The patient population
As the population ages (with older people consuming more medicines per capita) and medicines increase in cost and sophistication, the need for novel models of care in the NHS is becoming increasingly clear. Clinical pharmacology can play a vital role in this. Clinical pharmacologists employed in the NHS and universities usually combine their specialty work with responsibilities as a general physician. This involves:
- supervision of acute medical admissions
- managing medical inpatients
- running outpatient clinics including specialty clinics, eg:
- cardiovascular risk
- adverse drug reactions
- clinical toxicology.
The mission of the specialty is to improve the care of patients by promoting the safe and effective use of medicines and to evaluate and introduce new therapies. Therefore, clinical pharmacologists often make wider contributions to the NHS clinical service. At a local level, this usually involves:
- leading a drug and therapeutics committee
- advising on prescribing policy
- developing and maintaining a drug formulary
- assessing new products
- creating prescribing guidelines
- reviewing adverse medication incidents
- promoting evidence-based therapeutics
- leading and participating in research ethics committees.
At a national level, consultants in clinical pharmacology and therapeutics occupy many positions in key bodies, such as:
- National Institute for Health and Care Excellence (NICE)
- Medicines and Healthcare products Regulatory Agency (MHRA)
- Commission on Human Medicines (CHM)
- British National Formulary (BNF) and the BNF for Children (BNFC) joint formulary committees
- Adverse drug reaction regional monitoring centres
- National Poisons Information Service (NPIS)
Clinical pharmacologists are also involved in research, both basic and clinical. They participate in study design, conduct, and the dissemination of improved knowledge, leading to better clinical practice. They are involved in peer review of academic papers, editorial boards of academic journals and leadership of learned societies.
Prevention of disease
Clinical pharmacologists play several roles in protecting and promoting public health. They play a vital part in the development of new medicines, and they contribute to expert governmental scientific advisory and regulatory committees. For example, clinical pharmacologists sit on the Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment, which undertakes widespread toxicological risk assessments that are directly relevant to the long-term health of the nation, and the Veterinary Products Committee and Commission on Human Medicines, which assess the safety, quality and efficacy of new medicines, considering aspects of human exposure to medicines, including those preventing or postponing illness.
Clinical pharmacologists are involved in the post-marketing surveillance of medicines, helping to ensure that safety signals are detected and acted upon appropriately, for example by the withdrawal of a medicine, to the benefit of the population. The National Poisons Information Service, led by clinical pharmacologists, detected a new pattern of harm from liquid detergent capsules, which was followed by changes to packaging legislation throughout Europe, aiming to reduce accidental exposure.
Clinical pharmacologists promote the safe and effective use of medicines, including those that have preventative roles. This may occur locally through, for example, cardiovascular risk management clinics, or nationally through the development of new medicines and guidelines. Contributions to assessments of the clinical effectiveness and cost-effectiveness of medicines ensure that the NHS gets value for money, both in treating illness and in maintaining health.
Planning effective services
Clinical pharmacology is an exciting specialty that is perfectly positioned to support the NHS to respond to the changing nature of drug development and drug use, and support the NHS to meet the strategic challenges of the 21st century. Clinical pharmacology and therapeutics (CPT) is the only medical specialty focusing on the safe, effective and economic use of medicines. It is a diverse and wide-ranging discipline that plays an essential role across multiple areas of the NHS, contributing to its organisational objectives and, most importantly, improving patient outcomes and experiences.
In 2014, according to the RCP census, there were 74 CPT consultants. Given ongoing recommendations from the Royal College of Physicians to provide 1 WTE (whole-time equivalent) per district general hospital serving a population of 250,000, approximately 440 WTEs are desirable and the current workforce is under significant pressure as a result. To meet current and future demands, there is a need for a substantial increase in both the number of training and consultant posts. A minimum expansion of 10% per annum would be required to increase WTEs to 150 by 2025.
The expected significant increase in demand on the clinical pharmacology workforce in the coming years is driven by a number of factors, including:
- the increasing need to contain the medicines budget by assessing the clinical effectiveness and cost-effectiveness of new and expensive drugs
- the rising number of acute general medical admissions
- the growing number of medical students and the associated increase in teaching and training responsibilities for consultants
- the reduction in junior doctors’ working hours and associated increase in the consultant workload
- the limited availability of clinicians running specialty services to provide acute medical cover
- the ageing population and an increasing prevalence of complex long-term conditions and comorbidities are also expected to increase the demand on services across the NHS as a whole.
This increase in the number of clinical pharmacologists could be achieved by organisations responsible for workforce management in the four UK nations doing the following:
- ensuring that NHS organisations across the UK have equitable access to CPT consultants’ expertise
- committing to increasing the size of the CPT consultant workforce to 150 WTEs by 2025, accompanied by an increase in the number of specialist registrar training posts
- developing a joint strategy to achieve this increase, including the provision of enhanced undergraduate and postgraduate education and training
- providing a clear career route for clinical pharmacologists with associated career support and development.