Early results from the community pharmacy independent prescribing (IP) pathfinder programme show that the community pharmacy is increasing patient access to advice and medicines for acute and long-term conditions, according to an audit presented by Paula Wilson (Strategic Pharmacy Leader, NHS Midlands and Lancashire Commissioning Support Unit).

From 2026 onwards, all newly-registered pharmacists will be qualified as Independent Prescribers. In preparation for this development the Independent Prescribing in Community Pharmacy Pathfinder programme was set up, in selected sites, and went live in September 2024.  The purpose of the programme was to explore how community pharmacists and their teams could deliver integrated clinical services aligning prescribing activity with general practices and the population needs of local communities. The results from the pathfinder sites will be used to inform a commissioning framework for IP.

The data from 171 pathfinder sites were analysed for the period August 2024 to July 2025. A total of 30,351 consultations was recorded with 55% resulting in a prescribing decision – starting (42.3%), changing (10.2%), or stopping (2.9%) a prescription.  In total, 98.6% cases were closed by the pharmacist.  A number of different of clinical models or services were involved. By far the most common was for minor ailments (68%) followed by prescription management (8.4%), hypertension (7.5%) and lipid management (5.6%). The majority (79.7%) of consultations were completed face-to-face. Telephone consultations accounted for 17.8%. The average time taken for completion of a consultation was 22 minutes.

The authors concluded that the IP programme offered patients convenient appointments of longer duration than typical GP appointments and comparable to those offered by PCN pharmacists. As a result of the service, many patients did not need appointments with GPs. It is anticipated that a national roll-out will increase prescribing capacity in primary care, potentially increasing patient services, access and choice in the future.

Wilson P, Baqir W, Sidhu J, Titterton J, Dance J, Hampshaw S, Haydar G, Crouch T, Pearson H, Dulay M, Hobbs C Joshua A, Horgan J. Wearly findings from the Community Pharmacy Independent Prescribing Pathfinder Programme in England. Clinical Pharmacy Congress North, November 2025

Photo: Paula Wilson

National prescribing of transdermal and vaginal HRT and micronised progesterone increased while prescribing of oral HRT decreased after the documentary Sex, Myths and the Menopause, presented by Davina McCall, was aired, according to Dr Rosie Adsley (Assistant Professor in Pharmacy Practice, Nottingham University).

The Channel 4 documentary aired in May 2021 and provoked a large public response which was dubbed ‘the Davina effect’. The purpose of this study was to investigate prescribing trends for HRT before and after the documentary to examine whether the public discussion and awareness of menopause management had any impact on HRT prescribing.

Data on HRT prescribing over the period February 2019 to January 2024 were collected from the Open Prescribing Database.

The results showed that from April 2021 to January 2024:

• There was a 21% decrease in prescribing of oral conjugated equine oestrogens (CEE) and a 2% decrease in oral oestradiol prescribing
• Prescribing of transdermal combined HRT quadrupled with a sharp up-tick after May 2021
• Prescribing of transdermal oestrogen-only HRT more than tripled with a sharp up-tick after May 2021
• Prescribing of micronised progesterone capsules increased more than four-fold with a sharp up-tick after May 2021
• Prescribing of vaginal oestrogen-only HRT increased by 61% with a sharp up-tick after May 2021

Adsley R, Gonet D Mofunanya B. Prescribing trends of hormone replacement therapy (HRT) from 2019-2024 and ‘the Davina effect’. Clinical Pharmacy Congress North, November 2025

Photo: Dr Rosie Adsley

A drug-eluting implant has been shown to reverse cystoid macular oedema and reduce the need for systemic treatment in 80% of uveitis patients according to a real-world study presented by Ann-Marie Goacher (University Hospitals Sussex).

Uveitis is an inflammatory condition that affects the middle part of the eye (the uvea or uveal tract). It is often associated with systemic inflammatory (auto-immune) disease but many cases are idiopathic. Although uveitis is relatively rare it is important because it is a sight-threatening condition. Treatment involves the use of corticosteroids (first line) and immunosuppressant treatment (second line).

Iluvien (Alimera Sciences Ltd), a fluocinolone acetonide intravitreal implant has been developed to provide a continuous microdose of corticosteroid over an extended period.

The present study was undertaken to determine how these implants perform in a real-world setting.

Patient data for a five-year period were reviewed. This involved 45 eyes from 34 patients, 65% of whom were female.

Key findings included:

• The mean time to treatment failure (reactivation of disease) was 15 months.
• At 6 months, 80% of patients had a resolution of cystoid macular oedema.
• 84% of patients on systemic treatment were able to reduce their doses and 15% were able to stop all systemic treatment
• 58% of patients experienced improved vision.
• 14 eyes developed cataracts, a known complication of corticosteroid treatment; all had previously received dexamethasone implants.

The authors concluded that Iluvien offers significant benefits in managing inflammation and improving visual outcomes.

Goacher A-M, Ortiz G, Hughes E, Davidson C. Evaluating the use of Iluvien in uveitis patients in a real-world clinical setting. Poster presentation. Clinical Pharmacy Congress North, November 2025

Photo: Ann-Marie Goacher

Impedance flow cytometry is a quick and easy method for estimating the numbers and viability of bacteria in faecal microbiota samples, according to Anne-Christine Joly (Saint Antoine Hospital, Paris).

Pharmaceutical preparation units need rapid, economical methods for testing of faecal microbiota transplant material. It is possible to estimate the total microbial load and viability using flow cytometry but this is costly and complex to implement. The technique requires fluorescent labelling of cells. Impedance flow cytometry (IFC) counts and analyses cells by measuring variations in electrical current as they pass individually through an electromagnetic field. This study aimed to compare IFC with the current reference method (culture) to determine its usefulness for routine use.

Twenty stool samples, 10 from healthy donors and 10 from patients, were analysed by both methods. The results showed that there was no statistical difference between the two counting methods. The researchers concluded that the high degree of concordance between the results suggested IFC would be a robust method for estimating total bacterial concentration and viability. IFC has the advantage of not needing specific [fluorescent] markers. However, it cannot identify bacterial species, noted Mme Joly.

Sintes R et al. Evaluating microbial viability differently: impedance cytometry versus culture. Short communication. GERPAC Congress 2025

Photo: Anne-Christine Joly.  Photo – courtesy of GERPAC

Cyclodextrin-based chlorhexidine eye drops represent a promising approach to formulating stable and effective treatments for Acanthamoeba keratitis, according to researchers from the University of Picardy Jules Verne.

Acanthamoeba keratitis is a rare but serious, sight-threatening corneal infection caused by the acanthamoeba parasite. Chlorhexidine has demonstrated efficacy against acanthamoeba but no eye-drop formulation was available. Moreover, the use of chlorhexidine digluconate (CD), the most soluble form, was limited due to precipitation (of chlorhexidine hydrochloride) in the presence of chloride ions in vivo. In 2024 Akantior® eyedrops (polyhexanide 0.08%) were approved for this indication. Akantior was designated as an orphan medicine. Professor Frédéric Marçon noted that Akantior costs about €8,754 for 30 vials of 0.3 ml. The present study screened a number of cyclodextrins for their ability to form inclusion complexes with CD that would effectively protect the chlorhexidine from precipitation in saline conditions. Two suitable products were found and further investigations showed that they could be formulated as eyedrops and that the antibacterial activity of the chlorhexidine was preserved in vitro.

In vitro conditions may not reflect conditions in the eye and this could influence the efficacy of the formulation. Professor Marçon said that another important consideration was that acanthamoeba parasites tend to encyst in the cornea.

Professor Irene Kraemer said that at the University Hospital of Mainz they prepare polyhexanide eyedrops for this indication in a different strength from the commercial product.

Sebastian Rigaud et al. Formulation of a Cyclodextrin-Based Ophthalmic Drug Solution of Chlorhexidine for the treatment of Acanthamoeba Keratitis. Short communication. GERPAC Congress 2025

Photo: Frédéric Marçon. Photo – courtesy of GERPAC

The use of licensed ready-to-use (RTU) gemcitabine in polypropylene infusion bags (Sun Pharma) is associated with fewer carbon emissions than in-house compounding from glass vials, according to Dorian Protzenko (Centre Hospitalier Intercommunal des Alpes du Sud).

The researchers conducted a “cradle-to-grave” analysis of the carbon emissions associated with each product, taking into account the active pharmaceutical ingredient (API), excipients, packaging, upstream and downstream transport, formulation losses, consumables and disposal.  Carbon emissions were calculated using standard methods – Ecovamed© 2025, Carebone© v2.3 and in-house hospital data.

The results showed that RTU gemcitabine bags were associated with carbon savings of 40-60% per dose compared with traditional in-house preparation of doses. Major factors in the carbon savings were the switch to lightweight plastic containers (~42%), the elimination of sterile consumable devices (~19%) and lower quantities of clinical waste incinerated (~14%).

The researchers concluded that replacing glass vials of gemcitabine with the RTU bags reduced the environmental impact with up to 1.7 Kg of exhaust gas carbon dioxide (EGCO₂) avoided per dose administered. This corresponds to the emissions generated by a 15-minute car journey in an average petrol vehicle.

Protzenko D & Plan A. licensed ready-to-use gemcitabine bags cut carbon emissions versus in-house vial compounding. Short communication. GERPAC Congress 2025

Photo: Dorian Protzenko. Photo – courtesy of GERPAC

A near-infrared (NIR) spectroscopic method for analytical checks of compounded anti-cancer drugs could replace the current double visual checks in future, according Julie Evrard (Groupe Hospitalier Artois-Ternois). The major advantage of the NIR method is that the measurements are carried out through the final container – a bag, syringe or elastomeric pump – and no sample is required.

An evaluation of a NIR device (Ayna Analytics) was undertaken to evaluate its performance under real-life conditions. During a three-month period 10 commonly-prepared drugs – five cytotoxic drugs and five monoclonal antibodies – were included. For each molecule, diluents and final containers were identified in order to establish the calibration curves. Up to 50 data points for each molecule are required for calibration. During the study double visual checks (“four eyes”) were continued.

Ms Evrard said that the analytical procedure took just two minutes. So far, this analytical procedure has been validated for routine use for daratumumab SC, rituximab SC and fluorouracil Neopump 48h. have been validated for routine use. The next step will be to finalise calibrations for the remaining molecules before extending the project to include other molecules and containers.

During the discussion one member of the audience said that in a department that prepares 70 doses a day, this technology could eliminate the need for a someone to perform the visual checks (second checks).

Evrard J. et al. Analytical control of anticancer agents via sample-free near infrared spectroscopy: first feedback. Short communication. GERPAC Congress 2025

Photo – Julie Evrard

3D-printed doses of melatonin 1mg cost approximately half as much as the same doses prepared by manual encapsulation, according to an economic evaluation by Lena Lemierre (MB Therapeutics & University of Montpelier) and colleagues.

A study compared two hospital-based manufacturing methods for personalised oral dosage forms – semi-solid extrusion (SSE) 3D printing and traditional capsule compounding.  Resource inputs were calculated for preparation of 600-unit batches by each method. The 3D printing process relied on semi-solid extrusion of an industrially validated pharmaceutical cartridge, followed by drying within the printer (MED U PROD 1.0 ® – MB Therapeutics). Manual capsule preparation was carried out using a 300-capsule filling plate.

The costs for each dose were €1.55 (capsules) versus €0.72 (printed oral doses). The staff time required was: 35 min for analysis of printed forms (mass control only), versus 4 h 30 min for capsules (mass and content uniformity testing). HPLC analysis accounted for a large proportion of the cost of the capsules.

The authors concluded that the results demonstrated the potential of SSE 3D printing as a faster and more cost-effective alternative for hospital manufacturing of personalised oral dosage forms. The significant reduction in production time, particularly during analytical phases, enables more efficient use of human resources.

Lemierre L. et al. Techno-Economic Comparison Between Semi-Solid Extrusion 3D Printing of Oral Forms and Capsule Compounding in a Hospital Setting. Short communication. GERPAC Congress 2025

Photo – Lena Lemierre

The successful development of fenfluramine-loaded albumin nanoparticles paves the way for nasal administration of fenfluramine in drug-resistant epilepsy in children. Nasal administration would deliver the drug to the brain via the olfactory and trigeminal nerves and avoid significant hepatic metabolism to norfenfluramine which is cardiotoxic, explained Maxime Petit.

Successful nasal delivery of a drug depends on having a small volume and a prolonged residence time in the nasal cavity, to overcome mucociliary clearance. This calls for a formulation that combines a high concentration of the drug and a gelling agent or muco-adhesive.

In this study fenfluramine-loaded albumin nanoparticles were prepared and dispersed in an aqueous solution of pectin to make a final drug concentration of 10mg/mL. The particles were 107-135nm making them small enough to pass through the nasal mucosa. A stability study showed that 18.6% of the fenfluramine was released after three hours, indicating that the majority of the drug remained encapsulated. Local cytotoxicity (cell lysis) was assessed by measuring lactate dehydrogenase (LDH) release from a suitable cell line, as a model for nasal epithelium. The results showed that fenfluramine alone caused extensive cell lysis whereas with the nanoparticle formulation it was negligible.

The authors concluded that the sizes of the nanoparticles and the concentration of fenfluramine made the nanoparticle formulation suitable for therapeutic use. They plan to complete physicochemical studies before starting in vivo studies in mice.

Petit M et al. Development of fenfluramine in albumin nanoparticles for nasal administration. Short communication. GERPAC Congress 2025

Photo – Maxime Petit

Five studies were included, reporting the experiences of more than 7000 women with a variety of occupations within the NHS. The results showed that in addition to hot flushes, the most troublesome symptoms were brain fog, anxiety, poor concentration, fatigue and poor memory. Vasomotor symptoms were particularly difficult to manage because of the lack of ventilation in many clinical areas combined with standard uniforms of thick fabric and the need to wear personal protective equipment (PPE). Anxiety was heightened by work pressures and insufficient breaks. As a result, the women tended to take more sick leave, changed their working hours or even resigned.  According to one report in 2023, menopause-related occupational changes were estimated to cost the NHS £116,000,000 annually for nurses, midwives & health visitors alone.¹

The authors made three recommendations to mitigate the impacts described:

• Offer flexible working
• Increase support and education available for both employees and employers
• Supply uniforms that are more suitable for menopausal women

Dr Carding said: “There remains a marked lack of menopause education within undergraduate medical curricula, despite its profound impact on health, wellbeing, and healthcare systems. This project is particularly important in drawing attention to how menopause affects NHS clinicians, and in emphasising the need for better training and support. It has therefore been a privilege to supervise Isobel, a third-year medical student at The University of Manchester, whose enthusiasm and rigour highlight the important contribution that students can make in addressing this gap. Through this work and at Newson Education, where I serve as Education Lead, we are committed to advancing this agenda by developing high-quality, evidence-based resources that equip learners and healthcare professionals with the knowledge and confidence they need. Further information can be found at www.newsoneducation.co.uk.”

Ms Blanksby commented: “The impact of menopause on the NHS workforce is felt by many but spoken about by few. This project was a valuable opportunity to explore the wider effects of menopause and to develop recommendations that may help support NHS staff”.

References

The Strategy Unit.  Menopause and the NHS workforce.  October 2023 https://www.strategyunitwm.nhs.uk/publications/menopause-and-nhs-workforce

Holly Carding is a GP and menopause specialist. She is Education Lead for Newson Education www.newsoneducation.co.uk

Anticholinergic burden (AB) or anticholinergic load (AL) refers to the cumulative effect of taking multiple medications with anticholinergic actions, which can lead to adverse effects, particularly in older adults, including cognitive impairment, falls, constipation and urinary retention. Two recent studies^1,2 explored the problems associated with anticholinergic burden and the impact of pharmaceutical interventions.

Mariam Hijazi and colleagues (University Hospital Getafe, Madrid, Spain) investigated the relationship between anticholinergic burden (AB) and the degree of chronic functional constipation (CFC) in patients admitted to the emergency department with at least one chronic medication.  They reported that one-third of the 65 patients included in the study met the criteria for CFC. The mean age of participants was 76 years and a large proportion (67.7%) had medication with a medium-high AB. Multivariate analysis revealed that AB was significantly associated with a higher probability of CFC diagnosis [OR=19.0 (95% CI,2.2–162.9) p=0.007], along with female sex [OR=4.1(95% CI,1.2–13.9) p=0.023]. Although more than a quarter of participants usually used laxatives, half of them still met the criteria for constipation, suggesting that laxatives may be ineffective in the presence of significant anticholinergic burden.

Bernikier and colleagues (Rochefort Hospital, France) focused on analysing the anticholinergic load (AL) of prescriptions in hospitalised patients aged 75 and older and the impact of pharmaceutical interventions (PI). AL was calculated at admission using a scoring system where each molecule received a score from 0 to 3 based on its anticholinergic effects. A prescription was considered to have a “high” AL if it contained at least one drug with a score ≥ 2 and/or if the overall AL exceeded predefined thresholds.

The study found that almost 40% (23 out of 60) of patients had a high AL at admission requiring a PI. Following PIs, which often involved switching to drugs with lower scores or discontinuing unnecessary treatments, a reduction in the discharge AL score was observed in 56% of patients. There was also a notable decrease in the number of patients taking drugs with the highest anticholinergic score (3) and a reduction in the number of patients exceeding the theoretical AL thresholds.  The authors concluded that the calculation for AL should be integrated into hospital reports and the information be passed to referring doctors.

These studies underline the role of pharmacists in identifying and managing anticholinergic burden in elderly patients. In the hospital setting, proactive pharmaceutical interventions can significantly reduce anticholinergic load at discharge, potentially improving patient outcomes. This can involve suggesting dose adjustments, medication switches, or discontinuation of non-essential anticholinergic medications.

References

1. Hijaz Vega M, Alonso-Zazo J, Cosin-Munilla L et al relationship between anticholinergic burden associated with medications and functional chronic constipation in patients admitted to emergency departments. (Poster) EAHP Congress 2025

2. Bernikier E, Giraudeau C, Arcizet J et al. Anticholinergic load: a better score for a gold prescription? (Poster) EAHP Congress 2025

Prescribing by hospital pharmacists is now well-established in a number of countries and there is evidence that stakeholders take a positive view of this development on hospital workflows and patient safety. A national expert taskforce in Ireland has recommended that hospital pharmacist prescribing (HPP) be initiated in Ireland in 2027. In preparation for this, the views of existing Irish prescribers (doctors, nurses, and midwives) need to be understood. Marie Richardson (University College Cork and Our Lady of Lourdes Hospital, Drogheda, Ireland) undertook a survey of doctors, nurses and midwives working in Irish hospitals to investigate their perspectives about HPP and its potential impact on healthcare delivery.

In total, 238 Irish prescribers responded to an anonymous online survey. The findings revealed overall support for HPP among the surveyed groups, who anticipated benefits such as reduced prescribing errors and improved workflows. However, the study also indicated varied levels of support for pharmacists prescribing independently in different clinical scenarios. For example, about 20% of respondents felt that a prescribing pharmacist should not prescribe a new medicine at all. Overall, the findings suggested a positive reception towards HPP among Irish prescribers, with an expectation of enhanced patient safety and efficiency.

References

1. Expert Taskforce. Expert Taskforce to Support the Expansion of the Role of Pharmacy Final Report [Internet]. Dept of Health; 2024. https://www.gov.ie/en/publication/f3b42-expert-taskforce-to-support-the-expansion-of-the-role-of-pharmacy-final-report/
2. Richardson M, Dalton K, Spooner M, Murphy K. Doctors’, Nurses’, and Midwives’ views of Hospital Pharmacist Prescribing: a Cross-Sectional Survey Study (Poster) EAHP Congress 2025