Spending Review: Invest in clinical pharmacology to support our NHS workforce

The upcoming Spending Review is an opportunity to invest in the expertise that will help the UK to recover, grow and respond to priority health challenges. By committing to support an NHS workforce that is skilled in the development and use of medicines, the Chancellor can improve patient care now and make the NHS ‘research ready’ for the future.
The Clinical Pharmacology Skills Alliance today publishes its submission to HM Treasury ahead of the Comprehensive Spending Review this autumn.
The submission is published during #ClinPharmWeek, an annual event celebrating clinical pharmacologists and the role of clinical pharmacology in tackling major health challenges - including increasing healthspan for an ageing population, harnessing the genomic revolution and delivering on the promise of transformative treatments.
The Clinical Pharmacology Skills Alliance (CPSA), has worked with partners in NHS England & Improvement, the Department of Health and Social Care and the life sciences to develop an ambitious, multi-professional, future-focused vision for a medicines service network embedded in every Integrated Care System (ICS) - as they are established - and across devolved nations. Ahead of the spending review, we are asking government to make critical workforce investments now and to invest in strategic workforce planning for the future to support implementation of the Life Sciences Vision, Future of UK Clinical Research Delivery, NHS Long-Term Plan and the Overprescribing Review.
Specifically, we have asked the government to invest in our ten-year workforce strategy for clinical pharmacology and to support us in developing an innovative medicines service model for the NHS, to ensure that we get the best outcomes and value from medicines. 
Clinical Pharmacology Week takes place on 10 – 16 October 2021. Follow #ClinPharmWeek on social media, and register for our special BPS LIVE: #ClinPharmWeek webinar series to learn more about clinical pharmacology.
Investing in the workforce will unlock better outcomes for patients, a more efficient NHS, better medicines, and boost productivity:

  • Research-active healthcare settings and trusts not only have lower mortality rates and better patient outcomes across their services - staff morale is also higher.
  • 6.5% of all hospital admissions are caused by adverse drug reactions, and 237 million medication errors are made in the NHS in England each year. Older patients taking multiple medicines for multiple long-term conditions are at greater risk of medication-related harms. Decreasing adverse drug reactions and prescribing errors improves patient outcomes and results in nearly £6 saved for every £1 invested.
  • For every patient recruited onto a commercial clinical trial between 2016/2017 and 2017/2018, the NHS in England earned £9,189 from life sciences companies, and where a trial drug replaced the standard of care treatment, saved £5,813.
  • Clinical research activity conducted within the NIHR Clinical Research Network in FY 2016/17-18/19 helped to generate a total of £2.7 billion of gross value added (GVA) and over 47,000 jobs.
  • International data shows a £1 increase in government spending on medical research is associated with an increase in private research spending from the pharmaceutical industry of between £0.83 and £1.07.
Our vision describes a medicines service network that will provide advice, guidance and expertise to enable the NHS workforce and life sciences sector. It will help deliver healthcare and economic priorities through:
  • management of multimorbidity and complex polypharmacy
  • implementation of pharmacogenomics and precision medicine
  • development of NHS capability in clinical research
  • collaboration with life sciences to develop transformative treatments and attract commercial research to the UK
A partnership between clinical pharmacologists and pharmacists will be at the heart of this network, partnering with specialists such as clinical geneticists, pharmaceutical physicians, and clinical academics to provide support across the life-cycle of a medicine.
Clinical pharmacologists are expert generalists, using knowledge of how medicines work and affect the body to provide integrated assessment and care, including for complex polypharmacy. They are research leaders who investigate the mechanism(s) of action of potential therapeutics, translating these into clinical use through the design and delivery of innovative trials. They are precision medicine leaders, supporting stratification of trials and implementation of pharmacogenomics in the NHS. They are regulatory and policy leaders, ensuring safety, effectiveness, quality and value through regulatory evaluation, pharmacovigilance, and health technology assessment. They are education leaders, supporting the NHS workforce to be skilled in the use of medicines and to engage in research.
Now is the right time to make investments in clinical pharmacology: years of grassroots action have revitalised the specialty and the CPSA has created a community of people on the ground who can make this happen with the right support. In 2012, there were 77 clinical pharmacology consultants in the UK, significantly fewer than the cohort of 440 recommended by the Royal College of Physicians. In 2017, the Society set a target to increase this number to 150 consultants by 2025. In 2021, there are 105 clinical pharmacology consultants in the NHS.  Work by the CPSA led to an unprecedented 100% fill rate for clinical pharmacology training posts. In the last round of recruitment, there were also 13 new consultants trained in clinical pharmacology and therapeutics with clinical pharmacology included in their job plans. The specialty is now beginning to thrive, and government investment at this juncture would secure its future. 

Support for our submission, and for connected initiatives across the sector, will drive a strong and innovative NHS through collaborative, multi-professional working and the UK as a globally leading hub for life sciences and clinical research. This will cement the UK as a science superpower and support levelling up, by reducing health inequalities through reaching more patients with research and development.
The Spending Review represents an unprecedented window of opportunity for alignment across government, the NHS and the life sciences sector - it must be grasped without delay.
Andrew Foxley, CPSA co-chair (AstraZeneca on behalf of the Association of the British Pharmaceutical Industry (ABPI), said:

The upcoming spending review has the potential to be a catalyst that brings a number of pieces of work together across the sector. They are all reaching in the same direction – better care and better medicines for patients. A comprehensive settlement now will super-charge these benefits - and the UK’s position as a science superpower and hub for commercial life sciences research.

The recent ABPI clinical trials report stresses embedding research into patient care as a pathway to achieving this – but the NHS needs support to do this, both through workforce training and confidence, and through a strengthened mandate for research, as called for by ABPI, BPS and other research organisations.
Investing in clinical pharmacology as critical enabler of the workforce, and as part of a multi-professional approach to upskilling at scale can help research reach more patients.

Professor Sir Munir Pirmohamed, CPSA co-chair (Society President), said:

Over the next 10 years, the NHS must invest in the workforce of the future - characterised by multi-professional teams working in integrated care pathways, embedding research into care and taking an evidence-based approach to the development and use of medicines. Clinical pharmacology is a small specialty that, through expert knowledge and partnership working, creates a multiplier effect in exactly these areas.
Clinical pharmacologists are experts in the development and use of medicines; applying clinical pharmacology principles at all stages of therapeutics’ research, development and use can help establish not just whether a drug will work but crucially, whether it will be safe.

At a time when the development and use of medicines is becoming more and more personalised, when patients have increasingly complex needs, when trial design and delivery must include all patients (particularly higher risk patients such as pregnant women and the elderly) who need the benefit of a medicine, and when we need the early phase skills that will be critical to attracting commercial research, now is the opportunity to invest in clinical pharmacology so that it thrives and delivers for the UK.

Sir David Behan, Chair of Health Education England (HEE), said:

The coming decade will present both challenges and opportunities. As people get older, they are more likely to have multiple long-term conditions and take multiple medicines – challenging our health service to move away from a ‘one disease, one treatment’ model and towards integrated patient care. The genomic revolution can help maximise benefits and minimise harms through a personalised approach to care, and reach underserved populations with better care.
Investing in a multi-professional medicines service network in Integrated Care Systems and across devolved nations is a progressive step and will ensure we get the best value and outcomes from medicines.
Investments in clinical pharmacology and clinical genetics alongside the continued support for pharmacy will enable the delivery of this vision.

Professor Tim Higenbottam, (President, Faculty of Pharmaceutical Medicine and CPSA lead for this organisation), said:

Health Sciences can help and support society, but we need a skilled and supported workforce to enable and enhance the complex process of medicines and medical devices development. The Clinical Pharmacology Skills Alliance has published its vision for this workforce, asking the Chancellor to back it in the upcoming Spending Review. Investing now will support resilience and growth in the future.

Sir Andrew Morris, Acting Chair of NHS Improvement, said:

A central tenet of the NHS Long Term Plan is to prevent as much illness as possible. One of the biggest challenges we have over the next decade is to do this in the context of an ageing population with increasingly complex needs. Increasing health span through better medicines and better use of medicines is one of the ways we will get there.
This proposal for a medicines service network recognises that whilst most care pathways have onward referral options, this is not true for the use of medicines in complex settings - such as complex polypharmacy and pharmacogenomics. It also recognises that embedding research and innovation into care is better for patients but that the NHS needs support to do this. Its answer is to amplify and invest in the expertise of the existing workforce and to reimagine how these skills are deployed through a structural, multi-professional approach. It rightly identifies that we need to make investments in clinical pharmacology and clinical genetics now, because these are some of the critical skills we will need for the future – we cannot delay.
I fully support the proposed investments - and am keen that the NHS and the wider sector grasp the opportunity to come together and think bigger as we develop this work.

Professor Sir John Bell, Regius Professor of Medicine at Oxford University and Chair of the Life Sciences Industrial Strategy Implementation Board, said:

Enabling industry, regulators, academia, and the NHS to work together is the only way we will tackle big health challenges. COVID-19 has demonstrated this powerfully, and it is now received wisdom that we need to learn these lessons as we move through recovery and towards growth.
The new Life Sciences Vision sets an ambition to develop a strong talent pool with the variety of skills that are needed to drive better health outcomes and build on the UK’s scientific excellence and attractiveness to industry. Clinical pharmacology is one of these critical areas and investing in this workforce proposal will go a long way in addressing this long-standing skills gap.
The broader concept of a medicines service network is an interesting one, and I agree it warrants further investment. If we are to get transformative treatments to patients, industry and academia must work in true partnership with the NHS. Investing in clinicians (including clinical academics) who are experts in research and the use of medicines to support the NHS workforce, enable commercial research and embed research into patient care could unlock benefits for patients and productivity.

Dr Lisa Cotterill, CEO of the National Institute for Health Research (NIHR) Academy, said:

Embedding research into patient care will give us the best chance of tackling the health challenges of the future. For example, an ageing population is more likely to experience multiple long-term conditions – we are learning more about disease clusters and how to translate this knowledge into patient-centred care, through innovative therapeutic approaches and better use of existing medicines. These challenges will peak in the next decade - so we need to act now if our workforce is to be ready.
Clinical academics are trained in research and, as the CPSA point out, will play an important role in scaling this expertise through the NHS and improving connectivity with industry. The NIHR Academy is committed to growing the academic clinical research – particularly in at-risk, critical areas like clinical pharmacology.
We will work in partnership with the CPSA, HEE, and NHS England and NHS Improvement  to continue to strengthen expertise in the development and use of medicines within the NHS, building on our investment in clinical academic pharmacologists through the NIHR Integrated Academic Training Programme, our work to grow the academic base in pharmacy and our efforts to increase partnerships with industry through joint fellowships.

Read more about the CPSA
Read the CPSA representation to the spending review
To find out more about this work please contact Dr Anna Zecharia (Director, Policy & Public Affairs) via anna.zecharia@bps.ac.uk. For press enquires please contact Emma Needham (Acting Communications Manager) via emma.needham@bps.ac.uk

Published: 11 Oct 2021 in Society news