The recent North-South Pharmacy Healthcare Conference brought together over seventy oral and poster presentations from North and South of the Border. The Conference, a joint initiative of the ICCPE and its Northern counterpart the Northern Ireland Centre for Postgraduate Pharmaceutical Education and Training (NICPPET), highlighted the continuing impact that pharmaceutical research has upon changing national policy, pharmacy practice and new models of care.

Over seventy oral and poster presentations, illustrating a profusion of pharmaceutical research North and South of the Border, were put forward at the second North-South Pharmacy Healthcare Conference, held in Dundalk on September 14. The Conference, a joint initiative of the Irish Centre for Continuing Pharmacy Education (ICCPE) and the Northern Ireland Centre for Postgraduate Pharmaceutical Education and Training (NICPPET), was attended by 110 delegates (49 from the South) and included progressive research in all spheres of the profession including Risk Management and Audit, Medicines Information Systems, Clinical Therapeutics, Finance and Economic Analysis, and Technical and Technological Developments.

In his opening address to the conference, Tom McGuinn, Chief Pharmacist at the Department of Health and Children, heralded the theme of Medicines Management, a subject which was at the core of many presentations during the day. "There are many medicines which, if governments did not fund them, would be unaffordable to the vast majority of patients," he said. "This makes a need for cost effectiveness and avoidance of wastage all the more important. Pharmacists are in an ideal position to ensure that medicines are used rationally, cost-effectively and with a minimum of wastage."

The keynote address at the conference was given by Professor Claire Mackie, Head of the Medway School of Pharmacy, Kent, and continued on the theme of Medicines Management. Titled Medicines Management: Establishing an Evidence Base to Support New Models of Care, Professor Mackie's presentation dealt with Medicines Management as "an umbrella term" to encompass the areas of pharmaceutical public health, national drug policy and new developments in community pharmacy. "Effective medicines management is linked to outcomes of patients' quality of care and drug therapy problems," she said.

A principal feature of Professor Mackie's address was to illustrate the critical role that national policy plays in regard to the remit of pharmacists in the area of Medicines Management. Outlining the major shift in policy in the UK since the coming to power of the Labour Party, she observed that "New Labour is very much interested in smashing the monopoly of GPs and others." The implications of this approach have included improved access through NHS Direct and walk-in centres, direct supply of medicines schemes and a major extension of non-medical prescribing. Of chief concern to pharmacists are the opportunities presented by a New GMS Contract and a New Community Pharmacy Contract. Indeed the funding for the latter has substantially increased from 800 million to 1.766 billion, with its implementation anticipated by April 2005. The New Community Pharmacy Contract in the UK will expand the role of the community pharmacist through a three-tiered approach which encompasses:

1. Essential Services (current function plus health promotion, clinical governance, disposal of waste medicines and other services),
2. Advanced Services (medicines use review, the provision of private areas/appropriate facilities, prescribing interventions, and the demonstration of competence by pharmacists), and
3. Locally Commissioned Services (including supervised methadone, smoking cessation and supplementary prescribing).

One of the criteria for the provision of Advanced Services under the new pharmacy contract is that the pharmacist must demonstrate competence. The role of continuing pharmaceutical education in the demonstration of competencies will be critical, with the provision of a 20-part skills development programme titled Skills for the Future. Professor Mackie has played a pivotal role in the development of this distance learning programme having written all twenty modules, the first of which was launched in June. Modules are provided in electronic format and are freely available through the Chemist and Druggist website. Since its launch, Skills For the Future has had an uptake of over 1,000 pharmacists per month; indeed, demand for the programme has already surpassed its two-year target threefold.

A secondary feature of Professor Mackie's address was to demonstrate the vital function of research in driving new models of care. Citing research on Adverse Drug Reactions published in the British Medical Journal, which estimated that two thirds of ADRs could have been avoided, Professor Mackie pointed to the considerable burdens placed on the healthcare system by such preventable hospital admissions. The findings of these and other research projects must be employed to ensure that patients have "ready access to the right medicines in the right form at the right time," she said.

Professor Mackie concluded her presentation by citing a trend of interest to community pharmacists which emerged in one of her own research undertakings, The London [B&H] Medicines Management Project. Patients interviewed for the project were allowed to choose the location of their interviews. For every one person who chose the GP practice, eight chose the pharmacy. An interesting statistic for community pharmacists to ponder…

Four parallel sessions, including oral presentations from pharmacists and technicians demonstrated recent pharmacy research undertaken on both sides of the Border and its practical application within the workplace. Questions from the floor to each speaker ensured lively discussion and sharing of experiences North and South. In addition to the four parallel sessions, a total of 50 poster presentations, 24 from the South and 26 from the North, were on display (see Table 1).

New Directions in Community Pharmacy, chaired by Ms Pamela Logan, IPU included research undertaken on the feasibility of Helicobacter Pylori testing in community pharmacy (presented by Andrea Linton), an overview of the work undertaken by Pharmacy Locality Groups in Northern Ireland (presented by Michelle McCorry), a project utilizing the community pharmacy to promote awareness of Type II diabetes (presented by Martin Kerr), a scheme in North and West Belfast to promote the pharmacy as the first port of call in the treatment of upper respiratory viral infections (presented by Ann Overell), and a community pharmacy-based project aimed at preventing the spread of sexually transmitted infections (presented by Valerie Addy).

Medicines Management, chaired by Dr Carmel Hughes, School of Pharmacy, QUB, opened with a presentation on the impact of pharmacist intervention on secondary prevention of cardiovascular disease in a cohort in Cork (presented by Sheila O'Driscoll). Dr Brenda Bradley presented a Regional audit of antimicrobial prescribing in primary care in Northern Ireland and Fran Maguire gave an excellent overview of the interface pharmacy network-specialist medicines initiative in the province; guidance on the red amber list is available on the DHSS website. Non-dispensing of items on NHS prescription (by John Johnson) showed how community pharmacists can contribute to significant savings in prescribing budgets. Two presentations from the United Hospital Trust Integrated Medicines Management Project summarised the influence of integrated medicines' management on medication appropriateness (presented by Anita Hogg) and the impact of an intensive clinical pharmacy service on re-admission rates to hospital (presented by Peter Beagon).

Secondary Care, chaired by Professor James McElnay, QUB included presentations by Helen Glassett, AMNCH, Tallaght, on her review of skill mix and services in the acute hospital pharmacy setting, by Sinead Doyle, of Craigavon Area Hospital, on her involvement in the development of a pharmacist-led anticoagulant clinic, by Agnes Hunter on the role of pharmacy technicians in the introduction of patient medication lockers within the United Hospitals Trust, by Jane Whiteman on a new IT system introduced in Musgrave Park Hospital which facilitates medicines management and a pharmacist-led discharge system, by Corinna Collum and Sharon Hackett on their project to audit adherence to 'Management of Infections Policy' in Westdoc and the A&E Department of Erne Hospital, and by Ciara Kirke, Mater Hospital Dublin, on her research into Invasive fungal infections in heart transplant recipients in Ireland.

Managing risk is an increasingly important role for pharmacists in every sphere of practice. Maximising outcomes from medicines and minimising therapeutic misadventure risk is what pharmacists, supported by their team, do best. More often than not, this requires implementation of quality systems and procedures: in incident reporting, rationalisation of prescribing systems, disposal of unwanted medicines and patient education initiatives. The Risk Management session, chaired by ICCPE Director, Orla Sheehan, opened with an overview of The Northern Ireland Medicines Governance Project, presented by Tracy Boyce, Regional Co-ordinator of the Clinical Governance team. Other presentations from the governance team included A Regional Approach to Reducing the Risk of Confusion between Different Strengths of Warfarin Tablets, presented by Jillian Redpath and Hospital Pharmacy Staff Barriers to Medication Incident Reporting, by Kathryn King. Dr Denis O'Driscoll presented results of a DUMP campaign involving 155 community pharmacies in the SWAHB region and implications for prevention of suicide and parasuicide. Drug-related Problems and Community Pharmacists' Interventions, presented by Fearghal Ó Nia, discussed a dedicated intervention service in North Dublin and Maura Corry discussed a project implemented in the NHSSB Ensuring More Robust Repeat Prescribing within General Practice.

Table 1 Poster Presentations submitted by delegates from North (NI) and South (I)

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Capturing clinical activity electronically - a cultural revolution (I)

Hand-washing and infection control - is there something the dispensary should be doing? (I)

A review of patient perceptions of the clinical pharmacy service (I)

Development of prescription templates for specialist medicines (I)

An audit of oral syringe use pre- and post-implementation of a policy to prevent inadvertent injection of oral liquid medication (I)

Haemoglobin/erythropoietin audit in haemodialysis patients (NI)

Follow-up of an ergonomic review of an aseptic unit (I)

What should we educate patients about? (I)

Compliance in surgical antibiotic prophylaxis (NI)

Audit of hospital staff pharmacy service (I)

Doctors' views of the clinical pharmacy service at AMNCH (I)

In-house pharmacy education meetings - an improved model (I_

Medication administration to enteral feeding and dysphagic patients (I)

Assessment of the need for and feasibility of extending the aseptic pharmacy service in St Vincent's University Hospital to include non-cytotoxics (I)

Opioid analgesia conversion (I)

Cost of discarding patients' own drugs (I)

Investigation of medicines information sources used my medical personnel in St Vincent's University Hospital (I)

Risk-benefits - is a pharmacy-led warfarin clinic effective? (I)

Dispensing medication to Accident and Emergency - what's it worth? (I)

Drug level determination in neonates using dried blood spots: applications and off-label drug use (NI)

Mid-Ulster Locality Group: early screening for type 2 diabetes (NI)

An investigation into whether pharmacist-conducted clinical medication review can improve the quality of prescribing for older people in care homes (NI)

A qualitative study of issues relating to adherence and concordance in hypertensive patients (NI)

Is psychoactive medication usage in care homes related to staffing levels? (NI)

A retrospective evaluation of OTC drug related overdoses at A & E departments (NI)

Development of evidence-based drug selection system for formulary decision making (NI)

Audit of adherence to protocol for venous thromboembolism prophylaxis in primary hip and knee replacement (NI)

Preliminary standardisation of oncology regimens - expanding the role of the pharmaceutical technician through continuing education (I)

Exploring psychosocial influences on adherence to antihypertensive medication (NI)

Evaluation of pharmacists' interventions in community practice (I)

Guide to subcutaneous drugs commonly used in palliative care (NI)

Disposal of unwanted medicines in Mid-Ulster (NI)

NHSSB wound care formulary 2004 (NI)

NHSSB guidance on prescription security (NI)

Irish Patients' Association - patient attitudes research (I)

The introduction of a patients' own drug scheme in Craigavon Area Hospital (NI)

Use of government prescription data to capture benzodiazepine utilisation trends for North Eastern region of the Republic of Ireland (I)

Healthhub.ie (I)

Medicines information pharmacist - luxury or necessity? (I)

Medicines information as a tool to decrease medication error in the hospital setting (I)

Audit of allergy status documentation on inpatient prescription charts in Northern Ireland (NI)

Use of a medication review tool to facilitate multidisciplinary patient care in a nursing home setting (NI)

Development of a medicines safety newsletter in Northern Ireland (NI)

A study of clinical interventions made by a primary care pharmacy service in rural location (I)

The relationship between a multiple deprivation profile of general practitioners' practice lists and prescribing (NI)

The adjudication process for specialist medicines (NI)

Development of a communications strategy for the interface pharmacist network specialist medicines (NI)

Development of a rapid colorimetric method for determining synergistic antibiotic combinations for a treatment of cystic fibrosis lung infection (NI)

Herbal medicines: their perioperative use and potential drug interactions (I)

Recording clinical pharmacy technicians interventions (NI)

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The critical role of research projects such as those presented in oral and poster format at the conference was pinpointed by Norman Morrow, Chief Pharmaceutical Officer at the Department of Health and Social Services Northern Ireland, in his closing remarks. "Policies that you see in your work have come about because of the evidence base, because of the innovations in practice," he said. He noted that, while it was very encouraging to witness the range of research projects being undertaken in different domains at the conference, it was also necessary for those undertaking research to "feed the beast" by giving the Government evidence of success stories. "Research is very important in how it continues to inform policy," he said.

In terms of policy, Mr. Morrow observed that "we do need to have some clear research directions in which to go. We need to channel resources towards these fruitful and important areas." According to Mr. Morrow, these areas include Public Health (community development - how we engage and how we empower the public); Organisational research (how we restructure and reengineer things through new models of practice); Traditional focus in relation to patient groups and entities, including the elderly, paediatrics and palliative care; Risk Management, which, he noted, "is probably the single biggest issue for healthcare systems around the globe"; and Finance ("Where will governments make savings in a hard pressed healthcare system?" he asked.).

Another important area to pursue, according to Mr. Morrow, is the social value of pharmacists' services in how it adds value to patients' lives. Collaborative research and collaborative development must also be encouraged, not only with other pharmacists but with the voluntary and community care system and with other healthcare professionals. In concluding, Mr. Morrow noted that, above all, research must be applicable and evidence must be utilized. "Don't repeat the research for which the evidence is already persuasive," he says, "use it!"

The next North South Pharmacy Healthcare Conference will be held in Autumn 2006.

Julie Cronin

This article was first published in The Irish Pharmacy Journal in November 2004.