Who or what factor inspired you to choose to study pharmacy?
I was keen on science at school, particularly chemistry and biology, and I had always been intrigued by the human body. I knew about pharmacy as a career as I lived in a small village and had visited the local community pharmacy and thought what the pharmacist was doing looked interesting.
I knew from about the age of 13 that I wanted to be a pharmacist and as I knew the pharmacist’s son from school I managed to get some work experience in the local pharmacy which I thought was very exciting. I applied to study at Heriot-Watt University and started my degree there aged 17. Following my pre-registration training in hospital/industry I went on to do a PhD in medicinal chemistry research and an MSc in clinical pharmacy, both at the University of Strathclyde.
If we met at a conference and were not allowed to speak about pharmacy or the weather what topic would you choose?
Either my children or running. I have two daughters whom I am very proud of, one is training to be a psychologist and the other a doctor. I am keen on running as a way to keep body and mind healthy, and although I am pretty slow I run regularly with a local club, take part in the weekly Parkrun 5K in Falkirk and do a few 10K races each year.
Your area of interest is antimicrobial resistance – what drew you towards this area?
I worked in hospital pharmacy for many years before taking up my current role and during my time at St John’s Hospital in Livingston I managed the Aseptic Dispensing and Clinical Pharmacy services. My clinical specialty was surgery and ICU, and antibiotics were a key pharmaceutical care issue, checking that the correct antibiotics were used, whether they should be stopped or switched to oral treatment.
In my aseptic role I was overseeing the dispensing of IV antibiotics so I was aware about antibiotic use across the whole hospital. As part of being the ICU pharmacist I participated in daily ward rounds along with a young clinically focused microbiologist which increased my knowledge of infection management.
I first became aware of the issue of antimicrobial resistance (AMR) in the early 2000s and after a period of a ‘cephalosporin revolution’ where this group of antibiotics were being used widely in hospitals, it became apparent that antibiotic use needed to be reviewed.
I was lucky to become one of the first antimicrobial pharmacists in Scotland with a post in Forth Valley funded via money provided to deliver The Right Medicine. Policy documents followed: Antimicrobial Prescribing Policy and Practice in Scotland: recommendations for good antimicrobial practice in Acute Hospitals in 2005; and the Scottish Management of Antimicrobial Resistance Action Plan in 2008, which provided the framework for the Scottish Antimicrobial Prescribing Group (SAPG) to lead a national stewardship programme.
I was appointed as professional project lead for SAPG in 2008 which is an antimicrobial pharmacist role, but at national level.
Can you put the AMR problem into perspective?
AMR is serious and requires action to avert a return to the dark ages when infections commonly killed and people died from surgical procedure infections. AMR has been described by the World Health Organisation as one of the top three threats to human health and has been the focus of two annual reports by Dame Sally Davies, the Chief Medical Officer in England.
A report by Sir Jim O’Neill, an economist, commissioned by the UK government looked at the financial implications and global mortality if AMR is not tackled and called on government and the pharmaceutical industry to work together to enable drug discovery and bring new antibiotics to market. The report highlights that “up to 50,000 lives are lost each year to antibiotic-resistant infections in Europe and the US alone. Globally, at least 700,000 die each year of drug resistance in illnesses such as bacterial infections, malaria, HIV/AIDS or tuberculosis.”
In the UK we are fortunate that drug resistant infections are still fairly uncommon but they are increasing and many people may be carrying drug resistant bacteria, usually acquired overseas, but be unaware if they are fit and healthy.
In southern Europe and parts of Asia many patients in hospitals have drug resistant infections, treatment options are limited and mortality rates are high. Overuse of antibiotics through poor prescribing practice or access to antibiotics without prescription are the main drivers for AMR but in developing countries poor sanitation is also an issue.
Can you tell us anything about current antimicrobial resistance projects you are involved in?
SAPG has for the last 9 years delivered a programme of work to address the current issues with antibiotic use in Scotland. This is largely through behaviour change and involves quality improvement initiatives informed by national surveillance data for antibiotic use and supported by education resources for healthcare staff, patients and the public.
Initially the focus was around reducing use of broad spectrum antibiotics associated with a high risk of Clostridium difficile infection, then moved on to unnecessary prescribing in primary care for self-limiting infections, and now the focus is on hospital prescribing.
Currently in primary care we are continuing to focus on reducing unnecessary prescribing through several initiatives: a national quality indicator with a target using a ‘best in class’ approach to stimulate improvement, supported by quarterly reports feeding back prescribing data directly to GP Practices benchmarked against the local and national average; and a facilitated education resource for primary care teams with sessions on AMR, respiratory tract infections and urinary tract infections.
We have several new projects in hospital practice focused on reversing the current upward trend of antibiotic use and ensuring appropriate use of key antibiotics for severe and resistant infections. These include developing an education resource to support clinicians in reviewing IV antibiotic therapy, clarifying patients’ penicillin allergy status, national guidance on antibiotics for severe infections and for fungal infections.
We also have our annual contribution to European Antibiotic Awareness Day (EAAD), now part of World Antibiotic Awareness Week, where we use posters and leaflets across all health and care settings to inform and educate staff, patients and the public about the threat of AMR and appropriate use of antibiotics.
How can the problem of antimicrobial resistance be resolved?
AMR will never be resolved as it is a natural evolutionary process but in the developed world the biggest contribution we can make is to use antibiotics more prudently to preserve their activity. This means not prescribing antibiotics for self-limiting infections and ensuring that when antibiotics are required that we get things right: choice, dose, frequency, route, duration. Behaviour change both of healthcare professionals and of the public is crucial to ensure all prescribing is appropriate but also to manage patient expectations of receiving antibiotics.
New antibiotics are also important and there are several now in the pipeline which will help deal with current resistance problems.
How can pharmacists help on a daily basis?
Pharmacist in all settings can be antibiotic stewards to protect antibiotics and can do this formally by making a personal pledge to be an Antibiotic Guardian.
When patients are prescribed an antibiotic pharmacists should check that the prescription follows the local antibiotic guideline. All health boards have guidelines for hospital and primary care and these are generally available on-line or via an app, so are accessible to pharmacists working in all settings. Make sure you are familiar with your relevant local guideline and query any prescriptions that don’t comply.
The biggest contribution that community pharmacists can make is in educating patients and the public about appropriate use of antibiotics and in providing advice on self-care for patients with upper respiratory tract and lower urinary tract infections.
Community pharmacies should be promoted as the first port of call for patients with these conditions and this can reduce unnecessary GP appointments. There are a variety of useful leaflets to support community pharmacy teams and SAPG has a specific leaflet for pharmacists, available on request as a pad of 50 leaflets, to provide personalised advice about respiratory tract infections.
What is your opinion on read/write access to patient records in the community pharmacy?
I think it is essential for community pharmacists to have read/write access to patient records to allow them to contribute effectively to patient care. Without access to full records of clinical details including laboratory results pharmacists cannot assure patient safety in use of medicines. A multi-professional team approach to patient care is essential in all settings.
How do feel the community sector fits alongside the drive to place pharmacists in the GP practice setting?
Although I have not worked in community pharmacy for many years I think that collaborative working with pharmacists in GP practices will be beneficial for patient care and will allow all pharmacists to become more clinically focused.
What is your top tip for newly qualified pharmacists?
Take time to try various branches of pharmacy to see what you enjoy most as the opportunities is all sectors are developing and expanding. Don’t become focused on specialising too soon as the profession needs more generalists at foundation and advanced levels. Keep learning and take advantage of opportunities for post-graduate study.
Do you think pharmacist independent prescribers are capable of managing caseloads of patients in the community pharmacy setting?
I think experienced independent prescribers who have been actively prescribing for some time could take on a caseload of stable patients who are known to them within a community. Working in collaboration with GPs and practice pharmacists it should be possible to identify such patients.
How can we work better with pharmacy technicians?
In hospital practice pharmacy technicians have expanded their roles considerably over the last 10–20 years to utilise their skills fully and take on tasks formerly done by junior pharmacists. This has benefited both pharmacists and technicians and ensured that all professionals are working to the top of their license. A similar approach in other settings would facilitate pharmacist in primary care and community settings taking on more clinically focused activities.
Are you a member of the Royal Pharmaceutical Society (RPS)?
I have been a member of RPS since I qualified as a pharmacist in 1985. In 2015 I became a Fellow of the RPS Faculty and I am now working with the RPS as a Faculty Assessor and also as a Faculty Champion supporting other pharmacists to develop their portfolios.
I am a member of the UK-wide RPS Antimicrobial Expert Group which provides a peer network and contributes expert advice for RPS responses to consultations. In addition I work closely with the Scottish branch of RPS to advise on any AMR related issues.
I am delighted to see the recent announcement that RPS is launching a new collaborative campaign at the RPS Conference in September to help achieve the necessary reduction in inappropriate prescribing of antibiotics.
What is your hope for the future of the profession?
I hope the profession will continue to develop to ensure that pharmacists are integral to clinical teams in all settings and utilise their skills fully to ensure safe, rational and effective use of medicines in all patients.