of the CPE imposing impossible workloads on pharmacists without giving them any opportunity to veto them. Where is democracy in our profession? Why doesn't the RPS (who we are paying to serve our interests) stand up to this inexcusable liberty?
No wonder there is lack of recruitment and retention!
A fitting tribute to a truly outstanding colleague. I am one of the many whose lives were enriched by having met and known Nina as a friend. She may well have been the most thoroughly decent human being ever to have graced the pharmacy profession – that was certainly my experience - and we are poorer for her passing.
A quick analysis of the above shows that an average of one patient per 30 day month is required for the full quota ,but each February one or two patients will need to be dragged off the street in order to qualify, then the list of ailments contains "seasonal ailments eg. insect bites, sinusitis, spring and summer whereas Shingles and impetigo are rare. Only Pharmacies in cities will have enough footfall to hope to fill the quota, so Pharmacies in smaller towns and villages have little hope. So much for "Community Pharmacy" In my opinion the CPE needs to go back to the drawing board , and I agree with Mr Peter Robinson that the RPS need to act on this and if they need help I am sure Mr Robinson and I would be pleased to assist,
News of the recently published study on the effect of semaglutide on cardiovascular outcomes in people aged ≥45 years with cardiovascular disease (but not diabetes) and a BMI ≥27 kg/m2 has been widely reported in the medical and general media. The report in the PJ provides a brief overview of the trial results and presents the data on the primary composite outcome and the risk of discontinuing the trial because of adverse effects.
Unfortunately, the headline accompanying many of the news stories (including the one in the PJ) promotes the relative risk reduction in the primary composite endpoint of 20% rather than the more helpful absolute risk reduction of 1.5% .(1) To put this figure in context, 67 people would need to be treated for 34 months to prevent one primary endpoint event (a composite of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke). For the individual components of the composite endpoint, the 95% confidence interval for the hazard ratio (HR) was less than 1 for only one of the three outcomes and the secondary endpoint of death from cardiovascular causes was not statistically significant: Nonfatal myocardial infarction 2.7% vs 3.7% (HR 0.72, 95% CI 0.61 to 0.85) Death from cardiovascular causes 2.5% vs 3.0% ( HR 0.85, 95% CI 0.71 to 1.01; p=0.07) Nonfatal stroke 1.7% vs 1.9% (HR 0.93, 95% CI 0.74 to 1.15)
The data on adverse events leading to "permanent discontinuation of trial product" suggest that one person would discontinue treatment for every 12 people treated with semaglutide.
In October, DTB published an article (https://dtb.bmj.com/content/early/2023/10/25/dtb.2023.000007) in which Professor Joel Lexchin and Professor Barabara Mintzes explore the the evidence for semaglutide, discuss the hype surrounding the drug and highlight the need to tackle the other determinants of obesity. (2) They emphasise the importance of addressing the complex factors that contribute to the development of obesity rather than relying on medication as a damage limitation exercise.
It is important that we report the results from clinical trials in a balanced manner that allows readers to assess absolute risk reductions, relative risk reductions, numbers-needed-to-treat and numbers-needed-to-harm. We need to move beyond headlines that rely on data from company press releases.
1. Lincoff AM, Brown-Frandsen K, Colhoun HM, et al. Semaglutide and cardiovascular outcomes in obesity without diabetes. N Engl J Med. 2023. doi:10.1056/NEJMoa2307563. [Epub ahead of print 11 November 2023]. 2. Lexchin J, Mintzes B. Semaglutide: a new drug for the treatment of obesity. Drug Ther Bull. 2023. doi:10.1136/dtb.2023.000007 [Epub ahead of print 25 October 2023].
I was prescribed this off-label for ADHD, I was able to function 'normally' for the first time in my adult life within a couple of days of starting bupropion. When it was discontinued I went through sheer hell - the past year has been a nightmare: my job has been at risk, I have been suicidal, and was essentially left with no hope. This news is huge and Prof. Robert West needs to revise his comment - to say it will have little impact is ignorant and deeply insulting.
Dear Ralph! I only saw you a few months back and you were full of health and fun. Shocked to hear about you passing. Have fond memories serving with you at RPS branch and you being one of my best attendees at local CPPE events. You were so supportive for which I'll be forever grateful. You will be very much missed. Bless you my friend. Sam xx
Thank you, Emyr, for continuing to bang the drum on this topic. I worked on a project with a couple of Care Homes about 15 years ago when they were permitted to hold a small stock of CDs without a licence but by the time we got everyone's agreement, the law changed and the burden of the licence was regarded as too onerous for the home's owners.
I have long felt that we have developed such a blanket aversion to risk with CDs that it negatively impacts on patient care. It would be pefectly feasible to safely store, audit and use a small quantity of CDs in a nursing home with pharmacy support.
That period during Covid when we were able to use professional discretion was such a positive period for palliative care pharmacists and nursing staff and I know that no harm came to anyone in the area where I was working. Using very careful recording and monitoring we were able to save a huge amount of money and minimise the appalling waste too. I'd be happy to help if I can in any way to highlight this again although I'm now retired.
As someone involved in applying for CD license for an addictions setting it is a complicated process, and the HO offer little or no advice during the process, or communicate very clearly after it whether the license is granted or not. New licenses require a visit. And the advice on the visit seems to be dependant on the person who comes. Noting each individual named on the license must be DBS checked (even if they've been checked for other reasons or hold the Scottish equivalent) and you need to name the person responsible for destroying stock CDs on it too - so they have to be identified. And if any of those names change you have to update the license and pay another fee (and DBS check).
I can understand the care homes not wanting to go anywhere near that process, and the government could do with refreshing the process to be clearer and more supportive and more able to prioritise patient care.
not sure I agree with all of the "correct" answers
the one about the "first thing you should do" - the scenario suggests the pharmacist is already mid conversation with the patient so I would have expected they'd already have introduced themselves properly, so makes no sense that this is the first thing to do at that point and the last question doesn't say "tick all that apply" like other multi answer questions do.
Many thanks for your comment. I am senior editor for research and learning at the Pharmaceutical Journal. We will discuss this feedback with the original article authors and whether the wording for this question can be improved.
Dick Pinney was great friend of mine when I came to the Square as a mature student to do a PH.D in pharmaceutics under Prof JE Carless. We both worked on the third floor and shared many happy moments at "The Lamb" - a notable public house nearby. Dick was a person who always had the wellbeing of his students at heart and was passionate about the pharmacy profession. He will be greatly missed.
The article mentions the risk of AI chatbots providing incorrect information, but it could be expanded to include a more in-depth discussion of the ethical considerations involved in using AI in healthcare.
The problem with the drug is that it wasn't commissioned properly. Primary Care are uncomfortable with brand new injectable medicines, and Secondary Care would need to be paid to have the necessary capacity.
This announcement does not necessarily mean that the public want phamacists to administer Covid 19 vaccines.
In my own area none of the GP surgeries are providing the service, so the public have no option but to use pharmacies or not have the injection at all.
It's rather obvious that remuneration is uppermost in the profession's mind.
Excellent journalism, well done for highlighting unacceptable political interference at the highest level in independent long established professional processes. It’s good that professional practitioners have resisted prescribing of a medicine they appear to be incentivised by NHS England to prescribe. An exploration of the motivation and motivators behind the politics is now essential.
Perfectly appropriate to focus on reclassification for its own sake, but the MHRA should not be concerning itself with saving the NHS money. That’s a sure fire way to bias any risk assessment by its own teams. I hope this is merely a case of a passing statement being taken out of context.
Thank you to the authors for an excellent piece of investigative journalism.
NICE should be ashamed of what it has become. That the published documents from NICE TAs now contain blacked out costings, marked "commercially confidential" is nothing short of a scandal.
Try reading the published supporting papers for this drug. Or Romosuzumab, or any number of others. You can't, because the numbers are blacked out.
I am curious to find out if the interaction is purely with vitamin K antagonists, or if the bleed risk is increased for DOAC patients prescribed Tramadol
a good quiz but moveable responses were not enough easy or even possible to do on a phone. Suggest this is stated up front- i.e. Please complete on a laptop or computer
Hi Robert. Please allow me to introduce myself as the senior editor for research and learning. Thanks very much for taking the time to share this feedback with us. The quiz functionality is designed to work on mobile so we will need to investigate this further. Can I ask you to drop me an email so we can ask some follow up questions please? My email address is Alex.Clabburn@rpharms.com
I am deeply sorry to read of Prof. Brown's passing. I had no clue of his stellar achievements as he was so down to earth and unassuming. I fondly recall during our first small group tutorial as an Aston undergrad in September 1990 he told me to consider developing an unconventional pharmacy career. Puzzled, I had no clue of what that might mean. So it was only after many, many years' pharmacy practice in most branches of the profession that we met again briefly at the steps to the library of the London School of Pharmacy's in 2009/10 and somehow, he instantly remembered me! Naturally, I regaled him of his guidance about my portfolio career path. During the uncertainty of the global coronavirus pandemic, I often wondered whether the Sage scientists ought to draw on some of his expertise? So rest well Professor with my deepest condolences to your family and friends both inside and outside of the pharmacy profession.
Hello. Many thanks for your comment. I am the senior editor for research and learning at the pharmaceutical journal. Question 15 was derived from the article 'How to conduct a clinical review of a patient’s medicines' and the specific references behind the question statement are copied below:
Green AR, Aschmann H, Boyd CM, Schoenborn N. Assessment of Patient-Preferred Language to Achieve Goal-Aligned Deprescribing in Older Adults. JAMA Netw Open. 2021;4(4):e212633. doi:10.1001/jamanetworkopen.2021.2633
Jansen J, Naganathan V, Carter SM, et al. Too much medicine in older people? Deprescribing through shared decision making. BMJ. 2016;:i2893. doi:10.1136/bmj.i2893
Have there been any other members who were registered as members for eighty years? My father Montague Edward Seymour was one such person I believe, when he died in January 2017 at the age of 102. I believe he was first registered in 1936. His name was not on the list that year or any year. I have not noticed any members listed as members for eighty years in your lists so far.
Please check in “Treatment choice and stepwise approach” section: Under BP targets for Aged >= 80years, the article states Clinic BP < 50/90 mm Hg. This should read < 150/90.
I am grateful for your feedback but, of course, in practice one finds there are more than one or two arguably valid option which this quiz setter(s) does not seem to appreciate. I disagree with some of the answers you deemed correct or incorrect!
Thanks very much for your comment. I am the senior editor for research and learning at the PJ. The questions were derived from expert authored articles but I will be glad to look at the specific answers that you disagreed with. Would you be able to send me an email at Alex.Clabburn@rpharms.com so we can continue the conversation? Many thanks.
Thank you for the time and effort you have taken to highlight attempts to politically influence the decisions of NICE as an independent body. The motives of NHSE and the government remain unknown - some may be commendable in principle, in terms of securing the UK's future as a host for important clinical research. NICE was right to take a more circumspect view of the place of Inclisiran in the treatment pathway until long term cardiovascular outcomes, side-effects and influence on mortality are known. Is there a diminishing amount of Physician input into NICE at board level? Unwarranted government interference in the decision-making process of NICE is of grave concern, particularly as large NHS datasets are increasingly being made available for analysis by machine learning algorithms which will no doubt lead to commercially promoted 'opaque' decisions which the NHS will be under pressure to act upon. The NHS must resist becoming an instrument of industrial policy and strive vigorously to keep patient welfare at its heart.
Really liked this - I didn't know the answers in a few and enjoyed reading the documents. Antidepressant failure rates vary in reference sources so found it a bit difficult to answer
Motivation is the key element in managing Type2 through diet alone. I was shocked when diagnosed three years ago and resolved that I could conquer the problem. Researching available sources showed that, for me, stopping snacks between meals and radically changing the basic staples of my diet (Granary bread,not white;Whole grain rice;full fat rather than low-fat dairy products) relying on foods that digested slowly in the gut. Interestingly, I was told by my surgery that I would have to purchase my own test meter and strips ( perhaps the society could campaign for a change of NHS policy here). Three years on, I'm still keeping my blood levels within recommended levels
Thanks for flagging this. I am the senior editor for research and learning at the PJ. Can I ask you to drop me an email at Alex.Clabburn@rpharms.com so I can investigate further please?
UPDATE: We think we have identified the cause of the issue. Please try the questions again and let me know if the problem persists.
I think it's an attempt at finding a new model or solution to help the overburdened NHS and for that I support the originators of the scheme. However,how it will work on a day to day basis in an already stretched community pharmacies will remain to be seen. It's success will need to be audited and patients and staff delivering the service views gathered and some 'tweaks' may be needed. Expecting need to be managed, staff will need ongoing support,training and guidance. Without this reflection cycle the scheme may struggle to be delivered consistently.
It's no wonder that the uptake of Covid vaccinations has been lower than expected. There wasn't one single GP surgery in my area that was providing it!
In view of the statistics about the readiness of pharmacies to undertake this service, why has CPE agreed to it in the first place?
It highlites once again the callous indifference this contractor-led panel has for the ever increasing workplace pressure forced upon individual pharmacists.
No wonder pharmacist retention and recruitment is under pressure!
You’re joking right. I absolutely donot agree with this concept. I’m sure the patient safety tzar would agree that this is a ridiculous idea Does anyone agree with me ?
As a pharmacist leading a medicines optimisation in care homes (MOCH) team in Sussex along with my counterparts who together provide the service across the whole of Sussex we are very interested in seeing this legislation change for nursing homes.
The PDA position statement succinctly details the problems with proposal 3 in the current Pharmacy Supervision Consultation, and I have already submitted my response along similar lines. For too long, Schools of Pharmacy and Health Education England have held up Clinical Pharmacy and Pharmacist Prescribing as the holy grail to which all Pharmacists must aspire. This ignores pharmaceutics and formulation which distinguish Pharmacy from the other health care professions. Aseptic/Technical services within hospital Pharmacy practice is in itself a rewarding career path which for some Pharmacists (myself included for more than thirty years) have found professionally satisfying. Pharmacists are able to use their clinical knowledge to ensure the right product reaches the right patient at the right time, whilst ensuring patient safety and minimising the inherent risks with injectable medication - Clinical Pharmaceutics! Proposal 3 throws this on the bonfire in the unachievable pursuit of filling the work force gaps elsewhere within the NHS, and to mix metaphors, throws the baby out with the bath water! Pharmacy Technician education/qualification no longer includes any element of Aseptic/Technical services, and this makes it dangerous to allow Technicians to have overall control of an Aseptic Unit with little or no oversight from an experienced Aseptic Services Pharmacist. Chief Pharmacists are too remote from the coal face, and most have little or no relevant Aseptic/Technical services experience. Along with others, including the PDA, I call upon the Department of Health to withdraw proposal 3, and instead implement a separate and more in-depth and comprehensive review and consultation before deciding the merits or otherwise of changing the supervision requirements within Aseptic/Technical Services. I urge others to repsond similarly before the 29th February deadline. I am also disappointed that the RPS doesn't appear to have sought the views of those practicing within Aseptic/Technical Services before agreeing to support proposal 3! David Lovett, Retired Aseptic Services Pharmacist and a past Chair of the NHS Pharmaceutical Aseptic Services Group
Pharmacy First is based on the old fashioned ,no appointments, GP morning and evening surgery, which was the GPs main function in those days. Pharmacy First has now taken on that role but instead of 2 one hour surgeries Pharmacy First has condemned the pharmacist to a full day open surgery ,for a measly £1000 per month , and a £15 consultation fee. Hardly a just reward for a Pharmacy Qualification and all the responsibility plus the cost of indemnity insurance.
CTMUHB is the provider of the most clinical placements in the UK. We have a model that can be used to scale placements for other acute and community hospital sites. We are also looking at how to deliver GP and Prison placements, as part of our health boards offer. A chance to share and discuss this on a national level would be a great opportunity for other teams across the UK. My feeling, having delivered nearly 6 months worth of placements, for over 250 students, is that the model is not dependent on high levels of funding, though will increase provider will to undertake. A change in the culture in pharmacy education is a critical success factor, as well as working in partnership with local HEIs, clinical education colleagues. Strong leadership of the placements is essential, and the attitude of "it's too much work" is a risk to the future sustainability of the pharmacy professions development and ability to come out as prescribers in 2026.
I'd agree with Rhian that culture is as big a barrier as funding. In large organisations this funding can also get lost and not directly reach pharmacy teams. Very happy for you to talk to our placement development group in West Yorkshire ICS and Yorkshire & the Humber. The local HEIs and providers (of all sorts) are trying to understand each other's needs and capabilities.
Unfortunately my experience as a Locum Pharmacist is that pharmacy contractors decided to reduce their hourly rates at introduction of Pharmacy First. They expect Pharmacists to do more work without decent remuneration. Nothing changes
Dear Barry - this is a great letter. Many thanks for reading my blog post from February and taking the time to elaborate on your own experience and insightful views here. All the best, Parastou
That's a great article - it highlights the importance and relevance of well conducted research and also alerts us to challenges of AI. We need to manage these challenges to ensure we can continue to benefit from other aspects of AI.
Completely agree with Christine. Well done Parastou Donyai and nice appraisal of ascorbic acid in Covid19, noting large jointly published RCTs tREMAP-CAP and LOVIT The LOVIT-COVID Investigators, on behalf of the Canadian Critical Care Trials Group, and the REMAP-CAP Investigators. Intravenous Vitamin C for Patients Hospitalized With COVID-19: Two Harmonized Randomized Clinical Trials. JAMA. 2023;330(18):1745–1759. doi:10.1001/jama.2023.21407
I think that this is a very sensible step forward in the world of community pharmacy. I understand the training concerns, however the situations mentioned are all about supplying a medicine in a situation which is NOT to treat a medical condition, so is not complicated by diagnosis.
Thank you Shy for your letter and experience that really does highlight why it is important to include diverse clinical imagery within health education.
The notable lack of representation of conditions that affect skin of colour, as well as minimal expansion of statistics about conditions that predominantly affect Black people, is something that The PJ first highlighted in November 2021 in this episode of the PJPod (https://pharmaceutical-journal.com/article/feature/pale-and-stale-decolonising-the-pharmacy-degree). It specifically looked how then pharmacy student Adanna Anthony-Okeke led a project to ‘decolonise’ the curriculum at the University of Nottingham’s school of pharmacy and investigated the progress being made in universities across the UK to make the pharmacy degree more inclusive.
Subsequent to this, The PJ also produced specific learning materials with visual guides that sought to help pharmacists and pharmacy teams better recognise common skin conditions in people of colour, including eczema, psoriasis, acne vulgaris and fungal skin infections, see: https://pharmaceutical-journal.com/article/ld/recognising-common-skin-conditions-in-people-of-colour. More specifically, those skin conditions more commonly observed in skin of colour, such as melasma, post-inflammatory hyperpigmentation, traction alopecia, central centrifugal cicatricial alopecia and tinea capitis, see: https://pharmaceutical-journal.com/article/ld/common-dermatological-conditions-in-skin-of-colour.
Our approach to inclusion of clinical images in our content is to be as inclusive as possible. We rely on various image banks and, as you note, projects such as Black & Brown Skin or DermNet, as well as our expert clinical authors, to help with this. We support your call for more healthcare professionals to submit their own clinical photos, of course with appropriate patient consent, to help improve access to inclusive resources.
Thank you again for sharing your experience and for bringing this to attention.
Readers looking for PJ resources to support delivery of Pharmacy First and similar services across GB can access learning content by country or condition via our minor ailments hub here: https://pharmaceutical-journal.com/minor-ailments.
Michael Dowdall – Executive Editor, Research & Learning
From experience it is less a problem of recruitment but more a problem of retention of staff. Also pharmacists being asked to spend an inordinate amount of their time conducting audits which go on to achieve nothing.
I think a challenging aspect of medicines reconciliation is that the Summary Care Record is not accurately updated with recent medication changes from hospital discharge letters or medications prescribed from the private sector or out-of- hours GP prescriptions etc. As a result medicines reconciliations take an inordinate amount of time to complete when an accurate medication history should be readily available via an up to date Summary Care record.
I can highly recommend the book Mind The Gap (https://www.blackandbrownskin.co.uk/mindthegap) to help increase awareness of dermatological signs and symptoms in people of colour.
Ver well said, Jillian. Your frustration is completely justified and echoes the sentiments of many pharmacists in the profession. It's concerning to see the increasing demands placed on community pharmacists without corresponding support and resources. The Pharmacy First service, while well-intentioned, highlights the need for adequate staffing levels and support mechanisms in community pharmacy. Your dedication to patient safety and professional standards is commendable, and it's crucial to prioritize these principles above all else. Your decision to decline offering the advanced service is a courageous stand for what is right. It's disheartening to see experienced pharmacists like yourself feeling pushed out of a profession they love due to untenable demands. Your voice is essential in advocating for change within the profession.
Ms Armani is quite right. Reviews and strong support to mental health patients is important as well as regular follow up which should be with all treatments .
This is encouraging news given the devastation the opioid epidemic is causing. I've been able to supply naloxone in Ontario since I arrived in 2017, and uptake increased significantly once we were able to supply the nasal spray instead of the injection - in an emergency situation the fewer barriers to using a product the better.
I would encourage pharmacy organizations to push for narcan nasal spray to be able to be supplied without a prescription, and to the widest possible population. Supplies to those on prescribed opioids should be seen as best practice.
I have been on Effexor for 30 years and am hoping to get off it in one or two years by taking the drug in compounded form with tiny dosage decreases that occur every few days or so. Such an approach makes perfect psychological sense to me but I don't know anyone who's doing it. I think it's absurd that users trying to withdraw should have to be counting out pill pellets. That's what pharmacist are paid to do, and with the appropriate equipment. Also, regarding why people might want to stop using such drugs, here's one that no one ever mentions: the fact that it is humiliating to become an eternal patient and have to visit a "behavioral health clinic" every three months to have your refill approved by someone who's half or even one-third your own age. Such drugs turn users into eternal patient. That's the main reason I want to quit them in my retirement years.
I am saddened to read about the passing of Chris Barrett, especially to have read this two years too late. I too count myself among the "the large number of staff he inspired with a love and enthusiasm for pharmacy, many of whom went on to have very successful careers themselves." Mr. Barrett had a huge influence on my career, encouraging me, as a preregistration pharmacist at the London Hospital, to pursue a career in research.
I can attest to his "enthusias[m] in promoting some key management texts to the staff" and recall my puzzlement at why a preregistration curriculum supposedly focussed on clinical and hospital pharmacy, spent so much time on "off-topic" texts. But with his warm style who could not comply cheerfully, if not humouringly, with Mr. Barrett? Nonetheless, Mr. Barrett seemed to have overstepped the event horizon of sanity by introducing Edward de Bono's Art of Lateral Thinking and assigning us the task of coming up with an example of its practical implementation. It was precisely this task that was directly responsible for the trajectory of my career. Applying de Bono to a book I was reading forced me to ask a certain question, diverting me to a research path completely different from the one I had planned and away from the paths typically followed by research pharmacists.
Some 40 years later, I have deep appreciation to Chris Barrett for effectively launching a most rewarding and productive career. Perhaps more importantly I am grateful for Mr. Barrett's lessons in leadership and integrity, recalling particularly how he had time and encouragement for everyone in his team from his senior staff, to his pharmacy technicians, to the bottle washing assistants in non-sterile manufacturing and his prereg students.
With deep condolences to Mr. Barrett's family, his former colleagues and staff Sncerely David Wiseman, Dallas, Texas.
I found the scenarios very interesting.. Now I understand what person-centred really means, putting the person at the centre of care and practice. thank you
Great analysis of a very important study. Hope it leads to better understanding of antidepressant prescribing and deprescribing and further supports clinicians who care for people living with depression.
Thorough and comprehensive. On a personal note; as a T1DM sufferer since 1974, many of the acute treatment options have not changed over the last 50 years. There were no such things as SGOT2 inhibitors back then and I just wonder whether they have muddied the waters somewhat for Luddite, old fogeys like myself.
Thank-you you for printing my letter, albeit with some editing. I did not use the term patients for those over 80, I said people who are older than me. This seems to be a strange change to my wording. I was referring to all those over eighty years of age not just those who are 'patients'.
I'd like to support the author's comment above. The subeditors change in wording does alter the meaning - older people are not all patients - and the phrases are not interchangeable.
Dear Jennifer, thank you for highlighting this. I have removed the mention of 'patients' and replaced it with your original wording. Apologies for this editing error.
Sheralyn (Chief Subeditor at The Pharmaceutical Journal)
RSV in older adults is estimated to cause 14,000 hospitalisations in the UK per year. The need to protect this population is clear. On 26 June the US Centers for Disease Control and Prevention updated its recommendations for RSV vaccines in older adults. For the 2024 season they now recommend that everyone aged 75 or over should receive the vaccine, and people aged 60-74 at increased risk of serious RSV such as lung or heart disease. This seems much more clinically logical than the NHS position, which effectively writes off those of us who are over 80. The NHS should urgently review its proposed programme.
Totally agree. I have written to Wes Streeting and my MP but I think we need a more coordinated action with some publicity. This is a nonsensical decision!
Andy, when we organised a 50th graduation reunion for the Class of 1970 from the Square the UCL alumni office were able to help use contact people. KCL might be able to do the same for you.
See also: https://mag.nationalhealthexecutive.com/january-february-2024?m=62920&i=814120&p=6&ver=html5 - drone deliveries need to be seen in the context of the delivery of the whole healthcare episode. You may be able to cut time-to-delivery, but that is often irrelevant if you need to schedule it a week in advance to get the rest of the care episode (bed, staff, etc) organised. Then, in most cases, you can send your medication by the usual van - or a bicycle.
Hi Michael, As with our previous surveys, we will be publishing this year's results in news stories and long-form articles over the coming days and weeks. Kind regards, Carolyn Wickware (Executive editor, The Pharmaceutical Journal)
If comparing numbers, compare apples to apples, what is happening here is the data is getting portrayed differently, using numbers for women’s group and then percentages for men. The research supports testosterone for energy, fatigue, low libido, for both sexes, it should be given to both and follow up blood work on both. The research is so far behind, if women have been informed of risks, have them sign a waiver and then use their findings to help research this topic. By keeping women low energy, low libido and fatigued, it only supports keeping them ill and running from doctor to doctor for help, racking up more medical bills for them and their families.
“The number of women aged 49 years and under receiving testosterone gel also increased, from 228 in November 2015 to 2,913 in November 2022 (see Figure).
In contrast, the data show that NHS prescribing of testosterone gel in men has increased by only 33% in both age groups during the same seven-year period.”
Pharmacy Services provided for this patient group need to be remunerated on the basis of the care provided rather than product dispensed. In my experience many community pharmacists provide care which is way above that associated with dispensing a product. I have even seen community pharmacists who provide extensive social support for this very vulnerable group without any funding or even recognition. A care service based on an agreed standard of care supported by a quality training package could be partly funded by making use of the dispensing fee replaced by a fee per patient registered for the service with a community pharmacy. This would give the patient the necessary pharmaceutical care support and the community pharmacist the recognition by the wider healthcare system as a care giver rather than simply a provider of a product.
I couldn’t agree more Norman. A progressive shift from current remuneration package to a holistic approach would place community pharmacies firmly at the centre of supported care provision towards this patient group. As we know one size doesn’t fit all and the pharmacy model has shifted from “dispensing numbers” to “quality clinical care provision”, deserving of an equitable financial envelope.
The article does an excellent job of highlighting the challenges faced by people with substance use disorders, especially how stigma can worsen their situation. The use of statistics and expert insights really drives home the point that these individuals often face barriers to getting the care they need. The call for better education and training for healthcare professionals, along with the push for more consistent access to supervised consumption services, feels both timely and necessary. It's a well-written piece that not only informs but also encourages a more compassionate and understanding approach to addiction treatment.
Increased funding is definitely needed for providing these services - in Ontario the provincial government pays the equivalent of £5 a day for daily dispensing for each medication dispensed. The UK has been relatively fortunate to not have been flooded with illicit fentanyl in the same way that the US and Canada have been since 2016 (Canada has had around 46,000 deaths from opioid overdoses since 2016, the vast majority of which are due to fentanyl).
Naloxone should also be available from every pharmacy in the country, at no charge, with a fee from the government that is commensurate with the time needed for training on use of it. Eligibility should be as broad as possible to increase the likelihood of naloxone being available in the event of an overdose, and both injection and nasal spray formulations should be available to reduce barriers to use.
Well said Stephen. Thought provoking the issue of commensurate funding for community pharmacy teams, to provide the right level of care to people with SUDs. There remains the argument that a lot of work done by pharmacy professionals are not usually captured, renumerated or appreciated by policy makers. Equitable access to naloxone, a life-saving drug, with mitigated regulatory restrictions across community settings would have a positive impact in tackling the scourge of opioid-related deaths we face. We are constantly appealing on this matter.
Denis this is right on point. I recall last week my patient bursting out crying because of stigma. I just added a 'yellow caution' sticker to her bloods and she explained how that makes him feel and makes him detached from the service. I have never thought of this I think the compassionate and non judgemental approach is the way forward if we are to help people with SUD. Thanks for your insight
I believe pharmacy services as a whole is in urgent need of resuscitation. As Janet Morrison stated that 'community pharmacy businesses are in a perilous and critical state due to the entrenched underfunding of the Contractual Framework'. This also has a ripple effect on the sustainability of pharmacy services primarily in rural areas (with lower dispensing volumes and enhanced service provision), and with cost of living crisis creeping into business profits, the longevity of community pharmacies are at stake.
When a bid to obtain promotion (or whatever) in one's career fails, it is natural to wonder why. And it is natural to suppose that one's disability / religion / sexual orientation / accent / etc / etc was the reason for failing to gain that promotion. So, I wonder whether the survey was capable of disentangling individual perceptions from actual reasons for those failures to "climb the greasy pole"?
Bottom line: if you take in more fuel than your body needs, you will get sick. Type 2 diabetes was called "age-onset diabetes" when I first qualified as a pharmacist. It is now being diagnosed in 10-year olds. But medics still regard the advice to "eat less and move about more" as a ridiculous oversimplification ... because patients cannot resist the urge to eat when they feel hungry. Perhaps the simplest piece of advice to give is: if you are thirsty, drink water not fizzy pop (whether "full fat" or of the "diet" variety).
absolutely farcical, dependence happens across many medications. OUD by its recent definition is also fundamentally flawed. Bizarre to see this in a pharmaceutical journal, especially given even the most elementary comprehension of pharmacology is all that’s required to know how flawed it is.
'At our core, we humans are tribal. Constantly, our subconscious is bombarded with cues that identify who is “us” and “them.” Perceived similarities of status and values make it much more likely that we will connect and form lasting bonds with our fellows.' [https://behumanproject.org/why-are-we-tribal/]
So, when an individual perceives racism, it could just be tribalism. It is not so much about what we look like or where we come from, but how we speak and how we behave / conform with the norms of the tribe. I left a position in a university because I believed that I had been overlooked for promotion and that my achievements were not being recognised ... but this had nothing to do with racism. Was it "constructive dismissal"? No. It was my failure to "conform to the norms of the tribe" that made me want to look for another tribe to join where my achievements would be recognised. And I did indeed find such a place.
While reading this article I noticed a couple of things worthy of comment.
The figure depicting the patient-centred approach to managing polypharmacy is taken from an article that I was a co-author for in 2015. This full reference for this is not given, so it can be accessed here - Barnett NL, Oboh L, Smith K. Patient-centred management of polypharmacy: a process for practice. Eur J Hosp Pharm 2016; 23(2): 113-117. https://pubmed.ncbi.nlm.nih.gov/31156827/
The hyperlink to the IMPACT resource (reference 12) is not the most up to date version. IMPACT can be accessed here - https://prescqipp.info/our-resources/bulletins/bulletin-268-impact/ You need to be logged into the PrescQIPP website and you can register for an account here - www.prescqipp.info
Hello Katie. Many thanks for your comment. I am the senior editor for research and learning at the PJ. I am looking into this and will ensure it is addressed as a matter of urgency. If you would like to communicate directly in the meantime my email address is alex.clabburn@rpharms.com.
Dear PJ Why is there ZERO mention of diet as either a root cause OR an alternative treatment for Schizophrenia? I can quote numerous papers. Also there's very little emphasis on the metabolic syndrome that the drugs cause and the life-shortening side effects. For those wanting to know more I recommend Brain Energy by Prof Dr Chris Palmer and for de-prescribing a brilliant new Maudsley guide available to borrow free of charge from the RPS library
When I was an undergraduate at Chelsea in 1965-1969 about 33% of my fellow 1st year students and 25% of the second year were not allowed to continue because of exam failure but in the years when I was teaching at the now UCL school from before 2000 until around 2015 very few students were asked to leave.
I wasn’t aware of any students leaving of their own volition. What has happened? Barry Shooter MBE FRPharmS
A very accurate obituary for a man of good character and and excellent lecturer/teacher. A sad loss to the profession. Ron Pate MBE FRPharmS and former student
After my Multiple Sclerosis diagnosis 2 years ago, i stopped all the Multiple sclerosis medicines prescribed due to severe side effects, and decided look into alternative approach. My primary care provider introduced me to MS-4 programme from naturalherbscentre. com and i immediately started on their Multiple Sclerosis treatment, this MS-4 treatment has made a tremendous difference for me. My symptoms including shaking, muscle weakness, fatigue, mood swings, numbness, double vision and urinary retention all disappeared after the 4 months treatment!
I too was someone who benefitted enormously from David's influence and support through my early years as a resident pharmacist at Derbyshire Royal Infirmary (THE residency programme), clinical diploma and as a clinical pharmacist. I followed in David's footsteps with input to the Pharmacy Academic Practice Unit at University of Derby, and subsequently carrying the baton, as Chief Pharmacist at Derby Hospitals NHS Foundation Trust until 2013. As I reach the end of my own career, I am indebted to him for his wise counsel and support - a true mentor, a true gentleman. With my best thoughts for his family and friends.
I was an advocate of becoming a Royal College in 2010 when I represented the long gone Institute of Pharmacy Management on the Transitional Committee tasked with developing proposals for the then Royal Pharmaceutical Society of Great Britain after Government decided somehow it was no longer fit after 150 years or so to continue to regulate the profession. The fact that the Law Society and Faculty of Advocates continue to fulfil both functions 15 years on give the lie to that notion . The Society had been very successful in leading and putting forward a strong voice for the profession, and all registered pharmacists were members. It was the only organisation to represent all pharmacists. It was told that it needed to become a professional body “akin to a Royal College”. The Committee had representatives of other pharmacy professional organisations notably UKCPA and the College of Pharmacy Practice whose roles related to postgraduate education and training, but in the end the RPS were not convinced about the Royal College and not much changed. I’m sorry I destroyed all the work I did to highlight the Royal College benefits and to get RPS to coordinate the other professional pharmacy bodies. A few things come to mind.
Royal Colleges are the leadership body for their profession and are run mostly by Fellows who pay a higher fee than members, they offer specialist qualifications eg for surgery or paediatrics and in medicine these qualifications are needed for consultant jobs.
While I’m pleased to see great minds have been changed at long last I don’t find the arguments convincing as it seems the benefits and risks of this proposal are not clear and the pharmacy world has radically changed. To say we should do this because “If you look at the medical royal colleges, for example, I think I’m right in saying that each one of them is a registered charity and a royal college, “ is hardly convincing. Instead of being the sole voice for all pharmacists in 2010 it is now only one voice for pharmacy out of 9 Members of UK Pharmacy Professional Leadership Advisory Board. It could and should have seen in 2010 onwards it had the opportunity to provide the Leadership coordination role itself. It seems unlikely RPS could easily reclaim that role alone.
Much emphasis is placed here on Firetail, but Companies House says this has only 1 director so it will be interesting to see a summary of the proposals in due course. It’s too late for me, I wish you well.
Well said Howard, those leading this change could learn much from the work the former College of Pharmacy Practice. There is nothing in this article that presents a vison for the future or opportunities for the profession, patients and individual pharmacists
Thanks Ron lovely to hear from you. It’s worrying that such a pivotal decision has generated little debate on here. In the old days it would have been red hot. Sadly the organisation Transcom set up has not delivered and I had lost interest in it as have most of my contemporaries. I attended the Glasgow event as a swan song and enjoyed seeing some old friends and meeting new ones as branches used to do. I was hoping for inspiration and vision, but there was little in the presentations. I have learned since that the leadership body is pushing for this and set up a Nigel Clarke led Commission. Some background would have helped. frame the discussions It seems the Commission wants the GB and NI societies to form a leadership Council with technicians. This wasn’t mentioned. Only about 30 people attended the event so getting a two thirds majority of members won’t be easy. Many may even be unaware of the debate. The PJ doesn’t seem to be covering them to help. The change could drive older members away when a Royal College needs to retain its history and experienced members to learn from the past they may also have time to help free of charge. It would help to have explanations of why the public and profession will benefit from higher and common standards of service or guidelines or qualifications from a College and from new services. The benefits of being a Charity are ignored. Creative membership options for part time practitioners of family groups could help. There seems no vision for any role of Fellows or better using Fellowship. Medical models don’t fit well as their fellowship is an NHS requirement for specialist practice. The RCN seems better but wasn’t one of these studied by the Commission. In our day the members drove the leadership and innovated in ways the Society could have utilised. They and we were sometimes seen as a pain to Lambeth and the local branch democracy and some organisations like ours went after Transcom as a consequence. These days RPS feels like a top down organisation that is not open about its membership numbers, age profile and areas of practice making planning hard to the membership. GPhC numbers are growing by 1200 a year now at 62000 and 20000 Technicians registered. A College body serving all those dealing with patients should be growing. This isnt proposed. Surely it should be seen to be in all parties interests to coalesce quickly and for RPS to offer an olive branch in its proposal. It is ideally placed to offer a vision of how that could work. Finances are better but because services have reduced to much lower levels. A change of culture and radical rethink is needed to motivate young members to devote time and effort to the new College. Could Schools of Pharmacy not play a professional role here? A rebadged tinkering with existing Governance removing the Pharm Press won’t in my view do that and deliver the membership growth necessary to compensate for the estimated drop of around 600 members a year. A lot of suggestions came from attenders in Glasgow. I hope the final proposal takes these ideas and those at other events on board. To lose the vote would be a nightmare. There is a danger the vibrant leadership body of the 90s and noughties will fade into oblivion. The Government the GPhC, the public , pharmacists and technicians and other professions will suffer the consequences. It must not be allowed to happen. Time to smell the coffee, this may be the last chance saloon otherwise.
Thank you very much for your comments. Further feedback on the proposals can be shared with the RPS at their email address: feedback@rpharms.com
With regards to PJ coverage of the RPS roadshows, we do have coverage planned for our November issue that we hope will further inform members about the proposals.
If only this level of recognition, understanding and acceptance had been around 20-30 years ago. Neurodivergent people were generally classed as 'shy' or 'weird' or both, and misunderstood, ignored or bullied.
Well - I'm glad I read the detail as the headline would have completely misled!! PJ - you need to be more careful in presenting developmental new to clinical professionals: The juxtaposition of statements regarding type 1 and type 2 diabetes only supports widely held misbeliefs that the two conditions are the same! "...these insulins are unlikely to be used widely in T2DM because of the increased risk of hypoglcyaemic episodes compared with standard care. “This is likely to be due to the differing daily requirements and flexibility in insulin required in the management of T1DM, ""
Please editors - I think you need to take both a step back and consider the immediate effect of your headlines and the content of your articles and news items.
The narrow age range chosen for the RSV Vaccination is not only disappointing but illogical and to me ageist. My 79 year old wife has just booked her RSV vaccination. I am 81 but of course have not been offered the vaccine. I am fit for my age but occasionally (and currently) suffer asthmatic symptoms - Logically I should be just as entitled to the vaccine as my wife. The NHS approach can only be a cost saving measure.
Interestingly The Pharmaceutical Journal is the only place I can see where this issue has been raised. It needs far greater publicity and an explanation from the NHS why they have restricted the vaccine. I will, as Jane Wessman above, be writing to Wes Streetig and my MP.
I can see from the article on this subject that it it not going to be as straightforward as it initially appears ,but surely pharmacists can facilitate this step forward ,modest though it is, for the general benefit of patients, the smoother running of dispensaries, the redundancy of scissors and the reduction of waste. Percentage is a government word for--- well, not the efficiency of pharmacists !
I was saddened to hear of the death of John Jolley, a former Treasurer of the Society. John had been a well known and active member of the Industrial Pharmacists Group in the Society, serving as Chairman and hence as an advisor to the Society on industrial pharmacy policy. During the difficult times surrounding the granting of a New Charter in the early 2000’s, John advocated, along with others, the introduction of a two Board model of governance. Although this model was in due course rejected, compromises were eventually reached although at the cost of fractious elections to the Society’s Council and a change in the main Officers. As a senior and experienced pharmacist, John was the natural choice for the Society’s Treasurer, and he provided great support and a steadying hand to me during those difficult times. John was also a Liveryman and great supporter of the Society of Apothecaries where he advocated developing qualifications in Good Pharmacy Practice. As always, he expressed a keen interest and support for his profession, and it was always reassuring to have his calm logic on your side. He will be much missed. Nicholas Wood President 1993-4 & 2004-5.
Disappointing not all pharmacy staff in patient facing roles as counter staff provide the majority of needle and syringe supply. Naloxone is safe and easy to supply,no need for a pharmacist or pharmacy technician directly. Let's hope oversight is suffice.
It is interesting to note that, apart from speeches from the two candidates standing for vice-chair of the Scottish Board, this report consists entirely of statements made RPS officers. Did none of the board members say anything worth reporting?
Many thanks for your message. I am senior editor for research and learning at the PJ. I have completed an investigation into this and the article has now been updated to rectify. Many thanks for bringing it to our attention.
Many thanks for your comment. My understanding is that the issue was resolved on 11th October when the parameters of the question were corrected. If you are still seeing an uncorrected version can I ask you to please email me directly on Alex.Clabburn@rpharms.com so I can investigate further.
I am an employee pharmacist. It’s terrible feeling the pressure from the company directors to do more and more with fewer staff. Many many of us are working extra unpaid hours to get everything done.
Nobody can argue against personalised care, but the real gender problem with pharmaceutical care is lack of attention to differences between genders/sexes. For example, there are meaningful and marked differences between asthma experiences in males and females. After the age of around 12, death rates, severity of attacks and hosptalisation rates are higher in females, management needs to reflect different phases of pregnancy and many females experience different risks of attacks in different parts of the menstrual cycle. Do pharmacists counsel patients on this? Do girls approaching the menarche get advised that their asthma experiences and risks of attack may change? Likewise women approaching the menopause? If we don't, we should.
For asthma, the reason for the differences are not fully understood, but they are certainly in part related to sex hormone changes. There may, though, but be other issues - perhaps resulting from XY versus XX chromosomes, and it may vary with the type of asthma.
There will be plenty trans men and trans women who need appropriate support because of hormone treatments they are receiving.
If UK healthcare paid more attention to gender differences in multiple areas that we currently ignore (the list of conditions is very long and awareness is arguably particularly low in the UK), it would automatically follow that the trans community would receive appropriate support.
Because of the scale of the problem (i.e. affecting everyone), I would argue that it is awareness of healthcare differences between males and female that needs attention first with attention to the needs of trans individuals immediately building on that.
As a fellow Transitional Committee member I share Mr Churtons sentiments It’s worrying that such a pivotal decision has so far generated little debate on here and there are no reports of local meetings to inform the membership of discussions. I was close to following most of my contemporaries in leaving the Society but as a long term advocate of the Royal College idea I attended the Glasgow event as a swan song. I enjoyed seeing some past friends and meeting new ones as branches used to do. I was hoping for inspiration and vision, but there was little of that in the presentations. Too much was about tinkering with Governance. I have learned since the meeting that the leadership body is pushing for the college and set up a Nigel Clarke led Commission. This wants to coalesce GB and NI pharmacists and Technicians into one Council. Some background of that would have helped inform the debate on member benefits. Only about 30 people attended the event with few under the age of 30 so getting a two thirds majority of members won’t be easy unless the plan is to have low voting numbers. A Royal College needs to promote member advancement and retain its history and experienced members to hep new ones learn from the past. It would help to have explanations of how these professions will benefit from higher and common standards of service, guidelines or qualifications from a College and might develop close working relationships and new joint services. The benefits of being a Charity were ignored but they could lead to lower fees. Creative membership options need to be considered eg for part time practitioners or family groups or over 75s that could help growth. There still seems no vision for any role of Fellows or better using Fellowship. Medical models do but don’t fit well as their fellowship is an NHS requirement for specialist practice. The RCN model seems better suited but wasn’t one of these studied by the Commission. It has enhanced and consultant membership levels and includes midwives and assistants. In my day the members drove the leadership and innovated in ways the Society could have utilised much more. The local branch democracy and some organisations suited to advanced practice have gone making life easier for HQ staff. These days RPS feels more like a top down organisation that is not open about its membership numbers, age profile and areas of practice making planning hard to the membership. To leave FIP without any consultation suggests members views don’t count. These are not good messages. The market for a member driven College is there with GPhC numbers growing by 1200 a year now at 62000 and 20000 Technicians also registered. A College body serving all those should be growing. Surely it should be seen to be in all parties interests to coalesce quickly and for RPS to offer leadership and an olive branch in its College proposal rather that put it off yet again. It is ideally placed to offer a vision of how that could work with advanced practice for technicians A change of culture and radical rethink is needed to motivate young members to devote time and effort to the new College and to professional cooperation. In 1975 I set up the first UK wide pharmacy group in Drug Information and UKCPA soon followed. It benefited all countries and took only months to establish. Why has it taken so long for the whole profession to follow? Could Schools of Pharmacy not play a more active professional role within the College? A rebadged tinkering with existing Governance removing the Pharm Press won’t generate momentum for change in my view nor deliver the membership growth necessary to compensate for the estimated drop of around 600 members a year. A lot of suggestions came from attenders in Glasgow. I hope the final proposal takes these ideas and those at other events on board to offer a clearer vision of what the college will do, the member benefits and possible future joint opportunities There is a danger the vibrant leadership body of the 90s and noughties will fade into oblivion taking its history with it. The UK Governments. the GPhC, the public, pharmacists and technicians and other professions will suffer the consequences. It must not be allowed to happen. Time to smell the coffee, this may well be the last chance saloon otherwise.
Thank you very much for your comments. If you would like to share your feedback directly with the RPS team overseeing the proposals for change, you can do so using their email address: feedback@rpharms.com
Thank you very much for your questions. Please can I direct you the RPS's FAQs on the proposals for change for further information: https://www.rpharms.com/about-us/changeproposals/changefaqs
If your questions are not answered there, questions can also be sent to feedback@rpharms.com.
I believe more important than newer formulations of naloxone is access at community level. The concept of emergency supply of naloxone by community pharmacies in Scotland as a public health funded intervention would be a rational approach if agreed across England and Wales, improving access!
It was interesting to see a severely hyperkalaemic patient's patiromer being delayed to the next day because it had been prescribed as a morning dose on EPMA.
There is still a lot of scepticism about statins. I have conversations with well educated me friends who don’t want to become medicalised. They believe they can control their cholesterol with diet and excessive. They are suspicious of pharmaceuticals regarding them as rather like poisons! My wife and I did a three month trial on statins and reduced our cholesterol from 6+ to 4+. Impressive but even my GP said - so what?! Not sure he is that convinced either.
Many thanks for your comment. I am the senior editor for research and learning at the PJ. This piece is one of our shorter learning articles which do not generate CPD certificates. To see our full list of available CPD modules you can go to 'My account' and then 'My CPD'.
The trouble is largely that community pharmacy is/was always divided. Multiples and larger groups go their own way and the independent often regards another pharmacy as the opposition. There's always someone out there willing to try to get an advantage and whether this takes the shape of longer opening or offering to do something for nothing , in the long term this was unsustainable for all to follow. But try persuading any paymaster to give you additional cash when the guy down the road is already doing it. Our society often welcomed these initiatives since it appeared to elevate the status of the profession, conveniently forgetting that it was unsustainable in the long term without a real cash injection. How we laughed in 1967, my first year in a pharmacy when a greybeard told us about the bad old days pre WW2 when, as as apprentice, he would be sent along the street to see if the opposition was still open - plus ca change?
What an incredible achievement by Sharon and what an interesting, fascinating account of her programme from start to finish. The photos are fantastic, the experience will last a lifetime and the 'take home' message is clear. Congratulations to Sharon and wishing her ongoing success in IJPP.
Under the 'Diagnosis' subheading where it says "Women of childbearing age should have a pregnancy test to rule out ectopic pregnancy". This suggests all women should be assumed to be pregnant and could be perceived as condescending and patronising. Perhaps it should instead say something along the lines of "Where relevant women of child bearing age should be offered a pregnancy test".
Many thanks for your comment. I am the senior editor for research and learning at the PJ. We have considered your comment and agree with the sentiment so will edit this sentence accordingly. Many thanks.
I’m a pharmacy technician working at Boots’s pharmacy. As technicians we are expected to provide flu vaccination and blood pressure services, not being rewarded for it in a form of a better pay. Myself and my colleague run the pharmacy and we were told on multiple occasions that we have the best team in the area. Yet this year in November, my colleague who is a dispenser was excluded from a bonus scheme and myself was rewarded 2.38% of my Annual Salary. My manager and pharmacists were given 8% on their annual salary and assistant managers 4.76%. I think this is very unfair as makes myself and my colleague feel unappreciated, undervalued and our input into successful running of the pharmacy’s not being recognised. Moreover, I was rewarded this month with 3% pay rise whilst the pharmacists were given 5%. With raising cost of living, I think 3% is very inadequate and greedy. My shop floor colleagues were given 4% pay rise in April 2024 and I believe in April 2025 there will be 6.7% increase in their wages. My salary is growing slower than a minimum wage and I believe if this continues, the gap between my wage and minimum wage will be minimal anytime soon. Boots recently also introduced Technician Development Program. I was told the aim of the program is to upskill my existing skills so I could offer more personalised patient centered care. I think this program is aiming at developing new skills rather than updating existing and the main goal is to release pressure on the pharmacist by giving more responsibility to pharmacy technician. I do understand the importance of continuing personal development and for that reason I continue with CPDs, making sure my knowledge and skills are always up to date. I don’t mind on taking extra responsibility but I personally think this has to be recognised as the pharmacist being rewarded and recognised for their work. I was recently told that I face disciplinary procedure, if I don’t complete the program. I am deeply considering careeea change.
This is an excellent initiative by CGL. The real time notification of missed/late doses has the potential to save lived by preventing people 'falling off script' and by demonstrating clear joined up communications. The annual review by the pharmacist has the potential to utilise the relationship which many pharmacists develop with their MAT clients to identify issues they feel unable to raise with their community drug team. The pharmacist can be a strong patient advocate and by working together with colleagues in community, this could make the work of those of us in community drug teams better and more agile to patient need too. Well done GCL, I hope this roles out wider.
Sir, Whilst I welcome any initiative to improve the lot of patients with asthma, I feel that it may be a little more difficult to change the habits of the patients affected, because of their great attachment to Short Acting Beta Agonists (SABA) and Ventolin (only branded Ventolin not generic) in particular. When I was in practice I made counselling asthmatics a priority because it is so easy to improve the quality of life with just a few simple suggestions. Since I retired, I have used social media to spread the message. From the comments on Facebook and others it is quite obvious that the great British public have a very sketchy knowledge of medical matters and asthma in particular. As mentioned above they have an attachment to SABAs that in other contexts would be considered a dependency. My comment that anyone having only a SABA without an inhaled corticosteroid, not more than a few times a year because it can kill is met with derision. There is a role for the community pharmacist to educate their asthmatic patients, because I predict there is going to be resistance from patients. Regards Bob Dunkley
I have huge sympathy for community pharmacy which has been underfunded for years. However in taking the decision to vote on withdrawing locally commissioned services, including what has been termed 'addiction support services', I wonder if the evidence base for the benefit of these services has been considered? People who use drugs in receipt of substitution therapies such as methadone and buprenorphine are much less likely to die of an overdose (studies suggest approx 4 x less likely) compared to those not in treatment. The combination of needle and syringe provision with opioid substitution therapy can reduce hepatitis C transmission by up to 80% and is a hugely economical intervention. A lot of these services have already been lost from pharmacies post-Covid. Making the most marginalised and vulnerable people in our society who do not have a voice to speak out for them as pawns in this important fight for better funding feels ethically and clinically wrong.
I feel honoured to have had a small connection with Robert Twycross. The Palliative Care Formulary revolutionised our work as pharmacists specialising in this area of work where a large proportion of drug use was off-licence. The work started by Drs Twycross and Willcock hugely advanced our ability to make recommendations to non-specialists and reassure specialist colleagues. The advent of the bulletin board gave us an opportunity to share information and collect data. Attending the Oxford Advanced Course in Pain and Symptom Management was the most informative experience every year for a fortunate large number of specialists and I recall vividly being put on the spot to answer a question by Dr Twycross in front of an audience of far more erudite clinicians. All palliative care specialist pharmacists owe a tremendous amount to this inspiring man who really valued our contribution to the multidisciplinary team. He has left the most wonderful legacy as the work continues.
Thank you RPS for the official response. The gazetted official notice states clearly that the agreement of Assembly was to CANCEL the 2025 board election, not to “defer for up to 12 months” (which, as I have indicated in my letter, would have been a more acceptable proposal”. It is also notable that no response is given to the matter of extending the terms of officers and chairs/vice-chairs, which is central to my letter and should give members significant cause for concern. It is neither necessary or desirable that members are denied the opportunity to reconsider those in positions of leadership as the Society enters a significant and complex period of change as it seeks to establish itself as our Royal College of Pharmacy.
I agree with Mr Churton. It is noteworthy that membership of the Society is falling since it became optional and in my view those who participate in the Society's activities should be encourages to do so, rather than discouraged.
A helpful introduction but no one in the podcast mentions the public or patients.
“To be a charity in England or Wales, the organisation must be set up with purposes which are exclusively charitable for the public benefit.” That requirement might inhibit some current Society activities. It would help to know what of these a College would not be able to do. The Society has lobbied and influenced governments for years for members benefits, will that stop?
A College must be able to ensure the public receive the same standard of pharmaceutical care whoever is the provider be it an assistant, a technician, a pre registration graduate or newly qualified or experienced pharmacist. I look forward to the promised update of regional events to see if these issues have been covered.
Why doesn’t RPS demonstrate leadership of this issue. Get APTUK and PDA together with pharmacists and technicians who work well together to sort this out. There are issues that need to be resolved such as over how technicians are kept up to date on pharmacy practice, laws and ethics and what gaps there may be in their knowledge that a Royal College could resolve through an accreditation system. Pharmacists must remain responsible for standards of patient care and quality of medicines in a framework that maximises the use and skills of technical and assistant staff.
comments
Useful structured introduction to the subject for clinical purposes
Thank you Amrit for your feedback, we are pleased that you found this article useful.
Michael Dowdall, Executive Editor, Research & Learning
Dr Efi Mantzourani is a woman, not a man. Please correct this.
Thank you for bringing that to our attention Cheryl. We've corrected our mistake.
Graham Clews, News Editor
Please note that smoking causes enzyme INDUCTION not INHIBITION as stated. (Via aromatic polyhydrocarbons, not nicotine)
Hi James. Thank you for bringing this to our attention. This has now been corrected.
Hannah Krol, Deputy Chief Subeditor
Could you please explain to me why my name is not on the list of Long Service Members??
Ghamshyambhai Jashbhai PATIDAR
Registration No 6233
Hi there, RPS members' names are published in the Long service of members list when it is their anniversary year of 50, 60 or 70 years of continuous membership.
Sophie Willis, Senior Subeditor
Interesting debate. There is a qualification between technician and pharmacist in Ireland, pharmaceutical assistant. Its a closed register, no more being trained but they did an apprenticeship decades ago and as a result can cover a pharmacist day off each week and up to 2 weeks annual leave. The rest of the time they work alongside a pharmacist. They can only work in community. It would be a good compromise and Ireland has benefited from these healthcare professionals for decades and continues to do so. Ultimately healthcare professionals will seek good working conditions so may not solve multiples workforce problems.
I too am pleased to note the PJ's interest in genomics but since 99% of our genome in contained in the microbiome you risk missing 99% of the science and the clinical consequences. It is true to say "our genes are not our destiny" (epi-genetics) but it is equally the case (eg from studies of identical twins) that the microbiome plays a fundamental role
Worked with Arthur from 1974 to 1976 in D6 when he ran tabletting there and I was a newbie in the process improvement group. RIP old mentor!
It’s very well explaining the supposed shortage but in fact there is not a shortage of pharmacists in the Uk, please look at the current Gphc register. It’s actually pharmacists choosing not to work in community due to workplace conditions and pay and lack of progression. Address that first and see how you can improve working conditions as that it the root cause of the so called shortage to which you refer to when in fact there isn’t a shortage, it’s just a shortage of pharmacists willing to work in community.
I really enjoyed reeding the topic.
Thank you very much.
When the practices/individuals changing inhalers without consultation with the patient were approached for comment, what did they say?
How many fake drugs were detected under the previous scheme ? How many packs were scanned ? How much of our time was wasted on it ? It is tragic the new scheme will be delayed ! Hopefully I will have retired before it appears . Next time the PSNC should demand a fee per pack for scanning .
Interesting article
Community pharmacists can support patients on correct inhaler technique when prescribed a new inhaler by providing a new medicines service.
Only with Herbal formula I was able to cure my schizophrenia Illness with the product I purchase from Dr Sims Gomez Herbs A Clinic in South Africa
The study acknowledges the limited conclusions that can be drawn from this - likely selection bias for people with negative views, with many complaining that the device was harder to use (variable depending on biosimilar) or pain at injection site. We don't have denominator for how many people were contacted - was it a silent majority?
Much was made by originator company of their product being citrate-free and therefore less painful to inject, yet for many years it had contained citrate. That must have had an impact on patient perceptions.
The pressure to deliver the switch and the top-down decisions about what biosimilars were allocated to each area didn't make things easier either. There certainly wasn't the time to bring in every patient for face-to-face discussions (as was common pre-Covid).
The lessons we can draw are limited, except to say that people who felt they had enough information were less likely to complain.
Completely agree James. We switched all our patients in gastro to the citrate containing first line biosimilar. Currently only 10% of our patients are using a non-citrate biosimilar or originator having switch back/forward again after failing to tolerate the citrate biosimilar post switch. It's clearly a relevant factor, but the numbers are completely out of step with those of this study, suggesting there is bias at play.
Mr Tanna was formerly a prominent member of the RPSGB Council and made a substantial contribution to the Society in the 1980's and 1990s.
Lets hope that this year members who are not subscribers of twitter will at last be able to question and examine candidates before they vote.
Where has my previous comment gone?
Very inspiring.
Well done Aneela
Why can’t they bring ranitidine back without the cancer
Causing agent.? Famotidine which took its place is no where near as effective as ranitidine. Please bring back ranitidine it’s a brilliant antacid.
This is a personal account with no study, just how I treated my early stage of Covid. My husband was diagnosed with no real serious symptoms. This is in January 2022. I began to feel increasingly not well with extreme headache and other Covid symptoms and went to go get tested. I had noticed my daughters acne medication on our window sill, Doxycycline during this time and it needed refilling. Called it in for refilling on our (myself and daughter) way to get tested, symptoms of heaviness on my chest and very labored breathing got worse. My husband got the refill, I took it at 6:07 pm and 7:52 pm, felt 100% better in terms of my breathing and no pressure on my chest. I have often wondered what could have progressed into something with no real therapeutics at my Urgent Care and the Emergency Room with over 60+ in the waiting room. I have continued to Google Doxy with aspect to Covid 19 and have been increasing my stance that it is a therapeutic that should be used. For example, with the Lancet study, etc. I am a 53 year old female that could lose weight and am glad I had that antibiotic. I also used it with Vitamin C and Zinc.
I took a load of medication to Ukraine in 2001.(you can read about it in the Journal) This was to supply a dispensary in the west of the country- ie a non-urgent mission. It took extensive paper work just to get these medicines on board the bus we were using. Then we had to have paperwork for all the countries we passed through. When we got to the destination the medicines were held in quarantine for clearance by Ukrainian officials from Lviv. I realise that this is an emergency, but from my experiences medical aid from individuals is like as not going to be delayed, and the emergency might well have passed.Please, if you wish to help, send money.
I'm picking up a family from Western Ukraine later this week as I have a wheelchair access vehicle and I offered. They need Levo Thyroxine. It's not a problem for me to supply a small amount as my mother has a prescription. However is it appropriate or possible to access a larger amount to supply to the area? My contact say they are running out of this medication? Please let me know if possible. Thanks
Fantastic
Really interesting stuff! Will have to keep an eye on this in practice. Thanks so much!
As reported, there appears to be some conflation of a Pre-Payment Certificate (PPC) and the mechanism of eRD via the EPS.
The PPC is 'lodged' with the pharmacy.
I appreciate that the aim of a single charge for annual treatment is outwith the gift of EPS eRD - but this mechanism of supply makes sense in terms of reducing the touch-points the patient has to make in obtaining medication for a stable and persistent condition. We should be making life easier for patients.
I do hope the PPC scheme doesn't complicate issues for pharmacy teams.
But a simple solution would be to abolish prescriptions charges to align with other nations.
NICE 2021 has updated guidance on the recommended dosing or iron. There is now a recommendation that once daily oral iron (50-100mg elemental iron) is sufficient (not 100-200mg elemental iron as this paper suggests). This is due to hepcidin, which regulates iron uptake. Multiple daily dosing of iron increases the production of hepcidin, which reduces the amount of iron uptake. Hence, multiple daily dosing does not necessarily confer increased iron absorption but may lead to increased side effects.
This is taken from the updated NICE guidance:-
Traditionally oral iron salts were taken as split dose, two or three times a day. More recent data suggest that lower doses and more infrequent administration may be just as effective, while probably associated with lower rates of adverse effects.
The optimal drug, dosage and timing of oral iron for adults with iron deficiency anaemia are not clearly defined, and the effect of alternate day therapy on compliance and ultimate haematological response are unclear. Based on the available literature, a once daily dose of 50-100 mg of elemental iron (for example, one ferrous sulfate 200 mg tablet a day) taken in the fasting state may be the best compromise option for initial treatment.
For mental health medicines the Choice and Medication website portals have a series of leaflets on mental health medicines, also available in Arabic, Bengali, Hindi, Somali, Turkish, and Urdu.
🙎🏻♀️
really interesting article - very insightful and will support me in my clinical practice. I enjoyed learning about the holistic and individualised approach
An excellent clinical perspective on inhaler switching.
The question is why the UK do not consider recruiting the refugee pharmacists who are already live in the UK for so many years and cannot get back to their job in any way due to the overcomplicated rules and regulations. I am one of these people and I know so many pharmacists as me. You already have good assets but unfortunately no one would help.
Sorry, I'm not clear on this, about 'new' applications since the new . . . Does this mean that there have been successful applications before all this 'new' framework? Are there any licensed devices/solutions 'out there'?
Thank you, Paul. A clear, thorough explanation of the issues.
Thanks. That’s helped me to understand where we are and it seems, in my opinion, that the RPS Assembly made a sensible decision.
A further thank you Paul and further support for the Assembly's decision.
Charity status was considered by the RPSGB Council more than once in the past and rightly rejected for limiting the Society's ability to promote pharmacists and the profession. There is nothing that the Society cannot do now that would be achieved by College status, and much that could be lost.
I agree Nick on Charity and College status and don’t think they are the way forward but think the two issues are separate. See below.
I am not convinced the Society is any nearer to operating as a body akin to Royal College than it was in 2010. In many ways things seem to have regressed somewhat.
Take care
Follow the NICE guidelines and avoid unnecessary litigation.
They do not see individual patients face to face and cannot make idicts on that basis. Let practitioners practice and politicians debate.
The article shares the RPS Assembly's thinking as to why conversion was not pursued, but considerably less detailed insight of the actual benefits that Royal Colleges enjoy. I wonder if colleagues who support college status can fill in the gaps?
Organisational transition is by its nature complex, but the pain of change alone is not a primary reason not to do something. I read that the RPS is not ready for this yet; what would tip the balance in favour of the college status?
Could you please quantify what "moderate doses" of caffeine are? How many mg does that equate to?
Hi Lucy. Thanks for the query. By moderate consumption, I meant not more than the recommended limit, so 200mg per sitting and 400mg per day for non-pregnant adults.
As a former Transcom member who supported the idea of a Royal College I was interested to see Mr Bennett’s perspective on this recent decision taken it seems without membership debate.
Sadly my notes were shredded years ago but I hope these thoughts may offer a way forward.
From memory the old dual role RPSGB was deemed unfit for purpose and it was suggested the profession needed a professional body akin to a Royal College. NB not necessarily a Royal College per se. Transcom felt the RPS without its regulatory role could do that by engaging more with other pharmacy professional bodies.
I therefore reviewed how many of the Royal colleges ran to see what they offered and think I wrote to the PJ, but I cannot find anything I wrote before 2012 on the website. From memory I noted the following:-
They set standards for practice and qualifications beyond those needed for professional registration with the regulator.
They worked with the regulator on ensuring these met service needs.
They supported members though training, publications, examinations, libraries etc
Students could join for free or nominal sums
Membership level was focussed on training grades with fees often linked to salary growth to help younger members join and progress.
Fellowship was the aim after 8- 10 years or so and there were clear routes to gain that membership level often linked to a NHS Consultancy or GP status that were open to all.
Most provided free continuing membership/fellowship to those over 70 or 75 thereby retaining their expertise for future generations, and enabling them to continue within their social and professional networks.
The Colleges were run by elected Fellows with input from some elected members and students.
I agree with the conclusion the new RPS does not need to try to become a Royal College. It could however move to operate much more like a Royal College than it does now.
Our Fellows system needs a radical rethink. When I became one around 1991 I wrote thanking the President and asked what I might do to help the profession, but got no answer
I have no idea how many members or Fellows the Society has now but suggest the balance needs to change.
I am long retired and have gradually become disengaged, I am not into social media
so I’m not clear what the Society can do or is doing to identify develop or improve standards that employers or regulators want.
The Society might wish to commission research to see what employers and the regulator want from it and to investigate how Royal Colleges now work to see what can be done to mirror or improve as many of these roles and organisational arrangements as possible within the RPS without trying to become a College or Charity.
Regards
Howard McNulty.
A couple more things came to kind.
I mentioned Royal Colleges as did others in Transcom and I raised the idea of free membership for the over 70s to help retain expertise and give loyalty some reward. This caused a horrified reaction from RPSGB representatives, largely I think because of the enormous costs of providing and posting weekly Journals for nothing. Now that cost has gone, maybe it’s time to revisit that idea.
Mr Bennett refers to no name change being sought. Transcom suggested the then RPSGB should be rebranded to lose “the unfit for purpose label” and the simplest solution was by dropping GB from the title.
I think it would be worth contacting Nigel Clarke who chaired Transcom and then led GPhC to see if he can shed any light on what the Society might do going forward and for any thoughts on the past.
Asking members might even be worth undertaking too.
‘….NDMA is classified as a probable human carcinogen, although available safety data does not show that ranitidine increases the risk of cancer, and any possible risk is likely to be low. However, according to the EMA, NDMA had been found in several ranitidine medicines “above levels considered acceptable”, and there are “unresolved questions” about the source of the impurity…’ How long will this take it’s been two years ?
Thank you Paul for a clear explanation of the issues.
To anyone who takes up this offer: Do NOT underestimate the demands of an Independent Prescriber course. If working full time ensure your employer agrees to time for undertaking the practical shadowing and observing parts of the requirement, if not indeed additional study time, as well as the course attendance requirement. If you're working part time, also make sure you have the availability in your "non-employed" time plus your study time from your employer to succeed in this very demanding course. But please don't let me put you off... the Independent Prescriber annotation is an opening to all sorts of new professional activities once qualified and competent in a clinical area.
Thank you for the useful information!
https://clinosol.com/
Thank you for continuing to highlight the effects of LongCOVID.
very informative - will bear this in mind when reviewing patients. Thanks for a great article.
This indicates complete white wash of the responsibility of the HSE in regards to the safety of health workers. This response not only dramatically reduces the confidence in the reporting system but also makes you wonder whether you should be working in the NHS or any other healthcare system if there is no concern about adverse outcomes to the staff that work there.
Graham
I left this on the Chief Executives article on the Royal College decision.
You may not have seen it. I’m on board with what you say and am so disappointed how the Society has progressed.
Howard McNulty 29/04/2022
As a former Transcom member who supported the idea of a Royal College I was interested to see Mr Bennett’s perspective on this recent decision taken it seems without membership debate.
Sadly my notes were shredded years ago but I hope these thoughts may offer a way forward.
From memory the old dual role RPSGB was deemed unfit for purpose and it was suggested the profession needed a professional body akin to a Royal College. NB not necessarily a Royal College per se. Transcom felt the RPS without its regulatory role could do that by engaging more with other pharmacy professional bodies.
I therefore reviewed how many of the Royal colleges ran to see what they offered and think I wrote to the PJ, but I cannot find anything I wrote before 2012 on the website. From memory I noted the following:-
They set standards for practice and qualifications beyond those needed for professional registration with the regulator.
They worked with the regulator on ensuring these met service needs.
They supported members though training, publications, examinations, libraries etc
Students could join for free or nominal sums
Membership level was focussed on training grades with fees often linked to salary growth to help younger members join and progress.
Fellowship was the aim after 8- 10 years or so and there were clear routes to gain that membership level often linked to a NHS Consultancy or GP status that were open to all.
Most provided free continuing membership/fellowship to those over 70 or 75 thereby retaining their expertise for future generations, and enabling them to continue within their social and professional networks.
The Colleges were run by elected Fellows with input from some elected members and students.
I agree with the conclusion the new RPS does not need to try to become a Royal College. It could however move to operate much more like a Royal College than it does now.
Our Fellows system needs a radical rethink. When I became one around 1991 I wrote thanking the President and asked what I might do to help the profession, but got no answer
I have no idea how many members or Fellows the Society has now but suggest the balance needs to change.
I am long retired and have gradually become disengaged, I am not into social media
so I’m not clear what the Society can do or is doing to identify develop or improve standards that employers or regulators want.
The Society might wish to commission research to see what employers and the regulator want from it and to investigate how Royal Colleges now work to see what can be done to mirror or improve as many of these roles and organisational arrangements as possible within the RPS without trying to become a College or Charity.
Regards
Howard McNulty.
50% for and 30% against is a narrow majority. Really??
I note Chris' passing with great sadness. What a lovely tribute to him by his colleagues!
I count myself as one of the "large number of staff he inspired with a love and enthusiasm for pharmacy".
Whilst it is some years back, I still remember his quiet wisdom and gentle advice.
RIP
Thanks Howard and, as ever, we are in furious agreement! KR Graham
Very informative article.
Need to be read by all physicians, pharmacists and nurses too
Mike was my tutor at Chelsea College University of London where I studied for my B.Pharm. degree from 1968 to 71. I was so sad to read of his passing , but fascinated by his career after leaving Chelsea . I can totally concur with his wonderful warmth and help he gave me as a student. I too was invited to his home for a meal and he introduced me to the delights of Indian and Chinese cuisine! which was edifying to a naive young man from The Black Country! My sincere condolences to his family Malcolm Costley B.Pharm. M.R.Pharm.S.
The HSE might find it's hands tied in looking at both non-fatal and fatal cases of COVID, as unlawful killing merits a criminal rather than civil standard of proof.
Independent and dispassionate post-hoc assessment can offer perspective outside of the pressure cooker of the occupational environment. Regardless of the HSE, NHS organisations have a duty of care to their employees in real time and the Duck Test applies.
The length of consultation times is a question of parity more than anything else. 10 minutes is the minimum length supposed to be given to a GP appointment and in practice is the standard. In the face of unparalleled demand and a critical mass of undiagnosed morbidity I can't imagine GPs having a great deal of sympathy with requests for more time from other disciplines within their teams.
Resources, including time, are finite and will never be enough to deliver an equitable health service.
I wonder if there is any research on the number of housebound patients who would have the technology at home to be able to participate in a video call.
excellent presentation
What a sad loss, she will be greatly missed
A truly inspiration man who had a significant influence on my career and the emphasis I have placed on management and leadership training - I mention him always when I speak to pharmacists about the importance of leadership. I wrote to him a few years ago to thank him and was delighted to receive a response. May you RIP 'Mr Barrett'.
Chris was deputy chief pharmacist at Westminster hospital, where I & three others Madeleine , Carolyn, Claire started our preregistration year. He inspired, encouraged and imbued a love of hospital work. Two of us ultimately became ward pharmacists at Westminster. My husband also worked with Chris’ in later years. It is with sadness that we have lost a major innovator to hospital pharmacy procedures.We will always be grateful to have known him.
Tragic!!!
clobetasone cream is a medication used on the skin to regale enlarging, tingling, and irritation. It can assist with skin issues, for example, skin inflammation, including contact dermatitis. psoriasis. You should always use the lowest strength corticosteroid that is effective for your skin condition for the fastest possible time. It should also not be used to treat: Acne.
tenofovir 300 mg is utilized alongside different drugs to treat mortal immunodeficiency disease in grown-ups and youngsters 2 years old and more chronic. It is additionally used to dine continuous HBV in grown-ups and children 2 years old and more seasoned gauging 22 pounds or more.
There is very high pressure everywhere in the primary care system so people need to move away from the familiar lines, 'to reduce GP pressure', or to 'support GPs'. This is about changing systems so eveyone can serve citizens efficiently when they are providing primary care services.
Very sorry to hear of the passing of Mr Jagger . I always popped in for a chat during our annual holiday in north Norfolk .
What a wonderful career this gentleman had .
It was with great sadness that we learnt of the passing of Chris Barrett. I had the great fortune to spend my formative years under his mentorship at the London .His courtesy, sincerity and belief in his chosen profession were inspirational.
Chris seconded me to the London Jewish Hospital where I was introduced to the nursing staff and found my wife; for which I remain eternally grateful.
Fortunately we were able to correspond in his latter years and learnt of his many many interests.
Our thoughts are with his children and grand children.
Marie and Gary Boorman
Considering how bad job prospects are for a lot of pharmacists and how there is a shortage of doctors, Id say its mutually beneficial for pharmacists and the GMC. Whilst it is understandable that the last 2 years has had a heavy toll on healthcare worldwide, there ought to be more transparency from pharmacy and medical bodies, about this subject.
This is something which needs to be addressed and something I have been going on about for many years.
I graduated in 2013 but have been unable to get a DMP/ DPP during all this time. I have requested support from multiple general practices and CCGs within a 30 mile radius since 2016 but all have turned me down (ghosting, nepotism or demaninding more money than what I was earning in a month for the "privilege" of shadowing them for 90 hours a week).
THE GPhC and RPS really need to work together with IPSs and various bodies to come to some arrangement as it is ridiculous how thousands of pharmacists who can be great assets are being wasted
The worked solution to question three is incorrect as the price used in the question is £150/60 tablets and the price used in the solution video is £105/60 tablets.
Hi Kish. I am one of the Senior Editors at the PJ. Thanks very much for flagging this up. We have just updated the article to correct this.
I am happy NHS Education and the GPhC is working to help pharmacist who are keen to become Independent Prescribers in getting a DMP or DPP by incentivising this role.
I have also asked few GPs and CCGs for support and the first question asked is about the incentive for them or the pratice.
I am looking forward to a positive outcome in this ongoing development.
I am so very saddened on reading of the death of Sheila Beaumont. She had a wonderful way of making me feel most welcome when I relocated to work in East Sussex [between September 2005-February 2008]. Sheila was always looking to the future of pharmacy: Independent prescribing is the way forward! I fondly recall that Sheila was also an active member of the local Regional pharmacy group, CPPE tutor and active pharmacy delegate to many BPC conferences. Sheila you will be sorely missed. My heartfelt condolences to your family, friends, customers & colleagues.
I am saddened and shocked to read of Hillary Judd's death. I am fortunate that I interviewed with Hillary for an interesting pharmacist information job role in Exeter, Devon. Although unsuccessful, Hillary agreed to keep in touch via LinkedIn. And we chuckled about our shared connection as Pharmacy graduates of Aston University in Birmingham. I think Hillary would be delighted with the transformation of the Gosta Green campus! So, my heartfelt condolences to Hillary's family, friends & colleagues.
Informative and useful, confirms patient’s lived experiences and practical advice for professionals. Thanks PJ.
Why such an inertia? Red flag have been accumulating for long, from the bench, for more than a decade. Pharmacovigiliance is about drowsiness.
https://www.bmj.com/content/377/bmj.o1531/rr
Are obituaries published online?
Hi Ron. Yes, obituaries can be found here: https://pharmaceutical-journal.com/obituaries
Sophie, senior subeditor
It is difficult to discern what a telephone help line would achieve for Rx drug addicts. It would have been no good for me, when I had a problem with prescription drugs. It’s difficult to get meaningful advice from a phone line , especially if the person in the other end has no idea of your circumstances. Once again it is people who have not been there dreaming up schemes for those who have. The BMA don’t want to support it because their members caused the problem in the first place and are unwilling to help. Even though I had a problem for 40 years and had fitness to practice issues, even I don’t know the answer. But I do know it’s not a phone line.
The idea of a helpline *has* come from those who have been through prescribed drug dependence and have struggled to get a) recognition of their withdrawal responses b) info on how to withdraw safely and c) support whilst doing so. A dedicated national helpline staffed by trained people could offer all of this.
Well, Bob, first off, people who have become physically dependent on a prescription medication is NOT an addict. There is a massive difference between addiction and physical dependency. Many people who become dependent have not been given informed consent by their doctors that dependency could occur. Many are left with absolutely no support (emotionally, financially, etc) and have no clue how to slowly and safely taper off their drugs because doctors are so incompetent they aren't educated on taper protocols. A helpline would help point these people in a direction of someone who can help them as well has offer emotionally support for having their lives destroyed by doctors who couldn't kindly inform them their medication could cause dependency. Many people end up physically dependent, NOT ADDICTED, and end up killing themselves because they have no clue how to taper and the drug has destroyed their nervous system. Many people physically dependent are going online to taper communities and forums to learn how to taper when it should be their doctors and governments job to help them, not complete strangers.
Chronic fatigue is something completely different to ME/CFS. This is written with the terms confused. The complex multisystem disease, ME/CFS, see NICE Guideline ME/CFS 2021, is marked out by the symptom Post Exertional Symptom Exacerbation which includes fatigue (understatement to the point of being absurd) as well as other symptoms. It is not defined by fatigue. Chronic fatigue on the other hand just means fatigue that has become chronic, it is a single symptom that can arises from any number of other conditions such as multiple sclerosis, arthritis or even depression. It seriously doesnt help when articles confuse the two, and causes even more harm when research cohorts confuse the two - the results end up useless and potentially even harmful. Please correct the title so it is clear which of these two things the article is about, is it about the disease ME/CFS as in the NICE Guideline, or is it about the symptom of something else,, chronic fatigue? Thanks
Thanks for your helpful comments on our feature. The feature aims to explore what is known about fatigue in general, and the specific impact of long COVID fatigue on research in this area. ME/CFS is pulled out as an example of a condition in which chronic fatigue is one of the symptoms to highlight and compare the struggles of people who have been living with fatigue for a long time, but the feature is not intended to be specifically about ME/CFS. I have amended the text to clarify this.
Dawn Connelly
Features editor
The Pharmaceutical Journal
It's blatantly obvious you've never met anyone suffering from CFS/ME. As a sufferer myself, I can honestly say that PEM is NOT EVEN CLOSE to being the main symptom.
I thought the article made it clear that the relation between CFS & the scope of the article refers to the symptom of fatigue...Which is BY FAR the main debilitating symptom of the condition. (not just in my opinion, but EVERY person I've ever heard talk about it. I'm a member of a Facebook support group where thousands of CFS sufferers post about their difficulties.)
The article even mentioned how many people aren't even aware they experience PEM. I myself have never considered it a symptom due to the unrelenting fatigue I'm already constantly battling.
You made it sound as if ME/CFS sufferers primarily experience fatigue post exertion. (Or even that exertion is REQUIRED for fatigue symptoms).... Which is not the case whatsoever.
So, if anyone needs to watch out about spreading incorrect info, that's you my friend.
The author of this clearly has a deep understanding of how CFS affects the lives of those burdened with this illness.
As this is primarily an article about about ME/CFS please could you consider making this clear in the title - as many health professionals do not understand that there is a major difference between having ME/CFS and having chronic fatigue
Chronic fatigue is a very common symptom that occurs in a wide range of medical and mental health conditions. It is not a distinct clinical entity
ME/CFS is a syndrome that includes activity-related fatigue and post-exterional malaise/symptom exacerbation among its key diagnostic features
The new NICE guideline sets out a very clear list of symptoms that are required to make a diagnosis of ME/CFS:
All of these symptoms should be present:
Debilitating fatigue that is worsened by activity, is not caused by excessive cognitive, physical, emotional or social exertion, and is not significantly relieved by rest.
Post-exertional malaise after activity in which the worsening of symptoms:
--- is often delayed in onset by hours or days
--- is disproportionate to the activity
--- has a prolonged recovery time that may last hours, days, weeks or longer.
Unrefreshing sleep or sleep disturbance (or both), which may include:
--- feeling exhausted, feeling flu-like and stiff on waking
--- broken or shallow sleep, altered sleep pattern or hypersomnia.
Cognitive difficulties (sometimes described as 'brain fog'), which may include problems finding words or numbers, difficulty in speaking, slowed responsiveness, short-term memory problems, and difficulty concentrating or multitasking.
Dr Charles Shepherd
Hon Medical Adviser MEA
Member of the NICE guideline on ME/CFS committee from 2019 - 2021
Thanks for your helpful comments on our feature. The feature aims to explore what is known about fatigue in general, and the specific impact of long COVID fatigue on research in this area. ME/CFS is pulled out as an example of a condition in which chronic fatigue is one of the symptoms to highlight and compare the struggles of people who have been living with fatigue for a long time, but the feature is not intended to be specifically about ME/CFS. I have amended the text to clarify this.
Dawn Connelly
Features editor
The Pharmaceutical Journal
I've already commented above to someone who left a similar comment, so if you don't mind pls read that as well.
It's really scary to me that PEM is such a huge factor to the medical "expert" community... So much so that it's considered a requirement for diagnosis.
As I mentioned above, I've never considered "exertion" to be much of a factor when considering my symptoms. Sure, when I have to go do things I'm worn down even more afterward, but even if I lay around for days trying to rest up I'm still going to be fatigued!!
You could say that I'm only one person & insist most people would consider exertion to play a big role in symptoms, but based off countless posts I've read on the CFS/ME support group Facebook page that's not the case with them either!?!
The reason I'm so bothered by this is because it's just one more thing added to the confusion/misinformation surrounding this cursed illness. I'm aware that there's been a severe lack of funding for research which in turn resulted in very little studies being carried out. However the ones that have been done have obviously caused erroneous info to spread throughout the medical community.
I'm going to assume that what was actually meant by post exertional malaise was really just trying to say that activity does not help the symptom of fatigue.
Another thing that seems to be creating problems with research is how there's no distinction between severity levels. It doesn't seem right, in my opinion ,to group together people who are still able to work and function practically normally and those who can barely leave their bed.
I'm not trying to be rude... It's just that this condition has completely stolen my life. I'm alive but I don't consider this living. I desperately yearn for real progress to be made regarding CFS but the way things stand currently (esp the lack of real understanding by doctors) gives me little hope.
If only there were more truly insightful people, like the author of this article working to make progress concerning CFS/ME.
Really, guys ? "A local oestrogen therapy, taken orally " ? I am a GP but you folks are supposed to be the pharmacists !
Apologies about this - it was a very silly mistake and is corrected now. Thanks both for pointing it out!
PJ your proof reading needs improving. Vaginal tablet taken orally! We are suppose to be experts in medicines.
I’m very proud of the high antidepressant use in Norfolk. If you consider that maybe only 50% people with depression go to the GP, and few of those give enough clues to get accurately diagnosed, then Norfolk’s high use is probably only a small percentage of those appropriate for antidepressants. And, despite what NICE says, the evidence for psychological interventions is still poor (the use of waiting list controls instead of placebo is methodologically invalidating) and, although they may be flawed, antidepressants work in most people, are available at a moment’s notice and there’s no waiting list. I’d say the other areas are under-prescribing rather than those 3 areas over-prescribing.
Do these statistics reflect the way the death certificate is made out? In France, my wife died after "hitting the bottle" following the best part of a year in detoxification, but "alcohol addiction" did not feature on the certificate and I've been told it is rare there for any drug addiction to be listed, "cardiac failure" being the norm. Could this be the case elsewhere?
I was saddened to hear of the death of Isabel Bailey. As my onetime colleagues have said she was a pleasure to work with and someone who remained in the memory long after our cooperation had ended.
I too have happy memories of working with Sheila Beaumont at CPPE. She was she was always interesting to talk with, and provided wise counsel. My condolences to her family
Quote from email message sent to PCN Clinical Directors and PCN Lead Pharmacists from Medicines Value Team NHSEI on 7th July 2022:
'Neither the price at which the generic version of apixaban has been made available nor its limited supply justifies the NHS to change the existing commissioning recommendations that were issued in January 2022 and therefore, consistent with NICE guidance, we continue to recommend clinicians use edoxaban for new patients, where clinically appropriate.'
Concern re suitability of edoxaban for patients with CrCl > 95ml/min;
‘On the other side of the spectrum, a possibly decreased efficacy
of edoxaban 60 mg OD compared with warfarin was observed in
patients with a CrCl of >95 mL/min.31 Interestingly, as a result of
these findings, further post hoc analyses revealed a similar effect
also for Rivaroxaban188 and Apixaban.189’
from
The 2018 European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation’
https://academic.oup.com/eurheartj/article/39/16/1330/4942493
Obese patients. ISTH guidance is that unsuitability of DOACs in patients with BMI >40 weight >120kg applies to ALL DOACs:
see:
Martin, K., Beyer-Westendorf, J., Davidson, B.L., Huisman, M.V., Sandset, P.M. and Moll, S., 2016. Use of the direct oral anticoagulants in obese patients: guidance from the SSC
of the ISTH. Journal of Thrombosis and Haemostasis, 14(6), pp.1308-1313.
Colleagues may be interested in seeing how much antidepressants and other psychotropic drugs consumption in the UK compare to other 64 countries:
https://www.the-lancet.com/journals/lanpsy/article/PIIS2215-0366(21)00292-3/fulltext
I am sorry to contradict because patients on antibiotic treatment for 5, 7, 10, or longterm are the ones who pollute the environment. All that you need is 3 dose to kill all the bacteria in our body, and no study to prove you need to prolong treatment.
Using antiseptics, antibacterial soap, detergents and shampoo, kill sensitive bugs and help superbug and fungus thrive. Please stop polluting hospitals with plastic bins and expect to solve this problem of polluting environment.
A really interesting article, thank you for sharing. I'll be teaching Root Cause Analysis applied to medicines error on our PG diploma next month so this is a really useful, contemporary issue to weave in as an example.
Could I please encourage some reflection around the terminology and language used though. Firstly, the supply issues are affecting patient adherence not concordance, the term concordance refers to the consultation between the HCP and the patient, not the medicines act. Secondly, whilst I wholly understand the frustrations here, I'd just urge a little reflection around the sentiment that the nurse 'decided' to give the medicines daily not weekly. Whilst I'm sure unintended entirely this holds an implicit accusatory judgement of wrong doing and even infers potential mallice on the nurses part. The nurse misunderstood, got confused, made a human error...for example would hold less accusatory judgement than 'decided'. A really small point but the language that we use with these things really does make quite a difference.
Thank you for your comprehensive article on a complex subject. May I point out however that abatacept, adalimumab and etanercept while good options for polyarticular juvenile idiopathic arthritis (pJIA) are neither useful nor licenced for systemic juvenile idiopathic arthritis (sJIA) as erroneously stated in table 2. Tocilizumab is correctly identified as useful to treat sJIA ( as well as being useful for pJIA) . Please see SPC of these meds for further information.
Kind Regards
Clare Nash ( Specialist Pharmacist, Paediatric Rheumatology, Sheffield Children's Hospital)
Thank you for this very comprehensive account of a complex subject. May I just point out that the drugs abatacept, adalimumab and etanercept while useful drugs for polyarthritic juvenile idiopathic arthritis (pJIA) are unsuitable for (and not licensed to treat) systemic juvenile idiopathic arthritis(sJIA) as claimed in table 2. Tocilizumab is however useful for sJIA Please see the relevant SPCs for further information.
Kind Regards
Clare Nash ( Specialist Pharmacist Paediatric Rheumatology Sheffield Children's Hospital)
Hi Clare. I am the Senior Editor at the PJ working on our learning and CPD provision. Thank you very much for highlighting this. I am looking into this with the authors of the piece and will make sure any necessary corrections are made.
Is there any way to still get a hard version of the PJ delivered? I rarely read the online and miss the paper copy!
My first concern is for the welfare of the 7 care home patients affected by the alendronate switch to risedronate. The harm potential of risedronate shouldn't be underestimated in this very vulnerable cohort. But why was the Mar-chart not checked by at least two nurses before administration? The different colour, shape, markings ought to have alerted that the pre-breakfast medicine had changed from before etc. Alas, "to err is human; to forgive, divine" [Alexander Pope, 1688 to 1744].
It's so insightful of the Pharmaceutical Journal to include insights from the three patients above. Overall, I too hope GSK would reconsider their decision to discontinue their much-needed seroxat (paroxetine) 20mg/10mL oral suspension.
No mention of whether this is a second or third step? Would have been good to get an example or two
Great to see development of MH genomics.
Found it a useful resource for use in clinical practice
Recruiting more pharmacists from abroad will not solve the problem it is merely plastering the issue. Perhaps you might need to understand why pharmacists are leaving community In their droves. You fail to mention the workplace conditions in community pharmacy and the rising workloads. It comes to as no surprise that many pharmacist are choosing to leave community and for lower pay but a better work life balance. Until you properly address these issues then you will find it very difficult to recruit and retain pharmacists.
I must take issue with some points made by the author of this article. Although there are no errors in what has been written, it is the omissions that concern me. Firstly, there is no mention that the primary target may not be the metatarsal joints. Secondly, there is an implication that the condition is almost always accompanied by painful swelling of joints and rubra. Any, or all of, these features may be absent. I have a patient who presented with painless swellings in the proximal metacarpal joints of several fingers in both hands. There was limited flexor and extensor movements, and there was no pain associated with these movements, and only two fingers could be fully extended. Blood tests ruled out osteo- and rheumatoid arthritis, and it was only when the patient was tested for blood oxalate that we could confirm a diagnosis of gout with tophi. The clinical example in the article is misleading by failing to mentioning painless presentation, not mentioning the metacarpal joints and that the deformities and that there may not be flare-ups, but still progressive.
Hello Henry. I am the senior editor for learning and research at the journal. Thanks very much for your comment. I have shared your feedback with the author of the article and will look at this closely with them. Thanks again.
An excellent article to update knowledge on UTIS and also a very good reference source for community pharmacists.
SHENU BARCLAY
LOCUM PHARMACIST
David Ganderton was a very outstanding Fellow of the Society and his death war rants a special tribute of his life and work in pharmacy, which led to his OBE.
Please prepare one and publish it in the PJ.
Pharmacists in England have, for some time, been able to create their own contribution (vaccination, emergency supply of prescription items, minor illness contributions, etc) to the patient's record and share this with GPs in both England and Wales, (I have no information about Scotland and Northern Ireland). This is 'write' access. What other information would pharmacists wish to share with the wider clinical community?
Pharmacists in England also have access to the Summary Care Record, (and the Clinical Portal in Wales), which provides at least a level of 'read' access and is often all an admitting doctor can see when the patient turns up in Accident and Emergency.
It would be useful to understand what level of 'read' access pharmacists feel they need to see. Most elements of any 'clinical record' (the hospital progress notes or the GP notes) are not 'shared' with anyone else, as they are largely unstructured and thus hard to share, store and make sense of once they are in a central repository.
The Shared Medicines Record in Wales will provide access to up to date information about medicines for all clinicians (I use this term in its widest sense) who care for patients with medicines.
Data about radiology or pathology results or pathology laboratory results would be included in the National Data Repository within Wales - and may be included in some ICS-level shared records in England - but are not always easily shared between hospitals and GPs within England, so I'm not sure that community pharmacists are any less well-off (in terms of access to data) than others. This doesn't make it right - merely adds an additional perspective.
Data that is important to inform decision making is something that we should certainly press for, but we do need to specify what we wish to see (and why) to facilitate the provision of access. This isn't a 'censorship' issue - more a practical issue about identifying information that could (usefully) be made available.
Structured information, such as laboratory results, are easier to share than 'clinical narrative' that is often recorded in 'the notes'. Data included in centralised 'shared records' could be made available to all relevant clinicians, but understanding what is really important will make it easier for those who are working to make this available.
“pharmacists have revealed that patients are being switched to edoxaban without being informed”
As a profession we have a duty to lead this discussion with the patient & take ownership of the process if they wish to proceed -in all settings PCN/GP & Community Pharmacy. If a patient presents with a first request or prescription then it would surely warrant a call or NMS depending on setting.
Excellent guideline from Helen Williams with PCPA, UKCPA & PCCS
pcpa.co/AnticoagNVAFJuly22
This excellent survey highlights the need for ready to administer drugs to be made available from the pharmaceutical industry. Hospitals should be prepared to pay a small premium for the drugs presented in this way.
Agreed but there is also a need for regional / national hubs to be established within the NHS to produce batches of products which are not available from commercial sources. In addition to the question of whether the NHS is willing to pay a small premium for these products there is a need to establish a system to standardise these products to make them commercially viable to produce.
The granting of o the title Royal in 1988 was to the Pharmaceutical Society of Great Britain not the Pharmaceutical Society.
Thank you for your comment, this story has been updated to clarify this point. Sheralyn Bone (Chief Subeditor)
It’s easy to understand how clinicians have become used to a simplified “serotonin” explanation of how antidepressants work - the reality is complex and ambiguous and may sound less reassuring to patients. However, many people take medicines when they don’t understand how they work. Paracetamol for example. So, perhaps we should focus on finding out what the patient already knows about their medicine, what they want to know and what they’re concerned about. Then we can have an individualised (person centred) consultation and come to a shared decision about the optimal course of treatment for that patient.
Reform of the generic medicines procurement and supply system is essential for patients, the NHS and the future of our profession. It won’t be easy as change is difficult for everyone.
Where do I find death notices?
Ron Medlow
Update: we have finished looking into your comment and are satisfied that the article does not need to be updated.
Whilst in the past most closures may have been relatively infrequent and for a matter of hours this is most certainly not my experience in my local area in recent times. Instead of the 7 days one particular Pharmacy was supposed to be open they were only open 3 and these were very much reduced hours. This situation was for weeks, it was further exacerbated by the fact that despite not being open prescriptions were still being downloaded and therefore increasing the workload in GP practices having to re-issue the prescriptions and then try to contact the Pharmacies when they were open to return the originals to the spine for cancellation, this will also have increased the workload in the Pharmacy at an already stressful time.
I have to question how much the situation is trying to be downplayed.
Ravi Sharma has promised to take the results of the 2021 Workforce Wellbeing survey to 'governments across britain, the NHS and other stakeholders'. Much of the stress affecting pharmacy today is the result of the Society's own policies! Why isn't the Society working to reduce workload and stress by cutting its own ambitious itinery?
I think this article is a helpful summary, and tries to unpack some of the complexities surrounding this issue. I feel some of the responses by clinicians (not in this article!) have been slightly too defensive in saying "we don't use the chemical imbalance explanation with patients, so this is nothing new". I think if we are honest, it has previously been used quite commonly as a short-hand explanation (as Nina has mentioned in her comment). We need to reflect on that and refine our communication about antidepressant actions, understanding what each of our patients wants to know and what worries them. My other comment would be that a little more context about lead author Joanna Moncrieff would be relevant beyond describing her as a consultant psychiatrist. She's a prominent and longstanding critic of psychopharmacological approaches to treating mental illness, having published extensively in lay and scientific publications. I think that is relevant when reviewing this umbrella analysis and how it has been promoted.
The contents of medicines are surely only part of the story. What about the research on laboratory animals that is used to ensure safety, lack of toxicity, and effectiveness?
Thank-you for raising the awareness of this ongoing bone health-related issue.
At last! I think this is the key to delivering clinical services in community pharmacies. It will mean that NHSE will hold the register and demand a level of service required to deliver the service and will be clinically rather than commercially focused.
Vaccination administration can become a key area of contribution to the health of the Nation by Pharmacists in general. The sooner aspirant pharmacists can become involved so much the better . It may be a suggestion worth considering and that is to involve Retired Pharmacists in this important and necessary role .
John Edmunds
This is a great appointment - James is outstanding and I wish him all the best.
Understanding historical rivalries is key to understanding the situation we are in today. If they are put to one side it would be a monumental mistake. For example, the PIANA consultation was a total sham, with no indication at the time that it would effectively be a vote on the future of pharmacy. Now that we are living in that future we see the fruit of its misplaced agenda in terms of people leaving the profession, stalled recruitment, workplace pressure, overall dissatisfaction and policy outcomes that, I feel, are not representative of the majority of members.
Of course, if our peers are delighted with the current direction of travel, it's no wonder that they want to sweep the past under the carpet. They are, in effect, creating new rivalries in which the wishes of the majority are, again, being swept aside.
One of the leading researchers in this area is Delia Bishara, a pharmacist. Odd that she is not mentioned.
That all sounds great but not if you cannot get qualified due to lack of DP to mentor for the 90 hours needed.
I agree. There must be more support so existing pharmacists have better opportunities to level up this skill set.
What a great podcast! Recommended listening. Anticholinergic burden is important and often overlooked. Graham's team experience exactly mirrors what we found in East Lancashire - patients' quality of life improved with reduce drug burden. Clinicians inspired to deprescribe by witnessing positive patient outcomes. Good work!
Agreed
This problem has existed for many, many years. It not only impacts patients but it's extremely stressful for pharmacists.
Nobody has ever done anything about it that has made any real difference.
can I recycle my insulin pens in America and if so, how?
There are fundamental reasons that also need to be considered why an opportunity to move to GP practice can seem appealing when compared and contrasted with community pharmacy.
There is very little transparency at the RPS. I have tried on numerous occasions to voice my concerns to the English Pharmacy Board over many years - but the members can't be contacted, neither do they respond. I doubt if they even know that I have tried.
Assembly members make crucial decisions that the rest of us are unable to challenge. I have said on more than one occasion that they are 'cowards' since, once in the Assembly and EPB, they cut off all access to themselves and do what they like, completely unwilling to defend the decisions that they make or react to criticism.
Ms Buckle insists that she is very happy to hear from members. Would she then publish contact details for herself, the EPB and the Assembly members in order for this to happen?
I note that she has been a locum - but has she any experience of long term pharmacy management?
She speaks of wanting closer relationships with the PSNC (ie contractors) - but is she remotely interested in pharmacist employees?
I notice that she makes no mention of the intollerable pressures on pharmacy staff - partly due to what seems to be uncaring decisions made by herself and her colleagues and the PSNC which continue to cause great concern.
If there really is a desire to be an ambassador for the membership, please find out what the majority of members, who support the Society with their fees, really want - and please listen and respond.
With grateful thanks,
Peter.
Dear Peter,
Thank you for taking the time to both read and comment on this article.
The best way for the RPS to effectively respond to your questions on governance, policies or decision-making processes, is for you to contact 'commsteam@rpharms.com', where a member of the team will direct your inquiry to the most appropriate person at the RPS.
We are always grateful to hear from you, and the many other members for providing valuable insights that help us improve how we both represent and serve you, our members.
As a practicing employee community pharmacist, and a long-serving member of the RPS, I am acutely aware of the challenges facing our Profession at this time. We all need to pull together, support each other and continue to provide the excellent care to our patients for which we are increasingly recognised. And I can assure you, the RPS will continue to shout loudly on behalf of our Pharmacy Profession.
Thank you.
Sibby Buckle FRPharmS
This is very unwise, if it was necessary to pick a medication for OAB as a P med they would be better picking an anti-muscarinic with a lower anti-cholinergic effect on cognition like solifenacin. Furthermore the idea of using the logic of raising self awareness is the oldest trick to replace the word increase market share.
Parkinson's disease is a neurodegenerative disorder marked by motor impairments caused by the damage of dopaminergic neurons in the substantia nigra and the formation of Lewy bodies. The specific cause of the sickness, however, is unclear. It affects the upper and lower extremities including facial muscles. An increase in the frequency of the disease over the last decade has necessitated greater research to develop advanced diagnostic tests and therapeutic regimens that would provide a lasting cure for Parkinson's disease.
It would have been interesting to have had more detail on the specific reasons why statins, antidepressants and PPIs were chosen for the pilot. Members of the public taking these drugs might be alarmed to know their genetics might be putting them at risk of side-effects and want to know more.
https://www.youtube.com/watch?v=-sx1M4BIt5I Here's a light hearted song highlighting this issue
In my time as a proprietor pharmacist the idea of transferring to a GP practice was never even dreampt of let-a-lone seriously considered. What is the downside?
The declaration of interest is so important that I would have liked to see it at the start of the article.
How impartial is this piece?
Dear Nicola. Many thanks indeed for your comment. I am the Senior Editor for Learning and Research at the PJ. I will write to you directly with a fuller response via email but wanted to assure you that the article went through our full editorial checks and was closely assessed before publication and that we treat questions around clinical validity and impartiality very seriously.
Dear Nicola,
On behalf of all authors, I would like to thank you for bringing up such a valuable point. This case study was presented to us while the treatment was ongoing. The authors did not interfere in the treatment nor in the feedback provided. The patient and the caregiver signed a consent form provided by the PJ. For further discussion, please contact the corresponding author at: ljean@pccarx.co.uk or technicaluk@pccarx.com
very motivating
A good point raised by Nicola Phillimore, although the declaration of interest by a manufacturer would not necessarily impact on the findings or quality of a piece of research or a clinical observation or case study.
However, in this instance I have concerns that the case study only represents a single case, has no control such as physiotherapy alone or physiotherapy with just the permeation-enhancing base, and the time delay of 10 months between pre-treatment and post-treatment neuropathic pain questionnaires in a condition which is likely to fluctuate over time. Those confounding factors make it impossible to draw any valid conclusions about the effect of the treatment.
Whilst the report is an interesting single patient observation, the publication as a CPD and learning article "case study" raises serious questions about the rigour and validity of the PJ editorial checks.
Dear Derek,
On behalf of all authors, I would like to thank you for taking your time to provide feedback on our case study. CPRS is a complex condition and patients often struggle to manage their symptoms. This individual patient had a remarkable improvement in her condition, and we believe that this treatment option may be a benefit to other patients suffering from the same condition. Patient advised the physiotherapy sessions were made increasingly easier during the treatment period.
For further discussion, please contact the corresponding author at: ljean@pccarx.co.uk or technicaluk@pccarx.com
I can totally relate to all of this. The Squiggly Careers podcast and books were a life line for me to accept and embrace the role changes that I've made throughout my pharmacy career. I would add, finding a sponsor who will champion and advocate for you is another great support in career development.
I was told that back in the early days of the NHS self-employed owner Pharmacists decide to threaten to hand in their NHS dispensing contracts because they were not happy with them.
A large multiple Pharmacy company apparently refused to get involved and had the Owner Pharmacists gone ahead with their threat that would have left the Multiple with an open field.
Thus, the owner Pharmacists backed down.
So, my advice is not to strike, but to inform the Public that Pharmacists could strike as a last resort only and tell the Dept of Health that they need to address this problem as a matter of urgency for Pharmacists and Patients alike.
The patients do not deserve another NHS profession to jump on the band waggon of strike action. A strike would harm patients and Pharmacists and the Dept of Health would not turn a hair
Please allow me to introduce myself as the Senior Editor for Research and Learning at the Pharmaceutical Journal. First of all, thank you for taking the time to submit comments and raise these questions with us. We very much welcome constructive discussion and scientific critique of our publishing and the opportunity it provides for improved accuracy and better insight for our readers.
In this instance we have shared your comments with the authors of the article and encouraged them to submit a written response to the specific questions you have raised. We accept that due to the real-world nature of the case presentation there were limitations that the reader needs to consider alongside the information provided, but we remain of the view that the article represents an interesting learning opportunity for our audience. As a case-presentation, we would also expect readers to appreciate that it represents a single data point drawn from clinical practice, and to factor this into their assessment of whether any conclusions can or should be drawn about this specific treatment strategy.
Having reflected on the discussion that the article has generated, we acknowledge that there are improvements that we can make to the way we present case-based articles of this type, in particular around how learning points are communicated, the limitations of the case study as a source of evidence and the need for the reader to critique appropriately. We have initiated a review of our relevant editorial processes and author guidelines and will implement these improvements for all case presentations subsequently published.
Thank you again for your comments.
very interesting
Hello,
The link in the article is to the 2017 version of the standards. The link to the 2022 version is here: https://www.rpharms.com/Portals/0/RPS%20document%20library/Open%20access/Hospital%20Standards/RPS-Professional%20Standards%20for%20Hospital%20Pharmacy%20Services_2022FINAL.pdf
Hi Prijay,
Thank you for your comment. This has now been updated.
Kind regards,
Hannah Krol, Deputy Chief Subeditor
Thank you for this open and honest account
It is important to highlight to anyone using needle and syringe programmes in pharmacies to check their kits as they may not be engaged with drugs services. It is a balance to try to reach the most disengaged people and pharmacy teams have the privilege to be able to do that. I think the bottom line from this is, spread the word as much as you can. I have known people to use 1ml insulin syringes to withdraw naloxone when no needle was available (because it had been used). I have also heard of nasal administration of the IM solution. Not advocating either approaches, but just to illustrate the ability of people to be innovative in a crisis. What we need of course is more pharmacies supplying naloxone, that is important to have more even availability across the country and national commissioning would be ideal.
You were doing it for your country - it was an incredibly difficult time when we were all being called upon to work as we hadn't before and the fear and lack of clear guidance resulted in some people behaving badly towards healthcare professionals. Hope you have found counselling has helped this time and that you may be able to return to work if this feels right. It's brave of you to share your feelings and will help others who may not feel able to do so. Wishing you well
Really interesting! Have had several patients in my community pharmacy who have had issues with certain generic brands of tamoxifen, more than with most other drugs. Definitely worth someone researching properly.
I would not be wanting in any way to knock the desire of hospital staff working under heavy pressure not to continue with real terms pay cuts. However whilst pointing out that the Scottish Offer gives band 9 staff only a 2% rise, you could have mentioned that they are starting from over (if at top of scale of) £109,000. This is unlikely to garnish much sympathy with staff on a third of that.
An unbelievably brave account of a tragic situation. But your openness just might prompt someone to reach out for help and support sooner than they might have. The pharmacy profession often put others before themselves, but we need to realise that we need to be well, and functioning to help others.
My best wishes to you, and I hope you find a positive future.
The news that Pharmacists and their teams can self refer to the NHS Practitioner Health Programme is excellent news and long overdue. I send my thanks to everyone who has worked to achieve this outcome, well done.
Thank you for sharing! As a final year pharmacy student starting out my career, it was really an insightful read!
I can't believe the difference in placement tariffs. It is ridiculous. I know for a fact that based on this payment some GP practices will not host pharmacists if they could have a medical trainee at 6 times the payment. My practice wouldn't. It's a no-brainer isn't it? Why are pharmacists still so undervalued by the NHS?? Who is fighting our corner? How was this allowed to happen?
as a profession we can be very dismissive when patients tell us about these side effects. this is a good challenge from people within the profession that this is a lived experience and should be investigated further. do we need to change our testing protocols?
The article incorrectly asserts that "cannabis has two main species, Cannabis indica Lam and Cannabis sativa L.". Cannabis sativa L. is the one correct accepted species/taxon ; Cannabis indica Lam. is a heterotypic synonym – see https://powo.science.kew.org/taxon/urn:lsid:ipni.org:names:850879-1
Great to see your engagement. I agree, this is disputed territory!
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4604179/#!po=1.51515
Your point raising this will make an excellent pharmacy student project which I will task some undergraduates to dig into at next opportunity. The pertinent point of the study described was that prescribers selected any pharmaceutical grade, plant-derived, cannabinoid-containing oral product, which might have included CBD, d-9-THC, a combination of CBD/9-d-THC and other cannabinoids - rather than narrowing down.
It's laudable for the PSNC to request extra funding from the government for directing patients to community pharmacies. But this is not consistent with the regular "ask your pharmacist" campaign sponsored by the NPA which just finished a few weeks ago this year, for which we don't request additional remuneration. The profession would achieve more with a clear and coherent strategy from our representatives.
While it may be 'laudable' to request extra funding a major role for community pharmacists is to provide advice and support to members of the general public in respect of their health. Why else do some pharmacists choose to become community pharmacists?
As per current issues regarding cost of living crisis, increase in energy costs and work force issues. I am surprised that PSNC have not come out with a stronger mandate to actually ballot members on 1 day strike action in support of all the other health professions who have decided to strike.
This would send a clear message to the Government regarding crisis faced in the Pharmacy sector.
Healthcare professionals have a duty to protect and promote breastfeeding. There are many specialist resources available that provide information on the safety of medications when breastfeeding, most of which are open-access. e.g. LactMed, SPS Safety in Breastfeeding, e-Lactancia. Hale's Medication & Mother's Milk is subscriber-only. UKDILAS can be contacted by healthcare professionals, and the Drugs in Breastmilk Information Service [see contact info in the body of the article] have a team of volunteer pharmacists responding to parents, breastfeeding supporters and healthcare professionals 365 days a year. Wendy Jones, the founder of the DiBM service, can be contacted via her website [https://breastfeeding-and-medication.co.uk/contact-me]
Parents who choose to breastfeed should be supported with their feeding choice by selecting an appropriate treatment or procedure where possible. Most parents can be supported with medication use while breastfeeding so #dontsaystoplookitup or contact one of the services listed above for expert support.
Amanda Da Costa
The Breastfeeding Network's Drugs in Breastmilk Information Service Volunteer Pharmacist & Clinical Supervisor
With all the acknowledged advantages to mothers and babies of breastfeeding I have to say I have never read an article so negative about breastfeeding support for pharmacists. RCTs and large studies are not possible because of limited funding, even anecdotal reports suffer from publication bias as we never see the situations where the baby was not affected by the medication passing through breastmilk. There are several world wide expert sources of information based on the knowledge of the pharmacokinetics of medications passing through maternal milk - these have not even been acknowledged by the authors. UKDILAS is part of the UK Medicines Information Service and provides valuable individual data along with detailed factsheets. The Breastfeeding Newtork is run by volunteer pharmacists with a knowledge of drugs in breastmilk and breastfeeding in a service which has no funding. Women with complex medical conditions should be helped to make decisions based on evidence based information as supported by the MHRS consortium Safer Medicines in Breastfeeding and Medication. Outdated terms like fore milk and hind milk exemplify the concerns I have with this paper. I hope that fellow pharmacists will consult expert sources to enable them to support mothers who are breastfeeding and need medication. Dr Wendy Jones MBE Pharmacist with a special interest in breastfeeding and medication.
Has anyone heard of the effects UV light produced from backlit screens reducing the release of melatonin? It also happens with domestic energy-saving LED bulbs (including the daylight-mimicking ones). OK, it can be partly self-inflicted by young people but if you have ADHD then computer games are a good way to keep occupied.
Please don't underrate melatonin. Don't forget that in clinical studies the overall effect may not be overwhelming but, as I'm sure most of you will know from your knowledge of clinical studies, the so-called 'curse of the mean' means significant effects in individuals can be obscured by lack of effect in others. Cannabis for some forms of epilepsy is a classic example. Each person is an individual they may get a significant effect on sleep latency and efficiency that is way better than the mean.
David Ganderton was a lecturer in Pharmaceutical Technology at the University of Strathclyde when I was there . He was a great personality -RIP .
Whilst this article does raise the important issue of the data gap which exists for good quality published evidence for use of medicines during breastfeeding, we do not have to wait until this gap is filled before practical and evidence based advice can still be given.
Medication use is rarely a reason that breastfeeding cannot go ahead, and any risks can be managed. However, because of the data gap, advice and information sources can conflict with each other.
Nevertheless, my colleagues in their replies above, signpost to some very important information sources which are available to navigate this area, which includes the NHS UK Drugs in Lactation Advisory Service (part of the Specialist Pharmacy Service and the UK Medicines Information Network). The Specialist Pharmacy Service includes published advice from UKDILAS on their website and can be contacted regarding medicine use in breastfeeding (0300 770 8564). For more complex cases (including some of the scenarios mentioned in the article), UKDILAS can be contacted directly: https://www.sps.nhs.uk/breastfeeding-medicines-advice-service/
Laura Kearney
Clinical Lead Pharmacist, UK Drugs In Lactation Advisory Service
Thank you for adding these information sources: others are pasted below.
Our papers highlight that the ‘evidence base’ on medicines and breastfeeding is weak: however excellent the compilation of the evidence, there are too few large studies with long-term follow-up [1]. Without these, we shall not know either how isolated the case reports of harm [2] are or which prescription medicines affect breastfeeding rates.
We argue that professionals should be proactive in supporting women prescribed long-term medicines to address the increased risk of ‘not breastfeeding’ and to check infants for any signs of sedation [3], irritability or poor feeding [4,5]. In some less affluent areas, many women simply stop breastfeeding, rather than engage with the excellent helplines available. Active monitoring should be tested in this context.
Sources of information include:
• The British National Formulary (BNF) has information on product licensing https://bnf.nice.org.uk/ as do the Summaries of Product Characteristics Home - electronic medicines compendium (emc)
• LACTMED: Drugs and lactation database (lactmed). In.: Bethesda (MD): National Library of Medicine (US); 2006.
• Specialist Pharmacy Services (SPS) ‘MEDICINES INFORMATION GUIDELINES’
https://www.sps.nhs.uk/wp-content/uploads/2016/12/Resources-to-support-answering-medicines-related-questions-Feb-2019.pdf
• SPS breastfeeding information
https://www.sps.nhs.uk/home/guidance/safety-in-breastfeeding/
• UK Medicines Information, requires registration https://future.nhs.uk/UKMedsInfoNetwk/grouphome
references
1. Jordan S, Bromley R, Damase-Michel C, et al. Breastfeeding, pregnancy, medicines, neurodevelopment, and population databases: the information desert. Int Breastfeed J. 2022;17. doi:10.1186/s13006-022-00494-5
2. Soussan C, Gouraud A, Portolan G, et al. Drug-induced adverse reactions via breastfeeding: a descriptive study in the French Pharmacovigilance Database. Eur J Clin Pharmacol. 2014;70:1361–6. doi:10.1007/s00228-014-1738-2
3. Lam J, Kelly L, Ciszkowski C, et al. Central Nervous System Depression of Neonates Breastfed by Mothers Receiving Oxycodone for Postpartum Analgesia. The Journal of Pediatrics. 2012;160:33-37.e2. doi:10.1016/j.jpeds.2011.06.050
4. Anderson P, Sauberan J. Modeling drug passage into human milk. Clin. Pharmacol. Ther. 2016;100:42–52. doi:10.1002/cpt.377
5. Merlob P, Schaefer C. Psychotropic drugs. In: Schaefer C, Peters P, Miller R, eds. Drugs During Pregnancy and Lactation . Elsevier 2015. 743–774.
Deeply saddened to read this. I came to know Gul as part of the Pharmacy and Public Health Forum. She had such passion for pharmacy and steadfast belief in the profession’s potential to improve public health. She expertly invited opinion, probed and challenged fairly. She remains an inspiration, a role model and will be sorely missed.
Incredibly sad to hear of Gul's passing. We worked closely together from 2009 on the Health Living Pharmacy work programme and her passion for pharmacy's role in public health could never be doubted. I last saw Gul at the end of September; she was not feeling herself but keen to celebrate the achievement of others. We had a big hug, which I will remember with affection and true to her essence, Gul was keen to push forward community pharmacy's role in prevention. Mental health, cardiovascular disease and lipid management high on her agenda. More importantly, Gul always had a kind word for everyone, keen to celebrate success in pharmacy but beyond all else was a proud mother, wife and daughter. Gul, you will be so sadly missed in pharmacy and by your family and friends x
Great article! However, increased adjudication is not met up with increased seats for OSPAP in the universities, resulting into too many students not getting admission and wasting time and money. To put things into perspective, only about 200 applicants could secure a seat in 4 different universities for the year 2023. This will create a backlog of about 500 applicants, with addition to, I think, 700 more applicants for the next year (2024). But the number of OSPAP -offering universities and the number of seats will remain the same.
What Pharmaceutical qualifications does Mrs Afua Thompson have? The article doesn't make this clear.
Why has paper copy of the pharmaceutical journal stopped? It is very hard for me to get access to pj online.
I agree, I enjoyed reading the paper copy
I agree with Dharmendra Amin and Anne Parfitt-Rogers about paper copy of The PJ, but we are now living in a "digital word" and lots of publications are only available online. I MISS holding a hard copy in my hand and read it. Perhaps RPS will find a solution 🤷🏼♂️🤔!!! Any solutions RPS?
Thank you for your comments. We recommend that you consider signing up to our monthly newsletter in the preferences centre of ‘My Account’ for a link to our digital edition each month. This has links to all of the content published that month and a special ‘digital cover’. Not a complete replacement for the print edition, but a close second!
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Best wishes, The PJ team
Very sorry to hear this news. Gul made a great contribution to the public health role of pharmacy.
Sincere condolences . Out thoughts and prayers are with you Tim. Rajni Patel & Usha Khanna .. Batch mates from Brighton . Please get in touch 07984462329
Sincere Condolances from Brighton colleagues, very sad to learn the news. Still, have happy memories and you will be missed hugely, Also from Ranjnikant Patel and others.
Oh I am so very sorry to read of Gul Root's passing away. My condolences to Gul's family, friends & colleagues.
Please send me alert emails as before with information on CPS articles and up. to date news. The last email received from your end was back in September
Would have been nice to have had some response or private contact from Mr Bennett or someone in HQ to my comments, but like other responses submitted to other consultations or requests for ideas, nothing happens.
I won’t bother any more.
Happy New Year
Thorrun Gavind says that there has been a 'fantastic response' to the proposed Vision from the pharmacy profession.
Would she be kind enough to publish the percentage of Society members who have supported it?
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Michael Dowdall - Executive Editor, Research & Learning
Very well deserved, many congratulations.
Drug shortages have been a problem for many, many years and cause enormous stress for pharmacists. From time to time the Pharmaceutical Society has claimed to be doing something about it but to little effect. Has the Society no influence over manufacturers? Does anybody care about the stress and inconvenience this is causing?
Professor Alan Tallentire, Ph.D., F.R.P.S.
With much sadness and regret, I must write a few words about my research supervisor, colleague and friend, the late Professor Alan Tallentire. Alan's many academic and industrial achievements and accomplishments have already been enumerated In the Journal, nevertheless some personal reflections are appropriate. I had known Alan since 1968 when I was accepted to his team of radiobiology research students at the Pharmacy Department at Manchester University to work on radiosensitization of bacterial spores. I recall that on joining his small but select group as an enthusiastic young student raring to get started with my research, Alan's first priority was making sure I had suitable "digs" and financial support for tuition and subsistence. He was instrumental in helping me obtain a generous research grant from the Society.
Alan expected high academic standards from his students, and although highly critical of us in the lab, outside he was always most supportive and displayed pride in his students. He was keen that we present our research progress at academic meetings at every opportunity. I recall that within months after my arrival, he insisted that I should present my preliminary findings at a Spore Group Meeting in Harrogate.
He was also enthusiastic about his students acquiring teaching abilities and encouraged our participation as postgraduate tutors in pharmacy lab classes as well giving occasional lectures to the undergraduate pharmacy students. Alan not only taught me good scientific skills, but also how to write "good science", something I appreciate to this day. He was meticulous about good, clear and correct English usage and was highly critical of slovenly writing.
I often recall his high standards of "business" ethics (even in science) when it involved grants, stipends, travel grants and plagiarism. Alan was more than a research supervisor; in fact, he acted as a wonderful father figure to all his students.
Alan's many industrial contacts and his promotion of research within industrial pharmacy exemplify his not-living in an "ivory tower", yet he fought for high academic standards within the University setting, and was very much against the incorporation of non-academic subjects into the University's curricula (as was becoming fashionable in the early 70's). His scientific development of ISO Standard 11137 (a Standard for radiation dose setting for gamma-ray sterilization) is just one example of applying his research to the industrial setting. His founding of Air Dispersions after his retirement from academia is another.
Despite his crowded academic schedule, Alan was a keen sportsman. There was always time for a lunchtime game of squash or evening football game, a round of golf, as well as his unflinching support of Burnley (his home town) and England's cricket team.
Having moved to Israel after obtaining my Ph.D., we managed to keep in contact over the years - often when back in Manchester, I would visit him at the University or at Air Dispersions. As I continued in the same field both at the Hebrew University in Jerusalem and as an independent consultant on sterilization issues, we would both be invited from time to time as lecturers at International Atomic Energy Agency courses or meet at IAEA headquarters in Vienna. I last spoke to him a couple of years ago at an ISO zoom conference when we even managed to exchange a few jokes and reminiscences.
Alan was a most influential and sociable person, and would always find an excuse to take out his students for a beer, as well as inviting us all to his home. I fondly remember the annual dinners at his home supported by Lucy's culinary abilities.
My condolences are extended to his dear wife Lucy, and children Lawrence, Iain, David and Caroline and their families, to whom Alan was a wonderful husband and father. He will be sadly missed.
Geoffrey P Jacobs
Dr Geoffrey P Jacobs Associates
Consultants to the Pharmaceutical &
Medical Device Industries
POB 3304, Jerusalem 9103301, Israel
Phones 972 2 6422227 0525509207 Fax: 972 2 6432372
Completely agree. Thanks for putting this critical piece out. I'm Ali, co-founder of Chorus Sleep - a non-pharmaceutical for insomnia. Another problem with melatonin (in addition to what you raised here) is the amounts found in over-the-counter supplements can vary DRAMATICALLY, so you don't know what you're getting. I like that you highlighted the importance of changing routine more than using supplements. We conduct a ton of research internally, and as I'm sure many people in this community know, the most impactful thing for improving sleep quality is keeping a consistent wake and bedtime schedule seven days a week.
It's also interesting to call out the rise in sleep problems since COVID. I'm not sure of the equivalent number for children, but for adults in the US - before COVID, it was estimated that 66% of adults had trouble sleeping each week, and now that number is estimated to be 86%. Clearly, the rise of stressors in our life, disruption to routine and cues our brain relies on for circadian rhythms (like working from home under fluorescent lights late into the night) is making our sleep worse, which is problematic for mental and physical health.
The combination of rising sleep challenges and insufficient solutions is becoming a more dire problem by the day. Thank you for writing about this important topic - education is a critical part of working together to solve it.
PS here is my LinkedIn if you ever want to connect directly: https://www.linkedin.com/in/ali-abramovitz-cook-69458459/
This is a good step for pharmacist Independent prescribers, the NHS and the general public who usually could have received appropriate treatment in the pharmacy for many conditions, but have to be sent to their doctors or NHS111 or walk-in centres for the same treatment (becos the pharmacist cannot prescribe the medication needed).
My question is: how does one receive funding for the course? Is it self funding or it is NHS funded?
How does the program help Locum pharmacist to get a DPP? Thanks
I am not representing the course or provider in any context but in response to your first question about funding I see on the website materials somewhere it says that you can self- or NHS-fund the course.
Your second question is of course one of the many difficulties practising Pharmacists are facing in accessing these courses in a supported way. There are huge barriers, as many of us know. Not least if you are full time and attempting to try to fit that course in around your working life. This is something that urgently needs to be addressed. Who wouldn't agree that proper support and protected time for most aspects of that course needs to be there and this needs to be addressed at a higher level now.
I applaud this excellent, heartfelt, and candid opinion piece about pharmacy professionals being undervalued and poorly utilised within Primary Care Networks (PCNs) in England. Sadly, I also hear this a lot in my various working arenas, especially when teaching on the national Academic Health Science Network’s (AHSN) Polypharmacy Action Learning sets, and have written often, with my colleagues and allies , about why medicines experts are a necessity, not a luxury, in general practice (1-3)
As a former consultant pharmacist in acute medical care and medication safety who pivoted to work in primary care in a different NHS region, I would therefore offer the following succinct & pragmatic words of encouragement, about what can be a very harsh and tricky environment, and because, sadly, you can’t avoid personalities or politics in any job!
1 Be visible, have a medicines optimisation (MO) vision and share it often so pharmacy, medical, allied health professional, managerial teams are crystal clear what medicines experts can, and shouldn’t, do to improve patient care, improve medicines systems and safety, and save GPs time
2 Seek out respected GPs (ideally, but not necessarily, the prescribing lead) and managerial/administrative allies who have influence at a PCN board level as soon as possible once you are clear about the lay of the land. Use your patient honed communication skills to reach mutually beneficial outcomes
3 Ensure all pharmacy professionals document all clinical activities in patients’ clinical records and then agree what process and outcome data the PCN wants presented on a monthly or quarterly basis via a PCN wide medicines optimisation meeting
4 Set up the quarterly PCN wide medicines optimisation meeting chaired by the most respected prescriber but including all GP prescribing leads, senior pharmacy professionals, a community pharmacist lead plus Integrated Care Board (ICB) MO and PCN board representatives. Use national comparative MO data sets to help everyone see how well, or not so well, you fare compared with other PCNs in the ICB and understand / “buy into” the scale of sub-optimal medicines use
5 Go around obstructive practice / PCN personnel via 1, 2, 3, 4
6 Make sure you have agreed non-clinical sessions for thinking about, and dealing, with 1-5
7 Speak to other Additional Roles Reimbursement Scheme (ARRS) senior staff who may also have similar issues and can also help with 5
8 Ensure you have a personal mentor or coach outside your place of work and tap into any ICB wide pharmacy professional networks (What’s App groups and /or more formal groups) for reassurance, belief, and invigoration.
If I can help further feel free to drop me a line @STEVECHEMIST on Twitter
You have got this……..
Steve Williams
Senior Clinical Pharmacist
Poole Bay and Bournemouth PCN
Founder / Owner of One Less Pill Ltd
References
1 Williams SD, Hayes JM, Brad LD. Clinical pharmacists in general practice: a necessity not a luxury? British Journal of General Practice. Br J Gen Pract 2018; 68 (667): 85. DOI: https://doi.org/10.3399/bjgp18X694697
2 Williams SD, Hayes JM, Brad LD. Clinical pharmacists within primary care networks: a driver for collaborative general practice BJGP Life June 17th 2020 https://bjgplife.com/2020/06/17/clinical-pharmacists-within-primary-care-networks-another-driver-fo1 r-collaborative-general-practice/
3 Williams SD, Brad L, Jones D, Hayes J. Pharmacy professionals are part of the solution to reduce GPs’ workload BMJ 2021;373:n1176 https://doi.org/10.1136/bmj.n1176
Congratulations on writing this important article- we need to talk about givin (HRT)…
Brilliant. Thanks for this article! I’m going to try and share it with our PCN Manager to help planning better use of our time. My PCN is receptive and interested, hopefully will be a positive outcome.
I totally agree with the article and have found private providers very often request off label high doses of transdermal oestrogen which the patient then expects primary care to issue. This causes a lot of conflict as we as a practice have decided against any off label prescribing
Sodium valproate preparations should be classified as "special containers" so they are never issued in white boxes and always have the manufacturers warning clearly visible.
Should I be on the 50 year list?
Laurence May (1971- ).
I should like to see those with 70+ years of service also listed
Alan Trinder
Photo shows Technical Services lead Steve Almond, not Mark Easter as per the sub title!
Hi Mark,
The text underneath the image is the image credit. I have amended this to clarify.
Best wishes,
Sophie, senior subeditor
In Scotland there has been a huge increase in the number of Community Pharmacy Urgent Supplies (CPUS) too. Surgeries are directing patients to the community pharmacy quite often inappropriately. They are not processing repeats quickly enough taking around 7 to 10 working days. I realise this is a service we provide but it is not a repeat prescription service. Patients have been quite aggressive if it is something we cannot do. Obviously we try and help when we can but pharmacy staff are at breaking point .
Interesting article which raises questions over bio equivalence testing for PD medicines
I agree. I looked at bioequivalence requirements a long time ago (2014) & was surprised to see the wide tolerances permitted (80% - 125%) between test & reference product. For narrow therapeutic index meds (decided on a case by case basis) between 90% - 111.11%. This was the Bioequivalence Guidance document published by CHMP/EMA in 2010. I haven't checked to see if this has been updated since, but IMHO the bioequivalence tolerances should be tighter.
Janice Barnes should perhaps understand Community Pharmacy remuneration and Drug Tariff before making a statement like "legally this brand will be dispensed by pharmacist"
Community Pharmacists will only dispense what they get paid by NHS. Also, some PCN pharmacy advisors tend to muddy the waters by switching to "cheaper " brands to justify their existence of making savings. We notice that even in other clinical categories.
Paresh Modasia
I stand by my comment that pharmacists must dispense a medication brand if specified by the prescriber on the patient's prescription.
If the brand e.g., Sinemet is written on a prescription, the pharmacist must dispense Sinemet unless it is unavailable. If it is unavailable the pharmacist can
• ask the GP to alter the prescription to a generic product which may be easier to source
• signpost the patient to another pharmacy that has the branded product in stock
• in some circumstances where there is an ongoing stock shortage problem, NHSE issues a Serious Shortage Protocol (SSP) then the pharmacist can dispense an alternative product against a branded Rx and endorse accordingly (SSP reference number, date, brand and price of product supplied).
Whilst, I fully understand the current cost pressures and funding inequalities within community pharmacy, my role is to manage people with Parkinson's disease who have been stabilised on a specific brand of medication and a change of brand could have deleterious consequences on their symptom control.
Janine (not Janice) Barnes
Hi Paresh
I completely agree with the remuneration issue you describe. However, I think Janine is stating that patients ask the prescriber to write the brand on the prescription rather than demand that the a brand is supplied against a generic prescription.
As a pharmacist I always have conversations with patients purchasing otc pain relief products containing codeine. Unfortunately, I could refuse to sell the product, but another pharmacy can still sell the product to the patient. There is no viable solution but to reclassify these products
If sodium valproate is classified as a special container then it will be dispensed in a full complete pack in the original packaging. Under current legislation I’m not sure how this could be achieved otherwise. At the moment with pack sizes as they are you have to split boxes to dispense the quantity ordered.
Excellent article
Nice to hear the word ‘causal’ being used in relation to clinically relevant adverse drug reactions- something which regulators & clinicians are sometimes reluctant to use.
Regardless of merits the new body might have, in terms of accountability could the PJ explain to whom the new body would be accountable? The Chief Pharmaceutical Officers are all appointed by individual UK nations (ignoring for the moment NI government problems), and are accountable to their respective governments. Is the creation of the new body something that all four nations will need to endorse, or from where else will it it derive its authority. Who will scrutinise its budgets and who will be responsible for ensuring its accounts are audited?
Very wise words once again from the last president of the dual purposed society (regulation and representation) who clearly has not lost site of the opportunity we had for a clinical leadership body.
Do enough members want a clinical leadership body or will they wish to remain mired in a watered down PDA (which currently does a fine job of it’s own) pursuing perceived grievances and politically correct “right on” agendas rather than clinical leadership?
There are some fine people on the representative boards but I wonder if there are enough to inspire others to stand?
The annual embarrassment of “angry” members promising “Change “ usually directed at pharmacy employers has become cringeworthy. Most, whether elected or not, are seldom heard of again and that is worthy of reflection.
Why do they stand and how do we encourage the motivated individuals who have so much to offer in truly leading the profession to stand.
As Mr Churton says, we have a big opportunity now. But will individual pharmacists grasp it?
I hope so
Fantastic piece of work.
Viral, congratulations on this amazing achievement. Your work has been an inspiration to your fellow colleagues, not only with the vaccine rollout, but with your broad portfolio of public health work which has enhanced the provision of public health services nationally and strengthened the reputation of the profession.
It's easier to collect the data on how many women of childbearing age are being prescribed valproate, but not so easy to draw the conclusion that they are not being informed about the risks. The only way to gain this level of insight is through clinical audit.
Also with regard to women on valproate who have given birth, is there clinical audit to show whether they were informed about the risks or not before conceiving? How about those patients that choose not to complete the prevent form? I appreciate that more can be done, but need to be careful about assuming it is always due to a failure of healthcare professionals re informing the patient.
Even if the margin per pack calculated is correct (which I highly doubt), the government have not taken into account the spiraling costs of staff, utilities, fuel etc. More smoke & mirrors from this tory cabal.
OK, we are supposed to accept this tosh from an organisation that will not disclose the information it relies on in setting concession prices? Many concession prices are announced having been imposed. That means despite objections from PSNC and evidence from PSNC to the contrary.
We cannot believe a word these people say and that has been the case for 6 years. It really is time they were called out by PSNC.
“Profit”? Gross or net? Justify your findings.
Interesting that their working party includes no pharmacists. That may be a problem. And also their insistence of calling it sodium valproate throughout and not including the names valproic acid and semisodium valproate, which may confuse some people (service users and maybe one or two healthcare professionals and carers) and lead them not to make the connection.
It is very encouraging and important that the first step is being taken with resolve
This is a great initiative promoting further integration of care within the system. It would lead to better outcomes and a more effective, efficient and quality care for service users.
Great article, brief and very useful.
Very good
It's very interesting that when it becomes apparent that sodium valproate may have a reversible effect on male fertility the CHM advises that there should be greater scrutiny of the way valproate is prescribed and that further risk minimisation measures are required. Scandalous this situation has drag on for years effecting the lives of the pregnant women, the mother of the child and the child itself.
If a prescription dated February or March is not collected and paid for until after April 1st, will the certificate cover this or only prescriptions dated from April 1st?
Our research on the topic of CRP testing and its relevance in community pharmacy was published in PJ in May 2018. We identified the important benefits of CRP testing in terms of highly significantly reducing unnecessary GP appointments and antibiotic prescribing and presented the work at a number of conferences where our approach was applauded by Lord Jim O'Neill. Unfortunately, as you point out in this article political issues around funding prevented the scheme from being investigated on a larger scale.
https://pharmaceutical-journal.com/article/research/point-of-care-c-reactive-protein-testing-in-community-pharmacy-to-deliver-appropriate-interventions-in-respiratory-tract-infections
Best article I have read so far on the CPhOs appointed chairs report.
Change is a must in modern times. Thoughts about social responsibility have been suppressed in the discussions but for a body with a Royal Charter is important. Reforming the profession as well as the NHS is a necessity as societal, professional and other changes force a review of relevance to the needs of the nation. The article and the report rightly highlight some major challenges for professional leadership bodies, particularly the engagement of younger members, credentialing and career development for pharmacy professionals, and having a more powerful advocate for the value of pharmacy services in improving patient care. To say RPS has been a bit lethargic in these areas is an understatement yet it should be remembered that other national contractor bodies have worked overtime to clip its wings. And, tge NHS itself could have helped. For example, why is CFCP driven by service specifications rather than professional standards? I think the profession would agree that changes are needed. But, my discussions with the members of the profession indicate a divided view about the process. More information about the process is needed for an informed collective view to be formed within the profession. I feel there is a need for position papers written by independent experts to inform and stimulate a debate. Perhaps, RPS and joint chairs would pause and take steps together to publish necessary position papers and allow the profession to discuss, debate and hopefully engage more meaningfully in the change process including the formation of proposed council. Whether a new or a reformed broom is needed requires a discussion but the process must be effective in the end and have general support of the profession.
Should we not also be asking the media to also point out these dangers to kids using NO2 cylinders for 'kicks'
I think it’s a good idea for us all to consider reclassification as the abuse is worrying
Fantastic idea
Great news! ADHD is underdiagnosed and Tony Lloyd is absolutely right.
Excellent article.
Great article which familiarises oneself on how to suspect and deal with Digoxin toxicity in the community
I'm sorry, but if you think that protected learning time is the answer, you are wrong! There needs to be a drastic reduction in workload.
Quite right,no wonder people are considering leaving.Eventually it affect your health quite badly
Thank you to the authors for the important article which adds to the toolbox at the disposal of the Pharmacist and the duty of care to recognise nuances of thoughts, feelings and responses evoked by self-harm.
I read the case studies to be fictitious scenarios designed to illustrate the subtleties involved in recognising signs and the great impact that small adjustments can have on patient care and outcomes. If not fictitious, would it be possible to confirm that either of the two case studies represented a real scenario involving a real patient? Thank you.
Many thanks for your comment. I am the Senior Editor for Research and Learning who worked with the authors on this article. The case studies are based on a mix of the authors' professional experience combined with elements written to facilitate learning but were not purely based on a specific case or individual.
Is there not scope for the ICB to offer a new contract (in the vicinity of the closure) to provide NHS pharmaceutical services when there is a closure and the remaining local contractors cannot cope with the extra workload ?
Surely this is the rational way to ensure that local populations are not left disadvantaged because of commercial decisions made by corporate contractors who want to withdraw from providing NHS services in a locality.
It may well be the case that what may not be viable for a large corporate chain could be very viable for a small independent contractor.
Too complex 🙈
I am going to have to send patients back to GP for a separate script for HRT . Please can RPS & PSNC advise drs via NHSBSA to write separate scripts for 1 st April .
Thank you
I think there is an error in the table where Sodium Chloride 0.18% and Glucose 4% is repeated twice, do the authors mean Sodium Chloride 0.45% with Glucose 5% but osmolarity would be different than quoted in the table. Also, in the paragraph under the table "Thyroid Function rests". I assume 'tests' would be more appropriate.
Is there a role of hypertonic saline? Especially when considering the acuity of hyponatraemia i.e. <48hours vs chronic.
Strange that spironolactone is not mentioned as one of the diuretics that hyponatraemia particularly the higher doses used to treat ascites
Hi Kevin, thank you for bringing this to our attention. This was an error and has now been corrected.
Best wishes,
Sophie, senior subeditor
Hi Kevin,
Thank you for pointing out the typo's in the table, and elsewhere. This has been kindly addressed by Sophie and the team at the PJ.
With regard to your question about use of hypertonic saline, I think it was touched on in the article, albeit not in detail.
I would say it does not have a role in routine management of hyponatremia, especially in chronic hyponatremia (>48hrs) because of the risk of ODS. I would say never in the absence of close monitoring - hence why we have advocated it be done at least in a level 2 environment where those facilities are available.
However in severe hyponatremia presenting with neurological symptoms, typically acute rather than chronic (although it can be a rapid drop in pre-existing chronic hyponatremia), can be treated if there are adequate monitoring requirements to avoid the risk of over-correction.
In these subset of patients, we would give infusions of 150mL 3% hypertonic saline (or equivalent) over 20 mins aiming for a 5mmol/L increase ideally within the first hour, and then not more than 10mmol/L in the first day.
This use (i.e. the use of hypertonic saline) is advocated by the European guidelines - found here (https://eje.bioscientifica.com/view/journals/eje/170/3/G1.xml)
Hope that was the answer you were looking for.
Thanks,
Renita
Thanks Renita, great article of a complicated subject. Case studies were great. Interesting NEJM released some RCT data from Canada regarding ODS is rare and sodium may not play as big a role as we think https://evidence.nejm.org/doi/full/10.1056/EVIDoa2200215. However, in practice I have seen the devastating effects of ODS and hypertonic saline always makes me worry....
Rest in Peace Carina
Duncan and family
You are in my thoughts and prayers
John Hughes past colleague from
Brighton School of Pharmacy
I am very sorry for Duncan and the family. Carina was lovely to work with.
Enjoyed the podcast and it hi-lights a very important safety issue that has needed broadcasting widely for many years.
Having chatted to you both outside my house in North Lancing just prior to the death of Carina you can imagine what a shock it was to read your sad announcement. She was a colleague and friend who will be sadly missed to both the family and the profession. My thoughts are with you.
pharmacists, not paediatric trained, should be able to contact Paediatric pharmacists at their local Hospital
Very sorry to read this Duncan. My thoughts are with you. Jo Rhodes (nee Keightley)
My condolences Duncan to you and your family. Many happy memories of student life in Bradford with you both. Thinking of you. Lesley Angell (Peat)
What about prescription only anti emetics?? Do they have a role??
This would be unlikely in a patient intending to buy over the counter remedy on an ad-had basis. Cyclizine IS still a -pharmacy medicine, although it laboured under a bad press for a few years. You may attract criticism for selling it in that, it would be akin to using a sledgehammer to crack a nut!
Excellent quiz but not sure if the answers to question 7 (rashes) are correct. Can the PJ please review this?
Thank you for bringing this to our attention. The question has been reviewed to ensure that the answers accurately reflect the rashes pictured.
Michael Dowdall - Executive Editor, Research & Learning
I am a long lost aquaintenance of my dear dear neighbour and hope to think a friend .I can truly say a piece of my heart is broken to learn of Victor's passing away in 2022.I can believe his achievements and love for his community.
I have always treasured one memory.
When we were both kids growing up in Leeds Victor's father asked us to dig up the soil in his back garden. Well we decided , after reviewing options ,that a true achievement and more like a real brief was to transform the garden and add a feature of a 5 foot deep crater ,so we could both jump from the neighbours garage into the crater. We dug this crater from
Morning until it was to dark to see.Needless to say Victor's father was not as pleased with the result as we were.Think Victor's mother and my mother probably saw the amusing aspect and recognised what we could both achieve.
All my heartfelt wishes to Victor's family and friends. I can see that his colleagues truly loved him and still do. He showed that families and communities are important to welfare .There is no doubt that he would love music.
Yours
Stanislaw Antoni Smigielski BscHons Env Eng
Long lost neighbour
I believe there is an error in the second paragraph of this article. Finerenone is a mineralocorticoid receptor ANTAGONIST, but the article states AGONIST.
Hi Joseph,
Thank you for bringing this to our attention. This has now been corrected.
All the best,
Hannah Krol — Deputy Chief Subeditor
In the list of drugs that can cause pancreatitis the anti diabetic medications have been omitted and as use is increasing this is a serious omission
I am the senior editor for research and learning at the PJ. We are currently looking into this with the authors of the article and respond in due course. Many thanks for your comment.
This is an excellent project showing how a simple intervention with collaborative working across the health social care interface can lead to better care for both patients and planet. Should be replicated nationwide....
Looking forward to working with you James :)
Has any agency or research looked at the presence of nitrosamines in "food or health supplements"? Significant numbers of the public consume these too.
During 40 years on the Register I quoted Dr Robinson frequently to my Pre Registration graduates. A fine man!
Great and informative article
I agree with Mike Hannay's analysis of the proposals for a Government appointed PLC to oversee the leadership of the
profession and share his concerns about the government's intentions
Royal College status seems the best option but would be very difficult to acheive given that a Government recommendation to the Sovereign is required
DVid Carrington
So at last England adopts a system that has demonstrated proven benefits in the devolved administrations as well as evaluating well in pilots ( I took part in one in 2019 which really proved it’s worth during the pandemic as so many GPs withdrew F2F services).
But notable individuals including Sajid David as then health minister and particularly Thorrun Govind, chair of the English National Board have repeated the assertions that these are worthwhile schemes. And so, thankfully it’s come to pass.
Particular thanks are due to Janet Morrison and her team at PSNC but I don’t think this could have happened without the support of David Webb, the new Chief Pharmaceutical Officer so I put on record my thanks to him.
Well done all
So sorry to hear. Carina worked with us closely on medicines safety developing audits for PQS. Her work and impact on patient safety through community pharmacies across England will live on.
Exciting times!
Perhaps the same authors would like to comment on remote prescribing via GP practice ?
Very proud of you Katie, well done for your great work xxx
Wouldn’t it be nice if the various commentators and academics would consider that pharmacists actually have far more training on AMR and its consequences than any of the other prescribing professions? If you consider how many extra hours of pharmacology the average pharmacist graduate has studied it’s actually an insult to suggest otherwise. Allowing pharmacists to advise on clinically appropriate use of antibiotics is surely the safest way forward.
I also have reservations about this initiative. It will allow people to obtain antibiotics more easily which will encourage people to present earlier than waiting for a GP appointment.
Patients do not always tell the truth about the length of time they have had a condition and they can access pharmacies easily.
Perhaps target other initiatives for community pharmacy that don't involve antibiotics.
We need fewer prescribers of this group, not more
So what you imply is that pharmacists are not capable of making clinically appropriate, professional decisions about peoples presenting symptoms. Nor will they be able to follow appropriate NICE guidelines on treatment protocols? I am offended if that is what you mean.
Pilot should also consider other primary care providers (Community Pharmacies) for future proofing concept of testing access through different clinical pathways.
Excellent read and good to hear about TOXBASE. Feel more knowledgeable about poisoning with points to look for
I am saddened to hear of Don's passing. I worked with Don, and found him a kindred spirit when it came to technology. He would implementation various bits of code and programming to make like easier in the pharmacy.
Immensely intellectual, and always had time for others, especially if the conversation was around technology.
A great loss for the profession.
This article appears to rely on the misguided contention that Government is intent on undermining the natural order of professional leadership within the profession. Nothing could be further from the truth. The CPhOs are naturally concerned to ensure that leadership of the profession is “fit for future” given the professional developments and increasingly clinical roles which members of the profession will discharge over the coming years to the benefit of their patients. Nothing more, nothing less. And certainly not the conspiratorial concerns expressed by Professor Hannay. The independently chaired transitional advisory PLC will be charged with developing and delivering what the profession believes is needed. I emphasise the word “profession”. Its deliberations and recommendations will be informed and shaped through wide ranging consultation with all interested parties, and should ultimately a Royal College be decided upon it will be established without impediment. Thankfully the recent RPS AGM motion in the authors name, which unbelievably called for the RPS to refrain from all involvement in the PLC, was resolutely defeated. It is perhaps instructive to point out that if the RPS had followed through on its remit to establish itself as the Royal College for the profession (a very clearly articulated “end game” when it was established in 2010) then quite probably we would not now be having this discussion. We have “lost” at least 5 years in not doing so, and we now need to move with pace and determination to establish what is required.
Very useful article. One of the key missing actions is transparency in the supply chain. It is still unclear how many API manufacturers supply those that assemble the finished products (FDF), and how many FDF manufacturers then supply different generic companies. Without this, it is difficult to predict the potential impact of disruption at each stage.
In addition, there is a need to hold larger buffer stocks at each production stage to account for disruptions because pharmaceutical manufacturing is a long game over 5-6 months, and so increases in production will not be available quickly.
In terms of discussing personal issues which impact on work, confidentially, then please consider contacting Pharmacist Support.(PS) Listening friends who are volunteers with PS are pharmacists and an experienced source of support.
Hi PJ team. The NICE guidance actually says "including, but not limited to tiers 3 and 4", so from the outset it was viewed as something potentially suitable for Primary Care initiation.
I was very sad to read of David Cousins death. I first met him around 1980 when he came to work for me as a ‘Saturday pharmacist’ in the pharmacy I then ran on Canvey Island. He was a careful, conscientious pharmacist, someone with whom it was a pleasure to work. However he soon moved on, as did I and the next time I heard of him was in 1990 when I went at Orsett Hospital, where he had almost mythical status among those who had worked with him!
We watched his career with interest, and it was no surprise that he achieved the heights he did.
My deepest sympathies go to his wife and family.
Stating chickenpox is self limiting in adults suggests it is not a real problem. However in many cases it can be an extremely painful and unpleasant experience for many adults and Acyclovir would shorten the period of these symptoms. In my experience most patients do not receive this product in time. No figure for deaths in adults in the UK from chickenpox is available but the U.S estimates 100-150 deaths per annum.A vaccine in the Uk for those adults who have not had chickenpox would seem a worthwhile step forward.
Tribute to David Cousin: A Luminary in Pharmacy and Medicine Safety
It is with profound sadness that I learned of the passing of David Cousin, a figure of unparalleled stature within the world of pharmacy strategy and an extraordinary human being. As the president of the Royal Pharmaceutical Society of Great Britain (RPSGB) during our acquaintance, I was immersed in the mission to make Britain the safest place to take medicines. Our paths crossed during this pivotal time, and a shared fervour for medicine safety solidified our professional and personal bond.
Our frequent interactions were an exchange of passion and knowledge, from which I gleaned invaluable insights. David's presence was highly influential and impactful, marked by his steadfast leadership both nationally and internationally.
A memory that stands out vividly is of a gathering of global experts on medicine safety in Chicago. David's reputation preceded him there as well, with international colleagues expressing their immense respect and admiration for him. His natural wit and kindness added a distinctive charm to his personality, making him a cherished figure among peers and friends.
The pharmacy community, as well as his beloved family, has suffered a great loss. But David's legacy, deeply rooted in the realm of medicine safety, continues to thrive, influencing current and future generations in the field.
My heartfelt condolences extend to his wife, children, and extended family. David Cousin will be profoundly missed, yet his influence and memory will undeniably persist.
It was with great sadness that I learned of the death of David Cousins, a pharmacist whose legacy will live on for years to come.
Our paths crossed often during his career. I was invited to be the external assessor on the interview panel when he was appointed Chief Pharmacist at Derby Royal Infirmary and many years later, I chaired the interview panel when he was appointed to the National Patient Safety Agency. History tells us that the right person was appointed on both occasions. His contribution to the advancement of hospital pharmacy practice and education and to the improvement in patient safety, through the development of policies and procedures, are recognised across the world.
I offer my deepest sympathy to his wife and family.
I first met David while we were doing our pre-reg year in the South-West, with its famed 2-day residential courses. Even then, he was clearly head and shoulders above the rest of us and we could tell he was destined for greatness.
Although our paths didn’t cross that often after that, we did speak at a few conferences together and were able to chat.
I followed his career with interest and, whenever his name was mentioned, it was usually associated with the word “first” e.g. first to/first service to:first person. A remarkable man.
Although David was well known in the profession I didn't meet him until he joined the NPSA while I was at MHRA and we were both charged with implementing the findings of Organisation With A Memory - a report which sought to reduce the likelihood of medication errors happening in clinical practice. Patient safety was a passion we shared and it was an enormous privilege for me to work with David and to collaborate on the many guidelines he introduced over his years with NPSA. His work has had a lasting impact not just in the UK but across the international community. Patients across the world have much to thank David for and his legacy will be be a bedrock for future work in the area of safe medication practice. David and I also shared a love of music so our interactions also touched on the joy that our music brought to those around us. I am immensely saddened by his passing. My condolences and prayers go to his family. He will be missed by the profession but his influence will certainly continue. Rest in peace David.
I was shocked and saddened to hear of David's passing. David and myself were allocated adjacent benches for practical classes when we commenced at the School of Pharmacy, University of London in October 1972. So commenced a friendship that lasted in to the early stages of our careers in hospital pharmacy.
On graduation David returned to his native Devon and myself to Essex. He became frustrated with the limited career progression opportunities in the West Country. After mentioning this to Jeff Watling, then Area Pharmacist for South Essex, David was promptly installed as a Staff Pharmacist at Orsett Hospital, Grays, and Trina followed a few months later to take up a pharmacist technician post at Basildon Hospital.
David’s pioneering qualities soon became evident. He was in the first cohort of students to graduate from the University of London’s Masters in Clinical Pharmacy course based at Northwick Park Hospital. It was no surprise when David moved on to a Principal Pharmacist post at Derby Hospitals but before leaving Essex he was instrumental in founding the Essex Group of the Guild of Hospital Pharmacists (now Guild of Healthcare Pharmacists).
His enthusiasm for pharmacy and life in general was always to the fore, and will be missed.
Soon after Keith Ridge the former CPhO announced the funding cuts in December 2015 I had a meeting with him. I asked him what he wanted his legacy to be. He had made no secret of his desire to force 3000 pharmacies to close and when asked which ones he wanted to close he said “the market will decide “. Well now it has. And Keith’s legacy is clear. A disaster for our profession. A disaster for patient safety. A disaster for patients and the public. A period of prolonged silence on behalf of the former CPhO would be welcome. But that’s probably about as likely as a period of silence from Boris Johnson
Whilst the news that the government is scrapping the plans to make 66 the cut off age for prescription levies is welcome, it really irritates me when the Prescription Charges Coalition claim that people with long term conditions are unable to collect their medication because they can't afford the prescription charges. They are, I feel, being more than a little disingenuous in this as they are, or should be, aware that anyone having to pay prescription charges can get relief from these by buying a pre-payment certificate.
Pharmacists are not blameless in this. Anyone collecting more than three items on a regular basis who have to pay, should be counselled on how it would benefit them if they had a pre-payment certificate.
The NHS provide these certificates to help people who have long term conditions which aren't eligible for free prescriptions. Yet when the news of raised prescription charges appears on TV, people will spring up claiming they won't be able to afford their medication, and their condition will get worse because of a lack of medication.
Where are the pharmacists advising these people?
Regards
Bob Dunkley
Retired Pharmacist
What about side effects? Aren't there any significant side effects that can risk patients vitals or is it too safe to use?
Like with any drug this should be discussed with the patient and counselled on it.
My belated but no less sincere congratulations to Jonathan on receiving this prestigious award. Beyond any doubt a worthy recipient in recognition of his significant contributions to pharmacy practice, an inspirational leader that has been a major influence in key developments in Scotland and beyond for many years. Long may he continue so to do.
@ 75 years of age, living and remaining registered in Ireland (retired fromGPhC in UK) I locum, for a couple of hours t a time regularly!
Congratulations to all.
As someone who does not specialise in neurology and has only heard the mainline narrative, this was a fantastic read. True food for thought, with excellent points well argued and which need wider and (ironically) more informed debate. Well done to the author.
My daughters small pharmacy chain spends hours weekly chasing medicines that are short in an effort to supply patient needs There is currently no additional income for the time spent on this
As a pharmacist involved in the pharmaceutical industry I understand the complex problems there are in the manufacturing process.
Raw material shortage the more onerous requirements from the quality and compliance teams are currently very challenging
This is just a sample of the issues for the manufacturing sector
The closure of smaller GMP manufacturing facilities for whatever reason in the Uk all have taken a toll
I believe we need to find ways of ensuring we have a strong Uk sector and protect it
The consumer is now paying the price sadly
The regulators need to be part of the conversation team in an effort to improve supply
Gerry OBrien
I was saddened to hear of David's death, one of the outstanding hospital pharmacists of his generation and a giant for others to emulate.
David was an innovator, a firm believer in evidence as a basis for service development, a strong advocate for patient care at the centre of things, and a thoroughly nice guy…
So much of what others were able to achieve was built upon the foundations provided by David.
I will miss him and his common sense approach.
I offer my deepest sympathy to his family and hope that the profession will continue to benefit from his leadership and example.
An excellent, thoughtful and analytical article that crystallises so many of the concerns I have felt as I've seen this approach unfold. Thank you for writing and publishing it Rachel.
John was the first CAPO of Tayside Health Board.
He brought professionalism, an understanding of how Pharmacists could work together in Hospitals and the Community. He was much respected and a really lovely colleague.
A very useful guide which is up to date and will help to reduce unnecessary demands for antibiotic scripts
SHENU BARCLAY LOCUM PHARMACISTGLOUCESTERSHIRE
Shortages and reimbursement mismatches have become all too common. Surely, it’s time the responsible authorities use their legislative powers to prevent some “market players” from “gaming” the system and harming the collective.
nice blog, useful information is shared on this website. Thanks for sharing.
John Derrick Appleton died peacefully on 19th June 2023 just six months short of his hundredth birthday and six months after his wife of seventy five years. (He was John to his work colleagues but Derrick to his family). We first met in August 1978 when he gave me the greatest break in my career by appointing me as District Pharmaceutical Officer for Perth and Kinross at the age of twenty eight. Mr. Appleton, I could never bring myself to call him John, was the kindest boss I ever had. He gave me the freedom to make my own decisions but was always there with sound advice and a helping hand to rectify the consequences of the not so sensible ones.
A Yorkshireman through and through, he was for several years the Chief Pharmacist at St. James’s Hospital in Leeds before moving to Scotland as, up until 1974 and re-organisation of the NHS when he became Chief Administrative Pharmaceutical Officer (CAPO) for Tayside, the Regional Pharmaceutical Officer for Dundee and the East of Scotland, when he helped commission the new Ninewells Hospital in Dundee. John came from a generation of Hospital Pharmacists who were accustomed to having manufacturing as a primary activity and through hard work and cutting edge innovation, commissioned what is now Tayside Pharmaceuticals on the Ninewells Hospital site. At its opening it was the largest hospital pharmacy manufacturing facility in Europe. Sadly, in the early 1980s the role for which it was intended became unfashionable however following collaboration between NHS Tayside and NHS Greater Glasgow and Clyde and a £26m upgrade in 2019 it is still producing “specials” for the NHS and stands as a legacy to his vision of over fifty years ago.
He was an innovator in other ways, he encouraged the concept of Individual Patient Dispensing and clinical pharmacy when both were in their infancy and on his retirement in 1987 left a Pharmaceutical Service in Tayside that was at the cutting edge of professional practice.
John Appleton was one of a kind, he was passionate about the profession, a family man and, above all a gentleman who always encouraged, never belittled, and cared deeply about his fellow man. As a Yorkshireman he spoke his mind, but in a quiet unassuming way. This retired Pharmacist will be forever grateful for his support and friendship and will miss him sorely as will those others who had the privilege to know him and work with him.
Excellent
The serious shortage protocols were for the chewable form - minimally used and therefore fairly irrelevant to this article.
Test
In a world where we accept obesity to be a leading risk factor for cardiovascular disease and t2dm and many other conditions, why is the use of GLP1 agonists for weight loss use being criticised? I think it’s shortsighted. Patients with obesity who feel the need to pay privately to access drugs that could help them avoid long term conditions (not to mention improved mental health) are a massive cost-saving for the NHS and should not be made to feel that they are depriving other people of medication.
I have read and found good knowledge.
Retired, I am Deputy Chair of Healthwatch Shropshire which as an organisation which seeks to give voice to the seldom heard. We are aware of the difficulties some individuals face in accessing healthcare. Often these individuals are very reluctant to voice their concerns and it takes a long time to gain their trust. It is a deep seated problem, not only for those who seek to give exemplary healthcare but also those who fail to receive it.
After 16 years as Chief Pharmacist, Keith Ridge’s chickens are coming home to roost. He can’t say that he wasn’t warned
How about EPAs for newly qualified independent prescribers??
I'm not clear how they differ from competencies? There are competencies for NMPs...
Excellent article. The growth in private ADHD clinics is also driving this, but these can only thrive if the NHS isn’t willing or able to provide diagnosis and treatment.
It IS a good article but there's no consideration given to root cause analysis. WHY are we witnessing this massive growth not just in ADHD but in all forms of mental health problems. I've become fascinated by the link between diet and cardio metabolic health and the link between what we eat and brain function. Could it all be down to the role of the mitochondria? Prof Chris Palmer certainly thinks so and I can't recommend his book Brain Energy too highly
The increase is not only happening in the UK but also most part of the world. see: https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(22)00509-0/fulltext
Indeed not only ADHD treatment increase but also almost all psychotropic drugs in different part of the world. See: https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(21)00292-3/fulltext
It is probably a combination of better recognition, diagnosis and willingness to prescribe and take.
Sad news. Robert was my final year project tutor at Portsmouth. A dedicated and committed teacher, and a true gent.
That's really helpful, Hermant. I would add that we should consider the investment in patient health as part of the calculation of cost effectiveness. If we avoid future NHS/healthcare interventions, and support people to maintain/gain quality of life, not only will that contribute to patient experience, it also contributes to the wider economic environment. For example, perhaps it can allow people to continue working, or return to work. When you state medications should be delivered in the 'right manner', I would expand that to say - " in a way that they can fit into their lifestyle, and obtain the maximum benefit from" - it's important they *can* adhere to treatment, as well. K
Worrying. So many things could and will go wrong. Throw in bad actors and the dangers could be immense. International regulation and expert overseeing is needed early days or sleepwalking into a real mess could ensue.
I have been contacted by my GP practice who have told me they are given Flu injections in September, but would not take bookings for the Covid boosters!
How long before the expensive pharmacists will be replaced completely by technicians?
Should the position come that pharmacy technicians can undertake the roles currently delivered by pharmacists, then I would expect them to be renumerated at a similar rate, based on the responsibility and liability they would be undertaking.
That would seem fair to me, and I would hope they wouldn't undervalue that position.
I imagine that pharmacy technicians will become just as expensive if this proposed action is taken.
Very interesting article. Thank you PJ
The best solution is finding another way other than doing OSPAP to evaluate overseas pharmacists as the way GPs are evaluated.
If it is impossible, we should consider that there aren’t enough places in 4 universities providing OSPAP course and especially for pharmacists who are already living in the north ,Sunderland is only option to do OSPAP.
If some universities like Durham and Newcastle can provide this course in the North it would be great.
another problem is that the expiry date of adjudication letters is limited and it should be expanded for at least 5 years.
It would seem fair to me that pharmacy technicians took a pharmacy degree before embarking on pharmacists' responsibilities.
Dear Readers,
Firstly, I'd like to commend the entire editorial team for their hard work and efforts in putting together such a comprehensive article. The discussions and insights captured from the expert roundtable event around pharmacist prescribing are invaluable to our profession.
I'd like to provide some clarifications on a couple of points attributed to me, to ensure there is no confusion amongst our esteemed colleagues:
On the topic of MDTs supporting newly qualified pharmacists, my perspective is not that it's an 'alternative' to relying on DPPs. DPPs are the bedrock of the prescribing learning in practice time through both direct, indirect and sometimes delegated supervision. The ‘MDT-collaborative’ approach to prescribing simply helps to orientate the experience, in terms of the types of objectives and activities that might be supervised during the training.
When discussing ‘MDT-collaborative’ prescribing as a concept, the intention was never to suggest that decision-making should be 'outsourced' to other members. The essence of my message is to emphasize the power of collective knowledge within the MDT, ensuring optimal patient care with each member contributing their expertise. A pharmacist prescribing at a foundation level can leverage the knowledge and skills of the team, to make a competent prescribing decision.
Building on this, regarding the 'scope of practice' for pharmacist trainees, my emphasis was on the importance of pharmacists feeling supported to make competent decisions. Instead of being limited to specific medicines or disease states (e.g., hypertension), a pharmacist’s scope is modulated by the level of support that they have around them. This is in alignment with the medical model for junior doctors.
I hope these clarifications provide a clear insight into my views and contributions during the event. Once again, thank you to the editorial team for their dedication and commitment to advancing our profession.
Warm regards,
William Swain
Really pleased to see RPS support this evidence based intervention. We know from international data that consumption rooms save lives and are economically cost effective in enabling engagement in treatment for HCV and HIV and prevention of drug related harm. I am proud of the RPS for taking this stand and endorsing a health approach to substance use issues.
Diversity ?
I was delighted to read that Buproprion will be made available again later this year. A very good friend of mine was prescribed Zyban for Bipolar Disorder and the difference it made to her life was miraculous and it was devastating when it was withdrawn.
Is there a typo in this article? "Botulinum toxin is a neurotoxin that inhibits the release of acetylcysteine[36]." - should this read "acetylcholine" instead??
Many thanks for your comment. I am Senior Editor for Research & Learning at the PJ. We are currently investigating this with the author and will confirm if a correction to the article is necessary shortly.
This should come as no surprise to GPhC. Community Pharmacists repeatedly complain about the excessive workloads. GPhC take pride in announcing that pharmacists will be offering extra services with no consideration of the already excessive workload experienced in community. There are also many complaints about the poor staffing levels within pharmacies. GPhC simply say this is up to the employers to ensure staffing levels are adequate and that staff receive sufficient breaks. But employers are generally not interested and look at the bottom line and so continually cut staffing levels, not increase them. If you are already part-time and refuse to go full-time you are then faced with redundancy, but they say you can return as a locum for them the next day. (Yes illegal, yes reported to GPhC, no surprise GPhC not interested) That employer thankfully is rapidly dropping out of the UK market. . If GPhC supported its members better this crisis could easily have been averted.
Very sorry to learn that only 10-19% of smokers quit with vaping at 6 months. There is another important issue: having stopped smoking, do the ex-smokers continue to vape, and for how long. My anecdotal observation in community pharmacy practice in the 1990's, was that those prescribed NRT in forms that gave a substantial nicotine "hit" were more likely to continue using it long-term than those with "drip feed" NRT like shin patches. Nicotine itself is not harmless and is very addictive.
In other words, people seemed more likely to remain addicted to the "nicotine hit" formulations in the long term than the "drip feed" ones
I am in Australia and have been on Paroxetine for approximately 20 years, originally prescribed for severe peri-menopausal symptoms. I have only recently become aware of the numerous negatives related to this product. I’m watching a BBC report on “Stopping Antidepressants “ , I am mortified to discover the discontinuation of the liquid form. I was hoping to withdraw from this medication safely. I am not an academic but I seriously can’t understand how a company can stop production of a product that is so essential to community health and well-being.
I also I'm on Seroxat the past 20 years, the liquid version being disconnected is absolutely insane, and uttering dangerous. Knowing how hard it is to come off this medication. I just cannot get my head around GSK pulling this from the market and not giving people stuck on it a second thought. Talk about playing with people's lifes, and not caring. I am absolutely disgusted by what they have done. I was on the liquid all these years and to learn it was being discontinued when it has seriously effected my wellbeing ever since. Surely to god people that are on this medication should be still able to access the liquid version.
I daren't get too excited until GSK confirms it themselves. Return date is still down as 'TBC' on their product supply page. I've emailed them directly but not heard anything yet.
They literally published the update in the Pharmaceutical Journal.
All such statements are thoroughly approved by a legal department beforehand – they're hardly likely to have made this announcement by accident... Trust that you'll have it again in 10 weeks' time! 😊
I have been taking bupropion (off licence) since 2016 for depression after my psychiatrist read that it has been used successfully with autistic patients. He decided to try this 12 months before I got my actual ASD diagnosis. The waiting list for the assessment was 6 years long- I am one of the many middle aged women who have finally been correctly diagnosed after a lifetime of misdiagnoses due to the belief that only boys were effected.
Over the preceding 20 plus years, I had tried the majority of antidepressants with varying levels of short lived success.
I was over the moon to find something that kept me stable.
The past 12 months have been so stressful. Fortunately I have worked as a dispenser in the past and some of my ex colleagues had every locum they worked with scouring the shelves and drawers of all pharmacies they visited. I am grateful to each and every one as they have just about kept my rx filled whilst it has been unavailable. (Shout out to all locums everywhere! Thank you all for being there!)
I had just about given up hope and had arranged meds review with psychiatrist. That appointment is today and I came here to remind myself why it had been stopped so that I could explain the issue. I cannot tell you how pleased I am to see the news that it is coming back!!
I read Dawn Connelly's article on esketamine with interest. DTB published an article on this medicine in 2020 (Esketamine for treatment-resistant depression. Drug and Therapeutics Bulletin 2020;58:183-188) and it appears that many of the issues we highlighted have yet to be resolved.
A couple of points are worth noting. Firstly, the results of the ESCAPE-TRD study are taken from a poster, which was reviewed by the RCPsych Academic Faculty rather than by the standard BJPsych Open peer review process. It is not clear if the full results have been published in a peer reviewed journal.
Secondly, the article includes comments from various healthcare professionals but does not include any declarations of competing interests for those healthcare professionals. Although readers can search the ABPI's Disclosure UK website (https://search.disclosureuk.org.uk/), I would urge the PJ to include declarations of competing interests for healthcare professionals who are quoted in its articles.
Readers may also be interested to see that the UK Government is currently consulting on "legislation to place a duty on manufacturers and commercial suppliers of medicines, devices and borderline substances to report details of the payments and other benefits they provide to healthcare professionals and organisations". I would urge readers to contribute to the consultation (https://consultations.dhsc.gov.uk/en/64d60a6e9708bb745e0cb76b). As Sydney Wolfe (founder of Public Citizen's Health Research Group) noted in an article in DTB (Wolfe S. Mandatory disclosure of all pharmaceutical and medical device companies’ payments to healthcare providers: learning from the USA. Drug and Therapeutics Bulletin 2022;60:52-55), "Unfortunately, the UK as well as many European countries lack laws mandating such disclosure. Mandatory disclosure, though not sufficient in itself, can pave the way for other necessary changes. Declaring conflicts is only the first step in dealing with this problem’, but ‘Disclosure is not enough. The ultimate solution is to eliminate all industry relationships from the practice of medicine’."
David Phizackerley
Deputy Editor
Drug and Therapeutics Bulletin
BMJ Journals
BMA House, Tavistock Square, London, WC1H 9JR
Dear David,
Thank you for your comment regarding the results of the ESCAPE-TRD study. Please be assured that your points around including declarations of competing interests in PJ articles are under consideration.
Best wishes,
Carolyn Wickware
Executive editor
This is apparently incredibly!!!
I am shocked and saddened to learn of the untimely death of Nina Barnett. She was a wonderfully empathetic person and a true professional. My sympathies to her family.
Ian G Simpson MBE FRPharmS
I supplied the data in response to the FOIA inquiry on behalf of Sandwell and West Birmingham NHS Trust. In reply to the question "How many requests has your trust made to pharmaceutical companies for access to medicines offered through a company-led compassionate use of free of charge scheme each year between April 2014 and April 2023" we replied that we did not hold the data but in order to try and be helpful with the answer to the next question, "How many patients have received treatment with unlicensed medicines obtained this way each year between April 2014 and April 2023" I added the caveat "these are the number of patients who have received FOC, discounted, or compassionate-use medicines during the year regardless of their licensed status" as we could not distinguish between schemes put in place before licensing or after NICE approval.
This caveat has been completely ignored by the author of this article and it is disappointing to see the data misused in this way.
Dear Christopher,
Thank you for highlighting the caveat on the data from Sandwell and West Birmingham NHS Trust. The article has now been updated to reflect this. If you have any further queries on the data please get in touch: carolyn.wickware@rpharms.com
Kind regards,
Carolyn Wickware
Executive editor
I do not agree with extending the roles of pharmacy technicians or with the introduction of so-called 'physician associates' either.
There are undoubtedly a cost-cutting exercises going on but, apart from that, doctors should be doctors, pharmacists should be pharmacists and technicians should be technicians.
Peter, there’s no doubt that technicians are cheaper than pharmacists, and physician associates cheaper than medics.
However, focusing on pharmacy, another way of looking at it is that equipping organisations with pharmacists instead of technicians would be unaffordable and result in fewer staff on the floor. Technicians support the pharmacist infrastructure and allow pharmacists to work at the top of their skill set.
You want pharmacists to be pharmacists. I would argue that technicians afford us the freedom to be just that. I know I could not do my role effectively without technician support.
I’ve witnessed technician numbers and scope of practice expand over the course of my career, but this has not been at the expense of more pharmacists. On the contrary, both professions have grown together. We are reliant upon one another and this is no bad thing.
I agree with Stuart. Over the last few decades team working has become increasingly important for all healthcare professions, particularly multi-professional team working, as a result of the increase in scientific and clinical knowledge in all areas. Professional roles need to adapt and ‘being a pharmacist’ has certainly broadened from what it was when I first registered.
Key to developing roles and practice is good governance, ensuring that professions and individuals work within their competence and employing organisations use roles appropriately. This is essential to protect the public, the professionals and the organisations.
Thank you for your reply Cathy.
Pharmacy staff have always worked as a team - for which I am grateful.
Developments in scientific knowledge, as far as I can see, do not warrant the restructuring of our individual responsibilities.
Thank you for your reply, Stewart.
Equipping organisations with more pharmacists is exactly what is needed - rather than a re-appraisal of current roles.
I disagree with your opinion that the expansion of pharmacy practice has 'not been at the expense of more pharmacists'. There is, at present, a crisis of pharmacy recruitment and retention - proportionate, I would say, to the proliferation of new roles that nobody voted for or wanted in the first place, least of all the patient!
It was the so called physician associates who deliberately killed 7 babies, it was a nurse who was part of a regulated profession. So called commentators like yourself and your opinions reek of the classism and snobbery that everyone has come to expect from your ilk. Physician associates when given the correct support provide an excellent service, because you are too close minded you have never seen a physician associate and talk from ignorance. How many doctors and nurses are suspended from their roles due to deliberate and accidental fatalities. Bawa Garba, Harold shipman, Lucy Letby, Daniel Ubani. But you wouldn't know this just the word physician associate will trigger a snob
I am very sorry that you taken my comments to be a matter of class distinction. I apologise for giving you that impression. I assure you that that has never crossed my mind in any sphere of life at any time.
Many pharmacists, including myself, have qualified from working class backgrounds and are very grateful and respectful of the support offered by pharmacy technicians and others in their work.
That does not change my opinion.
you don't need to be upper class to be a snob. It is someone who looks down on others, called someone a " so called physician associate" is disrespectful, frequently pharmacists are called pill pushers and glorified shopkeeper how does that make you feel?
Hello!
Please be assured that I have never 'looked down' on others and I have frequently decried 'status' in the profession. I became a pharmacist because I wanted to help people from whatever background or social class they happened to come from. I'd much rather be called a 'pill-pusher' than a 'clinical pharmacist'. I have no interest in boastfulness and pride - but I have just as much right to express an opinion about current issues as anybody else
Is anyone questioning the FtP of the GPhC ?
Some look at their scope of practice, compare that to the scope of patient need, and somehow conclude they should just do what they did half a century ago
Others conclude that the skills of healthcare professionals should be stretched for patient benefit, to try address the gap between practice that is available and the practice that is required to service the patient need now.
Money is of course part of the solution to close that gap.
We do have to recognise though that PGDs are a highly regulated, thoughtful way of meeting the needs of a defined group of patients (that is their entire point). Adding pharmacy technicians to the long list of those regulated healthcare professions who can administer medications under a PGD is a pretty obvious step*.
And there is some really great news for the more conservative members of our society - pharmacy technicians would still be pharmacy technicians, just as prescribing pharmacists are still pharmacists, and doctors who also add to their skills (eg robotic surgery, informatics use, or law) are still doctors
PGDs can be used by
* chiropodists and podiatrists
* dental hygienists
* dental therapists
* dieticians
* midwives
* nurses
* occupational therapists
* optometrists
* orthoptists
* orthotists and prosthetists
* paramedics
* pharmacists
* physiotherapists
* radiographers
* speech and language therapists
I am shocked to hear of Nina's sudden death. I have followed her work for many years, and had the pleasure of working alongside her through PRIMM. Her death is a huge loss to pharmacy and my thoughts rest with her family and colleagues.
Dr Rachel Howard PhD MRPharmS IP
Barry, thank you for this heartfelt tribute. I am deeply saddened by Nina's death, and extend my sincere condolences to her family, friends and former colleagues.
She was one of the most inspirational, grounded clinical pharmacist role models of our generation; an innovator, leader, and passionate ambassador for patient-centred care. Her contribution to the Consultant Pharmacists Group when the consultant role was in its infancy was invaluable, providing support, encouragement and dynamic leadership.
Nina's love of her family, and her concern for the wellbeing of others (patients, professionals and more widely) were underpinned by her faith. May her memory be a blessing.
Thank you for your comments, Mark.
Patient need and patient benefit are adequately catered for under current arrangements. I see little need for the overlap of responsibilities (whether pharmacist, technician or physician associate) apart from role expansion.
What do the patients themselves want? Has anyone asked them?
Patients have indeed been asked in general, and the findings are a little at odds with the idea that patient need and benefit are adequately catered for under current arrangements
https://www.nuffieldtrust.org.uk/news-item/british-social-attitudes-satisfaction-with-the-nhs-falls-to-the-lowest-level-ever-recorded
If you are specifically asking about the public view on the the item about whether pharmacy technicians should be permitted to fall under PGD regulations, that is of course the point of the consultation. You and I clearly have different views on this, I hope we each can live with the result
I respect your reply, Mark. Thank you.
The fact that 'satisfaction with the NHS has fallen to the lowest level ever recorded' is testament to the fact that attempts to improve the service over the past two decades or so (by extending roles and services etc) have been a complete failure.
Continuing in the same vein by providing the public with what the profession wants rather than what the public wants is sure to fail as well.
A consultation is not a vote (although it is erroneously regarded as such by the profession) and is very unlikely to be representative of majority opinion.
Members of the Pharmacy Boards have such a poor level of support among the membership that they have virtually no mandate to make such wide ranging and important decisions either.
I would support a genuine majority vote if an election was conducted fairly with a significant response rate - otherwise I would suspect the outcome to be a 'fix'.
Thank you for your reply, Stewart.
Equipping organisations with more pharmacists is exactly what is needed - rather than a re-appraisal of current roles.
I disagree with your opinion that the expansion of pharmacy practice has 'not been at the expense of more pharmacists'. There is, at present, a crisis of pharmacy recruitment and retention - proportionate, I would say, to the proliferation of new roles that nobody voted for or wanted in the first place, least of all the patient!
I think it's probably also worth a comment that since the esketamine was approved in 2019 (which we have used here) under SMC there's been this small issue of a global pandemic. We had some fo the mental health facilty reallocated to palliative care patints for a while. We were going what we could. Mental health referrals have gone through the roof since and staff who were told they needed to stretch for a period of time to get us through the COVID emergency are still waiting for when they can relax to a more reasonable level of activity.
Both the nasal spray and the ketamine injection require staffing and a bed for the person for a period of time and many hospital are running at poor staffing levels and over capacity on beds.
I think it would be wrong to assume or suggestthat there isn't an appetite to treat people with these options but neither of these treatments are as simple as oral medication and are both costly in staff and facility requirements to facilitate in the context of a hugely over worked NHS where we are tasked to save the money that was spent over COVID.
If the Il-1 pathway is the key pathway could this be a niche for Anakinra?
I hope you don't mind me adding that Zero Suicide Alliance (https://zerosuicidealliance.com/) provide some excellent, free and concise training on how to engage with patients like those described in this article.
While this article will stimulate intellectual discussion of the position of the clinical pharmacist in a historical context, the current debate around Physician Associates means the title is likely to be inflammatory, and not in the spirit of the article - it feels like clickbait. This is the Pharmaceutical Journal, not Pulse magazine
The current controversy surrounding Physician Associates suggests we don’t need even allegorical muddying of roles between practitioners of pharmacy & medicine.
Can’t we just celebrate being super pharmacists & pharmacy technicians rather than trying to draw parallels with medics?
We owe it to our patients, their relatives, carers & to the public to be absolutely clear who they are seeing & speaking to.
In General Practice, where we have expanded teams over last 5 yrs to include a range of professions this role identification is absolutely vital - I’m proud to be a pharmacist, I’m not a medic.
Please allow me to make the following comments:
1. If pharmacists want to embrace a clinical future, why don't they take a medical degree? I would be interested know your thoughts!
2. If pharmacy technicians want to be pharmacists, why don't they take a pharmacy degree?
3. Why should those pharmacists who want a clinical future effectively force it (& all the extra regulation and training requirements) onto those who don't?
4. The plethora of new clinical roles is one reason why pharmacists are experiencing so much workplace pressure. Is this justified?
5. There are so many people able to prescribe and give advice these days that medical practitioners must feel like they're losing overall control of their patients' health. Is this advisable?
6. Doctors should be doctors. Pharmacists should be pharmacists and technicians should be technicians. Overlap of responsibilities causes unnecessary confusion - all in the name of professional recognition rather than patient benefit.
When you have a family, and your working full time (sometimes more!), eight to ten hours a week, the kind of future you envisage for pharmacy is not as exciting as you make out!
I should have said, 'eight to ten hours a day' - my apology.
In the interests of patient care and maintaining best practice, I think that it's important that clinicians (any healthcare professional) practice within their expertise. There is little to be gained from adding further confusion by using a new term such as 'pharmaceutical physician' - often my patients will call me 'doctor' in my consultations or when they want to book an appointment with me - they will say 'oh, you should have been a doctor', my response is usually along the lines of 'well, if I was, I wouldn't be an expert in medicines' which is essentially what they have found useful or helpful about the consultation or my intervention.
So advancing the pharmacy profession is not about taking the place of a doctor but excelling in what we do best - managing all aspects of medicines (including prescribing and therapeutics).
Does the public not need to be clear what roles are required and who is trained to do what in their care pathways before finding boxes and titles for practitioners.
Prof Anderson omits to mention consultant nurses who are undertaking medical roles too.
Physician Associates roles are unclear to the public.
RPS is focussed mostly on “clinical” and prescribing activities. There are many other roles for safe care provision. Managing resources, quality assurance, public health, manufacturing storage distribution compounding etc
Should the many roles required in future not be identified first and allocated to those best trained to deal with them.
It seems the public have no idea what these roles are and the team working required.
There are dangers of black holes appearing where leadership and management is confused where roles are forgotten or taken on with inadequate training or quality assurance.
What do doctors do in future as consultant nurses physician associates and pharmacists take roles over is key to the debate.
I was greatly saddened by this news and the sad loss of another member of the Square's Class of 70. Ralph was such a gentleman even in his youth - one of the genuine 'good guys'. RIP.
Doctors should be doctors. Pharmacists should be pharmacists and technicians should be technicians.
There are so many people prescribing these days that doctors must feel that they are losing control of patient care. That is not desirable or acceptable.
Clinical pharmacy has acheived more workplace pressure, more training, more regulation, more stress and more pharmacy closures. The pressure on pharmacists to acheive what they never had a chance to vote against is intolerable.
A pharmacist is a pharmacist - not a medic. Those intetested in clinical work should not force their ideas on every body else. They're welcome to the extra workload.
I’d be interested to know which Pharmacy systems these hospitals employed to interface with the EPS system
Clinical services have not stopped widespread closure of pharmacies nor have they demonstrably increased income - but they are a major cause of unacceptable stress and workload. The future relies on offering the public what it really needs - a safe, effective and efficient dispensing service!
Stuart paints a cogent if alarming picture of pharmacy’s future. However, pharmacy is different. A physician, surgeon, or indeed an accountant, surveyor or lawyer, gets paid for an expert service supplied to their client. Uniquely, a pharmacist supplies that expert service almost always in relation to a physical product, the medicine or drug. And either they, or someone delegated by them has to curate that product either by dispensing, storing, manipulating or in controlling its supply and preventing misuse. An entirely clinical pharmaceutical physician would not be in the business of curating the product. Indeed (and I have form here) this has all happened once before when the English apothecaries of 1650 had by 1850, abandoned pharmacy for general practice medicine, their curating role being taken by the chemists and druggists. If today’s pharmacists become pharmaceutical physicians, pharmacy technicians should indeed step into the curating role: which would make them pharmacists or perhaps even “apothecaries”, derived, from the Latin and Greek for a storekeeper.
I support Professor Anderson’s historical perspective. Sociologists’ interpretations of professionalization endeavours, including of pharmacists, fill libraries. They suggest that certain aspects may well be associated with the most intense jostling. I outline some “red flags” for those who prefer the status quo to continue.
What title will the new generation of doctor have? It must be neither doctor nor pharmacist. A new name facilitates new behaviours of occupations. I suggest “medico".
Other symbols also matter. For example, today’s optometrists, who use ophthalmoscopes, have battled with doctors for that right. Will tomorrow’s pharmacists wear stethoscopes? Hospital pharmacists already wear scrubs. I have eye-witnessed a junior doctor running to get a stethoscope. Fine — but before going to the canteen shared by all staff?
Tomorrow’s technicians need at least a bachelor's degree. Their present qualification at registration is BTEC level 3: equivalent to three A levels. The gap between that level and the master's held by today’s pharmacists is too large; I included that point in my articles in the PJ in 2003-4.
Pharmacists are losing interest in making medicines; biologists and chemists are replacing pharmacists, notably as QPs in industry. Is that in the best interests of patients?
If a drug is required, diagnosis and advice is worthless if the patient cannot get the empirical medicine. Medicines are corporeal things; pharmacists have stuck like limpets to their entitlement to possess those artefacts. Somehow, tomorrow's pharmacists must maintain that privilege, just as some of today’s doctors retain their birthright to dispense.
However, AI-enabled robotics may well change or remove the professions of pharmacists, pharmacy technicians and doctors, as we know them, within 5-10 years.
I’m all for levelling the funding across all systems, but this is a minimum of a £10k cost pressure for each trainee within NHS based placements.
How this is a good move for the Long Term Workforce Plan is beyond me.
So would I like to know what suppliers are now supporting EPS. I know some of these trusts use Cleo (we are in a limited implementation with Cleo too at UHCW for UTCs only), but are other systems yet NHS acceptable?
I work in ELFT, which is referenced in this article. We piloted the use of Cleo across our Memory Assessment and CAMHs services.
We must also consider the environmental impact of homecare services. Medicine deliveries to individual patients by road across the UK from a centralised company does not appear sustainable.
I notice that 'pharmacies' can opt out, but not 'pharmacists'!
This is another role negotiated by the CPE but not approved by members of the profession.
No doubt, because of attractive remuneration, pharmacists will be pressurised by contractors to complete as many consultations as possible to earn maximum money (for the contractor). This has happened before in the case of Medicine Reviews.
In view of escalating workplace pressures, increased regulation, staff shortages, stress and illness, how is all this going to be acheived?
Another example of the CPE imposing impossible workloads on pharmacists without giving them any opportunity to veto them. Where is democracy in our profession? Why doesn't the RPS (who we are paying to serve our interests) stand up to this inexcusable liberty?
No wonder there is lack of recruitment and retention!
A fitting tribute to a truly outstanding colleague. I am one of the many whose lives were enriched by having met and known Nina as a friend. She may well have been the most thoroughly decent human being ever to have graced the pharmacy profession – that was certainly my experience - and we are poorer for her passing.
A quick analysis of the above shows that an average of one patient per 30 day month is required for the full quota ,but each February one or two patients will need to be dragged off the street in order to qualify, then the list of ailments contains "seasonal ailments eg. insect bites, sinusitis, spring and summer whereas Shingles and impetigo are rare.
Only Pharmacies in cities will have enough footfall to hope to fill the quota, so Pharmacies in smaller towns and villages have little hope.
So much for "Community Pharmacy" In my opinion the CPE needs to go back to the drawing board , and I agree with Mr Peter Robinson that the RPS need to act on this and if they need help I am sure Mr Robinson and I would be pleased to assist,
News of the recently published study on the effect of semaglutide on cardiovascular outcomes in people aged ≥45 years with cardiovascular disease (but not diabetes) and a BMI ≥27 kg/m2 has been widely reported in the medical and general media. The report in the PJ provides a brief overview of the trial results and presents the data on the primary composite outcome and the risk of discontinuing the trial because of adverse effects.
Unfortunately, the headline accompanying many of the news stories (including the one in the PJ) promotes the relative risk reduction in the primary composite endpoint of 20% rather than the more helpful absolute risk reduction of 1.5% .(1) To put this figure in context, 67 people would need to be treated for 34 months to prevent one primary endpoint event (a composite of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke). For the individual components of the composite endpoint, the 95% confidence interval for the hazard ratio (HR) was less than 1 for only one of the three outcomes and the secondary endpoint of death from cardiovascular causes was not statistically significant:
Nonfatal myocardial infarction 2.7% vs 3.7% (HR 0.72, 95% CI 0.61 to 0.85)
Death from cardiovascular causes 2.5% vs 3.0% ( HR 0.85, 95% CI 0.71 to 1.01; p=0.07)
Nonfatal stroke 1.7% vs 1.9% (HR 0.93, 95% CI 0.74 to 1.15)
The data on adverse events leading to "permanent discontinuation of trial product" suggest that one person would discontinue treatment for every 12 people treated with semaglutide.
In October, DTB published an article (https://dtb.bmj.com/content/early/2023/10/25/dtb.2023.000007) in which Professor Joel Lexchin and Professor Barabara Mintzes explore the the evidence for semaglutide, discuss the hype surrounding the drug and highlight the need to tackle the other determinants of obesity. (2) They emphasise the importance of addressing the complex factors that contribute to the development of obesity rather than relying on medication as a damage limitation exercise.
It is important that we report the results from clinical trials in a balanced manner that allows readers to assess absolute risk reductions, relative risk reductions, numbers-needed-to-treat and numbers-needed-to-harm. We need to move beyond headlines that rely on data from company press releases.
1. Lincoff AM, Brown-Frandsen K, Colhoun HM, et al. Semaglutide and cardiovascular outcomes in obesity without diabetes. N Engl J Med. 2023. doi:10.1056/NEJMoa2307563. [Epub ahead of print 11 November 2023].
2. Lexchin J, Mintzes B. Semaglutide: a new drug for the treatment of obesity. Drug Ther Bull. 2023. doi:10.1136/dtb.2023.000007 [Epub ahead of print 25 October 2023].
I was prescribed this off-label for ADHD, I was able to function 'normally' for the first time in my adult life within a couple of days of starting bupropion. When it was discontinued I went through sheer hell - the past year has been a nightmare: my job has been at risk, I have been suicidal, and was essentially left with no hope. This news is huge and Prof. Robert West needs to revise his comment - to say it will have little impact is ignorant and deeply insulting.
Dear Ralph! I only saw you a few months back and you were full of health and fun. Shocked to hear about you passing. Have fond memories serving with you at RPS branch and you being one of my best attendees at local CPPE events. You were so supportive for which I'll be forever grateful. You will be very much missed. Bless you my friend.
Sam xx
Thank you, Emyr, for continuing to bang the drum on this topic. I worked on a project with a couple of Care Homes about 15 years ago when they were permitted to hold a small stock of CDs without a licence but by the time we got everyone's agreement, the law changed and the burden of the licence was regarded as too onerous for the home's owners.
I have long felt that we have developed such a blanket aversion to risk with CDs that it negatively impacts on patient care. It would be pefectly feasible to safely store, audit and use a small quantity of CDs in a nursing home with pharmacy support.
That period during Covid when we were able to use professional discretion was such a positive period for palliative care pharmacists and nursing staff and I know that no harm came to anyone in the area where I was working. Using very careful recording and monitoring we were able to save a huge amount of money and minimise the appalling waste too. I'd be happy to help if I can in any way to highlight this again although I'm now retired.
As someone involved in applying for CD license for an addictions setting it is a complicated process, and the HO offer little or no advice during the process, or communicate very clearly after it whether the license is granted or not. New licenses require a visit. And the advice on the visit seems to be dependant on the person who comes.
Noting each individual named on the license must be DBS checked (even if they've been checked for other reasons or hold the Scottish equivalent) and you need to name the person responsible for destroying stock CDs on it too - so they have to be identified. And if any of those names change you have to update the license and pay another fee (and DBS check).
I can understand the care homes not wanting to go anywhere near that process, and the government could do with refreshing the process to be clearer and more supportive and more able to prioritise patient care.
not sure I agree with all of the "correct" answers
the one about the "first thing you should do" - the scenario suggests the pharmacist is already mid conversation with the patient so I would have expected they'd already have introduced themselves properly, so makes no sense that this is the first thing to do at that point
and the last question doesn't say "tick all that apply" like other multi answer questions do.
Many thanks for your comment. I am senior editor for research and learning at the Pharmaceutical Journal. We will discuss this feedback with the original article authors and whether the wording for this question can be improved.
This a useful move to address workforce challenges, and the four models of employment offer flexibility depending on need.
A great colleague. Sad to hear of his passing.
Dick Pinney was great friend of mine when I came to the Square as a mature student to do a PH.D in pharmaceutics under Prof JE Carless. We both worked on the third floor and shared many happy moments at "The Lamb" - a notable public house nearby. Dick was a person who always had the wellbeing of his students at heart and was passionate about the pharmacy profession. He will be greatly missed.
Really loved your article,thanks for sharing.
The article mentions the risk of AI chatbots providing incorrect information, but it could be expanded to include a more in-depth discussion of the ethical considerations involved in using AI in healthcare.
https://www.technobridge.in/clinical-research-course
The problem with the drug is that it wasn't commissioned properly. Primary Care are uncomfortable with brand new injectable medicines, and Secondary Care would need to be paid to have the necessary capacity.
This announcement does not necessarily mean that the public want phamacists to administer Covid 19 vaccines.
In my own area none of the GP surgeries are providing the service, so the public have no option but to use pharmacies or not have the injection at all.
It's rather obvious that remuneration is uppermost in the profession's mind.
Excellent journalism, well done for highlighting unacceptable political interference at the highest level in independent long established professional processes.
It’s good that professional practitioners have resisted prescribing of a medicine they appear to be incentivised by NHS England to prescribe.
An exploration of the motivation and motivators behind the politics is now essential.
Perfectly appropriate to focus on reclassification for its own sake, but the MHRA should not be concerning itself with saving the NHS money. That’s a sure fire way to bias any risk assessment by its own teams. I hope this is merely a case of a passing statement being taken out of context.
Thank you to the authors for an excellent piece of investigative journalism.
NICE should be ashamed of what it has become. That the published documents from NICE TAs now contain blacked out costings, marked "commercially confidential" is nothing short of a scandal.
Try reading the published supporting papers for this drug. Or Romosuzumab, or any number of others. You can't, because the numbers are blacked out.
Thank you again, both of you!
I wonder if race and or genetics plays a significant role in terms of this interaction. Will be interesting to read further findings of the MHRA.
I am curious to find out if the interaction is purely with vitamin K antagonists, or if the bleed risk is increased for DOAC patients prescribed Tramadol
I want to get printed copy of the MEP please as part of my membership of RPS
a good quiz but moveable responses were not enough easy or even possible to do on a phone.
Suggest this is stated up front- i.e. Please complete on a laptop or computer
Hi Robert. Please allow me to introduce myself as the senior editor for research and learning. Thanks very much for taking the time to share this feedback with us. The quiz functionality is designed to work on mobile so we will need to investigate this further. Can I ask you to drop me an email so we can ask some follow up questions please? My email address is Alex.Clabburn@rpharms.com
I am deeply sorry to read of Prof. Brown's passing. I had no clue of his stellar achievements as he was so down to earth and unassuming. I fondly recall during our first small group tutorial as an Aston undergrad in September 1990 he told me to consider developing an unconventional pharmacy career. Puzzled, I had no clue of what that might mean. So it was only after many, many years' pharmacy practice in most branches of the profession that we met again briefly at the steps to the library of the London School of Pharmacy's in 2009/10 and somehow, he instantly remembered me! Naturally, I regaled him of his guidance about my portfolio career path. During the uncertainty of the global coronavirus pandemic, I often wondered whether the Sage scientists ought to draw on some of his expertise? So rest well Professor with my deepest condolences to your family and friends both inside and outside of the pharmacy profession.
Expected to get question 15 wrong and did.
Can you supply the reference for the "correct" answer please
Hello. Many thanks for your comment. I am the senior editor for research and learning at the pharmaceutical journal. Question 15 was derived from the article 'How to conduct a clinical review of a patient’s medicines' and the specific references behind the question statement are copied below:
Green AR, Aschmann H, Boyd CM, Schoenborn N. Assessment of Patient-Preferred Language to Achieve Goal-Aligned Deprescribing in Older Adults. JAMA Netw Open. 2021;4(4):e212633. doi:10.1001/jamanetworkopen.2021.2633
Jansen J, Naganathan V, Carter SM, et al. Too much medicine in older people? Deprescribing through shared decision making. BMJ. 2016;:i2893. doi:10.1136/bmj.i2893
Have there been any other members who were registered as members for eighty years?
My father Montague Edward Seymour was one such person I believe, when he died in January 2017 at the age of 102. I believe he was first registered in 1936. His name was not on the list that year or any year. I have not noticed any members listed as members for eighty years in your lists so far.
Please check in “Treatment choice and stepwise approach” section:
Under BP targets for Aged >= 80years, the article states Clinic BP < 50/90 mm Hg.
This should read < 150/90.
Hi Gillian,
Thank you for raising this. We have amended the figure.
Best wishes,
Sophie, senior subeditor
I am grateful for your feedback but, of course, in practice one finds there are more than one or two arguably valid option which this quiz setter(s) does not seem to appreciate. I disagree with some of the answers you deemed correct or incorrect!
Thanks very much for your comment. I am the senior editor for research and learning at the PJ. The questions were derived from expert authored articles but I will be glad to look at the specific answers that you disagreed with. Would you be able to send me an email at Alex.Clabburn@rpharms.com so we can continue the conversation? Many thanks.
Are the systems in place in dispensaries run by doctors' surgeries being similarly evaluated?
Reading the impact assessment, it mostly involves assumption, and the impact on patient safety constitutes just a few speculative lines.
Read and understood. I am now aware of the treatments and diagnosis of prostate cancer
Thank you for the time and effort you have taken to highlight attempts to politically influence the decisions of NICE as an independent body. The motives of NHSE and the government remain unknown - some may be commendable in principle, in terms of securing the UK's future as a host for important clinical research. NICE was right to take a more circumspect view of the place of Inclisiran in the treatment pathway until long term cardiovascular outcomes, side-effects and influence on mortality are known. Is there a diminishing amount of Physician input into NICE at board level? Unwarranted government interference in the decision-making process of NICE is of grave concern, particularly as large NHS datasets are increasingly being made available for analysis by machine learning algorithms which will no doubt lead to commercially promoted 'opaque' decisions which the NHS will be under pressure to act upon. The NHS must resist becoming an instrument of industrial policy and strive vigorously to keep patient welfare at its heart.
Really liked this - I didn't know the answers in a few and enjoyed reading the documents. Antidepressant failure rates vary in reference sources so found it a bit difficult to answer
Motivation is the key element in managing Type2 through diet alone.
I was shocked when diagnosed three years ago and resolved that I could conquer the problem. Researching available sources showed that, for me, stopping snacks between meals and radically changing the basic staples of my diet (Granary bread,not white;Whole grain rice;full fat rather than low-fat dairy products) relying on foods that digested slowly in the gut. Interestingly, I was told by my surgery that I would have to purchase my own test meter and strips ( perhaps the society could campaign for a change of NHS policy here).
Three years on, I'm still keeping my blood levels within recommended levels
unable to answer last question as question does not appear. Therefore am unable to score or finish the quiz
Thanks for flagging this. I am the senior editor for research and learning at the PJ. Can I ask you to drop me an email at Alex.Clabburn@rpharms.com so I can investigate further please?
UPDATE: We think we have identified the cause of the issue. Please try the questions again and let me know if the problem persists.
It would be helpful if this article had descriptions, pictures and video that include darker skin tones.
Good overview article. Knowledge check questions do not assess well enough
I think it's an attempt at finding a new model or solution to help the overburdened NHS and for that I support the originators of the scheme. However,how it will work on a day to day basis in an already stretched community pharmacies will remain to be seen. It's success will need to be audited and patients and staff delivering the service views gathered and some 'tweaks' may be needed. Expecting need to be managed, staff will need ongoing support,training and guidance. Without this reflection cycle the scheme may struggle to be delivered consistently.
It's no wonder that the uptake of Covid vaccinations has been lower than expected. There wasn't one single GP surgery in my area that was providing it!
In view of the statistics about the readiness of pharmacies to undertake this service, why has CPE agreed to it in the first place?
It highlites once again the callous indifference this contractor-led panel has for the ever increasing workplace pressure forced upon individual pharmacists.
No wonder pharmacist retention and recruitment is under pressure!
You’re joking right. I absolutely donot agree with this concept. I’m sure the patient safety tzar would agree that this is a ridiculous idea
Does anyone agree with me ?
At face value this appears as though it could drive further racially inequality and bias in workplace.
As a pharmacist leading a medicines optimisation in care homes (MOCH) team in Sussex along with my counterparts who together provide the service across the whole of Sussex we are very interested in seeing this legislation change for nursing homes.
The PDA position statement succinctly details the problems with proposal 3 in the current Pharmacy Supervision Consultation, and I have already submitted my response along similar lines. For too long, Schools of Pharmacy and Health Education England have held up Clinical Pharmacy and Pharmacist Prescribing as the holy grail to which all Pharmacists must aspire. This ignores pharmaceutics and formulation which distinguish Pharmacy from the other health care professions. Aseptic/Technical services within hospital Pharmacy practice is in itself a rewarding career path which for some Pharmacists (myself included for more than thirty years) have found professionally satisfying. Pharmacists are able to use their clinical knowledge to ensure the right product reaches the right patient at the right time, whilst ensuring patient safety and minimising the inherent risks with injectable medication - Clinical Pharmaceutics! Proposal 3 throws this on the bonfire in the unachievable pursuit of filling the work force gaps elsewhere within the NHS, and to mix metaphors, throws the baby out with the bath water!
Pharmacy Technician education/qualification no longer includes any element of Aseptic/Technical services, and this makes it dangerous to allow Technicians to have overall control of an Aseptic Unit with little or no oversight from an experienced Aseptic Services Pharmacist. Chief Pharmacists are too remote from the coal face, and most have little or no relevant Aseptic/Technical services experience.
Along with others, including the PDA, I call upon the Department of Health to withdraw proposal 3, and instead implement a separate and more in-depth and comprehensive review and consultation before deciding the merits or otherwise of changing the supervision requirements within Aseptic/Technical Services. I urge others to repsond similarly before the 29th February deadline.
I am also disappointed that the RPS doesn't appear to have sought the views of those practicing within Aseptic/Technical Services before agreeing to support proposal 3!
David Lovett, Retired Aseptic Services Pharmacist and a past Chair of the NHS Pharmaceutical Aseptic Services Group
Pharmacy First is based on the old fashioned ,no appointments, GP morning and evening surgery, which was the GPs main function in those days.
Pharmacy First has now taken on that role but instead of 2 one hour surgeries Pharmacy First has condemned the pharmacist to a full day open surgery ,for a measly £1000 per month , and a £15 consultation fee.
Hardly a just reward for a Pharmacy Qualification and all the responsibility plus the cost of indemnity insurance.
Very helpful in understanding mode of actions of various vaccineso
Nice to know there is a product against monkeypox
CTMUHB is the provider of the most clinical placements in the UK. We have a model that can be used to scale placements for other acute and community hospital sites. We are also looking at how to deliver GP and Prison placements, as part of our health boards offer. A chance to share and discuss this on a national level would be a great opportunity for other teams across the UK. My feeling, having delivered nearly 6 months worth of placements, for over 250 students, is that the model is not dependent on high levels of funding, though will increase provider will to undertake. A change in the culture in pharmacy education is a critical success factor, as well as working in partnership with local HEIs, clinical education colleagues. Strong leadership of the placements is essential, and the attitude of "it's too much work" is a risk to the future sustainability of the pharmacy professions development and ability to come out as prescribers in 2026.
I'd agree with Rhian that culture is as big a barrier as funding. In large organisations this funding can also get lost and not directly reach pharmacy teams. Very happy for you to talk to our placement development group in West Yorkshire ICS and Yorkshire & the Humber. The local HEIs and providers (of all sorts) are trying to understand each other's needs and capabilities.
Happy too, it's my passion! Send me an email on rhian.carta@wales.nhs.uk
Unfortunately my experience as a Locum Pharmacist is that pharmacy contractors decided to reduce their hourly rates at introduction of Pharmacy First. They expect Pharmacists to do more work without decent remuneration. Nothing changes
excellent article on red-flag identifier which is
clear and precise
given me confidence after reading and what to be aware of.
thank you
Dear Barry - this is a great letter. Many thanks for reading my blog post from February and taking the time to elaborate on your own experience and insightful views here. All the best, Parastou
That's a great article - it highlights the importance and relevance of well conducted research and also alerts us to challenges of AI. We need to manage these challenges to ensure we can continue to benefit from other aspects of AI.
Completely agree with Christine. Well done Parastou Donyai and nice appraisal of ascorbic acid in Covid19, noting large jointly published RCTs tREMAP-CAP and LOVIT The LOVIT-COVID Investigators, on behalf of the Canadian Critical Care Trials Group, and the REMAP-CAP Investigators. Intravenous Vitamin C for Patients Hospitalized With COVID-19: Two Harmonized Randomized Clinical Trials. JAMA. 2023;330(18):1745–1759. doi:10.1001/jama.2023.21407
Great article and a very useful case study.
I think that this is a very sensible step forward in the world of community pharmacy.
I understand the training concerns, however the situations mentioned are all about supplying a medicine in a situation which is NOT to treat a medical condition, so is not complicated by diagnosis.
Thank you Shy for your letter and experience that really does highlight why it is important to include diverse clinical imagery within health education.
The notable lack of representation of conditions that affect skin of colour, as well as minimal expansion of statistics about conditions that predominantly affect Black people, is something that The PJ first highlighted in November 2021 in this episode of the PJPod (https://pharmaceutical-journal.com/article/feature/pale-and-stale-decolonising-the-pharmacy-degree). It specifically looked how then pharmacy student Adanna Anthony-Okeke led a project to ‘decolonise’ the curriculum at the University of Nottingham’s school of pharmacy and investigated the progress being made in universities across the UK to make the pharmacy degree more inclusive.
Subsequent to this, The PJ also produced specific learning materials with visual guides that sought to help pharmacists and pharmacy teams better recognise common skin conditions in people of colour, including eczema, psoriasis, acne vulgaris and fungal skin infections, see: https://pharmaceutical-journal.com/article/ld/recognising-common-skin-conditions-in-people-of-colour. More specifically, those skin conditions more commonly observed in skin of colour, such as melasma, post-inflammatory hyperpigmentation, traction alopecia, central centrifugal cicatricial alopecia and tinea capitis, see: https://pharmaceutical-journal.com/article/ld/common-dermatological-conditions-in-skin-of-colour.
Our approach to inclusion of clinical images in our content is to be as inclusive as possible. We rely on various image banks and, as you note, projects such as Black & Brown Skin or DermNet, as well as our expert clinical authors, to help with this. We support your call for more healthcare professionals to submit their own clinical photos, of course with appropriate patient consent, to help improve access to inclusive resources.
Thank you again for sharing your experience and for bringing this to attention.
Readers looking for PJ resources to support delivery of Pharmacy First and similar services across GB can access learning content by country or condition via our minor ailments hub here: https://pharmaceutical-journal.com/minor-ailments.
Michael Dowdall – Executive Editor, Research & Learning
From experience it is less a problem of recruitment but more a problem of retention of staff. Also pharmacists being asked to spend an inordinate amount of their time conducting audits which go on to achieve nothing.
I think a challenging aspect of medicines reconciliation is that the Summary Care Record is not accurately updated with recent medication changes from hospital discharge letters or medications prescribed from the private sector or out-of- hours GP prescriptions etc. As a result medicines reconciliations take an inordinate amount of time to complete when an accurate medication history should be readily available via an up to date Summary Care record.
Agreed
I can highly recommend the book Mind The Gap (https://www.blackandbrownskin.co.uk/mindthegap) to help increase awareness of dermatological signs and symptoms in people of colour.
Ver well said, Jillian. Your frustration is completely justified and echoes the sentiments of many pharmacists in the profession. It's concerning to see the increasing demands placed on community pharmacists without corresponding support and resources. The Pharmacy First service, while well-intentioned, highlights the need for adequate staffing levels and support mechanisms in community pharmacy. Your dedication to patient safety and professional standards is commendable, and it's crucial to prioritize these principles above all else. Your decision to decline offering the advanced service is a courageous stand for what is right. It's disheartening to see experienced pharmacists like yourself feeling pushed out of a profession they love due to untenable demands. Your voice is essential in advocating for change within the profession.
Ms Armani is quite right. Reviews and strong support to mental health patients is important as well as regular follow up which should
be with all treatments .
This is encouraging news given the devastation the opioid epidemic is causing. I've been able to supply naloxone in Ontario since I arrived in 2017, and uptake increased significantly once we were able to supply the nasal spray instead of the injection - in an emergency situation the fewer barriers to using a product the better.
I would encourage pharmacy organizations to push for narcan nasal spray to be able to be supplied without a prescription, and to the widest possible population. Supplies to those on prescribed opioids should be seen as best practice.
Very educational and helpful information
I have been on Effexor for 30 years and am hoping to get off it in one or two years by taking the drug in compounded form with tiny dosage decreases that occur every few days or so. Such an approach makes perfect psychological sense to me but I don't know anyone who's doing it. I think it's absurd that users trying to withdraw should have to be counting out pill pellets. That's what pharmacist are paid to do, and with the appropriate equipment. Also, regarding why people might want to stop using such drugs, here's one that no one ever mentions: the fact that it is humiliating to become an eternal patient and have to visit a "behavioral health clinic" every three months to have your refill approved by someone who's half or even one-third your own age. Such drugs turn users into eternal patient. That's the main reason I want to quit them in my retirement years.
Unfortunately, only compounding pharmacies can perform dose manipulation (in reality). Wish extemporaneous preparation was still a thing in community.
I am saddened to read about the passing of Chris Barrett, especially to have read this two years too late.
I too count myself among the "the large number of staff he inspired with a love and enthusiasm for pharmacy, many of whom went on to have very successful careers themselves." Mr. Barrett had a huge influence on my career, encouraging me, as a preregistration pharmacist at the London Hospital, to pursue a career in research.
I can attest to his "enthusias[m] in promoting some key management texts to the staff" and recall my puzzlement at why a preregistration curriculum supposedly focussed on clinical and hospital pharmacy, spent so much time on "off-topic" texts. But with his warm style who could not comply cheerfully, if not humouringly, with Mr. Barrett? Nonetheless, Mr. Barrett seemed to have overstepped the event horizon of sanity by introducing Edward de Bono's Art of Lateral Thinking and assigning us the task of coming up with an example of its practical implementation. It was precisely this task that was directly responsible for the trajectory of my career. Applying de Bono to a book I was reading forced me to ask a certain question, diverting me to a research path completely different from the one I had planned and away from the paths typically followed by research pharmacists.
Some 40 years later, I have deep appreciation to Chris Barrett for effectively launching a most rewarding and productive career. Perhaps more importantly I am grateful for Mr. Barrett's lessons in leadership and integrity, recalling particularly how he had time and encouragement for everyone in his team from his senior staff, to his pharmacy technicians, to the bottle washing assistants in non-sterile manufacturing and his prereg students.
With deep condolences to Mr. Barrett's family, his former colleagues and staff
Sncerely
David Wiseman, Dallas, Texas.
This article was very informative and leads to many other well received articles, tools and referencing signposting.
Many thanks.......................
I found the scenarios very interesting..
Now I understand what person-centred really means, putting the person at the centre of care and practice.
thank you
Great analysis of a very important study.
Hope it leads to better understanding of antidepressant prescribing and deprescribing and further supports clinicians who care for people living with depression.
Thorough and comprehensive. On a personal note; as a T1DM sufferer since 1974, many of the acute treatment options have not changed over the last 50 years. There were no such things as SGOT2 inhibitors back then and I just wonder whether they have muddied the waters somewhat for Luddite, old fogeys like myself.
Excellent article - extremely comprehensive and detailed with regard to responses to treatment.
Thank-you you for printing my letter, albeit with some editing. I did not use the term patients for those over 80, I said people who are older than me. This seems to be a strange change to my wording. I was referring to all those over eighty years of age not just those who are 'patients'.
I'd like to support the author's comment above. The subeditors change in wording does alter the meaning - older people are not all patients - and the phrases are not interchangeable.
Dear Jennifer, thank you for highlighting this. I have removed the mention of 'patients' and replaced it with your original wording. Apologies for this editing error.
Sheralyn (Chief Subeditor at The Pharmaceutical Journal)
This is a crazy situation - and the process for new applications is not fit for purpose.
RSV in older adults is estimated to cause 14,000 hospitalisations in the UK per year. The need to protect this population is clear. On 26 June the US Centers for Disease Control and Prevention updated its recommendations for RSV vaccines in older adults. For the 2024 season they now recommend that everyone aged 75 or over should receive the vaccine, and people aged 60-74 at increased risk of serious RSV such as lung or heart disease.
This seems much more clinically logical than the NHS position, which effectively writes off those of us who are over 80. The NHS should urgently review its proposed programme.
Totally agree. I have written to Wes Streeting and my MP but I think we need a more coordinated action with some publicity. This is a nonsensical decision!
Andy, when we organised a 50th graduation reunion for the Class of 1970 from the Square the UCL alumni office were able to help use contact people. KCL might be able to do the same for you.
I needed to get information on my academic record from KCL a few years ago. They could not find records for ex Chelsea students!
See also: https://mag.nationalhealthexecutive.com/january-february-2024?m=62920&i=814120&p=6&ver=html5 - drone deliveries need to be seen in the context of the delivery of the whole healthcare episode. You may be able to cut time-to-delivery, but that is often irrelevant if you need to schedule it a week in advance to get the rest of the care episode (bed, staff, etc) organised. Then, in most cases, you can send your medication by the usual van - or a bicycle.
Interesting article when will we see a full analysis of the survey?
Hi Michael,
As with our previous surveys, we will be publishing this year's results in news stories and long-form articles over the coming days and weeks.
Kind regards,
Carolyn Wickware (Executive editor, The Pharmaceutical Journal)
Lovely idea and novel approach for medicines delivery, especially in remote areas and 'hard to reach' locations.
If comparing numbers, compare apples to apples, what is happening here is the data is getting portrayed differently, using numbers for women’s group and then percentages for men. The research supports testosterone for energy, fatigue, low libido, for both sexes, it should be given to both and follow up blood work on both. The research is so far behind, if women have been informed of risks, have them sign a waiver and then use their findings to help research this topic. By keeping women low energy, low libido and fatigued, it only supports keeping them ill and running from doctor to doctor for help, racking up more medical bills for them and their families.
“The number of women aged 49 years and under receiving testosterone gel also increased, from 228 in November 2015 to 2,913 in November 2022 (see Figure).
In contrast, the data show that NHS prescribing of testosterone gel in men has increased by only 33% in both age groups during the same seven-year period.”
Pharmacy Services provided for this patient group need to be remunerated on the basis of the care provided rather than product dispensed. In my experience many community pharmacists provide care which is way above that associated with dispensing a product. I have even seen community pharmacists who provide extensive social support for this very vulnerable group without any funding or even recognition. A care service based on an agreed standard of care supported by a quality training package could be partly funded by making use of the dispensing fee replaced by a fee per patient registered for the service with a community pharmacy. This would give the patient the necessary pharmaceutical care support and the community pharmacist the recognition by the wider healthcare system as a care giver rather than simply a provider of a product.
I couldn’t agree more Norman. A progressive shift from current remuneration package to a holistic approach would place community pharmacies firmly at the centre of supported care provision towards this patient group. As we know one size doesn’t fit all and the pharmacy model has shifted from “dispensing numbers” to “quality clinical care provision”, deserving of an equitable financial envelope.
The article does an excellent job of highlighting the challenges faced by people with substance use disorders, especially how stigma can worsen their situation. The use of statistics and expert insights really drives home the point that these individuals often face barriers to getting the care they need. The call for better education and training for healthcare professionals, along with the push for more consistent access to supervised consumption services, feels both timely and necessary. It's a well-written piece that not only informs but also encourages a more compassionate and understanding approach to addiction treatment.
Many thanks for your insight on this important issue
I have severe lung infections,, I would like to mix allicin with water and filter and Nebulize the solution
Increased funding is definitely needed for providing these services - in Ontario the provincial government pays the equivalent of £5 a day for daily dispensing for each medication dispensed. The UK has been relatively fortunate to not have been flooded with illicit fentanyl in the same way that the US and Canada have been since 2016 (Canada has had around 46,000 deaths from opioid overdoses since 2016, the vast majority of which are due to fentanyl).
Naloxone should also be available from every pharmacy in the country, at no charge, with a fee from the government that is commensurate with the time needed for training on use of it. Eligibility should be as broad as possible to increase the likelihood of naloxone being available in the event of an overdose, and both injection and nasal spray formulations should be available to reduce barriers to use.
Well said Stephen. Thought provoking the issue of commensurate funding for community pharmacy teams, to provide the right level of care to people with SUDs. There remains the argument that a lot of work done by pharmacy professionals are not usually captured, renumerated or appreciated by policy makers. Equitable access to naloxone, a life-saving drug, with mitigated regulatory restrictions across community settings would have a positive impact in tackling the scourge of opioid-related deaths we face. We are constantly appealing on this matter.
Denis this is right on point. I recall last week my patient bursting out crying because of stigma. I just added a 'yellow caution' sticker to her bloods and she explained how that makes him feel and makes him detached from the service. I have never thought of this
I think the compassionate and non judgemental approach is the way forward if we are to help people with SUD.
Thanks for your insight
I believe pharmacy services as a whole is in urgent need of resuscitation. As Janet Morrison stated that 'community pharmacy businesses are in a perilous and critical state due to the entrenched underfunding of the Contractual Framework'. This also has a ripple effect on the sustainability of pharmacy services primarily in rural areas (with lower dispensing volumes and enhanced service provision), and with cost of living crisis creeping into business profits, the longevity of community pharmacies are at stake.
Am I registered to receive And access the copies via email Please confirm
Dear Ramesh, a member of our support team will look into this and will be in touch shortly. Kind regards, Sheralyn Bone (Chief Subeditor)
When a bid to obtain promotion (or whatever) in one's career fails, it is natural to wonder why. And it is natural to suppose that one's disability / religion / sexual orientation / accent / etc / etc was the reason for failing to gain that promotion. So, I wonder whether the survey was capable of disentangling individual perceptions from actual reasons for those failures to "climb the greasy pole"?
Bottom line: if you take in more fuel than your body needs, you will get sick. Type 2 diabetes was called "age-onset diabetes" when I first qualified as a pharmacist. It is now being diagnosed in 10-year olds. But medics still regard the advice to "eat less and move about more" as a ridiculous oversimplification ... because patients cannot resist the urge to eat when they feel hungry. Perhaps the simplest piece of advice to give is: if you are thirsty, drink water not fizzy pop (whether "full fat" or of the "diet" variety).
absolutely farcical, dependence happens across many medications. OUD by its recent definition is also fundamentally flawed. Bizarre to see this in a pharmaceutical journal, especially given even the most elementary comprehension of pharmacology is all that’s required to know how flawed it is.
The fight against racism is a collective struggle not for only those affected but everyone.
Thanks a lot for sharing such an informative blog!
'At our core, we humans are tribal. Constantly, our subconscious is bombarded with cues that identify who is “us” and “them.” Perceived similarities of status and values make it much more likely that we will connect and form lasting bonds with our fellows.' [https://behumanproject.org/why-are-we-tribal/]
So, when an individual perceives racism, it could just be tribalism. It is not so much about what we look like or where we come from, but how we speak and how we behave / conform with the norms of the tribe. I left a position in a university because I believed that I had been overlooked for promotion and that my achievements were not being recognised ... but this had nothing to do with racism. Was it "constructive dismissal"? No. It was my failure to "conform to the norms of the tribe" that made me want to look for another tribe to join where my achievements would be recognised. And I did indeed find such a place.
Hi
While reading this article I noticed a couple of things worthy of comment.
The figure depicting the patient-centred approach to managing polypharmacy is taken from an article that I was a co-author for in 2015. This full reference for this is not given, so it can be accessed here -
Barnett NL, Oboh L, Smith K. Patient-centred management of polypharmacy: a process for practice. Eur J Hosp Pharm 2016; 23(2): 113-117. https://pubmed.ncbi.nlm.nih.gov/31156827/
The hyperlink to the IMPACT resource (reference 12) is not the most up to date version. IMPACT can be accessed here - https://prescqipp.info/our-resources/bulletins/bulletin-268-impact/
You need to be logged into the PrescQIPP website and you can register for an account here - www.prescqipp.info
Katie Smith
Hello Katie. Many thanks for your comment. I am the senior editor for research and learning at the PJ. I am looking into this and will ensure it is addressed as a matter of urgency. If you would like to communicate directly in the meantime my email address is alex.clabburn@rpharms.com.
Dear PJ
Why is there ZERO mention of diet as either a root cause OR an alternative treatment for Schizophrenia? I can quote numerous papers. Also there's very little emphasis on the metabolic syndrome that the drugs cause and the life-shortening side effects. For those wanting to know more I recommend Brain Energy by Prof Dr Chris Palmer and for de-prescribing a brilliant new Maudsley guide available to borrow free of charge from the RPS library
Very good quiz.
It is hard to believe these figures.
When I was an undergraduate at Chelsea in 1965-1969 about 33% of my fellow 1st year students and 25% of the second year were not allowed to continue because of exam failure but in the years when I was teaching at the now UCL school from before 2000 until around 2015 very few students were asked to leave.
I wasn’t aware of any students leaving of their own volition. What has happened?
Barry Shooter MBE FRPharmS
A very accurate obituary for a man of good character and and excellent lecturer/teacher. A sad loss to the profession. Ron Pate MBE FRPharmS and former student
Great news, but, getting all the content for even one kit has been a nightmare. We could do with a pre-filled syringe being marketed…
Very helpful.
On completion of final assessment a certificate was not provided
After my Multiple Sclerosis diagnosis 2 years ago, i stopped all the Multiple sclerosis medicines prescribed due to severe side effects, and decided look into alternative approach. My primary care provider introduced me to MS-4 programme from naturalherbscentre. com and i immediately started on their Multiple Sclerosis treatment, this MS-4 treatment has made a tremendous difference for me. My symptoms including shaking, muscle weakness, fatigue, mood swings, numbness, double vision and urinary retention all disappeared after the 4 months treatment!
I too was someone who benefitted enormously from David's influence and support through my early years as a resident pharmacist at Derbyshire Royal Infirmary (THE residency programme), clinical diploma and as a clinical pharmacist. I followed in David's footsteps with input to the Pharmacy Academic Practice Unit at University of Derby, and subsequently carrying the baton, as Chief Pharmacist at Derby Hospitals NHS Foundation Trust until 2013. As I reach the end of my own career, I am indebted to him for his wise counsel and support - a true mentor, a true gentleman. With my best thoughts for his family and friends.
Perhaps someone could explain what we be able to do as a Royal College that we can’t currently do?
Will annual membership costs
a.remain the same
b.decrease (by how much?)
c.increase (by how much?)
You will have already done the calculations so please tell us now BEFORE the ballot is posted out to members
Having read this article it is still unclear what the advantages are in becoming a Royal College other than the medics are so we should too.
I was an advocate of becoming a Royal College in 2010 when I represented the long gone Institute of Pharmacy Management on the Transitional Committee tasked with developing proposals for the then Royal Pharmaceutical Society of Great Britain after Government decided somehow it was no longer fit after 150 years or so to continue to regulate the profession.
The fact that the Law Society and Faculty of Advocates continue to fulfil both functions 15 years on give the lie to that notion .
The Society had been very successful in leading and putting forward a strong voice for the profession, and all registered pharmacists were members. It was the only organisation to represent all pharmacists.
It was told that it needed to become a professional body “akin to a Royal College”. The Committee had representatives of other pharmacy professional organisations notably UKCPA and the College of Pharmacy Practice whose roles related to postgraduate education and training, but in the end the RPS were not convinced about the Royal College and not much changed. I’m sorry I destroyed all the work I did to highlight the Royal College benefits and to get RPS to coordinate the other professional pharmacy bodies. A few things come to mind.
Royal Colleges are the leadership body for their profession and are run mostly by Fellows who pay a higher fee than members, they offer specialist qualifications eg for surgery or paediatrics and in medicine these qualifications are needed for consultant jobs.
While I’m pleased to see great minds have been changed at long last I don’t find the arguments convincing as it seems the benefits and risks of this proposal are not clear and the pharmacy world has radically changed.
To say we should do this because
“If you look at the medical royal colleges, for example, I think I’m right in saying that each one of them is a registered charity and a royal college, “ is hardly convincing.
Instead of being the sole voice for all pharmacists in 2010 it is now only one voice for pharmacy out of 9 Members of UK Pharmacy Professional Leadership Advisory Board. It could and should have seen in 2010 onwards it had the opportunity to provide the Leadership coordination role itself. It seems unlikely RPS could easily reclaim that role alone.
Much emphasis is placed here on Firetail, but Companies House says this has only 1 director so it will be interesting to see a summary of the proposals in due course.
It’s too late for me, I wish you well.
Well said Howard, those leading this change could learn much from the work the former College of Pharmacy Practice. There is nothing in this article that presents a vison for the future or opportunities for the profession, patients and individual pharmacists
Thanks Ron lovely to hear from you.
It’s worrying that such a pivotal decision has generated little debate on here. In the old days it would have been red hot.
Sadly the organisation Transcom set up has not delivered and I had lost interest in it as have most of my contemporaries.
I attended the Glasgow event as a swan song and enjoyed seeing some old friends and meeting new ones as branches used to do. I was hoping for inspiration and vision, but there was little in the presentations.
I have learned since that the leadership body is pushing for this and set up a Nigel Clarke led Commission.
Some background would have helped. frame the discussions
It seems the Commission wants the GB and NI societies to form a leadership Council with technicians. This wasn’t mentioned.
Only about 30 people attended the event so getting a two thirds majority of members won’t be easy. Many may even be unaware of the debate. The PJ doesn’t seem to be covering them to help.
The change could drive older members away when a Royal College needs to retain its history and experienced members to learn from the past they may also have time to help free of charge.
It would help to have explanations of why the public and profession will benefit from higher and common standards of service or guidelines or qualifications from a College and from new services. The benefits of being a Charity are ignored. Creative membership options for part time practitioners of family groups could help. There seems no vision for any role of Fellows or better using Fellowship. Medical models don’t fit well as their fellowship is an NHS requirement for specialist practice. The RCN seems better but wasn’t one of these studied by the Commission.
In our day the members drove the leadership and innovated in ways the Society could have utilised. They and we were sometimes seen as a pain to Lambeth and the local branch democracy and some organisations like ours went after Transcom as a consequence.
These days RPS feels like a top down organisation that is not open about its membership numbers, age profile and areas of practice making planning hard to the membership.
GPhC numbers are growing by 1200 a year now at 62000 and 20000
Technicians registered.
A College body serving all those dealing with patients should be growing. This isnt proposed. Surely it should be seen to be in all parties interests to coalesce quickly and for RPS to offer an olive branch in its proposal. It is ideally placed to offer a vision of how that could work.
Finances are better but because services have reduced to much lower levels.
A change of culture and radical rethink is needed to motivate young members to devote time and effort to the new College.
Could Schools of Pharmacy not play a professional role here?
A rebadged tinkering with existing Governance removing the Pharm Press won’t in my view do that and deliver the membership growth necessary to compensate for the estimated drop of around 600 members a year.
A lot of suggestions came from attenders in Glasgow.
I hope the final proposal takes these ideas and those at other events on board.
To lose the vote would be a nightmare. There is a danger the vibrant leadership body of the 90s and noughties will fade into oblivion. The Government the GPhC, the public , pharmacists and technicians and other professions will suffer the consequences. It must not be allowed to happen. Time to smell the coffee, this may be the last chance saloon otherwise.
Dear Howard,
Thank you very much for your comments. Further feedback on the proposals can be shared with the RPS at their email address: feedback@rpharms.com
With regards to PJ coverage of the RPS roadshows, we do have coverage planned for our November issue that we hope will further inform members about the proposals.
Kind regards,
PJ team
If only this level of recognition, understanding and acceptance had been around 20-30 years ago. Neurodivergent people were generally classed as 'shy' or 'weird' or both, and misunderstood, ignored or bullied.
Well - I'm glad I read the detail as the headline would have completely misled!! PJ - you need to be more careful in presenting developmental new to clinical professionals: The juxtaposition of statements regarding type 1 and type 2 diabetes only supports widely held misbeliefs that the two conditions are the same! "...these insulins are unlikely to be used widely in T2DM because of the increased risk of hypoglcyaemic episodes compared with standard care.
“This is likely to be due to the differing daily requirements and flexibility in insulin required in the management of T1DM, ""
Please editors - I think you need to take both a step back and consider the immediate effect of your headlines and the content of your articles and news items.
The narrow age range chosen for the RSV Vaccination is not only disappointing but illogical and to me ageist. My 79 year old wife has just booked her RSV vaccination. I am 81 but of course have not been offered the vaccine. I am fit for my age but occasionally (and currently) suffer asthmatic symptoms - Logically I should be just as entitled to the vaccine as my wife. The NHS approach can only be a cost saving measure.
Interestingly The Pharmaceutical Journal is the only place I can see where this issue has been raised. It needs far greater publicity and an explanation from the NHS why they have restricted the vaccine. I will, as Jane Wessman above, be writing to Wes Streetig and my MP.
I can see from the article on this subject that it it not going to be as straightforward as it initially appears ,but surely pharmacists can facilitate this step forward ,modest though it is, for the general benefit of patients, the smoother running of dispensaries, the redundancy of scissors and the reduction of waste. Percentage is a government word for--- well, not the efficiency of pharmacists !
I was saddened to hear of the death of John Jolley, a former Treasurer of the Society. John had been a well known and active member of the Industrial Pharmacists Group in the Society, serving as Chairman and hence as an advisor to the Society on industrial pharmacy policy. During the difficult times surrounding the granting of a New Charter in the early 2000’s, John advocated, along with others, the introduction of a two Board model of governance. Although this model was in due course rejected, compromises were eventually reached although at the cost of fractious elections to the Society’s Council and a change in the main Officers. As a senior and experienced pharmacist, John was the natural choice for the Society’s Treasurer, and he provided great support and a steadying hand to me during those difficult times.
John was also a Liveryman and great supporter of the Society of Apothecaries where he advocated developing qualifications in Good Pharmacy Practice. As always, he expressed a keen interest and support for his profession, and it was always reassuring to have his calm logic on your side. He will be much missed.
Nicholas Wood
President 1993-4 & 2004-5.
Disappointing not all pharmacy staff in patient facing roles as counter staff provide the majority of needle and syringe supply. Naloxone is safe and easy to supply,no need for a pharmacist or pharmacy technician directly. Let's hope oversight is suffice.
It is interesting to note that, apart from speeches from the two candidates standing for vice-chair of the Scottish Board, this report consists entirely of statements made RPS officers. Did none of the board members say anything worth reporting?
Dose looks to have changed to 225mg but patient requires 255mg. 6 vials needed final volume 1211.25ml rounded to 1211.24ml?
Many thanks for your message. I am senior editor for research and learning at the PJ. I have completed an investigation into this and the article has now been updated to rectify. Many thanks for bringing it to our attention.
I reached the same conclusion as Mr Clabburn with whom I agree, but online today, I see the incorrect calculation still features
Many thanks for your comment. My understanding is that the issue was resolved on 11th October when the parameters of the question were corrected. If you are still seeing an uncorrected version can I ask you to please email me directly on Alex.Clabburn@rpharms.com so I can investigate further.
I am an employee pharmacist. It’s terrible feeling the pressure from the company directors to do more and more with fewer staff. Many many of us are working extra unpaid hours to get everything done.
Nobody can argue against personalised care, but the real gender problem with pharmaceutical care is lack of attention to differences between genders/sexes.
For example, there are meaningful and marked differences between asthma experiences in males and females. After the age of around 12, death rates, severity of attacks and hosptalisation rates are higher in females, management needs to reflect different phases of pregnancy and many females experience different risks of attacks in different parts of the menstrual cycle. Do pharmacists counsel patients on this? Do girls approaching the menarche get advised that their asthma experiences and risks of attack may change? Likewise women approaching the menopause? If we don't, we should.
For asthma, the reason for the differences are not fully understood, but they are certainly in part related to sex hormone changes. There may, though, but be other issues - perhaps resulting from XY versus XX chromosomes, and it may vary with the type of asthma.
There will be plenty trans men and trans women who need appropriate support because of hormone treatments they are receiving.
If UK healthcare paid more attention to gender differences in multiple areas that we currently ignore (the list of conditions is very long and awareness is arguably particularly low in the UK), it would automatically follow that the trans community would receive appropriate support.
Because of the scale of the problem (i.e. affecting everyone), I would argue that it is awareness of healthcare differences between males and female that needs attention first with attention to the needs of trans individuals immediately building on that.
As a fellow Transitional Committee member I share Mr Churtons sentiments
It’s worrying that such a pivotal decision has so far generated little debate on here and there are no reports of local meetings to inform the membership of discussions.
I was close to following most of my contemporaries in leaving the Society but as a long term advocate of the Royal College idea I attended the Glasgow event as a swan song. I enjoyed seeing some past friends and meeting new ones as branches used to do.
I was hoping for inspiration and vision, but there was little of that in the presentations. Too much was about tinkering with Governance.
I have learned since the meeting that the leadership body is pushing for the college and set up a Nigel Clarke led Commission. This wants to coalesce GB and NI pharmacists and Technicians into one Council.
Some background of that would have helped inform the debate on member benefits.
Only about 30 people attended the event with few under the age of 30 so getting a two thirds majority of members won’t be easy unless the plan is to have low voting numbers.
A Royal College needs to promote member advancement and retain its history and experienced members to hep new ones learn from the past.
It would help to have explanations of how these professions will benefit from higher and common standards of service, guidelines or qualifications from a College and might develop close working relationships and new joint services.
The benefits of being a Charity were ignored but they could lead to lower fees.
Creative membership options need to be considered eg for part time practitioners or family groups or over 75s that could help growth.
There still seems no vision for any role of Fellows or better using Fellowship. Medical models do but don’t fit well as their fellowship is an NHS requirement for specialist practice.
The RCN model seems better suited but wasn’t one of these studied by the Commission. It has enhanced and consultant membership levels and includes midwives and assistants.
In my day the members drove the leadership and innovated in ways the Society could have utilised much more. The local branch democracy and some organisations suited to advanced practice have gone making life easier for HQ staff.
These days RPS feels more like a top down organisation that is not open about its membership numbers, age profile and areas of practice making planning hard to the membership. To leave FIP without any consultation suggests members views don’t count. These are not good messages.
The market for a member driven College is there with GPhC numbers growing by 1200 a year now at 62000 and 20000
Technicians also registered.
A College body serving all those should be growing. Surely it should be seen to be in all parties interests to coalesce quickly and for RPS to offer leadership and an olive branch in its College proposal rather that put it off yet again. It is ideally placed to offer a vision of how that could work with advanced practice for technicians
A change of culture and radical rethink is needed to motivate young members to devote time and effort to the new College and to professional cooperation.
In 1975 I set up the first UK wide pharmacy group in Drug Information and UKCPA soon followed. It benefited all countries and took only months to establish. Why has it taken so long for the whole profession to follow?
Could Schools of Pharmacy not play a more active professional role within the College?
A rebadged tinkering with existing Governance removing the Pharm Press won’t generate momentum for change in my view nor deliver the membership growth necessary to compensate for the estimated drop of around 600 members a year.
A lot of suggestions came from attenders in Glasgow.
I hope the final proposal takes these ideas and those at other events on board to offer a clearer vision of what the college will do, the member benefits and possible future joint opportunities
There is a danger the vibrant leadership body of the 90s and noughties will fade into oblivion taking its history with it. The UK Governments. the GPhC, the public, pharmacists and technicians and other professions will suffer the consequences. It must not be allowed to happen. Time to smell the coffee, this may well be the last chance saloon otherwise.
Dear Howard,
Thank you very much for your comments. If you would like to share your feedback directly with the RPS team overseeing the proposals for change, you can do so using their email address: feedback@rpharms.com
Kind regards,
PJ team
Hello,
Thank you very much for your questions. Please can I direct you the RPS's FAQs on the proposals for change for further information: https://www.rpharms.com/about-us/changeproposals/changefaqs
If your questions are not answered there, questions can also be sent to feedback@rpharms.com.
Kind regards,
PJ team
I believe more important than newer formulations of naloxone is access at community level. The concept of emergency supply of naloxone by community pharmacies in Scotland as a public health funded intervention would be a rational approach if agreed across England and Wales, improving access!
It was interesting to see a severely hyperkalaemic patient's patiromer being delayed to the next day because it had been prescribed as a morning dose on EPMA.
There is still a lot of scepticism about statins. I have conversations with well educated me friends who don’t want to become medicalised. They believe they can control their cholesterol with diet and excessive. They are suspicious of pharmaceuticals regarding them as rather like poisons! My wife and I did a three month trial on statins and reduced our cholesterol from 6+ to 4+. Impressive but even my GP said - so what?! Not sure he is that convinced either.
Apologies for spellcheck errors!
A good article. Learnt a lot. How can I acquire a CPD certificate?
Many thanks for your comment. I am the senior editor for research and learning at the PJ. This piece is one of our shorter learning articles which do not generate CPD certificates. To see our full list of available CPD modules you can go to 'My account' and then 'My CPD'.
Be helpful to have regular updates, has situation not moved on since 17th September (last update), now mid-November...
The trouble is largely that community pharmacy is/was always divided. Multiples and larger groups go their own way and the independent often regards another pharmacy as the opposition. There's always someone out there willing to try to get an advantage and whether this takes the shape of longer opening or offering to do something for nothing , in the long term this was unsustainable for all to follow. But try persuading any paymaster to give you additional cash when the guy down the road is already doing it. Our society often welcomed these initiatives since it appeared to elevate the status of the profession, conveniently forgetting that it was unsustainable in the long term without a real cash injection.
How we laughed in 1967, my first year in a pharmacy when a greybeard told us about the bad old days pre WW2 when, as as apprentice, he would be sent along the street to see if the opposition was still open - plus ca change?
What an incredible achievement by Sharon and what an interesting, fascinating account of her programme from start to finish. The photos are fantastic, the experience will last a lifetime and the 'take home' message is clear. Congratulations to Sharon and wishing her ongoing success in IJPP.
Under the 'Diagnosis' subheading where it says "Women of childbearing age should have a pregnancy test to rule out ectopic pregnancy". This suggests all women should be assumed to be pregnant and could be perceived as condescending and patronising. Perhaps it should instead say something along the lines of "Where relevant women of child bearing age should be offered a pregnancy test".
Many thanks for your comment. I am the senior editor for research and learning at the PJ. We have considered your comment and agree with the sentiment so will edit this sentence accordingly. Many thanks.
It is also an issue for POM-V dispensing via online pharmacies/dispensaries.
I’m a pharmacy technician working at Boots’s pharmacy. As technicians we are expected to provide flu vaccination and blood pressure services, not being rewarded for it in a form of a better pay. Myself and my colleague run the pharmacy and we were told on multiple occasions that we have the best team in the area. Yet this year in November, my colleague who is a dispenser was excluded from a bonus scheme and myself was rewarded 2.38% of my Annual Salary. My manager and pharmacists were given 8% on their annual salary and assistant managers 4.76%. I think this is very unfair as makes myself and my colleague feel unappreciated, undervalued and our input into successful running of the pharmacy’s not being recognised. Moreover, I was rewarded this month with 3% pay rise whilst the pharmacists were given 5%. With raising cost of living, I think 3% is very inadequate and greedy. My shop floor colleagues were given 4% pay rise in April 2024 and I believe in April 2025 there will be 6.7% increase in their wages. My salary is growing slower than a minimum wage and I believe if this continues, the gap between my wage and minimum wage will be minimal anytime soon.
Boots recently also introduced Technician Development Program. I was told the aim of the program is to upskill my existing skills so I could offer more personalised patient centered care. I think this program is aiming at developing new skills rather than updating existing and the main goal is to release pressure on the pharmacist by giving more responsibility to pharmacy technician. I do understand the importance of continuing personal development and for that reason I continue with CPDs, making sure my knowledge and skills are always up to date. I don’t mind on taking extra responsibility but I personally think this has to be recognised as the pharmacist being rewarded and recognised for their work. I was recently told that I face disciplinary procedure, if I don’t complete the program. I am deeply considering careeea change.
This is an excellent initiative by CGL. The real time notification of missed/late doses has the potential to save lived by preventing people 'falling off script' and by demonstrating clear joined up communications. The annual review by the pharmacist has the potential to utilise the relationship which many pharmacists develop with their MAT clients to identify issues they feel unable to raise with their community drug team. The pharmacist can be a strong patient advocate and by working together with colleagues in community, this could make the work of those of us in community drug teams better and more agile to patient need too. Well done GCL, I hope this roles out wider.
Sir,
Whilst I welcome any initiative to improve the lot of patients with asthma, I feel that it may be a little more difficult to change the habits of the patients affected, because of their great attachment to Short Acting Beta Agonists (SABA) and Ventolin (only branded Ventolin not generic) in particular.
When I was in practice I made counselling asthmatics a priority because it is so easy to improve the quality of life with just a few simple suggestions. Since I retired, I have used social media to spread the message. From the comments on Facebook and others it is quite obvious that the great British public have a very sketchy knowledge of medical matters and asthma in particular. As mentioned above they have an attachment to SABAs that in other contexts would be considered a dependency. My comment that anyone having only a SABA without an inhaled corticosteroid, not more than a few times a year because it can kill is met with derision.
There is a role for the community pharmacist to educate their asthmatic patients, because I predict there is going to be resistance from patients.
Regards
Bob Dunkley
I have huge sympathy for community pharmacy which has been underfunded for years. However in taking the decision to vote on withdrawing locally commissioned services, including what has been termed 'addiction support services', I wonder if the evidence base for the benefit of these services has been considered? People who use drugs in receipt of substitution therapies such as methadone and buprenorphine are much less likely to die of an overdose (studies suggest approx 4 x less likely) compared to those not in treatment. The combination of needle and syringe provision with opioid substitution therapy can reduce hepatitis C transmission by up to 80% and is a hugely economical intervention. A lot of these services have already been lost from pharmacies post-Covid. Making the most marginalised and vulnerable people in our society who do not have a voice to speak out for them as pawns in this important fight for better funding feels ethically and clinically wrong.
I feel honoured to have had a small connection with Robert Twycross. The Palliative Care Formulary revolutionised our work as pharmacists specialising in this area of work where a large proportion of drug use was off-licence. The work started by Drs Twycross and Willcock hugely advanced our ability to make recommendations to non-specialists and reassure specialist colleagues. The advent of the bulletin board gave us an opportunity to share information and collect data. Attending the Oxford Advanced Course in Pain and Symptom Management was the most informative experience every year for a fortunate large number of specialists and I recall vividly being put on the spot to answer a question by Dr Twycross in front of an audience of far more erudite clinicians. All palliative care specialist pharmacists owe a tremendous amount to this inspiring man who really valued our contribution to the multidisciplinary team. He has left the most wonderful legacy as the work continues.
Thank you RPS for the official response. The gazetted official notice states clearly that the agreement of Assembly was to CANCEL the 2025 board election, not to “defer for up to 12 months” (which, as I have indicated in my letter, would have been a more acceptable proposal”.
It is also notable that no response is given to the matter of extending the terms of officers and chairs/vice-chairs, which is central to my letter and should give members significant cause for concern. It is neither necessary or desirable that members are denied the opportunity to reconsider those in positions of leadership as the Society enters a significant and complex period of change as it seeks to establish itself as our Royal College of Pharmacy.
I agree with Mr Churton. It is noteworthy that membership of the Society is falling since it became optional and in my view those who participate in the Society's activities should be encourages to do so, rather than discouraged.
Why are RSV vaccines not available privately to middle-aged adults like Covid and Flu vaccines are?
Fantastic summary article!
A helpful introduction but no one in the podcast mentions the public or patients.
“To be a charity in England or Wales, the organisation must be set up with purposes which are exclusively charitable for the public benefit.”
That requirement might inhibit some current Society activities. It would help to know what of these a College would not be able to do. The Society has lobbied and influenced governments for years for members benefits, will that stop?
A College must be able to ensure the public receive the same standard of pharmaceutical care whoever is the provider be it an assistant, a technician, a pre registration graduate or newly qualified or experienced pharmacist.
I look forward to the promised update of regional events to see if these issues have been covered.
Why doesn’t RPS demonstrate leadership of this issue. Get APTUK and PDA together with pharmacists
and technicians who work well together to sort this out.
There are issues that need to be resolved such as over how technicians are kept up to date on pharmacy practice, laws and ethics and what gaps there may be in their knowledge that a Royal College could resolve through an accreditation system.
Pharmacists must remain responsible for standards of patient care and quality of medicines in a framework that maximises the use and skills of technical and assistant staff.
Dear Brona - well done for critically reviewing the appropriateness. Like you I'm concerned about the use of these drugs. Interesting letter.