About the podcast series
Pharmacogenomics is beginning to influence prescribing, medicines optimisation and wider patient care in general practice. In these podcasts, experts discuss the current and future role of pharmacogenomics in primary care, including how genetic testing supports clinical decision-making and personalised prescribing. The three episodes explore emerging developments highlighting what primary care and community pharmacists need to know to prepare for future changes in NHS healthcare.
The future of pharmacogenomics in community pharmacy
Rakhi Aggarwal speaks to Vicky Chaplin, Senior Clinical Lead, Genomics Unit, NHS England, about the role of genomics in community pharmacy. The discussion explores pharmacogenomic testing, personalised prescribing, direct-to-consumer genetic tests, and how community pharmacy can support patients as genomic medicine develops within the NHS.
Rakhi Aggarwal
Hello and welcome to Pharmacogenomics Podcast series from NHS Specialist Pharmacy Service [SPS]. My name is Rakhi Aggarwal. This podcast will explore what pharmacogenomics means as, for community pharmacy. Today I’ll be speaking to Vicky Chaplin, Senior Clinical Lead at the Genomics Unit at NHS England. Welcome, Vicky, it’s lovely to have you on speaking to us. Would you briefly like to introduce yourself?
Vicky Chaplin
Yes. Thank you for having me. So I’m a pharmacist with an experience across a variety of sectors in healthcare. And I currently provide clinical leadership for the NHS genomic medicine service, including for pharmacy and genomics informed medicines optimisation.
Rakhi Aggarwal
So I’m going to go straight into it. How will genomics affect community pharmacy, Vicky?
Vicky Chaplin
So at the moment in terms of nationally commissioned testing in the NHS Genomic Medicine Service, we’ve got quite a small number of pharmacogenomic tests. And they’re all kind of based in terms of the testing being done in secondary or tertiary care and the medicines being used in a specialist setting. However, we have had examples of pilots in the NHS looking at kind of more generalist medicines and where some of those patients have had medicines adjusted as part of those implementation pilots, community pharmacy professionals might start to be seeing some of those changes when they’re clinically checking prescriptions in the community, and it also just might be coming up in discussions with their patients. So an example of a recent pilot is one that was done for CYP2C19 genotyping in relation to clopidogrel for patients who had had a stroke or TIA. And as everyone will know, clopidogrel is a prodrug and therefore it needs the CYP2C19 gene to metabolise it to its active form. And we know that if there are certain changes in that gene then that can affect how effectively someone can metabolise it. And so if they don’t have as much of the active form, it can put them at a higher risk of further ischemic events. So it’s highly possible that those patients who are identified and might have been put on a different drug to clopidogrel, something like ticagrelor that may have been coming up in terms of patients coming back into the community, whether it be kind of routinely through the new medicine service or the hospital discharge service. So we already may be able to start to see these changes in the community. And again, the patient may be mentioning it as part of their, as part of their prescription when they’re being counselled, maybe asking some questions about it, they didn’t get a chance to in the hospital. So yeah, we definitely think we’re going to start to see more of those changes happening.
Rakhi Aggarwal
Thanks, Vicky. And what, what useful resources are available for community pharmacy?
Vicky Chaplin
So I think in terms of the test I’ve just mentioned there are some really useful resources that we’ve worked with NICE to make available on the NICE guidance page. So on that page, you can see links to clinical guidance through the Cersi, a bit of information about the implementation pilot if you want to learn more, and also professional statement from the RCGP [Royal College of GPs]. And I think just, just on that note, I think another area where perhaps pharmacy professionals in the community are starting to, to have discussions with patients and they might not be quite sure what to do, is also direct to consumer tests, which patients can purchase privately. And these tests, there’s a variety of them and they can test for various things, but sometimes they might be testing for pharmacogenomic variants or kind of more broadly testing the patient’s genome for variants related to inherited cancers or other inherited conditions. So again, those conversations may be coming into the community and the patient asking further up and bringing this report from the private test. So I think having that general familiarity and understanding how to advise on these that are coming from outside the NHS is supported by a professional statement that’s available from the RCGP, BSGM, other professional bodies, including the Royal College of Pharmacy. So I think, you know, there’s lots of resources out there to, to support pharmacy professionals in these conversations.
Rakhi Aggarwal
Thank you so much, Vicky. That’s, that’s really, really interesting. So how could genomics affect the role of community pharmacy in the future?
Vicky Chaplin
So in the ten year health plan, there’s obviously very clear ambitions for a real expansion in our genomic services, and that’s particularly spearheaded by the creation of the NHS genomic population health service. And within that, we know that it will be a key role for the neighbourhood health teams to deliver these and taking that shift from hospital to community. And we know that community pharmacy is, you know, going to be really integral to neighbourhood health. It enables that closer delivery for the patient closer to their home. And as pharmacogenomic testing increases as part of the population health service we expect to see more and more of that, you know coming through and around the services of community pharmacy and the patients that are accessing care in their neighbourhoods. And obviously we know in terms of kind of broader services, I’ve mentioned pharmacogenomics quite a lot, but we have other types of tests that will be kind of increasing as time goes on. So really looking in at the prevention of diseases, which obviously community pharmacy is getting increasingly involved in and as we have more genetic testing available that will also play a role. And other predictive testing for conditions like familial hypercholesterolemia, which, which we already have but we expect to see more and more of that to support the prevention of cardiovascular events.
Rakhi Aggarwal
So insightful, honestly, I feel like I’m learning loads today. So where, where do, where do you go next? If you want to find out more information around genomics?
Vicky Chaplin
Sure. Well, I think there’s lots and lots of kind of general resources around genomics and, and the use of medicines and, and all sorts of things to, to access if you’re interested. But I guess a key thing now, especially considering the things I’ve talked about today is probably thinking about how do you have those conversations with patients, you know, when they come in and they want to talk about it? So the Centre for Pharmacy Postgraduate Education has a genomics landing page where it links to lots of different resources, but in particular probably highlight that there is a module on there about having kind of, talking to patients about genomics, and that might be a really useful tool in terms of kind of bringing those conversations into consultations going forward.
Rakhi Aggarwal
That’s really, really helpful. Thanks, Vicki. I think I might even look at that myself. So I just want to say a massive thank you so much for, again, spending some time with us today. That’s all from us here at SPS for this episode and thanks for tuning in and we’ll be back with another episode soon. We’re always keen to hear from you about suggestions you have for resources or events that you would like us to cover. Our contact details are available on our website. Please remember to register on our website and opt in to receive our weekly SPS bulletin. This will make sure you’re always informed of our most up to date content, and you’ll receive news of upcoming events. You may also like to stay in touch with us by following us on LinkedIn, search NHS Specialist Pharmacy service.
Embedding pharmacogenomics: the ICB role in transforming care
Rakhi Aggarwal speaks to Natalie Curley, Lead Pharmacist, South West London ICB, about how pharmacogenomics is shaping medicines governance. They discuss its impact on formulary decisions and treatment pathways and explore how ICBs can prepare for the future delivery of personalised medicine.
Rakhi Aggarwal
Hello and welcome to Pharmacogenomics Podcast series from NHS Specialist Pharmacy Service [SPS]. My name is Rakhi Aggarwal. This podcast will explore what pharmacogenomics means for an ICB pharmacy professional. Today I’ll be speaking to Natalie Curley, Lead Pharmacist, South West London ICB. Welcome, Natalie. I wondered if you wouldn’t mind introducing yourself.
Natalie Curley
Thanks, Rakhi. I’m Natalie Curley, and I’m an experienced ICB pharmacist. I’ve also completed a secondment at South East GMSA, which is the genomic medicine service.
Rakhi Aggarwal
Wonderful. Thank you, Natalie. It’s lovely to have you with us today. So I just wanted to kind of explore with you. How does genomics affect your role within the ICB right now?
Natalie Curley
So at the moment there’s limited pharmacogenomic testing in the NHS right now, but you may find that you have some patients that have had their medicines adjusted due to genomic testing, and ICB pharmacy professionals need to understand how this affects their local population. And this is in terms of medicines governance processes, treatment pathways and formularies. So an example of this is the national pilot of CYP2C19 genotype testing which was last year. And this is for stroke or TIA [Transient Ischemic Attack] patients that may receive clopidogrel. So this follows the publication of NICE Health Technology guidance and CYP2C19 genotype testing to guide clopidogrel use after an ischaemic stroke or transient ischaemic attack. So clopidogrel is a prodrug, and this means that patients with certain changes in their CYP2C19 gene may be unable to effectively metabolize it to its active form, putting them at higher risk of further ischaemic events. And patients in the pilot found to have genomic variants may be prescribed alternative antiplatelet agents, such as ticagrelor. So you may have encountered new formulary requests for alternative antiplatelet agents for patients unable to effectively metabolize clopidogrel, and these, these may be unlicensed.
Rakhi Aggarwal
Thanks, Natalie. That’s really interesting, especially with, with my ICB hat on. That’s really insightful. Would you mind giving me some information around some useful resources? You know, if you’re working in the ICB?
Natalie Curley
Yes, certainly. The Regional Drugs and Therapeutics Centre has produced a really helpful resource on principles from bedding pharmacogenomics into NHS medicines governance. And there’s a few examples on there as well that can be really helpful for you, when following this guide.
Rakhi Aggarwal
Fabulous. Thank you very much. So how could genomics affect ICB pharmacy roles in the future?
Natalie Curley
So the NHS ten year plan outlines a substantial expansion to genomic testing to provide a population level genomic testing service, which includes plans for pre-emptive pharmacogenomic profiling as part of routine care in the NHS. So ICB pharmacy professionals will have a key role in integrating genomics into ICB medicines governance processes, which includes integrating pharmacogenomics into treatment pathways and formularies. So who will be prescribing these, supporting system wide implementation and adoption of genomics and for medicines optimisation to improve patient outcomes, including optimising treatment efficacy and reducing the risk of adverse drug reactions, and also supporting and monitoring equitable access to genomic testing for the local population to optimise patient outcomes.
Rakhi Aggarwal
Thank you. And if I wanted to find out more, where would I go next?
Natalie Curley
So the NHS Genomics Education Programme has a genomics in pharmacy web page, and this has further information and links to other educational resources. So I’d advise you to start there because there’s lots of information.
Rakhi Aggarwal
Fabulous. Thank you so much, Natalie. Really appreciate you taking the time out to speak to us. That’s all from us here at SPS for this episode. Thanks for tuning in and we’ll be back with another episode soon. We’re always keen to hear from you about suggestions you have for resources or events that you want us to cover. Our contact details are available on our website. Please remember to register on the website and opt in to receive our weekly SPS bulletin. This will make sure you’re always informed of our most up to date content, and you will receive news of upcoming events. You can also stay in touch with us by following us on LinkedIn, search NHS Specialist Pharmacy service.
Genomics and personalised prescribing in primary care
Rakhi Aggarwal speaks to Rachel Palmer, Consultant Pharmacist, Genomic Medicine, NHS South West Genomic Medicine Service, about the use of pharmacogenomic testing in general practice. They discuss its impact on prescribing, resources supporting clinical practice, and the evolving role of pharmacy professionals as personalised prescribing expands across the NHS.
Rakhi Aggarwal
Hello and welcome to the Pharmacogenomics Podcast series from NHS Specialist Pharmacy Service [SPS]. My name is Rakhi Aggarwal. This podcast will explore what pharmacogenomics means for PCN [primary care network] and GP based pharmacy professionals. Today I’ll be speaking to the wonderful Rachel Palmer, Consultant Pharmacist for Southwest Genomics Service. Welcome, Rachel. Lovely to have you with us. Would you like to do a brief introduction about yourself?
Rachel Palmer
Of course. Thank you, Rakhi. So my name is Rachel. I’m the Consultant Pharmacist for the Southwest Genomic Medicine Service. And I really just wanted to give you a bit of a summary, so if you’re a pharmacy professional working in a PCN or GP practice, really just to point out how genomics can impact your role right now and in the future.
Rakhi Aggarwal
Thank you so much, Rachel. So could you tell me a little bit actually how it might affect your role right now? In terms of pharmacogenomics?
Rachel Palmer
Yeah, sure. So actually pharmacogenomic testing in the NHS, it’s really at the beginning of the journey right now, so it’s relatively limited. However, there are patients who have had genomic testing, and it’s really important that pharmacy professionals need to understand the background about this and understand how this may impact medicines in terms of when they come to prescribe a medicine or review a patient’s medication. And also it’s important that they feel able to discuss this with the patient. So to give an example there’s been a national pilot of pharmacogenomic testing in GP practices across England. This is called the Progress Project, this has just stopped recruiting patients. And this is looking at the feasibility of pharmacogenomic testing for really commonly prescribed medicines in GP practices. And this is because nearly all of us have got at least one pharmacogenomic variant that affects how we respond to medicines. So if patients were about to be newly prescribed one of a number of trigger medicines, they would be eligible to participate in this study. And the trigger medicines were SSRI and tricyclic antidepressants, statins, codeine and tramadol, and proton pump inhibitors. And because actually, a relatively small number of common pharmacogenomic variants can affect the metabolism of lots of common medicines, instead of just testing the one pharmacogenomic variant or gene that affected the trigger medicine, the team tested a panel of the common pharmacogenomic variants.
Rachel Palmer
Importantly, instead of providing clinical teams in primary care with what might be quite a complex report from a genomic laboratory, these results were translated into prescribing advice for clinical teams, and they were integrated into clinical decision support systems. Preliminary results have indicated that around a quarter of patients had a recommendation for a prescription amendment on the basis of the pharmacogenomic testing, and that was just for the trigger medicine. But actually, because we’d stored these results on the healthcare records and integrated them with clinical decision support, it meant that in six months time, if a patient was then prescribed a statin, there was the potential that another pharmacogenomic result from this initial test could be surfaced and be used to optimise the prescribing of further medicines. But it’s really important to say it’s not just about pharmacogenomics. So GP practice based pharmacy professionals have got a really important role in identifying and helping with the management of patients with inherited diseases. An example would be familial hypercholesterolemia, and we’re all aware of the key role that pharmacy professionals have had in helping identify patients who may be appropriate for referral for genomic testing, to identify those with familial hypercholesterolemia. And then following diagnosis, obviously it’s really key that we optimise their medicines to manage their lipids appropriately.
Rachel Palmer
Another example that’s perhaps less well known is Lynch syndrome. And this is a common inherited cancer syndrome that affects about 1 in 300 patients. And following diagnosis, there are some really important preventative strategies that pharmacy professionals in primary care can really help implement. One of these is aspirin. So we know that if we give these patients aspirin, where appropriate, this can halve their risk of colorectal cancer. But there are also some really key messages that we need to get across to patients about lifestyle measures to reduce their risk of malignancy. So what are some useful resources if you’re a pharmacy professional in GP practices and PCNs? Well, the UK Clinical Pharmacy Association [UKCPA] have recently launched an excellent resource. It’s the Handbook of Pharmacogenomics, and this gives a quick summary of how to interpret and action pharmacogenomic test results. So you can search by either drug or pharmacogenomic results, and it gives you advice on how to action the results. And this short, sharp resource very much complements national guidance that’s been developed by a body called Cersi. Cersi have published pharmacogenomic guidance for the UK for clopidogrel and CYP2C19 genotyping, and on a number of other topics, and are in the process of producing further guidelines. There are links to both these resources that you can access.
Rakhi Aggarwal
Thank you, Rachel. So it’s really interesting to hear that actually, some of the medicines, you know, they’re your day to day and it’s actually happening at the moment. You know, I just wanted to ask you, how could you, genomics affect the role, our roles in the future?
Rachel Palmer
So we think that genomics is going to have a really big impact on the roles of pharmacy professionals in GP practices in the future. And that’s because the NHS ten year plan for England sets out big ambitions for a very substantial expansion in genomic services and a key role for neighbourhood health teams in delivering these. And this aligns with the shift from hospital to community. As I’m sure we’re all aware, GP practices will be at the centre of neighbourhood health teams. And to give a bit more detail, the ten year plan sets out an ambition for a population level pre-emptive pharmacogenomic profiling service, and this will very much bring pharmacogenomics into standard NHS care and standard pharmacy practice, and there are some considerations set out in that ten year plan about perhaps offering pharmacogenomic profiling at NHS health checks that are conducted in primary care.
Rakhi Aggarwal
Fab, thank you, Rachel. So what, what, kind of, what’s next? What would you recommend is next?
Rachel Palmer
So if you’ve listened to this and you thought, actually, I want to upskill myself, I want to learn more. Just to highlight that if you’re a prescriber, the Royal College of Pharmacy have recently published an excellent resource. And this is to complement its existing prescribing competency frameworks. This resource focuses on genomics and what you need to know, and the kind of skills you need to ensure that you’re competent in terms of genomics for your prescribing. So that’s a great resource. But more broadly there’s also the genomics education programme, Genomics in Pharmacy Practice. And that will link you to lots of different educational programs for genomics, from short blogs to more detailed webinars, if you want to just find out a little bit more.
Rakhi Aggarwal
Thank you, Rachel. That’s really insightful. That’s all from us here at SPS for this episode. Thanks for tuning in and we’ll be back with another episode soon. We’re always keen to hear from you about suggestions you have for our resources or events that you want us to cover. Our contact details are available on our website. Please remember to register on our website and opt in to receive our weekly SPS bulletin. This will make sure you’re always informed of the most up to date content, and you’ll receive news of the upcoming events. You can also stay in touch with us by following us on LinkedIn, search NHS Specialist Pharmacy service.
Further information
The NHS Genomic Medicine Service lead pharmacists’ Genomics Informed Medicines Optimisation webinars provide an introduction to pharmacogenomics in clinical practice. The webinars are hosted by PrescQIPP (registration with an NHS organisation email is required).
The SPS article Pharmacogenomics: resources to support answering questions (SPS page), brings together key guidance, tools and learning resources to support healthcare professionals.
Resources featured in the podcasts
Links to resources and guidance highlighted by guests can be found below:
Direct-to-consumer genomic testing position statement
NHS Genomics Education Programme Genomics in Pharmacy resources
UK Clinical Pharmacy Association (UKCPA) Handbook of Pharmacogenomics