In primary care, clinical pharmacologists may be directly involved with patient care through community-based medicines use reviews and the provision of hypertension or vascular risk clinics. The reduction of hospital admissions, by moving the care of people with (and at risk of developing) long-term conditions into the community, is an increasing priority for both patients and the NHS and the role of clinical pharmacologists will become more important in future. Given the increasing burden of polypharmacy in patients, clinical pharmacologists can also contribute to the important area of deprescribing.
In hospitals, CPT consultants undertake a variety of roles in addition to delivering clinical pharmacology and general internal medicine care for inpatients. The Future Hospital Commission highlighted the need for a greater proportion of doctors to be deployed in general medicine. Although clinical pharmacologists are specialists in relation to prescribing (and may have subspecialty interests, for example in toxicology or stroke medicine), most are dual-accredited in CPT and general medicine so have a general approach to diagnosis and management making them a key part of the ‘generalist’ workforce. Clinical pharmacologists provide specialist support for a range of clinics and conditions including:
- adverse drug reactions
- cardiovascular risk management
- clinical toxicology
- respiratory medicine
- renal medicine
- stroke medicine
- obstetric medicine
- paediatric medicine.
There is a pressing strategic need to use NHS resources wisely. At the national level, CPT consultants make a crucial contribution to activities which enable the achievement of local NHS services and standards, particularly in terms of patient safety and clinical effectiveness. CPT consultants are actively involved in medicines safety, advising the Medicines and Healthcare products Regulatory Agency (MHRA) on licensing issues and post-marketing surveillance for adverse drug reactions. They are also involved in assessing the clinical and cost effectiveness of medicines through the National Institute for Health and Care Excellence (NICE), the All Wales Medicines Strategy Group (AWMSG) and the Scottish Medicines Consortium (SMC). CPT consultants also play a leading role on committees overseeing the publication of the British National Formulary (BNF) and the BNF for children.
Nationally, CPT consultants lead the National Poisons Information Service (NPIS), which provides advice and on-call support to all healthcare professionals. Poison centres support patient care and contribute to the cost-effective use of NHS resources by, for example, preventing avoidable hospital admissions, reducing the number of unnecessary investigations and treatments, and facilitating shorter hospital stays.