Women in early pharmacy

By Matthew Johnston, RPS Museum

“There is an impression that women are something new in pharmacy, but nothing could be further from the truth.”

These were Jean Kennedy Irvine’s words on her election as the first woman President of the Royal Pharmaceutical Society in 1947.

Medieval monasteries

In her speech, Jean also mentioned the early beginnings of community pharmacy in the medieval monasteries, where residents would grow medicinal plants to treat themselves and local people.

One of the oldest items on display in the RPS Museum is a stone mortar from a Spanish nunnery (AD 410-1500), used for preparing medicines. The Hanbury Collection of the RPS Library also contains a later copy of the ‘Physica’, a work by St Hildegard, Abbess of Bingen. Originally written in the 1100s, it outlines the medicinal properties of various drugs obtained from the natural world. Read more Women in early pharmacy

I am what I am! LGBT History Month

By Mike Beaman, FRPharmS, retired pharmacist

I am writing this blog in support of the Royal Pharmaceutical Society’s response to LGBT History Month.  Although not a gay activist I have, nevertheless, been generally open about my lifestyle since coming to terms with being a gay man back in the early 1970s.

I was born in 1947 so I was 19 and a university undergraduate when the legislation decriminalising homosexuality became law in 1967. I was already a young adult and therefore having an intimate relationship with another man before that time would have been a criminal act and would also have resulted in my being sent down from university and unable to eventually register as a pharmacist. Read more I am what I am! LGBT History Month

Polypharmacy – what is it and why is it important?

By Clare Howard, FFRPS FRPharmS, lead author of the RPS guidance Polypharmacy: getting our medicines right

What is polypharmacy?
We know that medicines have an enormous, positive impact on the lives of millions of people. But as more of us live longer, with multiple long-term conditions, we take more and more medicines. Taking many different medicines at once can become either a practical challenge or increase the likelihood of harm, or both.

Problems with polypharmacy happen when: 
• Medicines are prescribed that are no longer clinically indicated, appropriate or optimised for that person
• The harm of a particular medicine outweighs the benefit
• The combination of medicines being taken has the potential to, or is actually causing harm to the person
• Where the practicalities of using the medicines have become unmanageable or are causing harm or distress.  Read more Polypharmacy – what is it and why is it important?

Primary care networks: getting started

by Stephanie West, RPS Regional Liaison Pharmacist

One of the things that excites me as a Regional Liaison Pharmacist for RPS is seeing examples of how local primary care professionals are coming together to discuss good patient care, provided by the right practitioner, close to home. So it was fantastic to see clear recognition of the key roles pharmacists play  Read more Primary care networks: getting started

Biosimilars: a great opportunity for pharmacists in England

by Jonathan Campbell, RPS Regional Liaison Pharmacist

Biosimilars have huge benefits for patients and the NHS and offer opportunities for pharmacists too.

The NHS Long Term Plan sets out how “the NHS will move to a new service model in which patients get more options, better support, and properly joined-up care at the right time in the optimal care setting”.

These new models of integrated care will need organisations and their staff to work together across the traditional boundaries of community, general practice and hospital – adopting a system leadership approach to improving population health that puts the patient at its heart. Read more Biosimilars: a great opportunity for pharmacists in England

Making a difference to mental health patients

By Caroline Dada, Lead Pharmacist for Community Services, Gender Identity & Medication Safety Officer

Mental health treatment has been transformed in the last 20 years leading to a significant reduction in the number of inpatient beds. The treatment of mental health is unrecognisable from the asylums of old, thank goodness!

This transformation has led to a major shift in care provision, with many patients with mental health problems being seen by the GP with limited specialist input. GPs have raised concerns about this change, reporting a need for increased knowledge and competence and improved co-operation between primary and secondary care. Patients are also concerned, with 22% reporting they needed more specialist input1. Read more Making a difference to mental health patients

World AIDS Day 2018: When a friend has AIDS

by John Betts, RPS Museum, Keeper of the Museum Collections

The history of pharmacy is usually thought of in terms of drug development and its ability to transform patient’s lives. Rarely do museums have an object in their collection that communicates what it was like to live with a life-threatening illness before there were any effective treatments.

The RPS Museum has a leaflet published by GMHC (Gay Men’s Health Crisis) in 1984, at the beginning of the HIV/AIDS epidemic, which does just that.

When A Friend Has AIDS provides advice to the friends of people living with AIDS on how they can offer them support.

Written with a great deal of compassion, it gives a moving insight into what living with HIV/AIDS was like at this time, from both the patient’s and friend’s point of view. Reading it never fails to move me to tears. Read more World AIDS Day 2018: When a friend has AIDS

Edward Frank Harrison – a pharmacy war hero

by Matthew Johnston, RPS Museum

If asked to list influential figures in the history of the First World War, few would probably know the name of Edward Frank Harrison. But it was Harrison who was responsible for saving the lives of thousands of Allied soldiers thanks to his work to combat the threat of chemical warfare.

Born in 1869, Harrison began his career as an apprentice pharmacist in North London aged 14. He was awarded the Pharmaceutical Society’s Jacob Bell Scholarship and won prizes in the subjects of chemistry, botany, and materia medica. He passed both the Minor and Major examinations at the Society’s School of Pharmacy and registered as a pharmacist in 1891. Read more Edward Frank Harrison – a pharmacy war hero

Pharmacy breakthroughs in mental health treatment

By Julie Wakefield, RPS Museum volunteer

From the 1950s onwards there have been significant breakthroughs in the medicines used to treat mental health problems.

In the early 1900s the drugs used in psychiatry were the ‘chemical straightjackets’ such as opiates, bromides, and barbiturates that simply sedated patients.

This all changed in the 1950s with the introduction of chlorpromazine for psychosis, lithium for bipolar disorder, and imipramine for depression.

It began a pharmacological revolution because it demonstrated that drugs, not just psychotherapy, could restore mental health.

Antidepressants

Imipramine was the first of a class of drugs called ‘tricyclic’ antidepressants. In 1955, researchers gave it to 40 depressed patients. The results were dramatically successful. The pharmaceutical firm Geigy had produced the first drug in the history of psychiatry that acted specifically against depression.

Since then many more of these drugs have been developed, with varying side effects. However, imipramine is still considered by many psychiatrists to be the gold standard of antidepressant therapy.

Antipsychotics for Schizophrenia

Many pharmacy historians have regarded chlorpromazine as the single most important drug in the history of psychiatry. Chlorpromazine treated the symptoms of schizophrenic psychosis with less sedation than previous drugs.

A trial on 38 psychotic patients in the early 1950s showed that it could not only calm the patient but also treat a whole range of their symptoms. These included hallucination, delusions, confusion, anxiety states and insomnia.

Chlorpromazine was the first of a class of drugs called ‘typical’ antipsychotics for schizophrenia. A dopamine antagonist, it works by blocking the uptake in the brain of excessive levels of the neurotransmitter (a chemical that helps transmit signals in the brain) dopamine, believed to partly cause the symptoms of schizophrenic psychosis.

Bipolar Disorder

Just as chlorpromazine brought relief to sufferers of schizophrenia, lithium carbonate, launched in 1954, became the ‘gold standard’ treatment for bipolar disorder. Lithium is a mood stabiliser used in the prevention and treatment of mania associated with bipolar disorder (manic depression).It is still the most common treatment today as it both treats and prevents mood disorders.

The pharmaceutical treatment of mental health in 2018

However despite the significant developments in psychiatric medication over the last 70 years, many patients with mental health problems are still not receiving a high enough standard of care.

As part of its mental health campaign, the Royal Pharmaceutical Society is exploring how pharmacy teams can help improve the physical health of people with mental health problems.  People with mental health problems often have more difficulty accessing healthcare than others and the life expectancy of those with a serious mental illness is 15-20 years less than average.

A key part of improving this is ensuring patients get the best outcomes from their medicines, so reducing adverse events, minimising avoidable harm and unplanned admissions to hospital, while using resources more efficiently to deliver the standard of care that people with mental health problems deserve.

Heads down or heads up?

by Nicola Gray, RPS Regional Liaison Pharmacist

One of the privileges of being a Regional Liaison Pharmacist for RPS is having the opportunity to go and speak to pharmacists working across different sectors of care about their current work and their aspirations.

One common theme across all sectors for me has been the difficulty so many of us have in imagining a different practice scenario to the one we currently work in. The very real and constant pressure of daily work means that pharmacists often have to concentrate on traditional tasks to meet the needs of an increasing – and more complex – patient caseload. It might be the community pharmacist chasing yet another medicine in short supply; the chief pharmacist considering how to cover their on-call responsibilities; the academic pharmacist running the same lab 5 times to accommodate student numbers; or the GP practice pharmacist team leader covering several practices themselves because of the churn in their team. The common feature is ceaseless demand, which restricts our capacity to think and act strategically and to connect with the wider system.

Tied to the wheel

I’ve come to call it the ‘heads down’ phenomenon, but another pharmacist recently described it to me as being like ‘hamsters on wheels’. Those of us who are not caught in this cycle might become frustrated by a disappointing pharmacist response to funded offers of training, or worry that opportunities for strategic development will be missed because system leaders do not see demands from the profession for their ‘place at the table’. I believe that the ‘heads down’ phenomenon gives us a very reasonable explanation for why this might be – and a way to consider what we really have to do to facilitate change.

Looking up

Each of the four Regional Liaison Pharmacists has many stories of the innovators and local and national pharmacy leaders who are determined to look beyond the daily grind. For example, I attended the Greater Manchester Pharmacy LPN conference in the summer and awards were given there to pharmacists, pharmacy teams and multidisciplinary initiatives to celebrate solid innovation rooted in the needs of local populations. These awards showcased pharmacy-led improvements in patient safety and equitable access to services, which need acknowledging in a national healthcare system where both seem to be an increasing daily challenge.

Becoming part of a movement

The future of pharmacy has to be a system-wide movement united by a common cause and guided by shared values. Where I live in Greater Manchester, a recent meeting about workforce strategy – involving representatives from all patient-facing sectors – showed strong consensus around moves to affirm our shared identity there and use it as a basis to market pharmacy to patients, the public and other professions. This isn’t window dressing – it is fundamental to creating an effective movement.

As a representative of pharmacists in different roles in my past, and in the role that I perform for RPS now, my greatest nightmare is that promises will be made to local system leaders about pharmacy without the certainty that everyone else is committed to that cause. Conversely, the critical mass of pharmacists needed to give that support can only be created if they too feel part of a movement that is not just about another plan, or pilot, but that has the capacity to actually get us from where we are to where we really want to be.

In order to encourage more pharmacists to raise their heads, they will have to start to see small but meaningful positive changes in their daily work. Nothing less will do. This may be facilitated by shifts in commissioning to align incentives for pharmacists with value for patients. It may also be linked to better retention of pharmacists in localities and roles so that the work becomes more proactive than reactive. This will promote trusting personal relationships between pharmacists working in different sectors and with the wider healthcare team. The right approach will be decided at an increasingly local level, but support for these ‘local pharmacy movements’ from RPS and other national bodies and employers will help to sustain pharmacy leaders, and raise more heads up.