Researchers led by London School of Hygiene and Tropical Medicine in collaboration with the University of Nottingham and Universities of Manchester and Oxford and experts at the UK Health Security Agency (UKHSA), have been awarded £2.4m by the National Institute for Health and Care Research (NIHR) to evaluate the new service introduced to allow pharmacies to prescribe for minor illnesses.

The under the Government’s NHS Primary Care Recovery Plan. From February 2024, participating pharmacies will be able to supply prescription-only medicines for seven common conditions: earache, uncomplicated urinary tract infections in women, sore throat, sinusitis, impetigo, shingles and infected insect bites, after consultation with a community pharmacist. 

The research team will evaluate Pharmacy First's take-up, safety, equity, cost effectiveness and acceptability, as well as its implications for antibiotic use and antimicrobial resistance.

Dr Kimberley Sonnex, from the University of Nottingham is lead for the take-up and safety evaluation, Pharmacy Practice and Policy, she said: “I’m excited to work with a research team including cross-discipline expertise from pharmacists, general practitioners, nurses, health economists, policy researchers, and experts in antimicrobial resistance to evaluate a new community pharmacy service that puts patients first.”

Professor Claire Anderson, Pharmacy Practice and Policy, University of Nottingham and president of the Royal Pharmaceutical Society said: “I am delighted to be part of the team evaluating Pharmacy First in England. We will have much to learn from similar, successful schemes in Wales and Scotland”

, lead for the 91ֱ�� Centre for Health Economics said: “I am looking forward to working on the evaluation of Pharmacy First. When resources are limited in the NHS, it is essential we spend that money on safe and effective services to make sure patients get the best value for money from their healthcare.

“Community pharmacies are important providers of healthcare and are accessible to all communities, including the medically-underserved. Through this evaluation we will contribute to understanding of potential consequences of Pharmacy First for inequalities in access to health services and outcomes.”

The authors of the study, published in the journal Addiction today (04/08/23), say doctors should avoid co-prescription of opioid agonists, with benzodiazepines, gabapentinoids, antipsychotics or Z-drugs if harm is greater than the benefit to patients.

Opioid agonists, medicines which include methadone or buprenorphine,  are used as a substitute for illicit drugs when treating people who are dependent on drugs like heroin.

The study was funded by National Institute for Health and Care Research (NIHR) Greater 91ֱ�� Patient Safety Translational Research Centre, a partnership between The University of Manchester and Northern Care Alliance NHS Foundation Trust.

In the patient records of 20,898 recipients of opioid agonist treatment that were analysed by the researchers, patients prescribed benzodiazepines - which are commonly used sedatives – were 1.45 times more likely to have a hospital admission for overdose compared to patients who were not prescribed them.

Gabapentinoids - which are used to treat a range of disorders including neuropathic pain, epilepsy and anxiety disorders- prescribed in combination with opioid agonists were 2.2 times more likely to result in hospital admission for overdose.

Z-drugs, which are also sedatives, were 1.6 times more likely and antipsychotics - used to treat psychosis were 1.85 times more likely to result in overdose.

There was no evidence for increased risk linked with antidepressant co-prescription.

The research team studied primary care patients in England with opioid use disorder aged between 18 and 64 years, 15,155 of whom were prescribed methadone and 5,743 buprenorphine between January 1998 and December 2017.

Opioid use disorder is characterised by cravings for opioids, continued use despite physical or psychological deterioration, increased tolerance, and withdrawal symptoms.

The data was obtained from the Clinical Practice Research Datalink GOLD and Aurum databases and linked to data from the Hospital Episode Statistics and Office for National Statistics.

Scientists already know that methadone, as a full opioid agonist, can trigger overdose at high doses; buprenorphine, a partial opioid agonist, appears safer.

However, both treatments may interact with other medications that are commonly prescribed for patients with opioid use disorder.

Lead author Dr Eleni Domzaridou, a Research Associate at The University of Manchester said: “We found an elevated risk of non-fatal overdose among patients who were prescribed opioid agonists together with medication prescribed for other reasons.

“A non-fatal overdose often precedes subsequent drug-poisoning death. Therefore informing clinicians to help them prescribe medication to these patients as safely as is possible is paramount.

“Our findings highlight the importance of joint working between GPs and mental health professionals when caring for the complex health needs of patients with opioid use disorder."

Co-investigator Professor Tim Millar added: “This is another part of the jigsaw in our understanding of how we might reduce overdose risk in this complex and marginalised patient population.”

Dr Jen O’Brien and Dr Jennifer Silverthorne are among the new fellows named in the Advance HE National Teaching Fellowship Scheme, which recognises individuals who have made a tremendous impact on student outcomes and the teaching profession in higher education. 

Dr O’Brien is a Senior Lecturer in Human Geography, as well as the University’s Academic Lead for Sustainability Teaching and Learning. She is an Inaugural Fellow of the 91ֱ�� Institute of Teaching and Learning and leads the ‘Informed and Inspired’ Challenge for Sustainable Futures. A Development Geographer by training, Jen is interested in the intersection between innovative pedagogy and independent field or applied research aiming to inspire and equip learners to ethically address challenges of sustainability, inequality and social justice to make a difference. She directs the University Living Lab, which links applied research needed by organisations with students who can undertake it for their assessment to effect change.

Jen leads 91ֱ��’s ‘Creating a Sustainable World’ course, which is run through the University College for Interdisciplinary Learning (UCIL). The first of its kind in the world, the course - which is available to undergraduates and postgraduates from across the University - uses the UN’s Sustainable Development Goals (SDGs) to equip them with the skills to make positive social change and reflect critically about sustainability. It has been recognised by the Times Higher Education University Impact Rankings, which ranks 91ֱ�� first in the UK and Europe and second in the world for its contribution to the SDGs.

Dr Jennifer Silverthorne is a Reader in Clinical Pharmacy in the Division of Pharmacy and Optometry who leads a team of clinical academics, senior NHS pharmacists and placement tutors providing clinical education. Her commitment to inclusive practice in the classroom, programme design and assessment has changed the University’s approach to Pharmacy teaching and influenced the practice of colleagues. Her reach into the sector through work with professional, statutory and regulatory bodies has transformed Pharmacy education to deliver a highly skilled, reflective and progressive workforce fit for the future.

“I’d like to congratulate Catherine, her team, Jen and Jennifer for their well-deserved awards,” said Professor April McMahon, the University’s Vice-President for Teaching, Learning and Students. “Being acknowledged in this way is a huge achievement, and it recognises their dedication to teaching, and to our colleagues and students.

“I’d also like to thank them for their overall outstanding contribution to the teaching and learning provision at our University. I am sure they will continue to drive forward even more positive change in the future.”

An independent panel of senior higher education leaders, representing the four UK nations, assures the quality of the National Teaching Fellowship Scheme and Collaborative Award for Teaching Excellence and recommends winners.

"Every year as we select the NTFS and CATE winners, we are in awe of these extraordinary and gifted people who are teaching with such professionalism, passion and commitment in higher education - this year was no different,” said Professor Becky Huxley-Binns, Pro-Vice-Chancellor for Education at the University of Hull, and Chair, UK Teaching Excellence Awards Advisory Panel 2023. 

“These awards are incredibly important in recognising and celebrating these people and in sharing 'what works' so that colleagues can build on their expertise too and students can enjoy the benefits of great practice in teaching and learning.”

The awards ceremony will take place in Birmingham on Thursday 28^th September. 

Although the reduction in the number of opioid prescriptions issued by individual GPs was small, when aggregated together they had a large effect.

The campaign was trialled in West Yorkshire and  the researchers say over a year, it resulted in 15,000 fewer patients being given opioids - and a net saving to the NHS of £700,000. If it were replicated across the UK, it could lead to 406,000 fewer patients taking opioid medications.

This study, led by researchers from the University of Leeds, co-aurthored by a University of Manchester epidemiologist, and published in the journal PLOS Medicine, involved a ‘feedback’ intervention that continued for a year, where GPs were given two-monthly updates on the number of people at their practice being prescribed opioids.

Opioids are morphine-based medicines that can result in addiction, dependency and an increased risk of falls and early death.

They are often given as painkillers, but the Royal College of Anaesthetists says there is they help with long-term chronic pain - although they work for acute pain and end-of-life care.

In early April, NICE – the National Institute for Health and Care Excellence – on how to help patients who are experience chronic or persistent pain, pain that exists for three or more months. It says they should not be started on commonly used drugs, including opioids.

The number of prescriptions issued by GPs in England for opioids has from 1998 to 2016, prompting claims that the UK has been in the grip of an “opioid epidemic”.

The researchers believe “physician prescribing habits” accounts for the increase in opioid prescribing, rather than the needs of patients. In the paper, they acknowledge the challenges facing GPs when some patients have a “strong expectation” of being able to access prescription pain relief.

As part of the feedback campaign, the doctors were reminded of the need to “...initiate opioids with caution” and to review whether patients should continue to receive opioids when there is no benefit.

How one GP helped a patient to reduce dependency on opioid

One GP involved in the study described how the intervention helped him get a patient off opioid medication.

The patient, who had multiple sclerosis, was on three different forms of opioids. Once on the drugs, no one had spoken to her about whether she needed to stay on them. The GP worked with her to gradually reduce the dosage.

The GP said: “I was really impressed by her progress - and it has made a difference to her life. When she comes to see me, she says ‘Look, I am changed person. I can now focus on things and I have an enthusiasm for life. Before I was just a blank’.”

Results of the Yorkshire and Humberside intervention

The feedback intervention - called the Campaign to Reduce Opioid Prescribing - was trialled in West Yorkshire. There were 316 GP surgeries in the group that received feedback - another 130 practices were in a control group and did not get any feedback.

Every two months, the GPs received an update detailing how many patients at their practice had received an opioid prescription. Patients with cancer or drug dependency were not included.

In the months prior to the campaign starting, the rate of opioid prescribing was rising in the intervention group by 0.18 per 1000 patients/month. In the control group it was 0.36 per 1000 patients/month.

During the intervention, the rate of prescribing in the intervention group fell by 0.11 per 1000 patients/month while it rose in the control group to 0.54 per 1000 patients/month

The results, with the 95% confidence interval in brackets

The overall difference between the intervention and control groups was -0.65 per 1000 patients/month which means across West Yorkshire, around 15,000 fewer people will have been put on opioids over the year-long trial, which equates to a net saving of more than £700,000 to the NHS once all costs have been accounted for.

Dr Sarah Alderson, Clinical Associate Professor at the University of Leeds and a GP in Holmfirth, West Yorkshire, who led the study, said: “Our analysis shows that the intervention was particularly effective at getting GPs to stop or reduce their prescribing for those groups at high risk such as older patients or those who also had a mental health condition.

“The study shows that GPs can be highly effective in identifying other ways of supporting patients who experience chronic pain.

“The feedback intervention could easily be adapted and delivered elsewhere at relatively low cost.”

The effects of the programme started to wane once the feedback was stopped and Dr Alderson believes the campaign needs to be sustained over a longer time period.

Dr Tracey Farragher, Epidemiologist at The University of Manchester and analyst on the study, said: “This study is a great example of how health records can improve patient care by providing up to date information to doctors about how many of their patients are being prescribed opioids.”

The study involved researchers from the University of Leeds with the University of Manchester and NHS Bradford Districts Clinical Commissioning Group, West Yorkshire.

The paper - The effects of an evidence and theory-informed feedback intervention on opioid prescribing for non-cancer pain in primary care: a controlled interrupted time series analysis – is here

The research was supported by the Academy of Medical Sciences, the Wellcome Trust, Medical Research Council, British Heart Foundation, Arthritis Research UK, the Royal College of Physicians and Diabetes UK.

Led by Dr Teng-Chou Chen from The University of Manchester, it is the first to study the medication history for opioid related death using half a million electronic health records.

Opioid related deaths are rare but can result from high opioid prescribing.

However, Dr Teng-Chou Chen’s study reveals around 25% of the 232 patients who died from opioids between 2000 and 2015 had not been prescribed the drugs for pain 12 months before their death.

That, argues the team, suggests they stockpiled previously prescribed opioids or had been given them from people they knew –without realising the dangers of taking high combined doses.

Around 35% of the patients had been prescribed high dose opioids of 120mg a day in the 12 months before their death.

Taking an additional opioid when already on such a high dose probably caused unintentional death in those people for similar reasons, the team argues.

Most of the overall opioid-related deaths occurred between the ages of 30 to 50. Around 55% of them were men, 30% had a history of substance abuse and 80% suffered from psychological illnesses.

Although the data is 6 years old, the team argue there is no reason to think the situation will be any different today.

The study, published in the British Journal of Anaesthesia, was carried out by a team based at the Universities of Manchester and Nottingham.

It used the electronic health records, Clinical Practice Research Datalink, representing 8% of the UK population - or 5.13 million people from 2000 to 2015.

Prescription opioids are mainly used for pain relief and work on the Central Nervous System by attaching receptors to our brain cells, releasing signals that block pain. The most common include morphine, tramadol, fentanyl, codeine, and oxycodone.

Overdose can cause respiratory depression, drowsiness, fatigue and falls. Respiratory depression is the most common cause of death in opioid overdose, though symptoms of drowsiness may mask it.

“Dr Teng-Chou Chen from The University of Manchester said: “Our research clearly shows that opioid prescribing could be linked to patient deaths in England.

“This is worrying as we already know that prescribing for these drugs has increased hugely over the past decade.

“Chronic pain, often accompanied by anxiety and depression, is a serious public health problem and makes the lives of millions of people a misery.

“People desperate for pain relief seemingly take whatever opioids they can find whether prescribed or not.

“They may stockpile prescribed drugs, or get them from friends or neighbours. Some obtain them online. But the terrible consequences of doing this are now very apparent.”

He added: “Psychotropic medicines, such as gabapentinoids and antidepressants are commonly prescribed for patients with chronic pain.

“Our study also showed an increased risk of opioid-related death when opioids were co-prescribed with those psychotropic medicines, even though in most cases, opioidswere prescribed with a lower daily dose.”

Dr Li-Chia Chen, from The University of Manchester who leads the research team said: “There is actually is no evidence to suggest that opioid-based painkillers are able treat  many complex long-term pain conditions, though if used appropriately for acute pain such as surgical pain they are extremely helpful.

“We think the guidance for doctors on opioid dosing should be much more detailed. But patients too need more knowledge about the dangers of overdosing on these drugs.

“We also believe better monitoring and systems should be in place for the disposal of these drugs.

“And clinicians should think very carefully about opioids prescribed ‘as required’, because these often stay in the cupboards of patients and are never returned to pharmacies.

“Most importantly, patients need to be offered other alternative options for managing their chronic pain, as the recent NICE chronic pain guidance suggests, and avoid long-term pharmacotherapy as a mainstay for chronic pain management.”

The paper Association between opioid-related deaths and prescribed opioid dose and psychotropic medicines in England: a case-crossover study is published in .

The Humanising Healthcare programme gives dentistry, pharmacy and optometry students the chance to deliver healthcare and healthcare education to poorer communities as part of the curriculum.

The MacJannet Prize for Global Citizenship, launched in 2009, recognizes exemplary university student civic engagement programs around the world and is a key element in the MacJannet Foundation’s work to build a community of global citizens.

The prize is sponsored jointly by the MacJannet Foundation and , a global association of 388 universities in 77 countries on six continents, all committed to developing student leaders who are actively engaged with society.

The Selection Committee said they were impressed by the initiative and wished to recognize and support the continued civic and community engagement work.

The scheme built on the success of a dentistry Service-Learning programme called ’, established in 2012 by Dr Senathirajah (Raj) Ariyaratnam and shortlisted for the 2018 MacJannet prize for Global Citizenship.

The work extended to pharmacy and optometry education to create the ‘Humanising Healthcare’ programme.

Dr Ariyaratnam said: “Humanising Healthcare is based on the premise that we cannot create excellent healthcare professionals of tomorrow without creating engaged ones.

“Our goal is therefore to support students to deliver essential healthcare and healthcare education to different communities as part of the curriculum.

“But it’s also about encouraging global volunteering while creating a workforce characterised by civic values and skills that have direct community benefit in meeting health challenges.”

Up to 2019, when COVID-19 struck, around 1,000 dental students treated 38,720 paediatric and 140,800 adult patients respectively over 10 years as a core part of the curriculum.

And 150 students volunteered in 15 countries across the world to provide oral health care and education to thousands of people under the supervision of the local dentists.

Working with students to co-design bespoke healthcare services in the UK, they helped refugees and asylum seekers, LGBTQ+ community members and native non-English speakers.

During the pandemic, dental students provided online support to Chinese and Tamil speaking 91ֱ�� communities which was extended to provide quality COVID information for hard-to-reach communities North Sri Lanka.

In 2019 the University hosted the UK’s first national Service Learning in Healthcare conference; as a result, a UK healthcare Service-Learning framework is now being developed.

Students organise an annual ‘DentMan’ conference to share their community experience with peers and to inspire future generation. The 2021 conference strengthened links with students and teachers at the University of Ghana.

The year three pharmacy curriculum was transformed to deliver healthcare awareness raising workshops to local 14 and 15-year-old school pupils.

Since 2017, over 400 pharmacy students have delivered 100 workshops to over 3000 pupils as part of the assessed core curriculum.

Topics include antibiotic resistance, mental health, wellbeing, diabetes, obesity and alcohol awareness. The workshops were well received by both high school pupils, teachers and the students delivering them.

Dr David Allison a Reader in Pharmacy Education at the University said: “We aim to help improve the health of the population by raising awareness of healthcare issues that start in adolescence

“It also gave our students an opportunity to give something back to society, and enhance their community engagement skills and sense of civic responsibility.

“ This is a unique, beneficial and enjoyable learning experience for our students; it is the first example of Service–Learning as a core curriculum activity in any UK School of Pharmacy”

An optometry clinic within the University has been running in 91ֱ�� as part of the optometry programme since 1913.

The clinic is a service learning centre that provides community eye care services to the local population while allowing students to gain valuable experience through providing the service.

Students and staff regularly engage with local schools and public through a series of activities. And more than 400 students have engaged with international and national charities to help raise eye health awareness.

The study of English data in the journal shows how people in our towns and cities divided by deprivation are also divided by opioid use.

Lincolnshire East was the most unequal clinical commissioning group area in England: the level of prescribing for most deprived areas was twice as much as those in the least deprived areas. It contrasts markedly with nearby Lincolnshire North.

They also showed:

• Prescribing in the most deprived areas in North England was 1.2 times higher than the national average for areas with similar deprivation levels and 3.3 times higher than the most deprived areas in London.
• Prescribing in the most deprived areas was substantially higher than the least deprived areas. On average it was 9.70 Defined Daily Doses/1000 people/day higher.
• In the most unequal Clinical Commissioning Group area, prescribing in the most deprived areas was twice that of the least deprived areas.

Led by PhD researcher Magdalena Nowakowska, the team used sophisticated statistical analysis linking different datasets to observe GP prescribing in 32,844 geographical units, each representing an average of 1,500 people in England, across 195 CCG areas.

Deaths from overdosing and dependency on the class of drugs which include Fentanyl, Morphine, Oxycodone, Tramadol and Codeine have risen dramatically in the West over the past two decades.

Though researchers and policy makers know that prescribing is associated with higher deprivation levels, this is the first time the patterns of this relationship across the country have been fully mapped.

East and South Lincolnshire, Fylde and Wyre, East Riding and the Wirral were the top five CCG areas with the biggest differences in prescribing.

Significant differences in prescribing within CCGs may suggest that policies and interventions at a smaller level, addressing specific communities may be needed.

However, say the team, the observed variations in opioid prescribing may reflect wider issues with social, economic and health inequalities which also need to be addressed.

“Much is known about increasing opioid prescribing and opioid-related deaths, but this study adds greater understanding of its association with deprivation”, said Professor Evan Kontopantelis, from The University of Manchester

Magdalena Nowakowska said: “Knowing where exactly which populations are being prescribed more is a powerful way to guide policy responses and interventions so they can allocate resources to areas with highest levels of opioid prescribing.”

“CCG areas have populations of 100,000 to 500,000 people, so these large units can’t really describe the experience of the people who live there.”

“However, the smaller units we used, using some novel methodological approaches and datasets, can give a more accurate picture – which can be incredibly useful for policy makers.”

The team measured opioid prescribing in Defined Daily Dose, a statistical measure devised by the World Health Organisation which allows researchers to compare drug usage between different environments.

They modelled the effect of socioeconomic deprivation on opioid prescribing controlling for population demographics and the prevalence of specific health conditions using data from 2018 and 2019.

The Index of multiple deprivation used by the team is recognised as an accurate measure, and uses health, public services, education, crime, and other factors.

She added: “We didn’t look specifically at why there are such stark differences within relatively small geographical areas, people living in more deprived areas are more likely to experience more complex health needs and poorer access to alternatives for opioids are likely to help explain the disparities.

The study was funded by the NIHR School for Primary Care Research and the NIHR Greater 91ֱ�� .

The paper Association of Socioeconomic Deprivation with Opioid Prescribing in Primary Care in England: a Spatial Analysis is published in 

Prescriptions for the addictive drug codeine jumped by a factor of five between 2006 and 2017, a University of Manchester study of 2 million opioid users has shown.

Other opioid drugs such as tramadol and oxycodone were used less commonly, but had even steeper rises over the same period.

Additionally, one in seven of all new opioid users became long-term users within the first year.

While opioid prescribing for non-cancer pain has risen in the U.S. and Canada, trends over time and factors associated with long-term use have been less clear in the UK.

Overall, 14.6% of patients with new opioid prescriptions became long-term users starting in their first year.

Physician prescribing behaviour has been implicated as a key driver of rising opioid prescriptions and long-term opioid use.

However, some argue that increasing prescriptions reflect the needs of the individual patient or the local population.

The study, one of the largest of its kind in the UK and published in PLOS Medicine, used depersonalised patient data from newly prescribed-users for non-cancer pain from general practices.

It showed:

• A five-fold increase in codeine prescriptions from 484 prescriptions per 10,000 in 2006 to 2,456 per 10,000 in 2017.
• A 30-fold increase in oxycodone prescriptions from 5 per 10,000 in 2006 to 169 per 10,000 in 2017
• And a seven-fold increase in tramadol prescriptions from 101 per 10,000 in 2006 to 690 per 10,000 in 2017

Individual factors such as having fibromyalgia, rheumatological conditions and history of substance, alcohol abuse, self-harm/suicide as well recent major surgery and social deprivation were also linked by the researchers to long-term opioid use.

After accounting for individual factors, three of the 10 UK regions were associated with a higher risk of long-term use: the North-West at 15.8%, Yorkshire at 15.3%, and the South-West at 15.2%. Additionally, 25.6% of GP practices were associated with a high proportion of long-term opioid use.

Dr Meghna Jani, from The University of Manchester was lead author on the paper. She said: “The opioid crisis in the US is well-known and well researched, however it has been unclear how the UK compares.

“These figures show that UK prescribing of opioids, especially codeine has increased considerably in recent years, while others such as tramadol have started to plateau.

“All opioids have a potential for dependence and addiction, a fact that has been highlighted by the recently through stronger warnings to patients starting these drugs.

“Importantly after adjusting for individual patient differences, prescribing practices resulting in long-term opioid use differ considerably across the country.

“Social deprivation, certain conditions such as fibromyalgia, rheumatological conditions, after major surgery and high initial opioid dose were amongst factors associated with long-term opioid use.”

“Given the potential harms of these drugs, we think it is imperative to promote safe practices in prescribing opioids and reduce the variability we observed between in regions, practices and prescribers.

“One way to do this would be to harmonise prescribing practices across regions through future well-researched policies. The other would be developing targeted interventions in high risk groups including areas of social deprivation and for those undergoing major surgery.”

Professor Will Dixon, Director for the Centre of Epidemiology Versus Arthritis said “Chronic pain is estimated to affect more than 40% of the UK population.

“The frequency of this common problem hasn’t changed noticeably in the last decade, yet these new results show that the use of opioids for treating pain have escalated considerably.

“It is always vital to balance the benefits and potential harms of treatments. The variations in opioid prescribing shown here, even allowing for differences in types of disease and other factors, means there is room for improvement.”

• If you are a patient and are taking opioids, do not stop your medication as that might be dangerous. Always speak to your doctor first.
• The study was limited to patients prescribed opioids in primary care and does not include opioids available over the counter, in hospital or drug treatment centres.

The  paper Time trends and prescribing patterns of opioid drugs in UK primary care patients with non-cancer pain: a retrospective cohort study is available

A research team from the Universities of Manchester, Nottingham, and UCL evaluating a service delivered by pharmacists since 2011 have calculated it will save the English NHS around £651 million.

They also show it will allow patients to enjoy around 278,700 more quality adjusted life years, a long term measure of disease burden used by health economists.

Since the inception of the New Medicine Service (NMS), the team say community pharmacists in over 12,000 pharmacies have delivered 5.7 million consultations between 2011 and 2018.

NMS works with patients who are prescribed medicines for asthma and COPD, high blood pressure, Type 2 diabetes or are taking anticoagulant therapies such as warfarin.

The NMS, in which pharmacists follow up patients with a telephone call after 7 to 14 days, and then again 2-3 weeks later, aims to support people taking a new medicine prescribed by their doctor.

The NMS came about after the discovery by psychologists working with the research team that the decision to adhere to a medicine is often made in the first 2 weeks of it being prescribed.

The team developed the ideas behind the NMS in the late 1990s, and were influential in the decision by the Department of Health to start the scheme.

The team of pharmacists, GPs, patients, policymakers, health economists and health services researchers, ran a trial of the NMS, with 504 people in 46 pharmacies.

Their paper in 2016 showed that 11% more patients adhered to their medication regimen after 10 weeks when they used the NMS.

The present study, published in , also followed up the same patients after 26 weeks, and showed that an extra 9% still stick their regimen, when they used the NMS.

However, because 66 people dropped out of the study after 10 weeks, the figures were not statistically significant. The cost to the NHS of paying community pharmacists to deliver NMS (£25) was absorbed by small reductions in other NHS contact-related costs.

The economic evaluation concluded that in the long-term, this improvement in adherence would still lead to reduced overall costs to the NHS and improved long-term health for patients.

Lead researcher from The University of Manchester Professor Rachel Elliott said: “The New Medicine Service has proved to be a simple, deliverable intervention which helps patients and saves the NHS money.

“The NMS workload had been absorbed into busy community pharmacists’ daily routines alongside existing responsibilities with no extra resources or evidence of reduction in other responsibilities.

“It’s not always easy for doctors to determine if their patients are sticking to their drugs regimen.

“As health care professionals, we sometimes underestimate the problems patients face around their medicines. Patients often decide to stop taking their pills when they see no difference in their symptoms, experience side effects, have found information from other sources such as the internet, or can’t afford prescription charges.

Professor Elliott added: “The results of this longer-term follow-up suggests NMS helps people when the medicine is started, and some effect lasts for quite a long time. However, reviewing medicines-taking, for example every six months, is probably needed to continue the support patients need around taking medicines.

“And we think clinical pharmacists, now often based in primary care doctor’s practices may be able to integrate NMS, and follow-up support, into their role.

“In addition to that, there are other medicines which we know patients are less likely to adhere to: for example, from talking to patient groups we know that mental health medicines, eyedrops and statins could also be candidates for the NMS.”

Dr Boyd, Co-project lead from the University of Nottingham said “The way patients access healthcare is changing. This work highlights the valuable contribution pharmacists make in protecting valuable NHS budget and improving outcomes for patients.”

is publishd in BMJ Qlaity and Safety

Community pharmacy staff are to be offered training on suicide prevention, based on findings from a new study published today. As a result, a first of its kind training video has been developed and will also be available from today to mark World Suicide Prevention Day.

The research from the National Institute for Health Research Greater 91ֱ�� Patient Safety Translational Research Centre's () mental health theme was published in the journal, .

The team conducted in-depth qualitative interviews with 25 community pharmacy staff and identified 6 key themes. The first two; relationship with patient and suitable pharmacy environment formed a basis for interacting about suicide. If supported by training, staff felt that they could maximise opportunities for contact. The need to create facilitated referral pathways and understand more about restricting access to means was recognised.

Dr Hayley Gorton who led the research team whilst at The University of Manchester, said: “This is the first qualitative interview study which has explored the important role of community pharmacy teams in suicide prevention. Our research discovered that, staff felt they could do more to support individuals if they were given training.

“It is heartening to see that pharmacists and their teams recognise that they can contribute to the suicide prevention agenda and welcome training to support them to do so.”

Community pharmacists are the most visited healthcare professionals in the UK, with pharmacy teams caring for over 1.6 million people in England alone every day. Yet, these teams are seldom mentioned in the suicide prevention plans, which are a current national and global priority.

Dr Gorton has worked with the Centre for Pharmacy Postgraduate Education (CPPE) to make the training a reality. They have produced a suicide awareness learning video aimed at pharmacy teams.

The innovative training video aims to prompt pharmacy staff to reflect on their current role in suicide prevention, and what it might be in the future. Three special guests, who speak about their experience in relation to suicide, also provide learning messages.

Dr Gorton, added: “We hope that the CPPE suicide awareness learning video is the first step in supporting our colleagues to have potentially life-saving conversations.”

The GM PSTRC mental health theme is also launching a campaign today to mark World Suicide Prevention Day, #seedsofhope with a photographic exhibition at 91ֱ�� Town Hall. Pictures carefully selected by members of the mental health theme’s patient and carer involvement group to represent what hope means to them will be on display for the day from 10:30 until 17:30. Everyone who visits will receive a packet of seeds. Once planted pictures of the plants growth can be tweeted with using #seedsofgrowth to raise awareness of the research underway by the PSTRC to make a difference to the treatment of mental health.

The first evaluation of pharmacists based in accident and emergency departments has concluded that with additional clinical skills, they are able to take on overall clinical responsibility for patients.

Daniel Greenwood a PhD student from The University of Manchester studied the work of people they termed Emergency Department Pharmacist Practitioners (EDPPs) from 15 NHS Trusts across the UK over 10 days.

The research, published in the I, observed the care they provided to 682 patients, and their contribution to the wider department, using an iPad-based questionnaire.

Because A&E doctors and nurses are in short supply, hospitals have started to employ pharmacists who have additional clinical skills to help deliver services since 2015.

Eleven EDPPs took on the role of designated care provider for at least some of their patients.

All 20 EDPPs carried out both ‘traditional’ and ‘practitioner’ activity; 9 of them sometimes provided more ‘practitioner’ than ‘traditional’ care to individual patients.

Of all 682 patients, EDPPs examined 264 (38.7%) and diagnosed 238 (34.9%).

Daniel Greenwood said: “This study shows that Emergency Department Pharmacist Practitioners can combine traditional clinical pharmacy with more hands-on medical practice including being designated care provider.

“No other A&E professional has the same medicines expertise.

“EDPPs who work as a designated care provider can fill gaps in doctor and nurse practitioner rotas, something that can only be welcomed given ongoing staff shortages.

“But they can also provide pharmaceutical care that is lacking in some departments, such as checking prescriptions.

He added: “The EDPPs we studied performed a wide range of rolls including performing or reviewing clinical examinations, diagnosis, prescribing, treatment and discharge.

“They worked as members of multidisciplinary teams, supporting and being supported by others. And they often took on overall responsibility as the patient’s designated care provider.

“There is no doubt that pharmacists with additional clinical skills training have a role to play in A&E departments.”

Victoria Bray has been Advanced Pharmacist Practitioner Emergency Medicine at Kings College Hospital for 4 years. She cares for patients with minor illness and injury as well as more acutely unwell adults, seeing, she says, between 15 and 25 patients per shift.

She said: “I have been able to experience first-hand the value that pharmacists can bring to patient care in the ED both as a practitioner and a clinical pharmacist.

“Pharmacists have the knowledge and skills to personalise a patient’s pharmaceutical care plan or to become the patients designated care provider, both supporting the multi-disciplinary teams and to act in an advanced capacity to relieve pressure secondary to staff shortages.

“I find my strength is in managing acute and urgent medical illnesses such as infections, pain, exacerbations of asthma and COPD and electrolyte disturbance, all of which require strong pharmaceutical knowledge as well as the application of assessment and diagnostic skills and interventions.

“And I also value the difference I make to a patients journey and the direct impact I am able to have to their healthcare.”

English patients living in poorer areas are likely to be prescribed more opioids by their GPs, according to a study led by University of Manchester and University of Nottingham researchers.

The research also shows how smoking, obesity and depression are all associated with more prescribing of the drugs for problems such as lower back pain and arthritis.

The study, published in the today, is a snapshot of 2015 data from the Office of National Statistics’ Index of Multiple Deprivation and a NHS Digital’s database of about 7,000 GP practices.

Also according to the research team, three out of the highest five GP areas for opioid prescribing are based in the North West of England.

GPs in NHS Blackpool CCG and NHS St Helens CCG prescribe the highest levels of opioids in England. One area in North East England and four areas in the North West are among the top ten highest prescribers.

Lead researcher , a Senior Lecturer at 91ֱ��, says the study is the first to quantify the association between opioid use and socioeconomic status in England.

Opioid overdosing of drugs including Fentanyl, Morphine, Oxycodone, Tramadol and Codeine have risen dramatically in the West over the past two decades.

However, the association between mortality and opioid use is not easy to study, as the official definition of opioid-related deaths is not the same as opioid-overdose death. Also, GP records do not capture the full picture of prescription opioids use.

Ranking English areas into 10 levels of deprivation, the average use of morphine increase 100 mg per 1000 patients per day when going from wealthy to poor by just 1 level.

An increase in numbers of smokers of just 1% is associated with an increase in the average use of morphine by 130 mg per 1000 patients per day.

An increase in numbers of patients with depression of 1% is associated with an increase in the average use of morphine by 43 mg per 1000 patients per day.

And an increase in numbers of obese patients of 1% is associated with an increase in the average use of morphine by 36 mg per 1000 patients per day.

Dr Li-Chia Chen said: “Chronic pain is difficult to manage and unfortunately, because their workload pressures are so stringent, GPs have limited capacity to counsel patients with persistent pain.”

“This might explain why drug therapy is the main way how GPs manage pain.”

“There’s no guarantee that long term use of opioid analgesics can resolve chronic pain. Indeed the risk of opioids’ side-effects such as dependency, respiratory depression and immunosuppression may sometimes outweigh the potential benefits.”

She added: “Social prescribing such meditation and acupuncture may be helpful, but little is available on the NHS.”

“We also feel it is essential to integrate pain management services with an interdisciplinary team approach.”

“Pharmacists could also play a vital role in pain management and, in our view, are an underused resource.”

Co-author Dr Roger Knaggs, Associate Professor in Clinical Pharmacy Practice at the University of Nottingham said: “Opioids are some of the most potent medicines for pain relief available at present, however they do not work for all types of pain or for everybody.

“Whilst they often are of help for pain following injury or an operation, and for pain at the end of life, there are only modest benefits for many types of chronic pain, such as back pain, arthritis and nerve (neuropathic) pain.”

“The results from our study confirm the substantial variation in opioid prescribing throughout the UK from two other studies published earlier in 2018.

“We need to understand more about why opioids are prescribed more commonly in areas of greater deprivation and to ensure there is collaboration between different parts of the healthcare system to provide appropriate services and support are available for people who are prescribed opioids.”

Co-author Dr Teng-Chou Chen, from The University of Manchester said: “This study shows that the socioeconomic status has a strong association with opioids prescribing for pain.”

“We suppose an average manual worker, which is common in socially deprived areas, is more likely to have musculoskeletal problems, and therefore needs opioids.”

“Smoking and depression are also more prevalent in poorer areas, but whatever the causes, it’s clear that people living in more deprived areas are at a higher risk of overdose, and it is helpful for clinicians to be aware of this.”

Dr Chen is also studying opioid prescribing internationally and will be publishing his results this year.

The highest 10 areas for GP opioid prescribing are:

1 NHS Blackpool CCG (North West)
2 NHS St Helens CCG (North West)
3 NHS Lincolnshire East CCG (East Midlands)
4 NHS Knowsley CCG (North West)
5 NHS Barnsley CCG (Yorkshire and the Humber)
6 NHS Corby CCG (East Midlands)
7 NHS Halton CCG (North West)
8 NHS Great Yarmouth and Waveney CCG (East Anglia)
9 NHS Doncaster CCG (Yorkshire and the Humber)
10 NHS South Tees CCG (North East)

A small but significant minority of people who use illicit opioids such as heroin may unknowingly be using a powerful and potentially harmful synthetic opioid that has been linked to a number of deaths.

This is according to the results of a pilot study carried out by health and social care charity and researchers from The University of Manchester, which is published for the first time this month in the Journal of Clinical Toxicology.

The study was launched to improve understanding of the health risks facing people who use illicit opioids and the steps that could be taken to mitigate these. For the research pilot, more than 460 adults receiving treatment from Change Grow Live, one of the UK’s main providers of drug and alcohol treatment, were additionally screened for the presence of fentanyl.

While fentanyl is a very widely used and valued medication, that is legitimately prescribed for people in pain, around the world it is increasingly being sold illicitly.

The results showed a fentanyl-positive rate in adults receiving treatment for opioid use of three per cent. Of those who tested positive for the presence of fentanyl, a majority (80 per cent) was unaware of having purchased or used fentanyl.

The study was conducted at 14 Change Grow Live sites across all nine geographic regions of England. Urine screening was used to detect the presence of fentanyl, while self-report data was collected from individuals to determine whether fentanyl had been knowingly purchased and used.

The new research comes after official figures from the Office for National Statistics (ONS) released earlier this year showed an increase in deaths caused by fentanyl. The official figures showed that fatalities involving fentanyl increased by 29 per cent from 2016 to 2017, from 58 to 75 deaths.

The research builds on Change Grow Live’s work to understand the growing threat posed by fentanyl. Sparked by the charity’s direct experience of managing and learning from fentanyl-related issues in its cohort of service users in collaboration with Volteface, the independent organisation that covers the policy and politics of drugs, it convened an expert round-table last year to discuss the most effective methods of addressing the lethal threat posed by fentanyl and similar substances. The resulting action plan included recommendations for drug and alcohol treatment providers and those who commission their services based around three key areas: prevention; detection; and control.

Commenting on the research findings, Dr Prun Bijral, Medical Director at Change Grow Live and lead author of the report, said:

“As with any pilot study, the findings need to be kept in perspective and we should be cautious about drawing definitive conclusions. However, in spite of these important caveats, this research was carried out across each of England’s nine regions and we can therefore reasonably say that it does give us an indication of the possible prevalence of fentanyl, where previously there was an absence of data.

“The data suggests that fentanyl is not only present in England, but may be more widespread than originally thought. Although we are not yet seeing a problem on the scale of the USA and Canada, there is no room for complacency.

“We need to build on the work and efforts already underway across the public health landscape, from ensuring that warnings about the prevalence and dangers of fentanyl are adequately communicated and understood, to exploring all options to reduce the risks of drug-related harm including the optimisation of medication-assisted treatment to address problematic opioid use, and distributing naloxone, a drug which can save lives in the event of an overdose situation.”

Professor Tim Millar, Professor of Substance Use and Addictions at the University of Manchester, said:

“Although it is difficult to reach definitive conclusions on the basis of this preliminary pilot study, we think it is important to highlight the possibility that there may be more fentanyl in circulation than many people, us included, had thought. We’re in the process of planning a more comprehensive, larger study that will help to clarify these initial results.”