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Community pharmacists ‘critical’ to mainstreaming genomics, says geneticist

Community pharmacists should play a “critical” role in integrating genomics into mainstream NHS practice, a clinical pharmacologist and geneticist has suggested.

Professor Sir Munir Pirmohamed believes that community pharmacy has a role in integrating genomics within the healthcare system, he told C+D in response to a question asked at a Labour party conference session on personalised medicine earlier this week (September 26).

Although genomics has started to be used within the NHS to study “cancer and rare diseases”, Dr Pirmohamed believes “we’re just scratching the surface with genomics at the moment”.

Read more: What could a successful pharmacy pharmacogenomics service look like?

He believes that pharmacists should get involved with pharmacogenomic (PGx) testing – “whereby you use genomics to be able to make sure [patients] get the right drugs and right dose”, he explained.

This is one of the ways to bring genomics into practice, and one of the areas of “mainstreaming” the science that Dr Pirmohamed is currently working on.

It will be “critical” for community pharmacists “to be involved in the pharmacogenomic process and mainstream genomic medicine…working with other healthcare professionals [such as] doctors, nurses”, he added.


Testing in pharmacies?


Meanwhile, panellist Clare Kingsley – senior director of laboratory services at the biotechnology company Illumina – told C+D that one of her roles is to make genomic testing “as accessible and simple as possible”.

“I can absolutely see a future” where testing will take the form of “a very simple blood test”, which community pharmacies could be involved with, Dr Kingsley added.

Some Boots pharmacies are already involved with the collection of biological samples from volunteers as part of the Our Future Health research programme, Anna Dickinson, policy manager at think tank Public Policy Projects, pointed out during the session.


What is pharmacogenomics?

A study published in April – and authored by Day Lewis head of pharmacy Tim Rendell and David Wright, head of school of Allied Health Professions at the University of Leicester – explained PGx as a way of predicting “an individual’s response to drugs using DNA testing”.

While PGx testing services are often delivered via community pharmacies in other countries, no such service has been set up in England, they found.

Under a pharmacy PGx testing service, the patient’s DNA would be collected via a cheek swab and sent to a laboratory. The community pharmacist would then use the results to review the patient’s medication and “make recommendations to their prescriber to amend their prescription”, the authors of the study indicated in March.

They believe that such a service would initially be privately funded, before being commissioned as an NHS service.

Cross-sectional approach


Rolling out genomics more widely will “take [a] cross-functional group approach”, Dr Kinsley said.

As Dr Pirmohamed put it, people who doubt that genomic testing can be widely used because it is “too Star Trek” are “not taking into account the flexibility and the intelligence of our healthcare workforce”.

This workforce is made up of “doctors, nurses, pharmacists” who mobilised under the extreme pressures of COVID-19 not so long ago.

This massive effort is an “evidence base” that proves that healthcare workers are willing and able to adapt their practice to introduce genomics within their systems, he suggested.


What is genomics about?


Genomics “can give you much more information about the right drug to prescribe”, and whether it is “safe and works in patients”, Dr Kingsley said.

Adverse reactions to drugs are “a huge cost of the NHS right now”, she explained.

For Dr Pirmohamed, genomics will help the NHS focus on “prevention” and move away from its “current revolving door policy whereby people get sick, come into hospital, get better and go out to come back in”.

Read more: ‘Super pharmacy’ CEO sets out plans for pharmacogenomics service

In recent months, Day Lewis Pharmacy and the Alitam group have both hinted at their intention to launch their own PGx testing services across their chains.

Separately, NHS England told C+D in August it was working out the details of how it could start offering a pharmacogenomic testing service across the NHS, and did not exclude the possibility that pharmacists could be involved.


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