One Year of Pharmacy First: What developments have been made to community pharmacy in the UK?2/19/2025  As January 31st marked one year of Pharmacy First, the UK has seen significant contributions to community pharmacy since the launch of the NHS service.
What is Pharmacy First? Pharmacy First is a free NHS consultation service that allows pharmacists to treat seven common conditions without patients needing to book an appointment with a GP (NHS England, 2024). It serves as an extension and replacement for the NHS Community Pharmacist Consultation Service (CPCS) which launched in October of 2019. With the aims of minimising pressure on primary and urgent care services, CPCS was introduced to enable patients to get an appointment at a community pharmacy for a minor illness or urgent supply of a regular medicine (Centre for Pharmacy Postgraduate Education, 2024). Building on what was previously provided in CPCS, Pharmacy First includes the addition of clinical pathways for the following conditions (Community Pharmacy England, 2023):
In terms of funding, pharmacies are paid £15 for every clinical pathways consultation completed (Community Pharmacy England, 2023). Monthly consultation thresholds have also been set for pharmacies to receive an additional fixed monthly payment of £1,000 for achieving targets. Successes of Pharmacy First Major successes have been observed since the introduction of the NHS service, with almost two million Pharmacy First consultations being carried out over the past year. Although Pharmacy First is an example of an advanced service within the NHS Community Pharmacy Contractual Framework (CPCF), meaning that it is not compulsory for all pharmacies to offer it, roughly 98% of community pharmacies are registered to provide the service as of 2025. Massive contributions have been made to relieve pressure on other areas of the NHS as a result of this. The Company Chemists’ Association revealed that in the first month of Pharmacy First, almost 50,000 clinical pathways consultations were delivered by CCA members, equating to almost 1,500 daily consultations. The impacts were particularly seen in areas of higher deprivation, with two and a half times more consultations taking place compared to less deprived areas – this highlights the difference made from improved access to care (Company Chemists’ Association, 2024). On launching, it was said by NHS England that Pharmacy First, in addition to pharmacy blood pressure and contraception services, would save up to 10 million GP appointments annually. Moreover, with a greater proportion of the workforce qualifying as independent prescribers, we can expect Pharmacy First to form the foundation of a more robust community pharmacy prescribing service including more clinical pathways in the future (McQuillan, 2025). Challenges of Pharmacy First Despite the launch of Pharmacy First achieving many successes, there have been several challenges that have accompanied them. Whilst some pharmacies have been able to stay on target, some independent pharmacies have expressed their struggles with meeting the minimum number of clinical pathways consultations to receive the fixed monthly payments of £1,000 (Trainis, 2025). Although many pharmacists agree that Pharmacy First has been a great development to community pharmacy, some believe that the funding is not proportionate to the workload they are receiving. To deliver the service well, pharmacists invest a lot of their time into training, ensuring that safe and effective care is provided to patients. Some pharmacists have suggested raising the fees for each consultation completed to support the sustainability of the service in the long run. With the thresholds continually being on the rise, several pharmacies have found it increasingly difficult to reach targets and have lost hope in reaching the new thresholds for future months. Struggles to meet the monthly thresholds could be linked to other issues over the year such as IT system disruptions and lack of public promotion (Community Pharmacy England, 2025). Incorrect GP referrals have also posed an issue as some pharmacies reported patients being referred to Pharmacy First despite not meeting the eligibility criteria for certain conditions (Chemist and Druggist, 2024). As responsibilities continue to increase, the need for at least two pharmacists to be working at every community pharmacy must be established in order to cope with the shift in pressure from GP clinics (The Pharmacists’ Defence Association, 2022). With the immense amount of pressure the NHS is under, a collective agreement can be made that Pharmacy First is a step in the right direction for patients to get access to the care that they deserve. By developing ways to further increase public awareness and increase GP referral rates, Pharmacy First has the potential to change the trajectory of healthcare in the UK for the better. References: Bowie, K. (2024) Sector calls for ‘clearer Pharmacy First messaging’ amid patient aggression: Chemist and Druggist. Available at: https://www.chemistanddruggist.co.uk/CD138007/Sector-calls-for-clearer-Pharmacy-First-messaging-amid-patient-aggression/ (Accessed: 9 February 2025). Centre for Pharmacy Postgraduate Education (2024) NHS Pharmacy First service: Centre for Pharmacy Postgraduate Education. Available at: https://www.cppe.ac.uk/services/pharmacy-first/ (Accessed: 9 February 2025). Community Pharmacy England (2023) Pharmacy First service: Community Pharmacy England. Available at: https://cpe.org.uk/national-pharmacy-services/advanced-services/pharmacy-first-service/ (Accessed: 9 February 2025). Community Pharmacy England (2025) Reflections on Pharmacy First: One Year On: Community Pharmacy England. Available at: https://cpe.org.uk/our-news/reflections-on-pharmacy-first-one-year-on/ (Accessed: 9 February 2025). Company Chemists' Association (2024) First month of Pharmacy First shows the NHS service is enhancing patient access and directly tackling health inequalities: Company Chemists' Association. Available at: https://thecca.org.uk/first-month-of-pharmacy-first-shows-the-nhs-service-is-enhancing-patient-access-and-directly-tackling-health-inequalities/ (Accessed: 9 February 2025). McQuillan, H. (2025) Pharmacy First: A year of transformation for community pharmacy: The Pharmacist. Available at: https://www.thepharmacist.co.uk/community/views/pharmacy-first-a-year-of-transformation-for-community-pharmacy/ (Accessed: 9 February 2025). NHS England (2024) Pharmacy First: NHS England. Available at: https://www.england.nhs.uk/primary-care/pharmacy/pharmacy-services/pharmacy-first/ (Accessed: 9 February 2025). The Pharmacists' Defence Association (2022) PDA publishes innovative proposals around opportunities for post-Covid-19 pharmaceutical care: The Pharmacists' Defence Association. Available at: https://www.the-pda.org/pda-publishes-innovative-proposals-around-opportunities-for-post-covid-19-pharmaceutical-care/ (Accessed: 9 February 2025). Trainis, N. (2025) Independents reveal struggles with Pharmacy First as service marks one year: Pharmacy Magazine. Available at: https://www.pharmacymagazine.co.uk/news/independents-reveal-struggles-with-pharmacy-first-as-service-marks-one-year (Accessed: 9 February 2025). Written by: Li Wei Law
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Pharmacist-Led Interventions: A Cost-Effective Solution to Cardiovascular Disease Prevention1/28/2025  Cardiovascular disease (CVD) remains one of the leading causes of morbidity and mortality globally. Within the United Kingdom, significant progress has been made to combat this issue through innovative healthcare strategies. A recent NHS England report portrays that pharmacist-led interventions in CVD prevention yield the highest return on investment (ROI) among public health initiatives, showing the important role of pharmacists in improving patient outcomes and optimizing healthcare spending (1). The Impact of Pharmacist-Led Interventions Pharmacists are uniquely positioned to play a central role in CVD prevention due to their accessibility, expertise in medication management and finally the ability to provide specific patient care. These interventions typically focus on early detection, lifestyle changes as well as medication optimisation. Examples include conducting blood pressure checks, managing cholesterol through lipid-lowering therapies, and supporting adherence to antihypertensive or anticoagulant medications. According to the NHS report, pharmacist-led approaches demonstrated a higher ROI compared to other CVD prevention strategies. This is due to pharmacists’ ability to reach a broader population, address gaps in care, and reduce the burden on primary care physicians (1). Early detection and prevention efforts lead to fewer hospitalizations, reduced emergency admissions, and lower long-term treatment costs. Cost-Efficiency Meets Clinical Efficacy The financial implications of CVD are massive with billions spent every year on treatment and associated complications. The NHS report indicates that pharmacist-led interventions not only improve patient outcomes but also reduce these costs by preventing disease progression and minimising expensive interventions such as surgery or hospitalisation (1). For example, regular blood pressure checks and cholesterol management can delay or prevent the onset of conditions like myocardial infarction or stroke. In addition to cost savings these interventions empower patients to take control of their health. Pharmacists take part in motivational counseling, addressing barriers to lifestyle changes such as diet, smoking cessation, and exercise. This holistic approach ensures sustainable health benefits that extend beyond immediate clinical outcomes. Bridging Gaps in Healthcare Access Another important element influencing pharmacist’s efficacy in preventing CVD is their accessibility. Preventive care is made more convenient by the availability of community pharmacies in busy locations. In these pharmacies patients can obtain treatments and advice without making an appointment. Furthermore, underprivileged communities with limited access to general practitioners benefit greatly from these services. Pharmacist-led interventions are typically successful in identifying high-risk individuals who could otherwise go undetected, according to the NHS analysis. For instance, undiagnosed hypertension, also known as the "silent killer," might result in serious consequences. Pharmacists can prevent these cases from developing by providing regular examinations and follow-up care, which will greatly lower the burden of disease (1). Challenges and the Way Forward Despite the clear benefits, some challenges remain. A critical issue is the integration of pharmacist-led services into broader healthcare systems. Collaboration between pharmacists, general practitioners and other healthcare providers is essential for ensuring high quality care. Additionally, adequate funding and resources must be allocated to support these initiatives and expand their reach. Training and professional development are also vital. Pharmacists must continue training in areas such as cardiovascular risk assessment and chronic disease management to maximize their impact. Conclusion The NHS report provides compelling evidence that pharmacist-led interventions are a cost- effective and clinically effective strategy for reducing the burden of cardiovascular disease. By leveraging pharmacists’ expertise and accessibility, healthcare systems can achieve substantial improvements in patient outcomes while optimising resource allocation. As the UK continues to face rising healthcare costs and an aging population, pharmacist-led CVD prevention initiatives represent a scalable, sustainable solution. References
journal.com/article/news/pharmacist-led-cardiovascular-disease-interventions- provide-highest-return-on-investment-says-nhs-report
 From the 18th to the 24th of November is World Antimicrobial Resistance Awareness Week (WAAW), which focuses global attention on a covert crisis threatening the health of humans, animals and the environment: antimicrobial resistance (AMR).[1] A hurdle in healthcare systems and an obstacle for the efficacy of once impervious life-saving antimicrobial drugs, AMR endangers progress in modern medicine and now renders once easily treatable diseases life-threatening.[2] This blog will cover what AMR is, how it occurs, its global impact, the role of pharmacists in combating AMR, and the often neglected human and future financial cost of AMR.
What is AMR When infectious microorganisms (like bacteria, fungi, viruses or parasites) evolve to become more resistant to their antimicrobial treatments, AMR occurs. This could mean bacteria are less affected by antibiotics or viruses are less affected by antivirals, resulting in infections caused by them being harder to treat.[3] Although AMR is a natural phenomenon driven by genetic changes in target organisms, its prevalence is primarily accelerated by the misuse of antimicrobial medications in humans and animals.[4] What causes AMR? AMR is the consequence of several coalescing factors, which can accelerate the birth of new ‘superbugs’. Superbugs are resistant, infectious microorganisms that cannot be killed by medicines that are usually the first choice for treating them.[5 6] One of these factors is the misuse of antimicrobials. For example, the overprescription of antibiotics for mild or even viral infections like colds and flu is a significant contributor to antibiotic resistance, with the sharing of medicines or failure to complete a course of one’s medicine only exacerbating the problem, as if not all of the infectious bacteria is eliminated from a patient, some stragglers can undergo genetic changes to become more resistant to the medicine and multiply to infect other people. The same principle applies to fungal or even parasitic infections.[7] Similarly, veterinary medicine in farming, whereby large amounts of cattle are given medicine to prevent disease, is another ‘hot-pot’ for the development of antimicrobial resistance.[8] A lack of awareness of the consequences of AMR resistance means careless behaviour regarding antimicrobial medications is encouraged, while a lack of regulation means that in some nations, the use of antimicrobials without a prescription is perfectly legal, resulting in overuse and improper use. Poor infection control is another factor that can lead to antimicrobial resistance. This is where poor hygiene practices in some hospitals and community settings increase the spread of superbugs, while poor sanitation and a lack of drinking water in developing countries worsen this problem, which highlights the fact that AMR is not a crisis unique to developed nations.[9] When unused drugs are improperly disposed of, and agricultural runoff containing antibiotics reaches the environment, they may present in low concentrations in water and soil. This furthers the spread of resistant microorganisms even outside of settings where medicines are used the most.[10] The Global Impact of AMR Antimicrobial resistance can be detrimental to modern society since it has substantial global consequences. Economic expenses are one of the most significant impacts of AMR. AMR generates large direct and indirect costs. Direct expenses include costs required while treating the disease at hospitals and pharmacies. Pathogens being resistant to their medications makes it more challenging for healthcare providers to deliver adequate treatment to the patient. This can result in a prolonged treatment period and increased charges. Moreover, AMR puts immense pressure on pharmaceutical companies, as there is a greater demand for alternative antibiotics, while there are more difficulties in the research process. In addition to the direct costs, AMR may also result in indirect costs due to the loss of output due to the lack of effective labour supply. This is because AMR leads to increased morbidity, disability, and premature death of workers.[11] According to the World Bank, the direct cost of AMR is predicted to be over $1 trillion over the next fifteen years. Furthermore, the GDP loss is expected to reach $ 1-3.4 trillion USD per year by 2030.[11] The Role of Pharmacists in Combating AMR Pharmacists could take part in a number of steps to address this worldwide issue. Firstly, pharmacists can help ensure the responsible use of antibiotics. This involves determining if antibiotics are necessary for an individual and providing the proper type, dosage, and frequency of treatment for the patient. Furthermore, pharmacists are responsible for educating patients about antibiotic misuse and encouraging safe and effective self-care.[1] Another strategy to help reduce AMR is to prevent infections from occurring in the first place. Infection rates can be reduced by encouraging vaccinations and promoting hygienic practices, including appropriate handwashing and food safety. Finally, pharmacists can assist in enhancing the general understanding of AMR risks. They can offer educational sessions in schools, workplaces, and local communities or actively engage in initiatives such as Antimicrobial Awareness Week to inform the public about the AMR. The Importance of Action The importance of pharmacists in preventing AMR becomes even more apparent when considering real-life cases like Rosa’s, where multidrug-resistant infections lead to severe complications. Rosa was 6 weeks old when she had a seemingly simple respiratory illness that turned out to be multidrug-resistant Klebsiella pneumonia. This led to three years of surgical operations, various unsuccessful antibiotic treatments, rehabilitation, and concerns about her future.[12] Antimicrobial resistance is a complex global issue that requires immediate action from everyone. Simple steps, such as raising awareness, using antibiotics responsibly, and maintaining proper hygiene, can significantly reduce the number of patients affected by this growing threat. By tackling antimicrobial resistance today, we can prevent a devastating healthcare crisis in the future and safeguard our health. Reference List 1. WHO (2023) Antimicrobial resistance, World Health Organization. Available at: https://www.who.int/news-room/fact-sheets/detail/antimicrobialresistance?gad_source=1&gclid=Cj0KCQiA6Ou5BhCrARIsAPoTxrDNqGzwS2D61DKznm3lBvudzMNMCBCuBCfVgA0YqXPoWx1PgL5UR4YaAiiEEALw_wcB (Accessed: 18 November 2024). 2. NHS Inform. (n.d.) Antimicrobial Resistance (AMR). Available at: https://www.nhsinform.scot/campaigns/antimicrobial-resistance-amr/ (Accessed: 20 November 2024). 3. NHS England. (n.d.) Antimicrobial Resistance (AMR). Available at: https://www.england.nhs.uk/ourwork/prevention/antimicrobial-resistance-amr/ (Accessed: 20 November 2024). 4. World Health Organization (WHO). (n.d.) Antimicrobial Resistance. Available at: https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance (Accessed: 20 November 2024). 5. Mayo Clinic. (2023) What in the World is Antimicrobial Resistance? Available at: https://newsnetwork.mayoclinic.org/discussion/what-in-the-world-is-antimicrobial-resistance/ (Accessed: 20 November 2024). 6. Cleveland Clinic. (n.d.) Superbug Infections. Available at: https://my.clevelandclinic.org/health/diseases/superbug (Accessed: 20 November 2024). 7. Dignity Health. (2016.) Why Is Finishing Antibiotics So Important? Available at: https://www.dignityhealth.org/articles/why-is-finishing-antibiotics-so-important (Accessed: 20 November 2024). 8. Wang, Y., Li, X., Wang, Y., Zhang, T., Liu, J., Zhu, L. and Du, X. (2023) ‘Understanding Antimicrobial Resistance: Progress and Challenges’, Frontiers in Microbiology, 14, p. 10044628. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC10044628/ (Accessed: 20 November 2024). 9. Prestinaci, F., Pezzotti, P. and Pantosti, A. (2015) ‘Antimicrobial resistance: A global multifaceted phenomenon’, Antimicrobial Resistance and Infection Control, 4, p. 22. Available at: https://aricjournal.biomedcentral.com/articles/10.1186/s13756-017-0208-x (Accessed: 20 November 2024). 10. Liu, Y., Gu, Y., Zhang, Z., Yang, C., Zheng, S., and Xie, L. (2023) ‘Intensive Agriculture and Antimicrobial Resistance: Potential Risks and Consequences for Human Health’, Frontiers in Public Health, 11, p. 10482381. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC10482381/ (Accessed: 20 November 2024). 11. World Bank Group (2017). Drug resistant infections, a threat to our economic future. Available at: https://documents1.worldbank.org/curated/en/323311493396993758/pdf/final-report.pdf Ecdc (Accessed: 18 November 2024). 12. European Center for Disease Prevention and Control (2024). Patient story: Rosa. Available at: https://antibiotic.ecdc.europa.eu/en/patient-story-rosa (Accessed: 18 November 2024). Written by Yoobin Cho and Zion Lindsay Cancer, from the citizens’ perspective, is a life-threatening illness that is more common in elders. It can always be attributed to contaminated living conditions (e.g. air pollution, radiation), inferior living habits (e.g. smoking, drinking alcohol), etc. However, apart from adults, children facing cancer also deserve attention.
There are an average of 1838 children’s cancer cases a year, and around 1 in every 420 boys and approximately 1 in every 490 girls in the UK will be diagnosed with cancer by age 14 as estimated. (Cancer Research UK, 2024). In the writer’s hometown, the number is lower. In Hong Kong, an average of 180 children contract the disease each year – about one child in every 10,000. (Children’s Cancer Foundation, 2024) While breast and lung cancer are most common in adults, leukaemia, brain tumour, and lymphoma are the most prevalent types of cancer children encounter. (Children’s Cancer Foundation, 2024) Since the 1970s, when most children diagnosed with cancer had little hope of survival, cure rates have grown dramatically thanks to the advancement of treatment. As a result, the number of survivors has also significantly increased. (Children’s Cancer Foundation, 2024) The cure rate of childhood cancer has rocketed by 4 times from a mere 20% in the 1960s to 84% nowadays. (Children's Cancer and Leukaemia Group,2024) Treatment of children’s cancer falls under three main categories --- chemotherapy, radiotherapy, and bone marrow transplantation. For chemotherapy, the doctor prescribes a combination of anti-cancer drugs administered orally and by injection. In addition to that, some patients may also require radiation to kill the cancer cells. Bone marrow transplantation is always considered the last line treatment given that finding a match bone marrow is difficult, not to mention the high risk of the operation for such a young child. As a long-term volunteer in a foundation and charity providing support to these children, it is pleasing to see how the improvement in treatment has hugely boosted the cure rates. Nevertheless, the side effects are worrying. They lead to inconvenience to children’s development and lack of self-confidence. Bone fracture has always been a commonplace but concerning side effects of steroids. It restricts the daily physical activities of children. The difference between them and other children may also hurt their self-esteem. Another alarming side effect is the increase in ocular pressure and steroid-induced glaucoma. As symptoms of glaucoma are difficult to define by children, it may already result in severe vision loss when the glaucoma is diagnosed. As pharmacists, we play a pivotal role in the healthcare system, including supporting these children and their families. A cancer diagnosis can sometimes be the first time a parent has had to give their child any medicines, apart from paracetamol. Treatment of paediatric cancer still relies heavily on chemotherapy drugs, whether administered by mouth or via intravenous infusion. (Children's Cancer and Leukaemia Group,2020) The effectiveness of the chemotherapy depends on the medication adherence. We have the responsibility to ensure children receive the medication accurately. We are also responsible for highlighting the possible common mild side effects and alarming symptoms they should stop and find the doctor straightaway. For example, in patients’ counselling, we can recommend lifestyle changes, including supplementation with calcium and vitamin D, diet, and proper exercise. These can slow the rate of bone loss. (Guise TA, 2006) Another way to assist them as a pharmacist is to join the research team. Pharmacists can apply their pharmacological knowledge and be involved in new chemotherapy research and review of international treatment options. This is also my motivation to study pharmacy. These children do need our help and support. They deserve a chance to live their lives. Not only can they grow as other children do, but they can also be the leading icons and professionals in their sector. For example, in Hong Kong, “Outstanding Little Life Warriors Award'' awardee, Yu Chui Yee, is a Paralympics gold medalist in fencing. Many awardees are now doctors and medicine students who aim to contribute to society and help patients. (Little Life Warrior Society, 2019) It is great to see how the advancement in treatment has saved so many lives and we are all looking forward to more children to be benefited. References: Cancer Research UK (2024) ‘Children's cancer statistics’, in Cancer Research UK [Online]. Version. Available at: https://www.cancerresearchuk.org/health-professional/cancer-statistics/childrens-cancers#heading-Three (Assessed: 29 January 2024) Children's Cancer Foundation (2024) ‘Childhood Cancer Facts & Figures’, in Children's Cancer Foundation [Online]. Version. Available at: https://www.ccf.org.hk/en/information/childhood_cancer_facts_and_figures/ (Assessed: 29 January 2024) Children's Cancer and Leukaemia (2024) ‘Survival rates’, in Children's Cancer and Leukaemia [Online]. Version. Available at: https://www.cclg.org.uk/survival-rates (Assessed: 29 January 2024) Children's Cancer and Leukaemia (01 Sep 2020) ‘Back to basics: The pharmacist’s role in treating childhood cancer’, in Children's Cancer and Leukaemia [Online]. Version. Available at: https://www.cclg.org.uk/contact-magazine/the-pharmacists-role-in-treating-childhood-cancer (Assessed: 29 January 2024) Guise TA (2006) ‘Bone loss and fracture risk associated with cancer therapy’, in The oncologist, 11(10), 1121–1131. [Online]. Version. Available at: https://doi.org/10.1634/theoncologist.11-10-1121 (Assessed: 26 January 2024) Little Life Warrior Society (2019) ‘The 4th "Outstanding Little Life Warriors Award" Awardees’, in Little Life Warrior Society [Online]. Version. Available at: https://www.llws.org.hk/pages/hk/Info.aspx?10_42_0_10202_ (Assessed: 29 January 2024) Written by Tim Chan  Pharmacists have a key role to play in society, as they provide a source of information and help to the community. However, by being on the front line, dispensing medicines and treatment for their customers, pharmacists need to be aware of the dangers and risks that arise, and how that may negatively affect their mental health. The mental toll that many healthcare professionals come under is often brushed past, and when it comes to pharmacists, there is no exception. There is an unfortunate rise in pharmacy-related crime in the UK, and with that comes alot of mental strain for the people working behind the counter.
The PDA state how over a third of pharmacists do not feel safe for more than half of their time at work, and 20% don’t feel physically safe at all (2021), and the following year, they conducted an online survey and found that 85% of pharmacists have experienced or work with someone who has experienced verbal or racial abuse that month (2022). A BBC news article even shows how some pharmacists have to carry a rape alarm and dye spraydue to how unsafe they feel from threats (Hayward, C, 2022). The stress and anxiety pharmacists face, and how unsafe they may feel at work have shown to have dire effects for not only the healthcare professionals, but for pharmacies and their customers, too. It can affect the quality of care a pharmacist may be able to provide and can also lead to staff shortages since the PDA concluded that 77% of pharmacists were thinking of changing careers or employment status due to the amount of pressure and mental health issues they face (2023). This would evidently cause many issues with the availability of care for the community. Despite many measures in place to limit dangerous encounters, one being the chief executive of the GPhC making it known that “any abuse of pharmacy staff is completely unacceptable and robust action should be quickly taken in response to any incidents, including by law enforcement” (Duncan Rudkin,2021), these encounters still happen. Most people assume it is a result of substance abusers using pharmacies in the hopes of gaining medicines illegally with prescriptions, yet many other factors come into play. For example, 111 pharmaceutical products are facing supply problems (BMJ 2023;383:p2602), and patients are being told that their medicines aren’t in stock. Difficulties in getting medicines can bring about frustration in customers which can be displaced onto community pharmacists, and staff can be blamed for these shortages. Additionally, waiting time in pharmacies is often long, and patients who have found it hard to access the GP and make an appointment may be further annoyed at the business in community and hospital pharmacies. Even though the pharmacist is not at fault here, customers may feel as though it is, and this can lead to verbal and even physical abuse towards the people behind the counter. The increasing frequency of these disruptions to patient and staff care has led to the creation of the PDA- the Pharmacist’s Defence Association and their copious amounts of resources. For customers, there are posters being displayed in pharmacies that remind them of the zero-tolerance policies towards abuse and violence, and for pharmacists, the PDA has made a “Safer Pharmacies Charter” that outlines how a pharmacist can prioritise their mental health. For example, getting adequate rest, raising concerns and ensuring physical safety are all things a pharmacist can do to feel safer at work . Pharmacies are also taking into account how these events can affect their staff, and are implementing training and therapy. A recent example is a pharmacy in Redditch that started counselling staff after an incident occurred involving a staff member being threatened with a knife (BBC, 2022). Some extreme measures are also being put into practice when appropriate, and pharmacies are asking staff to wear body cameras and installing panic buttons that are linked to police stations. (Isabel Shaw, 2021). Pharmacists are trained to always prioritise patient care, yet many do not realise that in order to optimise the quality of their care, they must feel safe and protected at all times. As pharmacists, self-care should be a major part of your lifestyle, and reaching out for help and resources is always a good idea. As customers, we should always be respectful, considerate, and appreciate that pharmacists are making supreme efforts to provide us with the best of care. References: BBC (2022) Redditch-based pharmacy chain gets counselling for staff over abuse. Available from: Redditch-based pharmacy chain gets counselling for staff over abuse - BBC News Accessed [23/01/24] BMJ (2023;383:p2602) Record number of drugs hit by supply problems, trade body warns. Available from: Record number of drugs hit by supply problems, trade body warns | The BMJ Accessed [23/01/24] Crimestoppers (n.d) Stopping violence in pharmacies. Available from: Stopping violence in pharmacies | Crimestoppers Accessed [23/01/24] GPhC (2021) Abuse or violence against pharmacy staff ‘completely unacceptable. Available from: Abuse or violence against pharmacy staff ‘completely unacceptable’ | General Pharmaceutical Council Accessed [23/01/24] Hayward, C (2022) Community pharmacists speak out against rise in abuse and attacks. BBC, 8 June. Available from: Community pharmacists speak out against rise in abuse and attacks - BBC News Accessed [23/01/24] PDA (2022) PDA highlights ongoing concerns about increasing levels of violence and abuse in community pharmacy. Available from: PDA highlights ongoing concerns about increasing levels of violence and abuse in community pharmacy | The Pharmacists' Defence Association [Accessed 23/01/24] PDA (2022) PDA launches violence and abuse in community pharmacy workplace survey. Available from PDA launches violence and abuse in community pharmacy workplace survey | The Pharmacists' Defence Association Accessed [23/01/24] PDA (2023) Pharmacists echo poor working conditions faced in NHS hospitals. Available from: Pharmacists echo poor working conditions faced in NHS hospitals Accessed [23/01/24] Shaw, I (2021) Pharmacists to start wearing body cameras for protection against patient abuse. The Pharmacist, 3rd December. Available from: Pharmacists to start wearing body cameras for protection against patient abuse Accessed [23/01/24] Written By: Zainab Siddique  Figure [1]
Sepsis is a severe medical condition where the body's immune system becomes overly active, leading to potential life-threatening complications such as shock, organ failure, and death. It can affect individuals across age groups and health statuses, although it is more prevalent in very young children, older adults, and those with pre-existing health conditions. The reasons for the development of sepsis in response to common infections remain unclear, making early recognition and prompt treatment crucial for preventing severe consequences. This essay delves into the pharmaceutical perspective on sepsis in the context of the UK, navigating the role of pharmacy in septic early diagnosis and exploring challenges and innovations in treatment. Within the UK, sepsis poses a significant challenge to the NHS, demanding timely and effective interventions. The unique aspects of the UK healthcare system, including the centralised NHS structure, accentuate the importance of early detection and swift intervention to improve patient outcomes. In particular, monitoring vital signs in a pharmacy allows pharmacists to contribute to the early diagnosis of sepsis. Hence, pharmacists can play a proactive role in identifying potential sepsis cases and promptly referring patients for further medical evaluation by closely observing these crucial physiological parameters. [2] The effective treatment of sepsis is hindered by the rise of antimicrobial resistance (AMR). AMR occurs when specific strains of bacteria, viruses, fungi, or parasites adapt to evade the effects of antimicrobials, including antibiotics, antivirals, antifungals, and antiparasitics designed to combat them. As more pathogens become resistant to these drugs used for infections, the risk of sepsis increases. This poses a significant challenge in the UK healthcare system, leading pharmaceutical research to explore innovative antibiotics. Collaborative initiatives with the NHS focus on implementing antimicrobial stewardship programs. The successful management of sepsis is intricately linked to the critical battle against antimicrobial resistance. [3] While previous sepsis drug candidates failed in clinical efficacy, recent advancements in understanding sepsis pathways have led to the development of promising drugs. Rather than a singular sepsis profile, various phenotypes have been identified, allowing for targeted drug development. New candidates focus on Pathogen-Associated Molecular Patterns, the Coagulation System, the Endothelium, End-Organ Damage, and Host Immune Response. These drugs, tested in randomised controlled trials, aim to reduce organ dysfunction and improve patient outcomes. The evolving understanding of sepsis phenotypes, biomarkers, and intervention timing suggests a more personalised and effective approach, similar to current cancer therapies, may emerge in the near future. [4] In summary, sepsis poses a formidable challenge in the UK's healthcare system, requiring a collaborative effort from healthcare professionals and pharmaceutical research. Pharmacists play a crucial role in early sepsis diagnosis by monitoring vital signs. The escalating concern of antimicrobial resistance underscores the need for joint initiatives between pharmaceutical researchers and the NHS to develop innovative antibiotics. Recent breakthroughs in understanding sepsis phenotypes offer hope for more personalised treatment approaches, resembling strategies in cancer therapies. The ongoing collaboration between healthcare professionals and researchers is essential for advancing sepsis management and improving patient care. References 1. Comanche County Memorial Hospital Community (2023) ‘Sepsis: A Silent Killer’ in Community Health [Online]. Available at: https://www.ccmhhealth.com/sepsis-a-silent-killer/ (Accessed on 8 January 2024) 2. United Kingdom Sepsis Trust (2022) ‘Yellow Manual 6th Edition’ in The UK Sepsis Trust [Online]. Available at: https://sepsistrust.org/wp-content/uploads/2022/06/Yellow-Manual-6th-Edition.pdf (Accessed on 8 January 2024) 3. Sepsis Alliance (2022) ‘POWER the AMRevolution’ in Antimicrobial Resistance [Online]. Available at: https://www.sepsis.org/power-the-amrevolution/ (Accessed on 8 January 2024) 4. Vignon, P., Laterre, PF., Daix, T. et al. (2020) ‘New Agents in Development for Sepsis: Any Reason for Hope?’ in Drugs 80 [Online]. Available at: https://doi.org/10.1007/s40265-020-01402-z (Accessed on 8 January 2024) Written by: Dasom Lee Ethical considerations often form the backbone of pharmacists' responsibilities, and pharmacy professionals have to find the delicate balance between dispensing medications and upholding patient autonomy. In the field of pharmacy practice, ethical considerations are the foundation on which pharmacists build their responsibilities. This blog focuses on major ethical dilemmas faced by pharmacy professionals in the UK, highlighting practical scenarios and potential solutions.
One of the most frequent ethical dilemmas that pharmacists face is encountering patients who deviate from prescribed instructions. The balance between persuading patients to adhere and respecting their autonomy is significant, especially when noncompliance risks significant side effects. With over 50% of patients facing this issue, pharmacy professionals navigate the fine line between advocacy and patient preference. Also, challenges arise when patients request quantities exceeding prescribed limits, whether due to severe pain or special circumstances. While accommodating such requests may be tempting, strict legal limits exist. Making a rational decision while empathising with genuine pain and regulatory adherence is pivotal. Exceeding medication limits could result in severe consequences, including licence loss. Maintaining impartiality is essential for pharmacy professionals as well. Guarding against personal biases ensures consistent interactions with patients. Refusing to dispense prescriptions based on personal beliefs, such as refusing to dispense prescribed birth control from a qualified prescriber, is unethical. A neutral stance is paramount, acknowledging the significant role pharmacy professionals play in ensuring unbiased care for every patient regardless of their religion, age, gender, race, and other personal attributes. This study, conducted in Kerman in 2018, is worth paying attention to. This investigation aimed to identify the challenges of ethical behaviors in the drug supply domain within pharmacies using a principles-based approach. The research focused on the ethical principles of autonomy, beneficence, non-maleficence, and justice, guided by the "Beauchamp and Childress Ethics" theory. The qualitative data analysis included interviews with pharmacy technicians, patients, pharmacists, insurance company inspectors, and other professionals in the pharmaceutical industry. The findings, derived from the analysis of data gathered through interviews, revealed eight main categories and 26 subcategories of ethical challenges in the drug supply at pharmacies. The primary categories included patient privacy, patient independence, communication principles, patient-centered services, drug suppliers, patient harm avoidance, supervision, and distributive, procedural, and interactional justice. Notable subcategories encompassed increasing patient awareness, culturizing prescription, rational drug use, confidentiality, and privacy. In conclusion, the study highlighted that the most significant challenges in ethical behaviors in the pharmacy domain were related to the principles of autonomy and beneficence. The implications of these findings suggest a need for healthcare to emphasize patient independence, privacy, and patient-centered services. The study's results can serve as a valuable resource for policymakers as well, aiding in the development of educational content, the establishment of professional ethics charts in pharmacies, and the implementation of accreditation measures to address these ethical challenges effectively. Pharmacy ethics in the UK are a powerful force shaping healthcare delivery. Pharmacists, armed with knowledge, compassion, and ethical commitment, navigate complex responsibilities to ensure each prescription reflects a dedication to patient care. Reflecting on these ethical considerations underscores the indispensable role pharmacists play in upholding the moral integrity of healthcare, where the pursuit of well-being is guided by principles grounded in compassion and professional responsibility. References: Iranmanesh, M., Yazdi-Feyzabadi, V. & Mehrolhassani, M.H. The challenges of ethical behaviors for drug supply in pharmacies in Iran by a principle-based approach. BMC Med Ethics 21, 84 (2020). https://doi.org/10.1186/s12910-020-00531-0 Written by: Seungeun Cho  Figure 1 [3] Geriatric bloodwork analysis stands as a fundamental component within the realm of pharmaceutical practice, especially when considering the various ailments that can happen concurrently in the elderly. During Term 1 that has just passed, I had the privilege of attending a hospital placement experience within the Care of Older People (COOP; or geriatrics) team at an NHS trust located in North London as part of a module coursework assignment. This experience offered invaluable insight into the critical role that pharmacists play in healthcare, especially in the senior population. Throughout this experience, I got to live life as a hospital pharmacist (albeit only for 2 weeks); screening prescriptions, looking for drug interactions, and establishing drug histories for newly admitted patients as part of the medicines reconciliation process. However, it is through performing these seemingly routine tasks where I was able to dive into the mindset of a hospital pharmacist, who places their patients’ healthcare as their priority. It is also during this placement that I recognised the importance of being detail-oriented, as minor alterations in blood tests can signal substantial underlying issues which demand a pharmacist’s meticulous attention. Unlike other specializations, COOP underscores the significance of polypharmacy, as many patients often have various ailments that require medical intervention simultaneously. For instance, an elderly patient with cancer may also have hypertension, hence it is not alarming to see cyclophosphamide on their drug chart with amlodipine right beneath it. Therefore, as a pharmacist, it is our job to ensure that all the drugs on the patient’s drug chart are safe, ie:
However, without providing any additional context, one might assume that a pharmacist would just sit at a patient’s bedside 24/7, eyes peeled and stuck onto the patient - because surely, that’s what monitoring means, right? Well, this is where the essence of this entry comes into play. Blood tests, or referred to bloodwork hereinafter, are essentially how pharmacists glue their eyes on their patient to pick up on any abnormalities, or signs that they need to stop or start a certain medication. Comprehending geriatric blood investigations involves the meticulous consideration of many biological markers, including haemoglobin count (Hb), red and white blood cell counts, platelet levels, coagulation factors such as INR, inflammatory markers such as CRP levels, as well as electrolyte concentrations such as sodium, potassium, and bicarbonate; to name a few. However, with that being said, the true challenge lies not merely in identifying these components, but rather the interpretation of their implications within the broader context of pharmaceutical care. This understanding of the bloodwork components must also come with fingertip clinical knowledge that is expected from the pharmacist, in order to produce the most effective patient care strategy. For example, a 79-year-old patient admitted for a chest infection, has been taking frusemide for the past 12 years, is said to have acute kidney injury (AKI). By looking at the patient’s bloodwork, their serum creatinine levels to be exact, will we be able to obtain a value to perform their creatinine clearance calculation, which is indicative of kidney function. Therefore, with this in mind, we will be determining if frusemide, the loop diuretic, is useful for them. Knowing that frusemide is cleared renally [2], the drug poses more harm for the patient than good, as processing the drug would burden the patient’s kidneys further and worsen their AKI. Therefore, this discussion can be brought up to the other healthcare professionals looking after the patient, to decide if frusemide can be temporarily taken off their drug chart until their creatinine clearance improves. Other than that, medications used for the patient’s presenting complaint (chest infection), should also be screened by the pharmacist to ensure that the patient will get treatment from their presenting complaint, whilst not worsening any of their already existing ailments. Therefore, by honing our skills in understanding and analysing these investigations, coupled with the clinical knowledge that the school is bequeathing to us, we equip ourselves with the tools necessary to provide informed and empathetic care to our senior patients. As we decode these results, it is imperative that we, as pharmacists, keep in mind that these aren’t just figures on a screen. These are our patients’ stories, and their cries for help. Every decision that we make has the potential to change not only our patients’ lives, but the lives of those they love as well. Let’s keep decoding and making a difference in geriatric care - one blood report at a time. References: 1. MedicinesComplete — BNF | Hyoscine Butylbromide | Contraindications [Internet]. www.medicinescomplete.com. 2023 [cited 2023 Dec 25]. Available from: https://www.medicinescomplete.com/#/content/bnf/_881463863?hspl=hyoscine%20butylbromide#content%2Fbnf%2F_881463863%23pot-contraindications 2. DrugBank Online. Furosemide [Internet]. go.drugbank.com. 2023 [cited 2023 Dec 25]. Available from: https://go.drugbank.com/drugs/DB00695 3. Sabah D. 10 tips for a healthy old age [Internet]. Daily Sabah. 2019 [cited 2023 Dec 31]. Available from: https://www.dailysabah.com/health/2019/04/22/10-tips-for-a-healthy-old-age Written by: Olivia Ho  Pharmacogenomics, a fusion of pharmacy and genomics, is revolutionizing healthcare by leveraging genetic information to tailor medication treatments to individuals. This field is a cornerstone of personalized medicine, an approach that considers unique genetic, environmental, and lifestyle factors in disease treatment and prevention. As the medical world increasingly recognizes that 'one-size-fits-all' doesn't apply to medication efficacy and safety, pharmacogenomics is gaining unprecedented importance.
Pharmacogenomics lies in understanding how genetic variances affect drug metabolism and efficacy. Individuals metabolize drugs differently, primarily due to genetic differences in enzymes responsible for drug metabolism. These variations can significantly impact the effectiveness and safety of medications, leading to varying therapeutic outcomes among patients. A striking example is the CYP2D6 gene, which plays a vital role in metabolizing antidepressants. Variations in this gene can lead to drastically different responses to the same medication. For instance, some individuals with certain CYP2D6 variations may metabolize drugs too quickly, reducing drug efficacy, while others may metabolize too slowly, increasing the risk of side effects. Healthcare providers now increasingly rely on pharmacogenomic testing to guide medication selection and dosage. This testing identifies specific genetic markers that predict how a patient will respond to a drug. With this knowledge, providers can tailor treatment plans, avoiding ineffective medications and reducing the risk of adverse drug reactions. Despite its potential, pharmacogenomics faces challenges, particularly regarding ethical considerations. Issues such as genetic data privacy, potential discrimination based on genetic information, and accessibility of pharmacogenomic testing are critical concerns that need addressing to ensure equitable and ethical implementation. For patients, understanding their pharmacogenomic profile can be immensely beneficial. It empowers them with knowledge about how their body might react to certain medications, allowing for more informed healthcare decisions and potentially leading to better treatment outcomes. The future of pharmacogenomics holds promise for more targeted drug development. As our understanding of genetic influences on drug response deepens, we can expect the emergence of new medications designed for individuals with specific genetic profiles, heralding a new era of truly personalized medicine. Pharmacogenomics is not just a scientific advancement; it's a paradigm shift in healthcare. By aligning genetic insights with clinical practice, it paves the way for more effective, safer, and personalized treatments. Its integration into mainstream medicine, despite challenges, signifies a significant step towards a future where healthcare is tailored to each individual's genetic blueprint. References : Roden, D.M. and Tyndale, R.F., 2013. Pharmacogenomics. The Lancet, 362(9390), pp.1619-1628. Weinshilboum, R. and Wang, L., 2014. Pharmacogenomics: Precision medicine and drug response. Mayo Clinic Proceedings, 89(5), pp.609-621. Johnson, J.A., 2013. Pharmacogenetics in clinical practice: How far have we come and where are we going? Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 33(6), pp.612-625. Written by Cecilia Perdikidi |
