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The Top 10

What has been happening in the world of pharmacy? Here’s our pick of must-read news from the past month…

Pharmacy student numbers will not be controlled


The decision not to cap pharmacy student numbers is in line with wider government policy

1. Reduce antibiotic use to 2010 levels

The NHS must commit to national targets to use fewer antibiotics, according to a coalition of five health professional bodies in the UK.

The leadership organisations for pharmacists, GPs, hospital doctors and nurses are jointly calling for the NHS to set annual goals to reduce antibiotic use to 2010 levels.

The NHS now uses at least 6% more antibiotics than in 2010, with overuse being linked to a rise in microbial resistance to commonly used medicines.

The coalition includes the Royal Pharmaceutical Society (RPS), the Royal College of General Practitioners (RCGP), the Royal College of Nursing (RCN), the Royal College of Physicians (RCP) and the Faculty of Public Health. They are working in collaboration with Public Health England and the Department of Health.

At a summit at the RPS in London on 6 November 2014, the coalition called for reductions in antibiotic use of around 1% each year, with progress measured against national targets agreed with government.

2. Pharmacy student numbers will not be controlled

Pharmacy student numbers will not be capped, says Health Education England (HEE) in response to a consultation on pharmacy education and training reforms.

Introduction of an intake control was the favoured option by most respondents to the consultation, but HEE went against this. “In light of the wider higher education policy on student intake controls announced in the 2013 Autumn Statement a student intake control for MPharm students will not be introduced,” it said.

HEE is working with the Department of Health on the options for introducing a five-year degree with integrated work placements. This would replace the current four-year degree plus pre-registration work placement year. The work placements are partially funded by the government, so will still require NHS planning.

In 2013, HEE together with Higher Education Funding Council of England (HEFCE) suggested three options for tackling the predicted oversupply of pharmacists: allow the free market to continue, control student numbers or create a break point into the degree.

3. Review highlights failings in Welsh hospitals

Unannounced inspections of facilities providing hospital care for elderly patients in Wales have revealed serious shortfalls in medicines management.

Spot visits were organised in response to the ‘Trusted to care’ report published in May 2014, which was critical of older people’s care at two hospitals in Wales. The inspections revealed shortcomings in the vast majority of wards visited. The problems were mainly related to storage and inspectors said the issues had the potential to compromise patient safety.

Steps are being taken to address the concerns, and a working group with pharmacist input has been set up by the Welsh government to develop solutions.

4. NHS could save nearly £2bn through waste reduction

Around £2bn of savings could be made in the NHS through reducing waste and improving clinical practice, says a report by the Academy of Medical Royal Colleges.

‘A doctor’s guide to cutting waste in clinical care’, published on 6 November 2014, points out that around 20% of mainstream clinical practice brings no benefit to patients and that wasted prescribed medicines cost around £300m a year.

The report outlines a series of simple measures that could help create savings, which could then be reinvested to improve care and raise standards. For example, it describes generic prescribing as a “high-value intervention with little potential waste associated”.

5. Green light for olaparib in Europe

The European Medicines Agency’s Committee for Medicinal Products for Human Use (CHMP) has recommended that Lynparza (olaparib) 50mg hard capsules be granted a marketing authorisation. The drug will be licensed for use in patients with epithelial ovarian, fallopian tube or primary peritoneal cancer and a mutation in one of two BRCA genes, who had relapsed but previously responded to platinum-based chemotherapy.

Lynparza (AstraZeneca) is the first of a new class of medicines that blocks the action of poly (ADP-ribose) polymerase (PARP) proteins and the first treatment to target forms of ovarian cancer carrying a BRCA mutation.

PARP proteins help to repair damaged DNA. DNA can also be repaired by a process known as homologous recombination repair (HRR), but this requires functional BRCA1 and BRCA2 genes. Lynparza works by blocking the PARP proteins so damaged DNA in a tumour cell cannot be repaired. The tumour cell dies, hopefully reducing tumour size or slowing tumour growth.

6. Medicines care plans proposed in Wales

An electronic ‘pharmaceutical care plan’ detailing a patient’s drug history and specific medication needs should be introduced to improve the integration of care, according to a report on the future of pharmacy in Wales.

The care plans would link to existing patient records and track the pharmaceutical aspects of patients’ treatment as they travel through various health and social care systems.

Pharmacists would create the care plans with patients and agree treatment goals. Named pharmacies would be responsible for maintaining the plans, which would be accessible to clinicians across the NHS.

The proposal is one of a series of ambitions detailed in a report by the Welsh Pharmaceutical Committee, which advises the Welsh Government. The report was supported by the Royal Pharmaceutical Society (RPS) with contributions from leaders from all sectors of the profession.

The report, ‘Your Care, Your Medicines: Pharmacy at the heart of patient-centred care’, was launched on 15 October 2014, ahead of the 4th Annual Wales Medicines Safety Conference in Cardiff.

7. Penicillin allergy rates may be overestimated

Many people who have not undergone penicillin skin testing falsely believe they are allergic to the antibiotic when they are not, according to research presented at the American College of Allergy, Asthma and Immunology Annual Scientific Meeting on 9 November 2014.

All patients attending the Mayo Clinic’s pre-operative clinic in Florida between August 2012 and August 2013 who said they had a penicillin allergy were given a skin test. Of the 384 patients tested, 94% received a negative result.

The researchers say that alternative antibiotics, which prescribers must substitute for penicillin if a patient reports an allergy, may be more toxic, more expensive and less effective.

8. Stronger warning on Iclusig blood clot risk

Warnings about the risks of developing a blood clot with Iclusig (ponatinib), a leukaemia treatment, are to be made more robust, following a European Medicines Agency (EMA) review.

The EMA says that any risks are likely to be linked to dosage but it does not have enough information to recommend that the existing starting dose should change. The agency will conduct a study to help clarify whether lowering the dose would also reduce the associated risks.

The regulator has advised doctors to stop prescribing Iclusig after three months if a complete haematological response has not occurred. Patients should also be monitored for heart problems.

9. Opportunities from five-year NHS plan

Opportunities for pharmacy to integrate with other services and to have an impact on patient care are contained within the five-year NHS plan unveiled by NHS England’s chief executive Simon Stevens on 23 October 2014.

‘Five year forward view’ outlines a vision for overhauling NHS service provision, to make it more patient-focused and efficient. The document highlights a need to make 2–3% gains each year to combat a £30bn funding deficit projected for 2020–2021.

Published by Monitor, Health Education England, the NHS Trust Development Authority, Public Health England, the Care Quality Commission and NHS England, the document emphasises chances to improve the prevention of ill health by breaking down traditional barriers between services and sets out proposed models of care.

One option proposed is the establishment of multi-speciality community providers, where GPs, nurses, hospital consultants, and other providers of community services, including pharmacists, create integrated care organisations which could become responsible for the provision of much outpatient care.

10. European regulator considers valproate risks

Regulators are considering tightening restrictions on the use of valproate in women because of the associated risks to children exposed to the drug in the womb, including the possibility of autism and attention deficit-hyperactivity disorder (ADHD).

A safety review found a 30–40% risk of pre-school children having developmental problems if their mother took the drug, which has been used in Europe to treat epilepsy and bipolar disorder since the 1960s. Valproate medicines are also authorised in some EU member states to prevent migraines.

The recommendations come from the European Medicines Agency (EMA) Pharmacovigilance Risk Assessment Committee (PRAC), which says valproate should not be prescribed to treat bipolar disorder or epilepsy in women or girls of childbearing age unless there is no alternative product, in which case the patient should have effective contraception. The drug should also never be prescribed for preventing migraine in pregnancy.

The recommendations now go to the EMA’s Co-ordination Group for Mutual Recognition and Decentralised Procedures — Human (CMDh) for a final decision. 

Citation: Clinical Pharmacist DOI: 10.1211/CP.2014.20067111

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