‘I am really delighted to be chairing this year’s Pharmacy Management National Forum for Scotland – even though it will be online. It is important that, having been through such a very difficult phase, we find ways to come together to share’


fact ‘doing something’ may introduce harms. To stand against this desire to take action requires us to be steadfast and ensure best practice.


SIgn worked closely with the clinical cell at the Scottish government to try and introduce that rigour and ensure that assessment, even of observational data and papers that weren’t yet published, was of a standard useful to help clinicians on the front line.


Angela Timoney


broader reach to improve patient care. In terms of cOVID, a number of things happened with SIgn. as pharmacists, we are used to the regulatory environment for medicines and have an expectation of the evidence base necessary to prompt a change in practice. We all like to work with prospective double blind, randomised controlled trials where we have an intervention group and a group that doesn’t receive that intervention. That is not what we were dealing with with cOVID. Instead of the highest quality evidence, we were often dealing with retrospective observational data of varying quality cohort and case control studies and sometimes simply case reports. That is inevitable where you have a virus that did not exist year ago. In addition, people think ‘you have to do something’ and in


Because the evidence was emerging rapidly, we worked quickly and we revisited guidance. One example was guidance around signs and symptoms of cOVID for primary care, because there really wasn’t any guidance on that. We worked closely with our academic colleagues at glasgow university, the first time SIgn had co- produced with an academic institution, and we did it over three weeks where normally it takes 24 to 30 months to produce a guideline. Because the evidence was of such poor quality, we didn’t make recommendations, but where we could, we pointed out where there was a strong association. This is what we believe the evidence tells us in terms of the patients that present to you. We then updated the guidance two months later and we are looking at it again. We were able to continue to do what SIgn does best and to work in an international context: the evidence comes from across the globe and then we put into the context of what works and what is most applicable to the nhS in Scotland.


I think that pharmacy, our knowledge of medicines, our knowledge of evidence, of how to apply evidence and how to critically appraise evidence, are well recognised. That


basic essential part of being a pharmacist – how we approach medicines – can be easily applied across all of the clinical spectrum and all therapeutic areas.


In terms of medicines for cOVID, it has been interesting and challenging. There haven’t been very many medicines found to be effective against the virus, but there was lot we had to do around standard critical care medicines. They were already available, but we have had to use them in doses that we wouldn’t normally use. There have been real challenges around end-of-life and palliative care medicines too, and pharmacists have been working to help to produce the best guidance for patients at a distressing time of their lives. That guidance played an essential role in supporting clinicians and patients, particularly in april, May and early June.


Then, as the evidence started to come through about the effective treatments – remdesivir,


dexamethasone and, more recently, hydrocortisone – our clinical colleagues asked us for our assessment of the data. I think dexamethasone is fantastic. It is a game changer and it is saving lives. Our assessment of remdesivir, however, is that it cuts hospital stays from an average of fifteen days to eleven days, and that makes it a different decision. cOVID has really challenged our skills as pharmacists and enabled us to practise at the forefront of our profession with issues that really matter.


Just as pharmacists have stepped up to the mark, so have pharmacy technicians, particularly around supply and distribution. Technicians


often run those services and have been fantastic. They need to be thanked for the part that they have played in the pharmacy service. I think, as we move forward, we now need to give some thought to the role of both professional groups, pharmacists and technicians, making sure that we play to our strengths and to our underpinning knowledge and skill sets.


I am really delighted to be chairing this year’s Pharmacy Management national Forum for Scotland – even though it will be online. It is important that, having been through such a very difficult phase, we find ways to come together to share. We need to ensure that physical distancing does not stifle networking and indeed supports innovation.


The conference programme is really robust. We have a broad spectrum of leaders of pharmacy in Scotland and I think that the attendees will want to hear what they are saying. I’m delighted that the newly appointed Director of the royal Pharmaceutical Society in Scotland, clare Morrison, is joining us. She is an innovator with a depth of knowledge about digital capabilities and a history of delivering rapid change across nhS Scotland. We also have alison Strath, Principal Pharmacist for the Scottish government and harry McQuillan from community Pharmacy Scotland.


Ours is actually quite a small profession and I’m really keen that we work as one integrated profession. The workshops are diverse and I hope that people will want to dip into sessions that are not always connected with their day jobs, to find out what’s happening elsewhere as well as developing their expertise in their own sphere of practice.


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