2 November 2018
What drew you to be a pharmacist and is there a personal story that you have come across that illustrates exactly why AMR is so important?
I went to a comprehensive school in Dagenham, Essex in England. I enjoyed my school days but there was no careers advice. It was also quite challenging in that the sixth form was very small and it was quite rare for anybody to go to university. For the last year of my physics A level we didn’t have a teacher so taught ourselves! After various jobs I ended up working in Guy’s Hospital’s pharmacy in London as a pharmacy assistant in the manufacturing department, and then went from there to be a laboratory technician at the School of Pharmacy in London, now part of University College London.
Eventually, after several discussions with the Professor of Pharmaceutical Chemistry, Willie Gibbons, I decided pharmacy was for me, and started the university degree in 1987. I was 22. I worked hard and did well, and then did my pre-registration year in what was The General Hospital in Birmingham. I enjoyed seeing and helping patients, and working in a team, and eventually worked as a basic grade, and then a staff pharmacist, for clinical services at the Whittington Hospital in North London. I was very lucky and came under the wing of John Farrell (who oversaw the Royal Free and Whittington Hospital pharmacy services) and Judy Cope (who was chief pharmacist at the Whittington, and until recently Chief Pharmacist at Great Ormond Street) who sponsored me not only to do an MSc in Clinical Pharmacy at Northwick Park, London, but then also a pharmacy practice PhD, registered at the University of Manchester.
I first started to think about antimicrobial resistance (AMR) when as a pharmacy student I managed to isolate some resistant plasmid DNA from bacteria. I read a lot about the subject and when eventually I was a clinical pharmacist in a hospital I saw some patients where the first choice of antibiotic failed due to resistance, and the consequences of that. Whilst I have now been involved with AMR policy for many years, it was when Dame Sally Davies, the Chief Medical Officer for England, asked me to help write her annual report on infection for 2011, and specifically the chapter on AMR, that things started to change. She listened to what we had to say and since then she has shown outstanding global leadership in raising awareness of this very important issue.
What are the three most pressing issues we need to tackle to further AMS and the attention provided to it?
In the UK, variation in antimicrobial stewardship (AMS) practice is a particularly pressing issue. This manifests in a number of ways, but includes differences between areas in the extent to which new national guidance is fully implemented, as well as in the adoption and use of clinical decision support tools. We need to ensure that AMS remains high on the agenda across the national medicines optimisation system, including at regional levels.
Ensuring that current antibiotics are prescribed appropriately, and maintaining the progress recently seen on this front, will be critical to these medicines remaining as effective as possible for as long as possible. This includes following best practice examples already evidenced nationally or internationally, particularly in relation to timely review – and if necessary withdrawal – of clinically unnecessary antibiotics in hospitals. Supporting AMS in low- and middle-income countries, in particular, and monitoring antimicrobial use globally are also important for maintaining national health security.
We lastly need, again in conjunction with international partners, to continue to advocate for the improved application of data – particularly surveillance data – as a way of promoting more rational and clinically sound use of antimicrobials.
What are the main challenges that affect the pharmaceutical profession and what impact do you think the scheme may have on this?
In some ways, the challenges are the same for all healthcare professions in England. The economics and affordability of modern healthcare, the dramatic changes in science (e.g. genomics) and technology, and of course changing demographics, and the demands of the public in an ever more transparent society. But right now the biggest challenge for pharmacy in England is to embrace the opportunities of the demand for clinical pharmacy, whilst modernising the structures and processes that will be needed to make the most of that opportunity within the changing structures of the NHS. This will take a whole new level of leadership at every level of the profession.
We are already making great strides in the deployment of clinical pharmacy into NHS primary care but the next stage is two-fold. First we need create a structure and quality assurance process that not only ensures long term sustainability of clinical pharmacy careers in primary care but also underpins pharmacy practice across all sectors, as pharmacy becomes even more clinical. Secondly, we need to create an integrated approach to pharmacy practice across all sectors, including community pharmacy.
I think the scheme is another key element in the development of clinical pharmacy practice both in the UK and worldwide for the benefit of patients – it’s about deploying our talent and resources to improve antimicrobial stewardship and patient care.
Why is this latest programme so significant for AMS?
The CWPAMS scheme will enable multidisciplinary teams to make a positive, practical difference to AMS practice on the ground in low- and middle-income countries, whilst providing key benefits back to the NHS. Acting as a strong global partner is a critical component of the UK’s refreshed national strategy for antimicrobial resistance, especially since resistant infections now travel increasingly easily and internationally.
What do you hope will be the main achievement of the scheme?
Improving patient care and AMS, and ultimately saving lives here in the UK, as well as the valuable cultural interchange and learning that will take place. These are challenging times and I know pharmacy professionals can do so much more to improve the quality of care of patients with medicines.