Issue 6 - Royal Pharmaceutical Society

May 2010 | Issue 6 | ISSN 2042-4493 

Pharmacy 

Professional 

e x c l u s i v e l y f o r m e m b e r s o f t h e R o y a l P h a r m a c e u t i c a l S o c i e t y 

News roundup 

Manifestos for pharmacy 

Pharmacy 

board updates 

The latest from England, 

Scotland and Wales 

Practice guidance 

Dealing with schizophrenia 

Professional Association/ 

Royal College Magazine 2010 

Winner! 

Industrial 

Pharmacist 

Pushing the boundaries 

Plus business | politics | learning & development | travel | gadgets | food

e x c l u s i v e l y f o r m e m b e r s o f t h e r o y a l P h a r m a c e u t i c a l s o c i e t y 

the latest from england, 

scotland and Wales 

Plus business | politics | learning & development | travel | gadgets | food 

Need support 

with your CPD? 

e d i t o r ’ s w o r d 

Miriam Gichuhi 

Professional Support Pharmacist 

Give us a call, 

we’re here to 

help. 

We’ve set up a dedicated team to support you with CPD, exclusively for members of 

the Royal Pharmaceutical Society. 

So, whether you need support getting started, help recording your entries 

online, or want someone to talk to when your records have been called for 

review, give us a ring. 

Published by 

The Royal Pharmaceutical Society of Great Britain 

1 Lambeth High Street 

London SE1 7JN 

Tel: 020 7735 9141 

Fax: 020 7735 7629 

www.rpsgb.org 

Editor 

Jeffrey Mills 

jeff.mills@rpsgb.org 

Contributors 

Matt Guarente 

Sue Heady 

Sam Lister 

Ruby Neilson 

Richard Northedge 

Alasdair Steven 

Art Editor 

Nick Atkinson 

Editor’s Advisory Panel 

Steve Churton 

Jeremy Holmes 

Mike Keen 

Sue Kilby 

Colin Morrison 

Umesh Patel 

Patrick Stubbs 

Advertising Sales 

Square7Media 

Tel: 020 3283 4056 

Fax: 020 3283 4069 

mark@square7media.co.uk 

www.square7media.co.uk 

Images 

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Cover Image 

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may 2010 | Issue 6 | ISSN 2042-4493 

Pharmacy 

Professional 

News roundup 

manifestos for pharmacy 

Pharmacy 

board updates 

Practice guidance 

dealing with schizophrenia 

Winner! 

Profe sional A sociation/ 

Royal Co lege Magazine 2010 

Winner 

Professional Association/ 

Royal College Magazine 2010 

Political moves… 

And pharmacy must be on the agenda 

These are exciting times, unless of course you happen to be a 

Member of Parliament who is about to, or has (depending on 

whether you are reading this before or after May 6), lost a seat in 

Westminster. 

And there’s a message for those heading for the corridors of power 

– make sure pharmacy is at the centre of the healthcare agenda mix, 

indeed the three Pharmacy Boards have launched their Manifestos for 

Pharmacy, documents setting out issues which need resolution by the 

next Government. 

There was plenty to celebrate at the RPSGB when the Society’s 

Marketing and Membership team won three out of 10 categories in 

the 10th MemCom (membership communications) Awards, including 

Marketing Team of the Year. 

Pharmacy Professional was named as the winner in the category for 

Professional Association/Royal College magazines, while E-news won 

the category for Email Bulletin. 

We turn the spotlight this month on the role of Gino Martini a senior 

industrial pharmacist at GlaxoSmithKline, working in a fascinating area 

in which pharmacy operates alongside big international business. And in 

the latest in our series of Professional Practice features we take a look at 

pharmaceutical care in psychosis and schizophrenia. 

In the travel section this month we take a trip to Rio de Janeiro, where 

where we take in the low life as well as the high life and in the transport 

section we look at what the ferry companies have on offer to tempt us 

this season. 

And don’t miss our new sections, one where we take a timely look at 

some of the most stylish watches on the market and the other where we 

trawl through the latest technology offerings to find some of the best 

gadgets available, for both work and play. 

I hope you enjoy reading all the news and features in this, and every, 

issue of Pharmacy Professional. 

This free confidential service is also available by email or online. 

industrial 

Pharmacist 

Pushing the boundaries 

RPSGB is working with the profession 

to build a new professional leadership 

body for pharmacy 

Make us your first port of call – we look forward to helping you out. 

Call 020 7572 2302 

Email support@rpsgb.org or visit pharmacyplb.com/support 

Pharmacy Professional ISSN 2042-4493 

© The Royal Pharmaceutical Society 2010. While every effort has been made to ensure 

that the information is correct, neither the editor nor publisher can be held responsible for 

any inadvertent inaccuracies or omissions. Pharmacy Professional is protected by copyright 

and nothing may be reprinted without written permission. Manuscripts, transparencies and 

illustrations are submitted on the understanding that no liability is incurred for safe custody. 

Jeffrey Mills, Editor 

May 2010 | Pharmacy Professional 

1

Contents 

May 2010 

22 

12 46 

52 

professionalLIFE 

05 News Roundup Manifestos for pharmacy 

11 Media View Sam Lister, Health Editor of The Times 

12 Comment The President and CEO speak out 

14 A View From... The English, Scottish & Welsh Boards 

20 Political Update Charles Willis Reports 

21 Business Practice Richard Northedge on Pharmacy 

22 Industrial Pharmacist At the cutting edge 

26 Professional Practice Care in schizophrenia 

learning&development 

35 Continuing Professional Development 

The Pharmaceutical Journal brings you the latest 

lifestyle 

43 Travel The glamour and 

grime of Rio 

46 Watches Stylish times 

47 Gadgets To look out for 

48 Fashion Practicle hairstyles 

50 Health Food Chef Bruno 

Loubet and his mussels 

52 Transport Hop on a ferry 

55 The Arts Alasdair Steven 

looks at pharmacy on TV 

56 Offers Spoil yourself with a 

Spring break 

56 Prize Crossword Win 

leading reference books 

47 

43 


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This week the three Pharmacy 

Boards launched their manifestos 

for Pharmacy, documents that set 

out a series of issues that require resolution 

by the next Government. The documents 

are a compilation of themes from the White 

Paper, the ongoing work at the RPSGB 

and from the direct wishes of individual 

pharmacists. 

RPSGB Head of Public Affairs, Charles 

Willis, commented: “The Manifestos are 

documents that provide an incoming 

government with a roadmap, directing 

ministers towards more the effective delivery 

of healthcare services. They enhance the role 

of pharmacists, offering additional services 

and enables a government to demonstrate 

real patient benefits within the space of a 

single Parliament.” 

The publication of three separate 

manifestos recognises the devolved 

nature of healthcare in Great Britain. “It’s 

something we can utilise to place pressure 

on the next intake of politicians – Scotland 

enjoys a successful minor ailments service 

and I’m sure Scottish Westminster MPs 

will help us press for a similar service in 

England,” adds Charles. 

The launch coincided with a drive to 

secure meetings with new politicians via a 

series of constituency meetings designed to 

explain the role of pharmacy to prospective 

candidates. They will also provide an outline 

of the way towards a more effective NHS – 

involving a greater level of participation by 

pharmacists. Charles is encouraged by the 

number of existing and new politicians who 

want to meet: “Politicians are genuinely 

interested in what the RPSGB is doing and in 

hearing what pharmacists have to offer.” 

The Manifestos were created via a series 

of surveys of members to seek their views 

on the importance to them of current 

issues within the profession. A distillation 

of these views in addition to those of the 

three Boards has resulted in three manifestos 

being distributed to Westminster hopefuls. 

If you would like to host a politician 

briefing, please contact Charles for advice 

and assistance. “Promoting pharmacy 

is a core role for the RPSGB and helping 

pharmacists with MP visits is a key part 

of my role. With an impending general 

election, it’s time for us all to put the case 

for pharmacy. For me, the most effective 

form of influencing is for individual 

pharmacists to participate in contacting 

decision-makers.” 

You can contact Charles by email at 

charles.willis@rpsgb.org. n 

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5


RPS Conference 2010 

registration open 

Supporting patient and professional decision making 

New diabetes 

resource available 

Supports pharmacists in improving care 

Want to know more about how 

to help patients make decisions 

about their medicines and 

advance your own professional skills in the 

process? Or how to better manage workplace 

and commercial pressures, while maintaining 

a commitment to high-quality patient care? 

These are just some of the wide ranging 

topics that the Royal Pharmaceutical Society 

will address at its new 2010 conference, 

taking place on September 5 and 6 at 

Imperial College London. 

With a focus on pharmacy practice and 

professional issues, the conference will 

explore patient and professional decision 

making - how pharmacists, as professionals, 

can lead the way in optimising the use of 

medicines while maintaining the best interests 

of patients at heart. 

Marjorie C Weiss, Conference Chair said: 

“We developed the conference programme 

with pharmacists’ professional and leadership 

skills in mind. The sessions will help 

pharmacists get better equipped to deal with 

the day-to-day professional issues they face 

at work.” 

Through inspiring sessions, designed to 

empower pharmacists’ professional and 

leadership skills, and against a backdrop 

of many competing workplace demands, 

delegates will leave the conference with 

real and practical solutions to tackle issues 

professionally and competently. There will be 

three conference streams: Your professional 

development; Developing your practice and 

Latest developments in practice research. 

All sessions will offer opportunities for 

Continuing Professional Development (CPD). 

Here are just three reasons why you can’t 

afford not to attend: 

Become a better professional in the 

1 interest of the public 

Learn to support and empower your patients 

to make better health choices and medicine 

decisions. 

Support your day-to-day work 

2 Discover latest developments in practice 

research that may affect your daily work, 

visit the exhibition and see the products and 

services which could assist your professional 

life, consider ways you can balance workplace 

pressures and develop leadership skills that 

will empower you to make better decisions. 

Boost your career development 

3 Be inspired by stories of others’ career 

paths and receive tips to enhance your own 

career development, learn how networking 

can increase your knowledge and skills and 

boost your reputation, hear tips on how to 

develop your networking opportunities and 

put these into practice by networking and 

forming contacts with your peers and field 

leaders at the conference. 

Put the date in your diary and register soon 

if you want to discover the latest developments 

in practice research, engage in thought 

provoking and enlightening discussions and 

be inspired by the stories of the career decision 

making and pathways of others. n 

For more information on the sessions, 

to book online or to submit a paper please 

visit www.rpsgb.org/events or contact 

the events team (tel:020 7572 2640; 

emailrpsconference@rpsgb.org). 

Correction 

In an article last month about pharmacy in 

Barcelona it was said by the writer there are 

20 “Colegios Oficiales de Farmacéuticos”, 

in Spain. It has been pointed out there are 

actually 52, one for each province. 

Diabetes affects nearly one in twenty 

adults. It is life-long condition and 

can be life-shortening. However, it 

is believed that between a third and a half 

of all medicines prescribed for long-term 

conditions are not taken as recommended. 

Integrating community pharmacy into 

the care of people with diabetes is the new 

practical resource to support pharmacists 

and their teams to improve the care of 

people with diabetes. 

Community pharmacists and their teams 

play a central role in the daily life of people 

with diabetes and can in particular help 

patients’ improve adherence to medicines 

and hence improve their long term health 

outcomes. 

White paper 

The guidance was developed by the Royal 

Pharmaceutical Society and National Pharmacy 

Association, in close collaboration with 

the Department of Health. In particular, Dr 

Rowan Hillson, the National Clinical Director 

for Diabetes, the diabetes policy team and 

Medicines, Pharmacy and Industry Group. 

Better men’s health 

through pharmacy 

Improved access to medicine 

DiABETEs affects nearly one in twenty 

adults. It is life-long condition and 

can be life-shortening. However, it is 

believed that between a third and a half of all 

medicines prescribed for long-term conditions 

are not taken as recommended. 

Improved access to medicine for men’s 

health through pharmacy has been welcomed 

by the Royal Pharmaceutical Society. 

Reacting to the news that tamsulosin, for 

men’s urinary problems – previously only 

available on prescription – is now available 

The Pharmacy White Paper recognised 

that the whole pharmacy team can 

contribute to the care of people with 

long term conditions and highlighted the 

important contribution that pharmacy can 

make to improving health by focusing on 

prevention as well as treatment. 

Heidi Wright, English Practice and Policy 

Lead said: “This is a practical resource 

and guidance for effective contribution of 

pharmacy within an integrated team of 

health professionals. 

“Community pharmacists and their teams 

through pharmacies, Graham Phillips, 

pharmacist, and Royal Pharmaceutical Society 

English Pharmacy Board Member said: 

“Racks of make-up and no spanners was 

the title of a report published by the Men’s 

Health Forum in 2009. It pointed out that 

pharmacists had a significant role to play in 

improving outcomes for men. The report asked 

directly – what do we need to do to get men 

engaged in healthcare through pharmacy? 

“The launch answers that question by 

providing men who have urinary problems 

have a vital role in the daily life of people 

with long term conditions and we look 

forward to seeing increasing involvement 

of the pharmacy team in the care of people 

with diabetes.” 

The NPA’s Margaret Peycke said 

community pharmacists are well positioned 

to support people living with a variety of 

long term conditions, including diabetes. 

“This document highlights the rich potential 

in pharmacy. It is intended to make it that 

little bit easier to commission and deliver 

services to people with diabetes,” she said. 

Integrating community pharmacy into 

the care of people with diabetes resource 

provides information on prevention; early 

diagnosis of diabetes; initial assessment and 

management; ongoing care and preventing 

or delaying complications. 

It will also help pharmacists proactively 

raise awareness of the contribution that 

they can make to the care of people with 

diabetes. n 

For more information go to http://beta. 

pharmacyplb.com/practice--science-andresearch/diabetes.asp 

or visit www.npa.co.uk 

access to a health professional on the high 

street to discuss their symptoms at a time 

convenient to them – and that can be done in 

confidence – the vast majority of pharmacies 

now have a private consultation area. 

“Pharmacists are ideally placed to 

compliment the role of GPs and other health 

providers by both treating symptoms of 

benign prostatic hyperplasia and crucially 

picking up the signs of more serious illness 

early – improving the chance of a good 

outcome,” he added. n 

6 Pharmacy Professional | May 2010 


7


Full house Academic, hospital, community and industrial pharmacist delegates attend the first Local 

Practice Forum (LPF) Showcase in the country, organised by West Yorkshire LPF 

The first West Yorkshire Local 

Practice forum Conference Showcase 

Gill Hawksworth WYLPF lead and Peter Taylor, deputy lead, report 

An outsTANDiNG programme, under 

the direction of clinical pharmacist 

Chris Acomb, was the draw for 

more than 80 pharmacists and pre-registration 

pharmacists when the West Yorkshire Local 

Practice Forum put together an inspirational 

showcase of best practice at the first meeting 

of its type, staged at Bridhouse near Leeds. 

WYLPF lead Gill Hawksworth was on hand 

to welcome those who attended and to 

thank sponsors Pfizer, Boots, Reckitt Benkiser, 

Health-smart, UKCPA, the University of 

Bradford School of Pharmacy and the Royal 

Pharmaceutical Society for their support 

and taking part in the exhibition which ran 

alongside the showcase. There was further 

sponsorship from Morrisons pharmacy, Kirklees 

LPC and the Leeds, Halifax, Harrogate and 

Huddersfield branches of RPSGB, all of which 

contributed to the success of the conference. 

Chris Acomb opened the proceedings with 

a presentation prepared by Catherine Duggan, 

Director of Professional Development and 

Support at the RPSGB, who was unfortunately 

unable make the meeting. This was an 

aspirational vision of leadership on ‘Advancing 

Pharmacy Practice’. 

Professional body 

This included using science in practice 

to improve the care of our communities; 

developing a new career pathway; nurturing 

newly qualified registered pharmacists 

consistently; and putting patient safety 

high on the agenda, all within the context 

of government policy requiring more cost 

effective healthcare and taking account of an 

increasingly older population with increased 

chronic conditions. 

Part of the role of the new professional 

body is to help prepare pharmacists fit for 

purpose, trained and validated, attendees 

were told. Postgraduate education relating 

CPD to practice, competence and revalidation 

is growing in importance. The General level 

framework provides core competencies 

which have been shown to allow a consistent 

measure of ability to practice. 

A practitioner can then progress through to 

the advanced and consultant level frameworks. 

The term ‘Credentialing’ has been coined 

for collecting and providing evidence of your 

practice at your particular framework level. 

The curriculum for the Advanced and 

Consultant level postgraduate schemes 

should be determined to a large extent by 

the specialist groups, coordinated through 

a Programme Board to give a standardised 

format suitable for use in revalidation. This 

brings benefits for employers to match 

pharmacists with jobs and benefits to 

patients who will want more assurance 

about patient safety. 

A session on ‘Practice Pearls’ then followed 

where two West Yorkshire Pharmacists with 

a special interest, Linda Hirst and Marta 

Hildebrandt, talked about their pharmacist-led 

anticoagulation clinic and how they had both 

undergone accreditation by Bradford PCT to 

provide the service in a local GP surgery. It was 

noted that they had access to patients’ clinical 

records, which made a huge difference to their 

ability to manage their 80 patients one day 

per week, including housebound and nursing 

home patients. 

They were screening patients with atrial 

fibrillation who were not on warfarin. 

They were now an accepted part of the 

whole practice team with good clinical and 

administrative support from the practice but 

they also collaborated with local community 

pharmacists. 

Another West Yorkshire pharmacist, David 

Alldred, then described his clinical role in 

medication review in care homes, where 

he monitored the frequency and causes of 

medication errors, including prescribing, 

dispensing and administration, outlining how 

he suggested solutions. 

Half of the errors were omissions and one 

fifth were wrong dose, which was slightly 

higher than in hospitals and mainly due to lack 

of systems and communication between GPs, 

care homes and pharmacy, with no one taking 

overall responsibility for the system. Future 

solutions include the summary care record 

and independent pharmacist prescribers doing 

clinical medication review. 

An Nhs Direct pharmacist in Yorkshire 

taking a national role, Liesa Harrison, spoke 

about how, since 2008, pharmacist advisers 

had joined nurses and health information 

advisers providing a service for 24 hours seven 

days a week. Being a pharmacist adviser gave 

her additional roles in supporting, coaching 

and training other staff as well as dealing with 

2,500 calls a week of medicines enquiries. 

Role development 

These could be anything about POM, P, 

GSL,homeopathy, herbal, food supplements, 

recreational drugs or drugs of abuse, and 

were answered using an algorithm and two 

approved reference sources, one of which was 

the BNF. Nhs Direct medicines fact sheets and 

Q and A’s were being constantly reviewed and 

there was an ongoing role development for 

example in pharmacovigalence. 

Four workshops then followed which 

were repeated in the afternoon’s session, to 

allow participants some choice in what they 

took part in. 

That on Ethical Dilemmas was run by 

Margaret Culshaw and in the session she tried 

to develop the thinking behind handling such 

dilemmas, often experienced by pharmacists, 

and to be able to turn that into teaching for 

undergraduates. 

The audience became the ‘experts’ for 

the likely outcomes of three scenarios. 

Some options for each were presented but 

if the participants could not find an option 

they would use then they could offer, with 

explanation, a further option which if agreed 

would go into the final version and be used 

with students. 

Role-play exercise 

with a ‘patient’, a 

‘pharmacist’ and 

an observer 

Consultation Skills and Medicines Use 

Review, was run by Helen Bradbury, Julie 

Sowter and Gemma Wint, looking at the 

purpose of the different types of MUR; a 

structured approach to consultation using the 

Calgary Cambridge model and then what is 

entailed in the provision of an MUR service. 

The second running of this session moved on 

to look at practical issues involved in providing 

this service. 

Working with participants, some of the 

barriers and enablers were drawn from actual 

experiences and then the group worked on 

finding solutions. Finally participants worked 

in triads to improve consultation skills in a roleplay 

exercise with a ‘patient’, a ‘pharmacist’ 

and an observer. 

Workshop Three, How I Manage, was run 

by Ann Page. In this session she took real 

but anonymous cases that had presented 

real difficulties in handling and asked the 

participants to identify ways to handle the 

situation. Such things as excessive prescribing 

of controlled drugs or a patient admitted to 

hospital on a drug whose dose had clearly 

not been stepped down from the loading 

dose, gave participants plenty to think about. 

The outcome of the session should result in 

pharmacists thinking much more widely about 

the issues than perhaps they would have done 

previously. 

The final workshop, run by Marie Bell, 

Kuljit Thiaray and Chris Acomb, looked at 

revalidation and how CPPE can help. One 

of the outcomes of CPPE should be a better 

understanding of therapeutics and how it 

can be applied in practice. Chris went on 

to demonstrate this by describing atrial 

fibrillation, its aetiology, how it presents and its 

treatment. 

Community pharmacists need to 

understand this subject as the prevalence 

is increasing and so they will come across 

the drug treatment more often and should 

be in a better position to help optimise that 

treatment. 

During lunch pharmacists were able 

to visit a lively exhibition with stands 

featuring the many sponsors. In addition 

a local practice research poster display ran 

alongside an LPF research recruitment stand 

where pharmacists from each locality of the 

LPF were invited to get involved with the 

local science and research networks by the 

LPF research work stream lead Jon Silcot. 

The showcase was brought to a close 

by two Yorkshire pharmacist independent 

prescribers who shared best practice 

examples in two distinct clinical areas. 

Carl Booth worked in a multidisciplinary 

chemotherapy consent clinic with doctors 

and nurses and since becoming an 

independent prescriber working within his 

own competence he is able to decrease the 

delay in patients’ treatment as he is now 

able to prescribe unlicensed medicines and 

will, when legislation allows, be able to 

prescribe CDs. He sees the future possibility 

of pharmacists prescribing in both oncology 

and haematology chemotherapy review 

clinics. 

In contrast Claire Barber worked in a 

community pharmacy as an independent 

prescriber in substance misuse. Having 

a supportive GP designated medical 

practitioner and good communication with 

GPs was very important, along with good 

relationships with drug action teams, PCTs 

and patient forums. 

The prescribing course had been 

instrumental in developing reflective practice 

which actually changed the way that she 

practiced, enabling her to support 17 of her 

own patients on a clinical management plan 

as she was prescribing CDs (supplementary 

prescribing). The contract was with the DAT, 

not the PCT, and money was saved as there 

had only been one clinic non-attendee in six 

months. The future possibility is to become 

a PhwSI and when she can prescribe CDs, 

then developing a rapid access clinic. 

Feedback from the showcase was 

excellent (see chart) and plans are already 

underway for another WYLPF conference 

showcase next year. n 



9


m e D I a v i e w 

The Great Pharmacy Debate 2010 

Meet the champion scholars 

Sam Lister, Health Editor, The Times 

Integration – the new watchword 

Challenges to come for a new administration 

Winning arguments The team from William Farr Comprehensive School, (left to right) Jack Culpin, Anya 

Green and Chris Bridgwood, receive the winner’s trophy from Professor Jayne Lawrence (left). 

For the second year, secondary schools 

from across the country gathered at the 

Royal Pharmaceutical Society for a day 

of debating about pharmacy topics past and 

present. Eight schools sent teams of three 

Stage 4 science pupils to take part in three 

rounds of debates, inspired by talks, resources 

and the Museum’s displays. The event was 

funded by the Economic and Social Research 

Council as part of their ESRC Festival of Social 

Science, and also took place during National 

Science and Engineering Week. 

Eight schools took part, travelling from 

as far as Liverpool, Lincoln and Norfolk. 

They had prepared their opening debate, 

‘This House believes that cannabis should 

be legalised’, using the Museum’s Pharmacy 

Debate Packs schools resource http://www. 

rpsgb.org/informationresources/museum/ 

resources/pharmacydebatepacks.html 

Inspiration 

The following debate topics were not 

revealed until the day itself, and each was 

introduced by an ‘inspiration session.’ The 

schools debated personalised medicines 

following a talk by Professor Jayne Lawrence, 

the Society’s Chief Scientific Advisor. The third 

round was inspired by a session exploring 

how the National Institute for Clinical and 

Healthcare Excellence (NICE) works, prepared 

by Professor Adam Hedgecoe from the ESRC 

Centre for Economic & Social Aspects of 

Genomics at Cardiff University. The teams’ 

next debate was around the motion ‘This 

House believes that NICE is an unfair way to 

ration healthcare and should be abolished.’ 

We had a brilliant 

time and hope to 

return to win the 

trophy next year! 

Each of the four debates in the first three 

rounds was chaired and judged by volunteers, 

primarily pharmacy students who had been 

recruited via BPSA and Kings College School 

of Pharmacy and trained by the English 

Speaking Union. 

The two highest scoring teams made it 

through to the grand final – William Farr 

Comprehensive School from Lincoln, and 

St Francis Xavier’s College from Liverpool 

– which was fought over the motion ‘This 

House believes that the government’s 

response to an imminent pandemic should 

always be a mass vaccination programme.’ 

The judges were from the English Speaking 

Union alongside Jayne Lawrence. It was 

a closely fought debate, but the judges’ 

unanimous decision was that William Farr 

Comprehensive School were the winners. 

Illustrated history 

The winning team were presented with two 

Pharmaceutical Press publications – Popular 

Medicines: An illustrated history and Making 

Medicines: a brief history of pharmacy and 

pharmaceuticals – with additional copies 

for their school library, and a trophy based 

on a delftware drug jar from the Museum’s 

collections. 

One of the competing teams, Langley 

School from Norfolk commented “We 

had a brilliant time and hope to return to 

win the trophy next year!”. Henry Bealby, 

teacher from William Farr Comprehensive 

School, the winning team, said “One of the 

pupils said that it was the most demanding 

intellectual activity that they have engaged in, 

which is just the sort of experience we were 

looking for.” Briony Hudson, Keeper of the 

Society’s Museum Collections said: “Bringing 

together school pupils, pharmacy students, 

pharmacists and the museum makes for 

an incredibly stimulating event. We were 

impressed by the achievements of the pupils, 

and the students for judging the debates. 

We hope to find more funding to continue to 

run the competition as an annual event.” n 

When it comes 

to electoral 

promises, few 

are as expansive as those on 

health. As the Tory former 

chancellor Nigel Lawson 

once observed, the NHS is as 

close as the country comes to 

a national religion; at times 

the last month’s campaigning 

looked more like applications 

to become the high priest of 

healthcare. The gifts kept on 

coming: Cuts in cancer waits, 

better GP access, respite 

breaks for carers, a fund for 

less mainstream medicines. 

The patient guarantee became 

like a passcard for the prime 

ministerial contest. 

Of far greater importance was 

the talk of efficiency savings 

and productivity gains – ways 

of making a budget that isn’t 

getting any bigger work better. 

The mere mention of cuts to 

the nhS frontline is electoral 

suicide, so none were made; 

instead there were assertions 

about “ringfenced funds” and 

“protected budgets”. The reality 

is somewhat different for the 

new administration, however. 

Forecasts suggest that average 

real terms cuts of 2.3 per cent 

will be inflicted on departments 

across Whitehall by the 

comprehensive spending review. 

To protect the nhS will be nigh 

on impossible without hacking 

back on equipment for armed 

forces or mothballing schools. 

Something has got to give. 

Real savings 

The most effective, least 

traumatic strategy is 

“integration” – expect it 

to become a parliamentary 

watchword in the months to 

come. Get different arms of 

the NHS to work in a more 

coordinated, coherent manner, 

and real savings will come. 

This much is clear from 

Labour’s laudable efforts to 

drive care for the elderly up 

the agenda. Historically, and 

for no decent reason, this area 

of social care has sat outside 

the NHS, even when the health 

service ends up providing a 

Is it beyond 

the whit of 

man to make 

the pharmacy 

more central 

to disease 

management? 

substantial part of it. More 

healthcare at home, earlier 

intervention with old-age 

diseases and fewer repeat trips 

to A&E means not only higher 

quality care, but at a lower cost. 

The same can, and must, 

apply to pharmacy services. 

The All-Party Pharmacy 

Group recently set out a dozen 

calls for action for the new 

Government on policies that 

can improve the sector, and 

the NHS as a whole. It offered 

an optimistic but necessarily 

urgent timeframe – “100 days 

to make a difference”. 

Some of the APPG proposals, 

while much needed, carry 

financial/infrastructural 

implications that prohibit their 

introduction anytime soon. 

More effective use of NHS 

information technology is a 

must, but secure mail systems 

to replace all paper-based 

communication of MURs and 

other information between 

every GP and pharmacist carry 

kit and training costs. 

IT has become the NHS’s 

poisoned chalice, consuming 

too much money with too 

little impact, and will struggle 

to make it far up the priority 

list. Likewise safeguards to 

the pharmacy budget held 

by primary care trusts – “if 

necessary provided for in 

legislation” – will be hard 

to elicit from organisations 

already scratching around 

for ideas of how to balance 

the books, and politicians 

happy to make bold pledges 

on the stump, but fearful of 

straitjacketing themselves when 

the cash actually has to be 

counted. 

The APPG recommendations 

with a fairer wind are in 

areas of integration. The 

group reiterates the desperate 

need for better collaboration 

between pharmacists, GPs and 

other health professionals, set 

out in the Pharmacy White 

Paper but as yet only acted 

on in patches. If social care 

can be integrated, is it beyond 

the whit of man to make the 

pharmacy more central to 

disease management? The 

social care tenet of saving 

money by keeping the “repeat 

attenders” out of hospital is 

as applicable to the pharmacy 

sector. 

Better commissioning is 

required, and pharmacy input 

at PCT board level – two other 

APPG requests. All this will 

help realise more immediate 

savings, such as reducing 

the age-old problem of poor 

medicine adherence. Reduce 

the wastage and PCT budgets 

could quickly look less peaky. 

One proposal from the all-party 

group could go some way to 

addressing this – the launch 

of a national First Prescription 

Service in community 

pharmacies, aimed at getting 

patients with newly-diagnosed 

long-term conditions trained up 

in best medicine practice from 

the outset. Intervene before the 

bad habits bed in. 

Engage pharmacists 

The first 100 days of any 

administration is a bunfight of 

competing interest groups, but 

one or two cost-free statements 

of intent will do much to engage 

pharmacists in a high quality, 

financially-constrained future. 

To quote Rahm Emanuel, 

President Obama’s chief of staff, 

“you don’t want to let a crisis 

go to waste”. Let the current 

climate be an opportunity to 

make the pharmacy not an nhS 

outrider, but a fully-integrated 

part of a more cost-conscious 

health service frontline. n 

l Sam Lister is Health Editor 

of The Times. An award-winning 

former health correspondent 

and news editor, he has covered 

the NHS and medical workforce 

through reformation and revolt 

and groundbreaking advances 

in clinical practice and disease 

control. 



11

c o m m e n t 

Respect and trust 

Steve Churton, President 

Making a meal of it 

Jeremy Holmes, CEO 

RPSGB President Steve 

Churton takes stock and 

looks forward to inspiring 

times for the “new” Society 

Since it was established in 1841, the 

Society has represented the interests 

of a profession that has earned the 

respect and trust of the people it serves so 

faithfully. “Through an unwavering passion 

for delivering the highest possible standards 

of care and public service, we have earned 

ourselves an extremely enviable reputation, 

a reputation based on integrity, expertise and 

compassion,” President Steve Churton told 

leaders of the Profession attending a special 

celebratory Council dinner. 

“In fact, as we continue to be recognised 

to this day, we were commended for our 

outstanding contribution to ‘society in general’ 

only two years after the RPSGB was created 

– when Queen Victoria granted us the Royal 

Charter – which set out our role very clearly... 

‘To advance knowledge and education 

in pharmacy; to safeguard the interests of 

pharmacists; to promote and protect the 

health and well-being of the public and 

to maintain and develop the science and 

practice of pharmacy’. 

“I’m pleased to say that these same 

objectives, this same philosophy, lie at the 

very heart of the new Royal Pharmaceutical 

Society,” he said. But he warned that enjoying 

the trust of patients and the public comes with 

a heavy responsibility. 

“Patients place themselves in our care. 

They seek the best possible advice on taking 

their medicines, and on taking care of the 

healthcare needs of those closest to them – 

and we commit to providing the best possible 

standards of care, wherever they live, and 

whatever their needs.” 

And from public trust comes esteem, Steve 

said. “We have earned that esteem over nearly 

170 years, and we continue to earn it every 

day of our working lives. Every single point 

of contact with our patients and their carers 

provides us with a ‘golden moment’ – a 

moment that provides yet another opportunity 

to strengthen our relationship with them – a 

moment we need to recognise and seize. 

“Every one of us accepts the responsibility 

that goes with our role. We accept that being a 

professional means being held to account for 

the actions and decisions we take,” he said. 

“This responsibility, and the desire to do the 

best for our patients, is hardcoded within the 

DNA of all of us who consider ourselves a 

true professional”. 

Understanding of drugs 

“Pharmacy is represented in almost every 

community in Great Britain. We embrace our 

role, engage with the public and inform them 

to the best of our abilities. We offer expert 

opinion and unbiased advice – and maintain 

an essential check on the safe and appropriate 

usage of medicines. 

“We promote others’ knowledge and 

understanding of drugs, we discover new 

therapies and treatments – either with 

existing or new drugs – and pharmacists and 

pharmaceutical scientists in this country have 

an international reputation for their skills and 

expertise,” Steve Churton says. 

“The Society has long championed and 

promoted the potential for pharmacists to 

deliver so much more for patients. Monitoring 

those with long-term conditions; screening 

as part of a public health service; ensuring 

that patients use their medicines effectively; 

and making pharmacist prescribing the norm 

rather than the exception. 

Royal remedies Queen 

Victoria’s medicine chest at 

Osborne House, Isle of Wight 

“These are all part of our future – and I 

want that future for my profession. 

“We are moving, rightly and inexorably 

towards more clinical roles,” Steve Churton 

said. “The old Society has influenced public 

policy and put the foundations in place for this 

to happen, and the new Society will now need 

to drive this forward with pace, and with the 

energy it surely deserves. 

“Of course there will be challenges. 

Healthcare professionals are set against each 

other by a commissioning framework that 

encourages competition: Competition for 

contracts, for services, for funding and for 

patients – rather than collaboration that puts 

the needs of the patient and their carers first 

and foremost – each and every time. 

“The new professional body will need to 

work with other professions to help shape a 

new healthcare landscape that encourages 

collaborative working, more cost efficient, 

effective and convenient care pathways, more 

informed patient choice, and greater equality 

of access to expertise and treatments,” the 

President said. 

“Making good healthcare easier is really 

what it’s all about – we need partnerships 

and pathways which will lighten the load on 

patients, healthcare professionals, the NHS, 

the employers and the economy. 

“To make a credible contribution to this 

debate, the new RPS will need to provide 

respected and valued leadership, and be 

the reliable source of opinion across all 

sectors of the profession, across the myriad of 

specialist areas of practice, and across all of 

our nations. 

“It will need to inspire every member, 

and to speak on behalf of all of them with a 

strong and clear voice. The key influencers 

of our new body, and the key focus of all 

of our activities, must be our members. We 

must be obsessively driven by their needs and 

aspirations,” he said. Warning that failure to 

respond to the needs of our members will lead 

to failure of the organisation. 

Challenge and support 

“It is vital that our new body works closely 

with our new regulator – to ensure appropriate 

and proportionate regulation. It must 

challenge and support the regulator to deliver 

the best possible codes, rules, frameworks and 

processes to ensure regulation that is effective 

and informed; regulation that maintains 

appropriate standards, and regulation that is 

realistic and practical in its application. 

The regulator must of course safeguard 

public interest, but it must also be alive to 

the professional spirit of those who seek to 

diversify and extend their services to patients, 

and to advance professional practices and 

boundaries. 

“The new RPS must be different. It must 

feel different and it must be seen to be 

different,” Steve Churton said. “It must, 

and will, continue to build its capacity 

to campaign on behalf of pharmacists, 

consulting with them on issues that affect 

their working lives and the lives of their 

patients, and channelling their views directly 

into debate on public policy and patient 

safety. 

“I genuinely believe that we are now an 

organisation which is noticed more, asked 

more, listened to more, and appreciated more. 

We should welcome this, and resolve to do 

even better as we go forward. 

“The long and exhaustive review of 

internal processes and structures we have 

undertaken allows us to move ahead with 

the pace, energy and agility required to far 

better represent and serve our members,” the 

President concluded. n 

It was my younger daughter’s birthday in 

April and we went out for a celebratory 

meal. It happened to be the day after 

the Professional Leadership Group, the 

Society’s senior management team for the 

professional body, had been swapping 

stories of their best and worst restaurant 

experiences. There were some great and 

some jaw-dropping stories which made 

Fawlty Towers seem tame. 

You might ask why on earth we’d been 

doing that. Well, the point about all our 

experiences was the food was important, 

but not as important as the way people 

were treated. We were doing a workshop on 

customer focus, and it was quite instructive. 

The Society as the professional body is 

looking to treat people as they would expect 

to be treated by their own organisation. 

Members have a right to expect a good 

service, a professional profile and a range of 

support that’s relevant to their needs. But 

they also have a right to expect recognition 

of their identity as a customer, and honesty 

when things go wrong. That’s one thing we 

didn’t put in the flyer we sent out in early 

April on the benefits of membership of the 

new Society (www.rpharms.com) – but it’s 

an important part of the “intangible value” 

of membership, and we’re taking it seriously. 

Awards 

On the subject of meals, we held the last 

Council Dinner at the end of March. It was 

an opportunity to look forward, but also 

to celebrate some significant achievements 

with the Charter Gold and Silver medal 

awards being announced by the President. 

Gill Hawksworth, the Gold medal winner 

(pictured), is an inspirational leader in the 

development of Local Practice Forums; Beth 

Taylor and Peter Jones, the Silver medal 

winners (pictured), are both past National 

Board Chairs who have led from the front. 

All three continue to demonstrate the very 

best of commitment to their profession and 

its new leadership body. 

The dinner also saw the announcement of 

the Synergy award for a non-pharmacist who 

has made an exceptional contribution to the 

profession. This year it went to Nigel Clarke 

(pictured), whose management of the Inquiry 

and then the TransCom process resulted in 

the prospectus for the new professional body. 

Engagement 

The process of moving from an abstract 

idea of a professional leadership body to 

its purpose and functions, the blueprint 

for its design and now an operational plan 

is one that has had wide and increasing 

engagement from right across the profession. 

The recent scoop of three firsts at the 

prestigious Membership Communications 

awards (including one for Pharmacy 

Professional), and the series of well-attended 

partnership meetings which continued in 

April, are strong evidence of that. I recognise 

there’s still more to be done, but they are a 

great endorsement of the work the team has 

been doing. 

No-one could be accused of cooking it all 

up in the back kitchen and presenting it in a 

“take it or leave it” fashion. Quite the reverse. 

This will be a professional body genuinely 

designed by and for its members. Thank you 

to all those involved. 

If that means we’ve been making a bit 

of a meal of it, I for one plead guilty to the 

charge. n 

Award Winners (from left) Gill Hawksworth, Beth Taylor, Peter Jones and Nigel Clarke 



13

T h e V i e w f r o m e N G l a n d 

As I write this piece (in early 

April) spring is really getting 

off the ground. Change is in 

the air with the new English Pharmacy 

Boards having their feet under the table 

and by the time you read this there may 

be a new government in Whitehall. I hope 

that the current activity around the white 

paper “Pharmacy in England; Building 

on strengths – delivering the future” will 

bring some good news for members. It has 

now passed its second anniversary and it 

contains a lot of good things that a new 

government can claim as quick wins in 

the all important first 100 days. A minor 

ailments DES and the First Prescription 

service would hit the mark nicely. 

Howard Duff, Director for England 

Ne’er cast a clout till May is out 

New faces 

The spring and summer will certainly still 

feel the chill of the economic situation. This 

is already being felt with recruitment freezes 

in hospital pharmacies and a tightening of 

commissioning purse strings in PCTs. We will 

be working hard to ensure that pharmacists are 

seen as being part of the solution. 

We will have many new faces to meet with 

and promote the role of the pharmacist. It 

has become our double mantra now, that the 

drug bill in England is huge and the potential 

for harm needs mitigating – pharmacists 

as the medication experts are central to 

the management of both. Having used this 

on politicians of all ranks and hues, DH 

apparatchiks and leaders of other healthcare 

professions I know the response. It is always 

positive, a thoughtful nod of the head, direct 

eye contact (no need to disseminate) the 

mental cogs whirring to come up with a line 

of questioning. 

It is always this next question that is 

telling and indicates if they really understand 

the potential on offer. We always have a 

set of prepared examples to illustrate the 

point. These examples vary depending on 

the audience and are anecdotal examples 

of good practice or research providing an 

evidence base for pharmacy practice. The 

latter is often hard to come by and as a 

profession we need to up our game, I hope 

and expect the LPFs to do great things in this 

area. The former list of good practice can 

always benefit from getting refreshed, all 

suggestions welcome. 

Fertile Ground 

One way that we intend to keep up to date 

with all of the great things that pharmacists 

are doing is the creation of a map of good 

practice. This will appear on the new 

website. More about that next month. 

The spring has also brought a respite in the 

plethora of consultations that seem to come 

during the autumn and winter seasons. I can 

only hope that our responses have fallen 

on fertile ground and that the summer will 

bring us some clarity around PNAs, a back 

to basics approach with the GPhC code and a 

simplification and acceleration of the generic 

substitution proposals. 

I am looking forward to a productive 

summer as we head towards the demerger, 

but I do sense a chill wind blowing over the 

river from Westminster. n 

Generic substitution in primary care 

The RPS response to the consultation 

Responding to the Department of 

Health’s consultation on generic 

substitution, the English Pharmacy 

Board (EPB) of the Royal Pharmaceutical 

Society makes it clear it does not consider 

any of the options in the consultation fully 

acceptable. 

Pharmacy has an important role and 

responsibility in making the best use of NHS 

resources. Generic Substitution could harness 

the expertise of pharmacists to help with this. 

Therefore the Society says while 

it supports the principle of generic 

substitution, it does not, however, consider 

any of the three options proposed to be the 

best courses of action to achieve this. 

“The primary purpose of generic 

substitution should be patient safety. 

Generic substitution is a professional matter 

which should be left to the professional 

judgement of the pharmacist,” says Howard 

Duff, the Society’s Director for England. 

“Under the current proposals there is 

no opportunity for pharmacists, who are 

experts in the use of medicines, to be 

involved in the decision process of when to 

substitute generically.” 

Understand 

The Society is also concerned about the 

additional workload the proposals could place 

on pharmacists, who will need to understand 

how the scheme operates in practice and 

then explain the process to patients. 

The proposals are operationally extremely 

complex and there is a huge reliance on 

prescribers to get it right. The EPB have 

concerns about liability and the potential 

for misconduct or fraud because of 

communication failure between healthcare 

professionals, which needs to be addressed. 

The proposals 

are operationally 

extremely complex 

and there is a 

huge reliance on 

prescribers to get 

it right 

This could damage relations between 

general practitioners and pharmacists at a 

time when we are encouraging collaboration 

between healthcare professionals. 

There is also scarce information on 

reimbursement issues within the consultation 

document. 

In a situation where the pharmacist 

chooses not to make the generic substitution 

for the clinical benefit of the patient, it is not 

clear how remuneration will be addressed. 

The EPB conclusion is that these proposals 

for generic substitution are a short term 

fix and not a long term solution, strongly 

believing that the current proposals could 

harm both pharmacy/patient and pharmacy/GP 

relationships, that patient care could suffer and 

that pharmacists could face financial loss. n 

To access the full response visit 

http://www.rpsgb.org.uk/pdfs/ 

consdocgenericsubstitution.pdf. 

Lindsey Gilpin 

Chair of the English 

Pharmacy Board 

The GPhC consultation – 

Pharmacists’ voices heard 

f YOu felt it was totally wrong to supply 

Ia lethal dose against a prescription, 

even if euthanasia were legal, do you 

think you should to be forced to? 

The conscience clause question was 

part of the recent consultation written on 

behalf of the GPhC, the new regulatory 

body for pharmacists and technicians. 

Keeping the conscience clause had 

strong support among respondents 

(52% for, 20% against). Pharmacists 

felt that although they personally might 

not have any problems supplying, for 

example, emergency contraception, they 

wanted to support colleagues who felt 

it was against their beliefs and ‘future 

proof’ their own professional practice by 

making sure that nothing would force 

them to provide services they did not feel 

able to undertake. 

Another question which caused 

much interest was whether pharmacy 

medicines should be available on selfselection. 

This was a matter critical to 

public safety in many respondents’ view. 

The ability of a pharmacist to recognise 

the risk to patients from inappropriate 

use of these medicines and to be able 

to intervene in a sale was seen as vital 

for ‘P’ medicines which have a greater 

potential to cause harm. 

The role of the pharmacist in ensuring 

that the remedy is appropriate was 

seen as fundamental to the safety of 

the public, particularly underlined for 

medicines which have recently been 

available only on prescription. 

No fewer than 58% of respondents 

disagreed with the idea of offering selfselection 

of ‘P’ medicines, many having 

strong views, 32% agreed with the 

proposal. 

In the consideration of the proposals 

developed on behalf of the GPhC, there 

was some surprise that the Code of 

Ethics, which had been reviewed recently 

and was generally well accepted by the 

profession, was to be replaced by a much 

more lengthy and complex set of 15 

standards. This would seem to be totally 

at variance with the stated aim of the 

new regulatory body to regulate in an 

agile and flexible way. 

Fortunately the GPhC took notice of 

the comments made and has chosen 

not to change the Code of Ethics, at 

least for the immediate future. Any 

further proposed changes should take 

into account the Society’s comments 

and the Society will continue to have a 

dialogue with the GPhC in the area of 

proportionate regulation. 

The Royal Pharmaceutical Society will 

always reply to relevant consultations on 

behalf of its members. However there 

is absolutely nothing to prevent each 

member also responding on their own 

behalf. You do not have to respond to 

a whole questionnaire, perhaps just the 

parts you feel strongly about. 

It was noted that for this GPhC 

consultation, many pharmacists 

responded only to questions about the 

conscience clause and ‘P’ medicines. 

Their opinions mattered, however, and 

were reflected in the percentages in each 

case. In fact more individual pharmacists 

responded to the consultation than 

all the other bodies (NHS groups, 

representative organisations, educational 

bodies etc.) put together. 

Given that the Government will be 

consulting soon on very many matters of 

great importance to pharmacists, never 

feel that your opinion does not matter. 

Your Boards will keep you in touch – 

take the opportunity to make your own 

opinion count. n 



15

T h e V i e w f r o m s c o t l a n d 

Lyndon Braddick 

Director for Scotland 

Hospital and Locum Pharmacists 

join the Scottish Pharmacy Board 

As pharmacy undergoes some 

of the biggest changes in the 

profession, the prospect of being 

able to influence the future direction of 

pharmacy in Scotland was a key attraction 

for the two new members of the Scottish 

Pharmacy Board. 

Fiona MacLean and Janine Milne 

(pictured) recently completed the make-up 

of the Scottish Pharmacy Board after they 

were co-opted to fill seats for a hospital 

pharmacist and locum pharmacist in the 

community sector. Their appointments 

ensure the Board is able to benefit from 

experience in a range of pharmacy sectors. 

The New Professional Body for 

Pharmacy: The Prospectus included a 

recommendation for the National Pharmacy 

Boards to be the backbone of the new 

professional body, reflecting the differing 

health policy agendas for each country. 

The Prospectus also proposed that some 

seats on the Boards should be reserved for 

specified sectors of practice. Following 

elections to the new Scottish Pharmacy 

Board earlier this year, the vacant places 

were widely advertised and Fiona and 

Janine were invited to fill the sector seats 

on the Board after a careful review of the 

applications. 

Leadership 

Fiona believes that Scottish pharmacy has 

to grasp the opportunities that the demerger 

and the change in the profession will bring. 

One of these is for the new Pharmacy 

Board to take responsibility for driving 

forward professional development and 

policy, and making clinical leadership and 

innovation central to the delivery of the 

Board’s objectives. 

Fiona brings 20 years of hospital 

pharmacy experience with a focus on 

pharmaceutical care to the Board. She 

Medicines are our business, pharmaceutical 

care is our aspiration. The safe clinical and 

cost-effective use of medicines is core to 

pharmacy practice 

vows to represent the needs and wishes of 

hospital pharmacists. While recognising 

that this sector is smaller, she believes 

hospital pharmacists deliver key frontline 

services to acutely unwell patients and 

work collaboratively with other healthcare 

staff. It is through a partnership approach 

to working with other sectors that Fiona 

believes pharmacists can deliver a first 

class health care service. 

“The profession must continue to 

modernise and build on successful models 

of care delivery”, says Fiona. “Medicines 

are our business, pharmaceutical care 

is our aspiration. The safe clinical and 

cost-effective use of medicines is core to 

pharmacy practice and we must work in 

partnership to ensure the seamless transition 

of patients between care episodes. 

“The new Board must unite the Scottish 

pharmacy profession to ensure we have 

a workforce fit for the future; a strong 

focus on research and innovation; and a 

framework for professional and career 

development. 

“I will endeavour to ensure pharmacists 

have the leadership necessary to embrace 

21st – century healthcare and above all 

else to assure the quality of a pharmacist’s 

contribution to patient care.” 

Fiona is also an independent prescriber 

for the South Glasgow lung cancer team 

and is Lead Pharmacist on the West of 

Scotland Managed Clinical Network 

Lung Cancer Advisory Board. She has 

contributed to the medicines sections of 

SIGN 80 Lung Cancer, NHS QIS Lung 

Cancer Standards, and the National Lung 

Cancer Core Data Set. She chairs the 

Greater Glasgow & Clyde Pharmaceutical 

Care Standards Group and has an interest in 

developing e-pharmaceutical care plans. 

Janine, a locum pharmacist with a wide 

background in community pharmacy, 

believes she can bring experience and 

knowledge of her sector to the Board. 

Previously a community pharmacy owner 

she went on to develop an integrated 

health care clinic, bringing together 

chiropodists, physiotherapists and 

complementary therapists – a project 

that earned her a Scottish Pharmacy 

Award. She acts as a locum in community 

pharmacies throughout Scotland and has 

been involved in developing training 

sessions for GPs and nurses. 

Strive for change 

As a result, Janine is very familiar 

with the time and staff constraints in 

increasingly busy community pharmacies 

and dispensaries. She wants to strive for 

change in the profession to be implemented 

in a staged approach, which is realistic and 

manageable. While the current environment 

can be demanding for pharmacists, she is 

confident it can also be rewarding. As a 

member of the Board she hopes to be able to 

offer clear direction in a climate of change. 

“At this crucial time of change, education 

and training are of prime importance. I want 

to see more integration of academic, hospital, 

and primary care pharmacists with their 

community-based colleagues,” she says. 

“The opportunities that the shared care 

agreement gives us are welcomed by the 

majority of hard working pharmacists but 

require careful planning and feedback from 

members to be developed and implemented 

in a workable way for busy community 

pharmacists and their teams. 

“It is essential that we collaborate with 

our GP colleagues in the rollout of CMS, 

and I believe the networking facilities that 

are being developed by the Board will help 

this happen. 

Committed 

“To implement evidence based research 

work into the community pharmacy setting 

requires sharing knowledge with colleagues 

in other fields of pharmacy. Having read 

the aims of the new governing body, I 

believe that we can all make this possible 

and the Board is committed to making this 

happen through online seminars, training 

workshops, and developing forums for 

networking and the pooling of knowledge. 

This will enable service development to 

be evidence based, and to develop over 

time, with input from all members of the 

pharmacy profession. 

“The way forward is open communication, 

clear direction and above all, desired 

outcomes – not only for the patient, but for 

the pharmacy profession of the future”. 

Janine also works as a consultant 

pharmacist for PDC Healthcare, which 

focuses on service development and liaison 

between the pharmaceutical industry and the 

NHS. She is currently working to develop 

an established primary care project into one 

that can be implemented in a community 

pharmacy. n 

Sandra Melville 

Chair of the Scottish 


A crucial contribution 

Pharmacists are increasingly 

becoming recognised, by the public 

and government alike, as key players in 

looking after the health of our nation. 

As their roles have evolved in recent years 

from a traditional focus on dispensing to 

include a broader remit of giving advice, not 

only on the safe and effective use of medicines, 

but more generally on health issues, and 

providing extended services such as health 

checks, pharmacist-run clinics and, in Scotland, 

the innovative Minor Ailments Service, (where 

patients can access free advice and, where 

appropriate, prescribed medicines for a range 

of ailments, without having to wait for a GP 

appointment) so the public has recognised 

the valuable resource they have right there on 

their high street, where accessibility is a major 

advantage. 

But that’s only part of the story. What most 

people don’t see is the crucial contribution 

pharmacists make to patient care and, indeed, 

patient safety in our hospitals. For just as 

community pharmacists have moved from being 

based in the dispensary to delivering front-line 

services, so in hospitals there has been a parallel 

movement from the hospital dispensary to the 

wards, where they have become key members 

of the healthcare team, using their expertise to 

optimise therapies in specialist areas such as renal 

medicine, intensive care, cardiology and cancer. 

As medicines become increasingly more 

complex, increased involvement of pharmacists 

on our hospital wards, where they can optimise 

their safe and effective use, has been shown 

to be paramount to patient care. This was 

highlighted recently in a report by the General 

Medical Council which showed a 10% error 

rate in hospital prescribing by junior doctors and 

cited how valuable pharmacists are in picking up 

prescribing errors and intervening before they 

reach patients. 

Why is there a shortage? 

Why then, is there such a shortage of hospital 

pharmacists? To answer this, it is worth looking 

at where the problem lies. Figures show that 

the main shortage is at basic grade level (“Band 

6”). Recent figures show a 24 % vacancy rate of 

Band 6 pharmacists in England, and in Scotland, 

where that figure rises to 40%, the situation is 

even worse. 

I recently had the pleasure of contributing to 

the training of two pharmacy graduates who 

are due to register as pharmacists this summer. 

Both were in the process of completing their 

pre-registration year – the practical aspect of 

pharmacists’ training, following a Masters degree 

in Pharmacy. They had elected to do this in 

community pharmacies but are required to spend 

a portion of their time in hospitals. Both were 

enormously impressed at the opportunity hospital 

pharmacy would afford them to use their skills to 

directly enhance patient care, but felt that their 

financial circumstances prohibited them from 

seeking jobs in the hospital sector once they 

qualified, as the pay differential between hospital 

and community pharmacy is too great. 

The solution would, therefore, seem to 

be simple – increase the pay for hospital 

pharmacists, particularly at the levels where 

the largest problems lie. Yes – but it’s also 

essential that we look at the bigger picture. 

Pharmacists are highly trained professionals. As 

more complex, potent and expensive therapies 

continue to be developed it becomes all the 

more pertinent that these medicines are used 

safely, effectively, and cost effectively. To do that 

we need to utilise fully the resource that lies 

within the whole pharmacy team. 

To allow pharmacists to use their expertise 

most effectively there need to be more of them 

practising, and being rewarded, at a more 

appropriate level. This model should ensure 

that the skills and expertise of pharmacists and 

pharmacy technicians are utilised fully and the 

end result would be enhanced patient care, 

effective use of resources and increased job 

satisfaction, suitably rewarded. n 

Scottish Pharmacy Board Chair Sandra Melville 

is Clinical Pharmacy Manager, Lorn & Islands 

Hospital, Oban. 



17

T h e V i e w f r o m wa l e s 

Paul Gimson, Director for Wales 

Nuala Brennan 

Chair of the Welsh 


The Faces of Pharmacy 

As part of a series of short features on the shape of the new Welsh Pharmacy Board, two 

members are the first to share their ambitions for the future of the Board and the profession 

Bob Gartside, currently works 

as a locum and has owned 

a number of pharmacies 

throughout his career as well 

as being LPC secretary 

OuTSide of pharmacy, my main 

interests have been motor sport, 

as a competitor, photography and 

narrow gauge railways, as a builder. By 

frugal and effective management, I helped 

save Caernarvon and Anglesey motor club 

when we lost a very great deal of money 

in cancelling the Welsh International 

Rally because of the last Foot and Mouth 

epidemic. On the brighter side, I began the 

process which led to the Welsh Highland 

Railway obtaining a Millennium Grant 

of £4.3 million to kick start the biggest 

railway rebuild in Britain, which is now 

very close to completion . You may guess 

from all this, I regard money and resource 

management as one of my strengths which 

can only benefit the board.” 

Keith Davies currently works 

as a locum community 

pharmacist and sessional 

prescribing support pharmacist 

(pharmacy advisor) with 

ABM health board. As well 

as this he is a member of the 

Locum Group and Union 

representative of the PDA 

I 

reTAin experience of grassroots 

pharmacy by actually working in the 

role. I engage with other pharmacists 

and always listen to their views and 

concerns, as well as having my own. I 

work in more than one area, and because 

If there was one thing you could achieve 

by the end of the current WPB’s term, 

what would it be? 

“Ensure that pharmacists could continue 

to remain personally in charge of all work 

related to medicines in both primary and 

secondary care, as this is the best way 

of ensuring patient safety. This implies 

both the abandonment of any ideas about 

‘Remote Supervision’, but also implies a 

degree of rolling back of the influence of 

non-pharmacist management, in day to day 

operations.” 

What are your ambitions for the future 

of pharmacy? 

“Eventually, pharmacists must be in 

charge of all maintenance medication 

since they are the only health 

professionals with both the interest in, 

and knowledge of this vital therapeutic 

area. GPs are too busy, and delegation to 

pharmacists is likely to be more effective 

and safer than any other arrangement.” n 

of this, I can bring knowledge and 

understanding of both these sections of 

practice. 

I believe I bring a wealth of experience 

to the board from my past roles; which 

include chemist contractor, member of 

Local Pharmaceutical Committee, District 

Pharmaceutical Committee and Welsh 

Pharmaceutical Committee, a locum in the 

hospital sector, pharmacist manager, as 

well as a few sessions working in the prison 

sector. 

Also, being a member of the locum group 

of the PDA means that I am in contact 

with pharmacists and board members from 

outside Wales.” 

If there was one thing you could achieve 

by the end of the current WPB’s term, 

what would it be and why? 

“To ensure that we have a new professional 

body that is fit for purpose and is able to 

represent all pharmacists; one which listens 

to its members and ensures that they are 

appreciated, protected and supported. I want 

it to be a professional body that pharmacists 

want to be a member of. The new body must 

encompass a complete change in attitude to its 

members now that membership is no longer 

compulsory. I hope it will show concern for 

the individual and value for money.” 

What are your ambitions for the future of 

pharmacy? 

“I want pharmacy to reach its potential 

and be established as a major member 

of the health-care team, being the expert 

in medicines. Whenever medicines are 

discussed I want the pharmacist to be the 

first professional that others turn to.” n 

All the latest 

LPF news 

We want to make sure everyone in 

Wales knows what is going on in 

their LPFs and beyond. We have 

recently sent out an LPF update 

but for those of you who may not 

have received it, here’s a selection 

of the latest LPF news from Wales 

North Wales Pharmacy 

Practice Forum 

(Gwynedd & Clwyd Branch areas) 

In NORth Wales, their Pharmacy 

Practice Forum has got off to a fantastic 

start! In July 2009, the Welsh Pharmacy 

Board asked North Wales to pilot LPF 

development in Wales. At a Stakeholder 

meeting in December 2009, members 

agreed to form a shadow Steering Group 

for the North Wales Pharmacy Practice 

Forum. The Clwyd and Gwynedd 

branches were dissolved at their 

respective AGMs in January and March 

2010 and all branch members transferred 

to the Forum. The Steering Group has 

produced an implementation plan and 

a draft budget for the Forum. When the 

Society de-merges fully, the Forum will 

hold a formal AGM to elect the Lead 

Officers. n 

Abertawe Bro 

Morgannwg 

University LPF 

(Morgannwg Branch area) 

Their ENGAGEMENt event was held 

on 4th February with over 40 people 

in attendance. The first meeting of the 

Steering Group took place on March 18 

when work began on pulling together 

the initial activity plan and discussing 

ideas for the first LPF meeting. This LPF 

also suggested an update on GPhC as a 

topic for a meeting and, as there appears 

to be a demand for this update, an all 

Wales LPF event and webinar are being 

developed for June 2010. The Steering 

Group are currently in the process of 

arranging an AGM to officially close the 

Branch. n 

Hywel Dda LPF 

(Bro Myrddin, Ceredigion & Penfro 

Branch areas) 

The first The first of the engagement 

events in West Wales took place 

on March 9, with about 20 people 

attending, all very enthusiastic about 

being involved. Two further engagement 

events were planned with a successful 

turn out on March 23 in Carmarthen at 

the Ivy Bush Royal. There were lots of 

good ideas suggested, and names put 

forward for the Steering Group. The 

third engagement event for West Wales 

was held in Narberth on April 20 at the 

Hotel Plas Hyfryd where lead roles were 

discussed, along with the names put 

forward previously other events, as well 

as discussions about the focus of this 

LPFs first meeting. 

As West Wales covers such a large 

area we have held to LPF events 

within each of the three regions, 

Pembrokeshire, Ceredigion and 

Carmarthenshire, but West Wales will 

still have one LPF (Hywel Dda) with 

an overarching Steering Group. The 

Steering Group will probably have to 

work virtually the majority of the time as 

it will be more difficult arranging faceto-face 

meetings. n 

Powys Teaching LPF 

(Powys Branch area) 

At tHE MOMENt, we see this LPF 

working virtually because of the 

small numbers within the large area of 

Powys. A Powys LPF Group will be set up 

within the virtual network and we want 

to get as much interaction for this area as 

possible – if you would like to be involved 

in this virtual network please contact 

Christine Horan, LPF Facilitator for Wales, 

christine.horan@rpsgb.org. It is doubtful 

that we will host an Engagement Event 

unless requested, so if you would like one 

please do let us know. n 

Wales join the fight 

to beat bowel cancer 

ThrouGHOut APRIL, Welsh 

pharmacists have been backing the 

national Beating Bowel Cancer campaign, 

endorsed by RPSGB, ‘Don’t hide your 

symptoms behind closed doors’. 11,500 

pharmacies across Wales and England 

have been equipped with information 

materials to help them recognise the 

high and low risk symptoms of bowel 

cancer, as well as discussing these with 

their patients and advising people to seek 

further help and advice from their GP 

should they be concerned. n 



19

p o l i t i c a l v i e w 

And it’s goodbye to some of them 

All the latest from the corridors of power from 

RPSGB head of public affairs Charles Willis 

The last few days of 

Parliament are now over 

and the election campaign 

proper has begun – even though 

it feels like the media have talked 

about nothing else for a very long 

time. In an attempt to sway the 

electorate by bombardment of 

pro-Conservative stories, I fear 

it has actually switched off most 

sane voters, who have real lives 

and concerns to focus on. 

Politics is brutal. MPs are 

given removal boxes and told to 

pack their offices away before 

the election. Those who lose their 

seats are given 10 days to empty 

their office and move out. Life as 

an ex-MP can be difficult. 

For those politicians with a 

professional career, there is little 

Cpd throughout the duration of 

their term as an MP. A person who 

spends a parliament or more away 

from their chosen profession may 

have difficulties in finding a new 

role. There are those who turn 

up as chief executives of various 

organisations and some who 

rebrand themselves as lobbyists. 

My profession is currently held 

in a level of esteem that rates 

slightly lower than estate agents, 

politicians, slugs or snails. This 

is primarily as a result of dubious 

practices undertaken by those who 

wish to take a chance, cut corners, 

and don’t realise they will be 

found out. Inevitably, Parliament 

has spoken: We need to clean up 

lobbying. It has ignored the key 

fact that those most prominent in 

bad practice are politicians and 

not lobbyists. 

I see how pharmacy is served 

and hope to see in my lifetime, 

a profession that is registered, 

with a code of ethics and with a 

professional body representing 

every practitioner in the UK. 

We have several organisations 

representing various aspects of 

lobbying, equating to contractors 

and professionals, but the latter 

organisation has a wide net and 

contains sections across the whole 

of public relations: IT, healthcare, 

business to business, consumer etc. 

I await the day when there is 

one organisation representing 

the whole of my profession and 

protecting the image of a much 

maligned body of people. 

My time at the RPSGB has 

demonstrated that there is a lot of 

work involved to create a body 

that speaks for all members, 

speaks with clarity on issues 

of importance and defends 

from harmful intervention by 

governments of al shades and 

political persuasions. 

I’m sure you won’t believe me 

when I say that politicians are 

largely good people. I worked 

for far too long with key political 

figures, saw and heard much and 

was surprised to see situations 

reported in the media that bore no 

resemblance to reality. 

Political parties are in danger of 

becoming more extreme as those 

with mainstream views leave the 

extremists to get on with things. 

In my view, a political party with 

a large membership is much more 

likely to have a sensible majority. 

I always urge critics to get up 

from the sofa, put a rosette – any 

colour that suits them – and try to 

make a difference. Make politics 

honourable. As an outsider, I 

feel the same about the new 

professional leadership body. I 

believe there is a real need for 

a strong voice that listens to all 

views and puts a considered 

opinion forward. My role is clear: 

MPs are given 

removal boxes 

and told to 

pack their 

offices away 

To take your views, build a case, 

and deliver opinion to opinionformers 

and decision-makers. To 

make your views one step away 

from Westminster and Whitehall. 

Increasingly large numbers of 

pharmacists are responding to our 

surveys, providing me with the 

evidence I need to put the case for 

pharmacy. 

Manifesto 

The three Pharmacy Boards have 

just published their manifestos for 

pharmacy, sent to Westminster 

MPs in the three countries. Look 

on our website to find them. These 

are essential documents that help 

us set out what we want to see for 

pharmacy in the next four or five 

years. The three main Westminster 

political parties have signed up to 

the majority of the deliverables in 

the Pharmacy White Paper. The 

RPSGB continues to push this 

forward, complete with new aims 

for our profession. I was pleased 

to send the manifesto to one MP 

who had asked why we were so 

silent on our view of pharmacy 

in the future. We are never silent, 

we just want to get things right. 

At the end of the Manifesto for 

Pharmacy was an offer to arrange 

visits in constituencies for those 

wishing to understand more about 

pharmacy. I’ll be contacting 

those of you who have won 

the lobbying lottery and have a 

candidate who wishes to learn 

more about community pharmacy. 

Decriminalisation 

Conversations with key 

individuals in two government 

departments and one agency tell 

me that the RPSGB campaign on 

the decriminalisation of single 

dispensing errors will soon 

pay dividends. I suspect I have 

promised this every month for the 

previous six months. I sincerely 

hope to report success in the 

near future. In the meantime the 

RPSGB will continue to press 

for delivery by the Civil Service 

and offer whatever practical help 

we can to find an effective and 

speedy resolution. 

Goodbyes 

This month is likely to see over 

200 MPs leaving for good. Many 

of those I have known for 25 

years. Decent, honest people who 

have served the public to the best 

of their abilities, and leave now 

hearing the electorate say they 

are all as bad as each other. Good 

luck to them all. n 

l charles.willis@rpsgb.org 

b u s i n e s s p r a c t i c e 

Men’s grooming market open for grabs 

Rapidly growing 

markets in a recessionbattered 

economy are 

rare, but one where pharmacies 

are ideally placed to profit 

seems too good to be true. 

However, the expansion of sales 

of male grooming products is a 

bonus in which smaller retailers 

can share. 

Men’s grooming is still less 

than one-tenth of the £9.6bn 

that Mintel marketing group 

estimates is spent on women’s 

products each year but it is 

increasing while the rest of 

the market is static. Not long 

ago, men using moisturisers 

or artificial tans would have 

been embarrassed but a total 

change in attitudes mean they 

are now must-haves according 

to UK research by L’Oreal, the 

cosmetics global market leader. 

Instead of shunning grooming 

products, men are becoming 

major consumers. 

Impress friends 

The recession is partly to 

blame says the manufacturer. 

The Verdict research group 

had already identified health 

and beauty products as strong 

sellers during economic 

difficulties because they 

are low-cost substitutes for 

expensive luxuries, but L’Oreal 

says the downturn has left men 

feeling stressed and seeking 

solutions to wrinkles and 

greying hair. Its research found 

24 % claiming the recession has 

left them feeling tired – 32 % 

among men in their early 30s. 

And besides wanting to impress 

friends and partners, men are 

grooming themselves to appear 

in a better light at work. They 

Richard Northedge 

Pharmacies ideally placed to profit 

think looking good helps them 

get or keep a job, suggesting 

employers’ attitudes have 

changed too. 

But because this market is so 

new, buying patterns have not 

been established. Department 

stores, supermarkets or 

specialist outlets have yet to 

claim a dominant share but 

independent pharmacies are 

well positioned to become a 

chosen selling point. Their long 

history of offering cosmetics 

means they start with a 

reputation among consumers 

and existing purchasing 

agreements with suppliers on a 

high-margin fast-selling product 

range that requires limited shelf 

space. 

L’Oreal claims there is a 

new male stereotype - the 

retrosexual - that wants to 

reclaim its masculinity by 

adopting old-fashioned values 

of pride and confidence. 

Perhaps, but whatever is 

behind the sales growth, male 

acceptance of these products 

has certainly changed since 

a weekly bath and a bottle of 

after-shave was sufficient. A 

study by researchers at Ipsos 

found 41 % of men shampoo 

daily and L’Oreal’s survey of 

over 1,000 representative men 

claims a third spend £10 a 

week. There is a slight London 

bias to consumption and among 

the under 30s, but older men are 

concerned about greying and 

balding too. Losing hair is the 

greatest fear of a quarter of the 

young and a third of all men, so 

potential consumers come from 

all corners of the population. 

Artificial tans are must-haves 

for two-thirds of men, it is 

claimed – behind shampoo but 

ahead of sun protection and 

shaving preparations. More 

than half list facial moisturisers, 

styling, fragrances and hair 

colour with conditioners and 

facial cleansers just behind. 

Most use products daily rather 

than only for special occasions. 

Yet manufacturers are only just 

waking up to this market and 

men frequently share female or 

unisex products. Some 39 % of 

men admitted to using women’s 

products each day and only 42 

% use male-specific shampoos. 

However, male product ranges 

The downturn 

has left men 

feeling stressed 

and seeking 

solutions to 

wrinkles and 

greying hair 

are being widened to meet 

demand and while advertising 

on women’s skincare products 

fell 12 % last year, according to 

Mintel, there was no cut in the 

spend on male offerings. 

But the growth of a market 

from an almost standing start 

means consumers have yet to 

form loyalties either. That is 

why they have been as likely 

to use a partner’s product as 

buy their own and why even 

L’Oreal, with products to 

promote, admits men are not 

discerning buyers, deciding by 

price as much as brand. Indeed, 

a quarter of male products are 

bought by women for men. 

Women also account for half 

the gift market, according to 

research by Taylor Nelson 

Sofres. 

Benefit 

If nothing else this, this mass 

of statistics shows the market 

is being taken seriously. It is 

not often small business has 

the chance to be in at the start 

of a new phenomena, but this 

market can surely only expand. 

It has grown six times faster 

than women’s cosmetics over 

the past decade and is still 

growing at twice the rate says 

AC Nielsen. 

Even if male grooming did 

turn out to be a temporary 

fashion, pharmacies can benefit 

from it without making longterm 

commitment. 

The women’s market 

provides a model of how the 

male equivalent can develop 

into utility products, premium 

brands, gift sales, etc. And 

the large manufacturers plus 

rival retailers will provide the 

marketing spend. Securing 

even a small share of this rising 

market will give independent 

pharmacies extra sales and 

attract new customers to 

purchase conventional lines. 

While the market is still so 

young, pharmacies have the 

chance to establish themselves 

as a destination for men’s 

grooming products. n 

l Richard Northedge writes 

for the Spectator, Wall Street 

Journal, Independent on Sunday 

and other publications. 



21

f e at u r e i n d u s t r i a l p h a r m a c y 

Pharmacy at the 

cutting 

edge 

Blending the skill of pharmacy 

and the power of big business, 

Jeff Mills meets senior industrial 

pharmacist Gino Martini 

If ever anyone was in any doubt about the importance of the 

industrial pharmacy sector to the UK’s economy, let alone the 

nation’s health, they could do worse than take a trip to one of the 

major laboratory sites and manufacturing plants operated by the likes 

of GSK, Pfizer or their compatriots. 

So, after just about an hour and a half of driving in the rain 

from London, I have bypassed most of Harlow, which looks not 

unlike a work in progress, and am at the high-security gates of 

GlaxoSmithKline’s Pharmaceutical Development facility, or to be 

more precise just one of its major facilities. There are, I’m told, 

similar sites virtually all around the outer suburbs of London, such 

as Stevenage, Ware, Brentford and even Weybridge, in the leafy 

stockbroker belt of Surrey. 

But it is not until I have checked in at the gatehouse, been security 

cleared, have been allowed in and parked my car as directed that I 

really start to become aware just how large and impressive this facility 

is. If you didn’t know better you could, as a visitor, be forgiven for 

thinking you had taken a wrong turn somewhere along the way and 

wound up somewhere such as Stansted Airport, which is just down 

the motorway a bit, or perhaps in the middle of one of the New Towns 

such as Milton Keynes and Crawley, which were so popular in the 

1960s and 70s. Æ 

22 Pharmacy Professional | May 2010 May 2010 | Pharmacy Professional 23

f e at u r e i n d u s t r i a l p h a r m a c y 

It may be a slight exaggeration to say you 

need a shuttle bus to get from the visitors’ 

car park to the main reception area but in the 

persistent drizzle on the day I was there one 

would have been handy. 

The reception building is certainly big 

and dramatic. But that comes as no surprise 

when I hear from my host and the man I 

have come to visit, Gino Martini, that it was 

originally part of British Petroleum and its 

design was based on a rather grand building 

in Bahrain, one of the Middle East’s best 

known oil centres. 

Gino, or to give him his correct and 

more formal title, Dr Luigi Martini, is a 

senior director of GSK. He is also President 

of the European Industrial Pharmacists 

I give the plB my 

full support and I 

encourage all my 

fellow industrial 

pharmacists to stay 

in membership 

Group and elected Vice Chair of the UK 

Industrial Pharmacists Group. In 2008, he 

was awarded a Fellowship from the Royal 

Pharmaceutical Society of Great Britain for 

his services to science and the pharmacy 

profession. He is also a great advocate of the 

Society. 

“The RPSGB is heading for change but it 

must embrace that change if the pharmacy 

profession is going to grow,” he says. 

“Pharmacy has lagged behind professions 

such as nursing and dentistry, if we’re not 

careful we could lose even more ground,” 

he warns. “I want to see a Professional 

Leadership Body (PLB) with well thoughtout 

agendas and a collective voice.” 

The PLB must be confident in its role and 

must avoid getting too involved in internal 

politics and disputes, he says. Rather it 

should look at the bigger picture – it should 

be able to influence government, and work 

with the Department of Health and other 

bodies such as the MHRA.. 

“I give the PLB my full support and I 

encourage all my fellow industrial pharmacists 

to stay in membership,” Gino says. 

Back at his main job at GSK, Gino is 

responsible for pre-clinical development for 

Asia Pacific, Japan and various emerging 

markets, such as India, China, the area 

known as “Latina”, even Australia, with the 

brief to expand the company’s portfolio of 

products into these regions, primarily ethical 

prescription products. 

The job involves plenty of overseas travel, 

too. “I’ve already been to Beijing twice this 

year,” he says, plus plenty of other places. 

“Last year I seem to have spent a lot of my 

time travelling to Shanghai and Hyderabad”. 

Reflecting GSK’s mission statement Gino 

points out; “Our mission is to improve the 

quality of human life by enabling people 

to do more, feel better and live longer,” 

GSK is a research-based pharmaceutical 

company and is committed to tackling the 

three ‘priority’ diseases identified by the 

World Health Organization: HIV/AIDS, 

tuberculosis and malaria. 

So how did Gino’s career lead him to such 

an exulted role? I wonder. So let’s take a 

look at his CV. 

Gino graduated from the University of 

Manchester with a degree in Pharmacy and 

a PhD in Pharmaceutical Sciences. After 

spending a short time in retail Pharmacy, he 

joined Catalent Pharmaceuticals (formerly 

Cardinal Healthcare) as a senior drug 

delivery scientist developing novel oral and 

ophthalmic drug delivery systems. 

In 1996, he joined the pharmaceutical 

development department of 

GlaxoSmithKline and has undertaken a 

number of roles working in drug discovery 

support; product development, strategic and 

particulate technologies. 

It was when he was working in this 

capacity that Gino was responsible for 

adapting and developing the DiffCORE 

dosage form and for the co-development of 

the MyDOSE variable dose technology, both 

of which are trademarked to GSK. 

Innovative drug delivery 

Producing tablets with holes, which Gino 

was keen to show me during my tour of the 

GSK facility in Harlow, may not sound a 

very sophisticated approach to innovative 

drug delivery, yet the ‘hole’ idea is at the 

heart of a new generation of controlledrelease 

tablets being introduced by the 

company using its DiffCORE technology. 

It’s a problem, long recognised by 

pharmacists, that many patients do not 

adhere to their medical treatments. There are 

various reasons why they don’t, but one way 

the pharmaceutical industry is helping tackle 

the problem of compliance is by improving 

options for the delivery of medications. 

Exploration State-of-the-art buildings and 

laboratories at a GSK development site 

Taking fewer, more recognizable tablets 

a day makes for better patient compliance. 

If the active ingredient of the drug can be 

delivered more effectively, then the number 

of tablets needed for the treatment might be 

reduced. One route is to somehow control 

or time the release of the active ingredient 

into the body so the equivalent daily dose is 

the same or similar to taking several tablets 

a day. 

The DiffCORE technology involves 

creating holes of different size and number 

into coated tablets, allowing the active 

ingredient to be released in a much more 

controlled way than previously. 

Clinical trials 

Making these ‘tablets with holes’ is, of 

course, not as simple as it sounds. Gino says 

the company spent significant amounts of 

time and money on developing DiffCORE 

technology since it was purchased in its 

basic form from academia in 1999. 

“Most conventional tablets and capsules 

release the active ingredient quickly, but 

by controlling the release rate we can often 

extend the therapy and in many cases reduce 

the dosing frequency from several times a 

day to once a day,” he says. 

Tablets that use DiffCORE technology are 

easily recognisable and look different from 

conventional ones; a feature that Gino says 

should make them unusually difficult for 

counterfeiters to copy. 

When the tablet is swallowed, 

gastrointestinal fluids enter the tablet hole 

in the coat and penetrate the core, releasing 

the drug. The rate of release also depends on 

the make-up and composition of the internal 

matrix, Gino explains. 

“It’s not a matter of just drilling holes in 

our existing tablets – clinical trials are still 

involved as if they were a new product”. 

Alongside these pharmaceutical and 

patient safety considerations, a key part 

of the technology has been the design and 

development of the processing equipment 

needed for large-scale production. 

GSK is using DiffCORE technology 

in an increasing number of products for 

treatments, including epilepsy and metabolic 

disorders, although Gino points out it may 

not be appropriate for all the company’s 

tablet products. 

“There’s a lot of pressure to make sure 

our medicines are superior to what’s out 

there on the market at the moment,” Gino 

says, adding that most of the innovations 

and advances in treating diseases have come 

from the UK. 

“It’s a competitive market, so we have to 

make sure our treatments are effective. We 

have a very proud tradition of delivering 

cutting-edge technology and treatments, and 

long may it reign. 

And what can we look forward to in 

future? Drug delivery might, for example, 

see microchips in capsules of medicines 

lodged in specific parts of the body, 

programmed to release treatments at various 

times, Gino suggests. 

And as though all this wasn’t enough, 

Gino is active in plenty of other areas, too. 

He tutors PhD students and maintains links 

with several Universities. 

In 2004, he was awarded a Visiting 

Professorship at John Moore’s University of 

Liverpool and a Visiting Lectureship from 

King’s College London in 2005. n 

GSK at a glance 

• The company employs around 99,000 people 

in over 100 countries 

• Makes almost four billion packs of medicines 

and healthcare products every year 

• Over 15,000 people work in its research 

teams to discover new medicines 

• The company screens about 65 million 

compounds every year in its search for new 

medicines 

• The company supplies one quarter of the 

world’s vaccines 

• In July 2009 the company acquired Stiefel 

Laboratories, the world’s largest independent 

dermatology company. 

• In November 2009, it launched ViiV 

Healthcare, a global specialist HIV company 

established by GlaxoSmithKline and Pfizer to 

deliver advances in treatment and care for 

people living with HIV. 

• January marked the anniversary of its 

programme to help eliminate lymphatic 

filariasis (elephantiasis). During 10 years 

to 2008 the company donated 750 million 

albendazole tablets, reaching over 130 

million people. 


f e at u r e s c h i z o p h r e n i a 

This latest practice guidance from the Society on 

schizophrenia is part of a mental health toolkit which is under 

development. Ziba Rajaei-Dehkordi (lead author) and Denise 

Taylor (co-author) provide advice on pharmaceutical care 

services for schizophrenia. The RPSGB would like to thank all 

those who contributed to a mental health toolkit, including the 

focus group members, for their advice and expertise. 

Professional 

practice 

We bring you an update and the 

latest expert advice on dealing 

with patients suffering from 

psychosis and schizophrenia 

Practice Guidance: 

Pharmaceutical Care in 

Psychosis and Schizophrenia 

Guidance OBJectiVes 

• To gain an understanding of psychosis or schizophrenia and its 

management 

• Identify pharmaceutical issues and meet patients’ needs 

• Explore and implement pharmaceutical care services for psychosis 

or schizophrenia in practice 

RPSGB competencies for completing a CPD entry (see appendix 6 of 

“Plan and Record” www.uptodate.org.uk):- 

• “making sound decisions and solving problems in relation to drug 

therapy” 

• “promoting health and healthy lifestyles” 

Æ 



Background 

Psychosis – a syndrome or a collection of 

symptoms, which can include delusions and 

hallucinations. It can be drug-induced or be 

part of another illness such as: schizophrenia, 

schizoaffective disorder, intensive psychosis 

or brief psychotic disorder. 

Schizophrenia is the best-known psychotic 

illness and the most common psychotic 

disorder. Schizophrenia is not a “split 

personality” but a split between the mind 

and reality. Schizophrenia is characterised 

by positive and negative symptoms (see 

Symptoms). The negative symptoms are 

less responsive to treatment with medication 

and are associated with decreased rates of 

recovery and the positive symptoms can also 

be very distressing to the patient. 

Prevalence 

It is a chronic mental illness affecting 1% 

of the population. Schizophrenia normally 

presents between the ages of 18 and 30, 

and is slightly more prevalent in males than 

females. 

Possible causes 

The actual cause is still unknown but the 

following factors may be involved:- 

• Genetic link is strong. Children of people 

with schizophrenia are about 9% more 

likely to develop schizophrenia. 

• Environmental stressors such as poor 

maternal upbringing, deprivation in 

childhood, relationship problems. 

• Viral exposure in-utero can impair 

neurodevelopment and possibly lead to 

schizophrenia. 

• Drugs which may cause or exacerbate 

psychosis. Illicit drugs (e.g. cannabis, 

“magic mushrooms,” LSD, amphetamines, 

cocaine or ecstasy) have been implicated, 

and prescribed drugs (e.g. opiates, 

corticosteroids) can cause psychosis as a 

side effect 

Symptoms 

The common symptoms of psychosis: 

• Odd beliefs or magical thinking 

• Anxiety, blunted affect or depression 

• Irritability or loss of initiative 

• Low energy or poor concentration 

• Sleep disturbance 

• Social isolation and withdrawal 

• Perceptual disturbance 

• Odd thinking and speech 

• Odd behaviour or appearance 

• Paranoid ideation 

Positive and negative symptoms in schizophrenia 

Positive symptoms can present in a number of ways:- 

Hallucinations 

Delusions 

Formal Thought 

Disorder 

Passivity 

Affective flattening 

Alogia 

Avolition 

Anhedonia 

Drug-induced psychosis should be 

considered if delusions or hallucinations 

occur after the administration of a new 

medicine (prescribed or illicit). Treatment 

is generally delayed for at least 7 days to 

determine whether symptoms abate once the 

causative agent is stopped. 

Possible Consequences of 

Schizophrenia 

Hospitalisation: The first episode often 

results in hospitalisation and, of these, 

20% of patients will recover fully without 

relapse, 20% will never fully recover and 

require high levels of social and medical 

input. More commonly, patients will 

partly recover but not return to baseline 

functioning and will suffer further relapses 

during their life. 

Suicide: The lifetime risk of people with 

schizophrenia committing suicide has been 

estimated at 10%. 

Type-2 diabetes predisposition: People 

with schizophrenia are 2 to 4 times more 

likely to develop type 2 diabetes than those 

Most commonly auditory command (someone telling them to do 

things such as jumping off a roof or to kill themselves) or olfactory. 

Visual and tactile are less common 

May be persecutory (i.e. someone is out to hurt them), religious 

(i.e. they believe they have religious powers or their god talks 

to them), grandiose (e.g. they are a celebrity; have telepathic 

powers), bizarre e.g. thought insertion (i.e. thoughts are put into 

their mind by others) or thought withdrawal (i.e. thoughts are 

removed from their mind) or ideas of reference (the person on the 

television/radio is talking just to them). 

Disorganised speech, with rapid change of topic or words put 

together which make no sense. 

Emotions, body movements or sensations are experienced as being 

caused by an external agency 

Negative symptoms lead to disturbances in social 

or occupational functioning. These include:- 

Present as if they are depressed 

Poverty of speech and an inability to talk and communicate to 

people 

Inability to do anything. This can sometimes be interpreted as 

laziness but it is part of the illness 

Lack of ability to get pleasure from doing anything 

who are not. The actual prevalence of type 

2 diabetes in people with schizophrenia is 

between 15 and 18%, but the prevalence of 

impaired glucose tolerance may be as high 

as 30% depending on age. 

Treatment 

The NICE Clinical Guideline for 

schizophrenia http://guidance.nice.org. 

uk/CG82 outlines a holistic approach to 

patient care including pharmacological and 

non-pharmacological interventions. It is 

an important consideration that medication 

forms only part of the overall care package 

for people with schizophrenia and that 

supported adherence interventions can 

improve long-term outcomes in patient care. 

Non-Pharmacological 

• Talking therapy such as problem-solving 

therapy, 

• Cognitive behavioural therapy, 

• Family therapy and support with social 

integration, 

• Psychotherapy is recommended if there 

is a history of psychological and physical 

abuse, 

• Patient support groups such as ‘Hearing 

Voices’; supports people to live with 

auditory hallucinations. 

Pharmacological 

There are two groups of antipsychotics used 

to treat schizophrenia:- 

• Typical (or first generation) and 

• Atypical (or second generation) agents. 

Their main mode of action is to block 

dopamine pathways in the brain, and 5H2 

blockade (atypical antipsychotics). 

For further information See Practice 

Guidance: Supporting Patients on 

Antipsychotics 

Pregnancy and Breastfeeding – Specialist 

input is required to support women who 

are planning pregnancy or have become 

pregnant during treatment, or wish to 

breastfeed. 

Practice Points for 

Pharmacists 

• Encourage and support patients to 

undertake activities and address lifestyle 

issues, to promote good mental. 

Signpost to local and/or national support 

resources. 

• Drug-induced psychosis – if suspected 

refer for medical review to either the 

prescriber, GP or local mental healthcare 

team. 

• Poorly compliant patients may benefit 

from a once daily preparation and/or use 

of compliance aids. 

• Recognition of persistent side effects 

requiring support and/or advice and/or 

referral for clinical review. 

• Check for interactions, including OTC 

remedies. See BNF www.bnf.org 

• Patients at risk of suicide require urgent 

referral to a crisis resolution team 

or psychiatric emergency services or 

Accident and Emergency Department 

or GP. 

• Poisoning by antipsychotic drugs requires 

immediate referral to doctor. Features 

include convulsions, extrapyramidal 

symptoms and hypotension. 

• Clozapine 

• Signs of infection, temperature and 

sore throat require immediate patient 

reporting to doctor. Explain to patient 

that they are likely to need an additional 

blood test. 

• Caffeine increases and smoking 

decreases plasma clozapine levels. 

Advice on clozapine dose should be 

sought from prescriber if there are any 

changes in caffeine intake or smoking 

status. 

• Clozapine (and olanzapine) can cause 

up to 10 to 15kg weight gain. Advise 

patients about healthy eating and 

exercise. 

• Missed doses: if a patient misses 

medication for 2 days then clozapine 

needs to be re-initiated. Continuing with 

the same dose without re-initiation can 

result in cardiovascular effects. Refer 

urgently 

• Chlorpromazine warning - Owing to the 

risk of contact dermatitis, avoid direct 

contact with chlorpromazine; (tablets 

should not be crushed and solutions 

should be handled with care) 

• Photosensitivity can occur with 

chlorpromazine. Advise patient to wear 

sun protection in the sun. 

Levels of 

Pharmaceutical Care 

Services for Supporting 

People with psychosis 

and schizophrenia 

In general pharmacists can: 

Recognise possible symptoms of 

schizophrenia/psychosis especially when 

responding to symptoms and refer as 

appropriate 

Identify people possibly at risk of 

schizophrenia/psychosis and refer 

appropriately. 

Signpost people to support groups and 

information on pharmacological and nonpharmacological 

treatments 

Level 1: Pharmacists can: 

Provide a medication review service, with 

a key focus to support any adherence 

problems:- 

• Identify new patients by prescription 

(ensure understanding of illness, 

its treatment and available support 

including information on adverse effects, 

concordance, diet and exercise and support 

groups) 

• Be aware of concomitant medicines that 

may cause or exacerbate psychosis 

• Identify any pharmaceutical issues 

(interactions including OTC medication, 

alcohol and smoking). 

Pharmacists can offer 

support for healthy 

lifestyle interventions 

Level 2: Pharmacists can: 

Recognise symptoms of relapse: e.g. 

self-neglect; poor speech and ability to 

concentrate or interact with others; strange 

thoughts or behaviour. Referral to the 

appropriate care team, or, following a preset 

agreement for how the patient wishes to 

be managed in relapse, and who should be 

contacted. 

Pharmacists can offer support for healthy 

lifestyle interventions, including:- 

• Smoking cessation - Be aware that 

smoking reduces clozapine levels resulting 

in a need to increase dosages; if a person 

on clozapine stops smoking make urgent 

referral for blood monitoring and dosage 

review 

• Use of alcohol NHS Choices: Live well 

cut down on alcohol http://www.nhs.uk/ 

Livewell/Alcohol/Pages/Alcoholhome. 

aspx 

• Diet and exercise support and advice. Top 

Tips for eating more fruit and vegetable 

http://www.5aday.nhs.uk/topTips/default. 

html 

• Sleep hygiene advice and support 

• Vascular risk and weight management. 

Patients with psychosis and schizophrenia 

are more likely to develop diabetes due to 

the risk of antipsychotics causing weight 

gain. 

Level 3: Specialist Mental Health Level; 

Pharmacists role in effective care for those 

with chronic psychotic illness 

Pharmacists can: 

• Provide medicine education sessions 

• Monitor response and side effects 

• Suggest therapeutic changes if poor 

response 

• Prescribe (if appropriately trained and 

qualified) in collaboration with healthcare 

team and Community Mental Health Team 

(CMHT) if appropriate 

• Provide (if appropriately trained and 

qualified) a basic talking therapy service 

e.g. cognitive based therapy, mindfulness 

training 

• Provide clozapine dispensing services in 

the community. 

Æ 



Practice Guidance: 

SuPPorting Patients on Antipsychotics 

Guidance OBJectiVes 

To understand, identify and meet the 

pharmaceutical care needs of patients:- 

• initiating antipsychotic therapy 

• on maintenance therapy, and 

• withdrawing from antipsychotic therapy 

RPSGB competencies for completing a CPD 

entry (see appendix 6 of “Plan and Record” 

www.uptodate.org.uk):- 

“making sound decisions and solving 

problems in relation to drug therapy” 

“promoting health and healthy lifestyles” 

Background 

Antipsychotic drugs are also known as 

‘neuroleptics’ and (misleadingly) as ‘major 

tranquillisers’. Antipsychotic drugs generally 

tranquillise without impairing consciousness 

and without causing paradoxical excitement 

but they should not be regarded merely 

as tranquillisers. For conditions such as 

schizophrenia the tranquillising effect is of 

secondary importance. 

1. Pharmaceutical Care at Initiation 

People presenting for the first time with 

psychosis will generally be initiated 

treatment in a secondary care setting. It is 

recommended that the potential side effects 

are discussed with the patient at the point 

of prescribing, to ensure the optimal choice 

of medication is aligned with the patient’s 

lifestyle. 

Advice to patients at Initiation 

• Possible side effects (see Side effects) 

All can cause side effects; people should be 

made aware that these medicines may make 

them feel worse (due to side effects) before 

they start to feel better. 

• Time to onset of action usually has an effect 

in a few days, with effect building over 3-4 

weeks 

• Take at a regular time each day 

• Possible withdrawal effects 

Do not to stop taking suddenly as may 

experience a withdrawal syndrome. (see 

Pharmaceutical Care on Withdrawal section) 

• Drowsiness may affect performance of 

skilled tasks (e.g. driving or operating 

machinery), especially at start of treatment; 

effects of alcohol are enhanced. 

• Avoid alcohol (Alcohol is a CNS 

depressant; can also increase sedative side 

effects of antipsychotics) 

• Provide information and signpost:- 

- Leaflets on psychosis/schizophrenia and 

medication 

- Support resources e.g. audiotapes, peer 

support groups, including diet and 

lifestyle 

Antipsychotic side effect profiles 

Antipsychotic drugs are considered to 

act by interfering with dopaminergic 

transmission in the brain by blocking 

dopamine D2 receptors, which may give rise 

to the extrapyramidal effects, and also to 

hyperprolactinaemia. Extrapyramidal effects 

and hyperprolactinaemia are less common 

with atypical antipsychotics. 

Antipsychotics also interact with a number 

of other receptor systems such as histamine 

receptors, alpha-receptors and muscarinic 

receptors resulting in a range of different 

side effects (e.g. weight gain; postural 

hypotension and drowsiness respectively). 

Typical Antipsychotics 

Extrapyramidal symptoms (EPSE) are 

the most troublesome. They are easy to 

recognise but cannot be predicted accurately 

because they depend on the dose, the type of 

drug, and on individual susceptibility. The 

relative incidence of EPSE is as follows:- 

Most likely 

Moderately 

likely 

Least likely 

Fluphenazine, 

perphenazine, 

trifluoperazine, 

zuclopenthixol and 

haloperidol 

Flupentixol, pipotiazine 

Chlorpromazine, 

levomepromazine 

Pericyazine, sulpiride 

Atypical Antipsychotics 

Clinically less likely to cause extrapyramidal 

side effects including tardive dyskinesia, 

or to affect prolactin levels. There is an 

increased risk of developing or exacerbating 

diabetes with all antipsychotics but 

especially some atypical antipsychotics (e.g. 

clozapine, olanzapine and quetiapine). 

Clozapine has proven benefit in treating 

associated negative symptoms of 

schizophrenia. 

Aripiprazole, clozapine, olanzapine, 

quetiapine, cause little or no elevation of 

prolactin levels. 

Clozapine used in ‘treatment resistant’ 

schizophrenia, can cause blood dyscrasias. 

Its use is restricted to patients registered 

with a clozapine monitoring service (see 

Clozapine Monitoring). 

Side Effects: Advice on Management 

People need to be informed about the most 

common side effects to self manage and 

identify when to seek urgent medical advice. 

For a detailed list of side effects see BNF 

www.bnf.org 

>> See table opposite 

Interactions: prevention and advice 

For interactions see BNF www.bnf.org 

Key considerations: 

• Metabolism by the cytochrome P450 

system: Blood levels of antipsychotics can 

be affected by concomitantly prescribed 

medicines which undergo the same 

metabolic pathway. Check for interactions 

at all times. 

e.g. Patient on clozapine prescribed 

erythromycin; may increase clozapine levels 

and induce adverse effects such as seizure 

• Immunosupression can occur with 

some antipsychotics, e.g. clozapine and 

chlorpromazine. Use with caution and 

monitor patient when co-prescribed with 

myelosuppressive agents. Regular blood 

monitoring is mandatory for clozapine. 

Risks of sudden death: Generally only 

one antipsychotic at a time should be 

prescribed; exceptions are when stopping 

one and starting another, or if a depot is 

being prescribed and there are breakthrough 

symptoms. Risks include sudden death 

(especially if doses are above BNF limits) 

and Neuroleptic Malignant Syndrome 

(NMS). NMS is rare (in approximately 1% 

of patients treated with antipsychotics), but 

potentially fatal and should be treated as a 

medical emergency. 

Signs & Symptoms of NMS 

Severe muscle rigidity and elevated 

temperature with two of the following: 

tremor; diaphoresis, dysphagia, incontinence, 

changes in consciousness, mutism, 

tachycardia, increased blood pressure. 

Side Effects: Advice on Management 

Medication 

Extrapyramidal 

Hormonal – hyperprolactinaemia 

Cardiovascular – Hypotention, 

arrhythmias and sudden death 

Antimuscarinic 

Blood dyscrasias 

Hyperlipidaemia 

Diabetes 

Weight gain 

Presenting signs and symptoms 

Considerations & Advice 

Parkinsonism 

Approximately 20% of patients treated with typical antipsychotics 

will develop the parkinsonism side effect of rigidity, tremor, 

akinesia (lack of movement) and bradykinesia (slowness of 

movement). Onset is usually within days or weeks of treatment. 

Patient’s medication to be reviewed with their doctor, 

potential management options of:- 

Reducing dose of antipsychotic 

Prescribing an anticholinergic 

Switching to an atypical antipsychotic 

Akathisia (restlessness) 

Common in over 25% of patients with typical antipsychotics, 

characteristically occurs after large initial doses and may resemble 

an exacerbation of the condition being treated. Refer to doctor 

Dystonia (group of muscles go into spasm (e.g torticollis (neck) 

oculogyria (eyes)) 

90% cases of occur in the first 5 days of treatment. Up to 10% of 

patients treated with typical antipsychotics will develop dystonia 

in one form or another. Immediate medical attention is 

required – with administration an anticholinergic and/or change 

to an atypical antipsychotic 

Tardive Dyskinesia (rhythmic, involuntary movements of tongue, 

face, & jaw) 

Develop over months or even years following chronic exposure to 

antipsychotics or with high dosage. May resolve (up to 6 months) 

by stopping the drug, but in some cases it is irreversible. Atypical 

antipsychotics are thought to have a lower risk. Refer to doctor. 

Typical antipsychotics and some atypicals (e.g. risperidone) may 

cause increased levels of prolactin, which can cause a number 

of symptoms such as gynaecomastia (breast enlargement) 

and galactorrhoea (secreting breast milk), increased risk of 

osteoporosis, menstrual and sexual dysfunction, acne and 

hirsutism. 

Counselling Point: Women of childbearing age may need 

contraceptive advice when switching from a typical to an 

atypical antipsychotic. 

Postural hypotension and arrhythmias with some antipsychotics 

(especially during initial dose titration). Clozapine: Fatal 

myocarditis (most commonly in first 2 months) and 

cardiomyopathy reported. Refer to doctor if present with 

cardiovascular symptoms 

Symptoms such as dry mouth, constipation, difficulty with 

micturition, and blurred vision. Advise as appropriate 

Clozapine has the greatest risk of causing neutropenia and 

agranulocytosis; not dose-related. Can occur at any time, but 

the first 18 weeks are considered the period of highest risk. See 

clozapine monitoring below. 

Can occur with any antipsychotic. Advise and support, provide 

cholesterol testing 

Antipsychotics, particularly some atypicals have been associated 

with increased risk of hyperglycaemia and development of 

diabetes. Recognise potential signs and symptoms, advise and 

support, provide glucose testing 

Associated with all antipsychotic medication. Provide weight 

monitoring and management support and advice 

Clozapine Monitoring 

Monitoring is essential due to risk of blood 

dyscrasias (usually reversible neutropenia 

in 3-4% patients, which may progress to 

agranulocytosis in 0.8% patients over one 

year). Patients MUST be registered with a 

clozapine patient monitoring service. 

• A full blood count must be performed 

weekly for 18 weeks, fortnightly up to 52 

weeks and 4-weekly thereafter and 4 weeks 

after discontinuation. 

Other monitoring: 

• Check for interactions: concomitant 

medication, caffeine ingestion and smoking 

affects clozapine blood levels. Report 

potential interactions to Doctor immediately. 

• Caution if used with drugs which cause 

constipation (e.g. antimuscarinic drugs) 

or in history of colonic disease or bowel 

surgery. Monitor for constipation and refer 

to doctor or advise on laxative if required. 

• Signs of infection, temperature and 

sore throat require immediate patient 

reporting to doctor. (Usually an additional 

blood test is taken). 

2. Pharmaceutical Care for 

Maintenance 

People prescribed antipsychotics are at 

risk of weight gain, metabolic malignant 

syndrome and potentially type 2-diabetes. 

Diabetes is an independent risk factor for 

cardiovascular disease; therefore monitoring 

and support should include the following: 

Weight gain: provide advice on healthy 

eating and weight management 

Diabetes and Cardiovascular risk 

Lifestyle issues: promote good mental & 

physical health 

Switching antipsychotics due to 

inadequate efficacy Switching is generally 

achieved by gradual reduction of the dose 

of the first agent and simultaneous titration 

up of the second agent (cross-tapering). 

For further advice see the BNF www.bnf. 

org, Psychotropic Drug Directory and the 

Maudsley Prescribing Guidelines 

3. Pharmaceutical Care on 

Withdrawal 

When stopped suddenly, antipsychotics may 

produce an acute withdrawal syndrome in 

some people. Rapid relapse can also occur. 

Withdrawal of antipsychotic agents after longterm 

therapy should always be gradual and the 

patient should be closely monitored for signs 

of relapse or discontinuation symptoms. 

Æ 



31


Patient Resources and 

Support Groups 

• MIND www.mind.org.uk 

• Mental Health Foundation 

www.mentalhealth.org.uk 

• Rethink www.rethink.org 

• Patient UK www.patient.co.uk/selfhelp.asp 

• Choice and Medication 

www.choiceandmedication.org.uk 

• Hearing Voices www.hearing-voices.org 

• Saneline www.saneline.org.uk 

• PharmacyHealthLink Lifestyle resources 

(“resource cards”, leaflets, posters): www. 

pharmacyhealthlink.org.uk/?q=leaflets-andfactsheets 

• Lifestyle www.nhs.uk/livewell/Pages/ 

Livewellhub.aspx (weight loss, alcohol, smoking, 

sleep, mental health etc.) 

• Department of Health ‘Choosing 

talking therapies?’ www.dh.gov.uk/en/ 

Publicationsandstatistics/Publications/ 

PublicationsPolicyAndGuidance/DH_4008162 

• Mental Health Foundation Talking therapies 

www.mentalhealth.org.uk/information/mentalhealth-a-z/talking-therapies/ 

Useful Resources for Pharmacists 

• United Kingdom Psychiatric Pharmacy Group 

www.ukppg.org.uk 

• Bazire S. Psychotropic Drug Directory 2009. Aberdeen: 

HealthComm UK Ltd; 2009 

• Taylor D, Paton C, Shitij K. The Maudsley Prescribing Guidelines 

10th Edition. London: Informa Healthcare; 2009 

• Francis SA, Patel M. Caring for people with schizophrenia: 

family carers’ involvement with medication. Int J Pharm Pract. 

2000:8:314-23 

• Bleakey S, Weatherill M. Treatments for patients with 

schizophrenia. Pharmaceutical Journal 2009:283:101-104 (July 

25) www.pjonline.com 

• Khan S. Getting ready for NHS Health Checks. Pharmaceutical 

Journal 2009:282:417-418 (Apr 11) www.pjonline.com 

• RPSGB Practice guidance: obesity www.rpsgb.org/pdfs/ 

obesityguid.pdf 

• Neuroleptic Malignant Syndrome: www.nmsis.org 

Pregnancy and Breastfeeding 

• UKMI www.ukmi.nhs.uk/default.asp 

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Analgesia 

An association has been found 

between regular use of analgesics 

and an increased risk of hearing 

loss, especially in people under 50 

years of age (American Journal of 

Medicine). ● Amitryptiline or 

pregabalin should be used firstline 

for neuropathic pain, except 

in diabetic neuropathy, the 

National Institute for Health and 

Clinical Excellence has advised. 

● Patients with cardiovascular 

disease should only use nonsteroidal 

anti-inflammatory drugs 

at high doses for prolonged 

periods if unavoidable, the Drug 

and Therapeutics Bulletin advises. 

Naproxen is associated with the 

lowest cardiovascular risk and 

diclofenac with the highest. 

Asthma 

Step up therapy benefits children 

with asthma uncontrolled by low 

dose inhaled corticosteroids, with 

the addition of a long-acting beta 

agonist producing better 

responses than a leukotriene 

receptor antagonist or doubling 

the corticosteroid dose. However, 

concerns remain over the safety of 

long-acting beta agonists (New 

England Journal of Medicine). 

Diabetes 

Intensive management of blood 

pressure in patients with type 2 

diabetes to a target systolic blood 

pressure of

L E A R N I N G & D E V E L O P M E N T 

CPD 

Managing diabetic emergencies 


Panel 1: Treatment options in diabetes and likelihood of hypoglycaemia 

Diabetic emergencies can occur either in patients known to have 

diabetes or as an initial presentation of the disease. Ram Prakash 

Narayanan and Mark Peasley discuss their management 

THE usual presentations of a diabetic 

emergency are hypoglycaemia, 

diabetic ketoacidosis (DKA) or a 

hyperglycaemic hyperosmolar state. 

Response to treatment is generally good but 

delays can lead to adverse outcomes (eg, 

brain injury and fatalities). In the absence 

of a strong evidence base, treatment is 

usually based on commonly accepted 

guidelines modified for local practice. 

Acute hypoglycaemia 

Hypoglycaemia is the most common 

complication of diabetes, accounting for 

around 90,000 ambulance call outs 1 and 

8,000 hospital admissions 2 per year in the 

UK. Symptoms generally present at blood 

glucose levels of 2.5–3mmol/L but they 

also manifest outside this range and 

patients can report different symptoms. 

Patients should be told that any capillary 

blood glucose (CBG) less than 4mmol/L 

requires treatment — “four is the floor”. 

Symptoms consist of anxiety, 

palpitations, tremor and sweating 

(adrenergic symptoms, sometimes called 

warning symptoms), irritability, incoordination, 

confusion, weakness, fatigue and 

seizures (neuroglycopaenic manifestations) 

and, later, loss of consciousness. 

Hypoglycaemia can occur in both type 1 

and type 2 diabetes. It is most commonly 

seen in patients treated with insulin or drugs 

that affect the activity of insulin (ie, 

insulinotropic drugs), such as 

sulphonylureas, or both. Long-acting 

sulphonylureas (glibenclamide and 

chlorpropamide) are more likely to cause 

hypoglycaemia. These are renally excreted 

so should be avoided in those with impaired 

renal function — drug accumulation 

increases risk of hypoglycaemia — and in 

elderly patients (who are likely to have 

some renal impairment). Panel 1 describes 

diabetes treatments and their risk of 

hypoglycaemia. Hypoglycaemic events can 

also be a consequence of efforts to tighten 

glycaemic control and a balance is needed. 

Non-antidiabetic agents that have been 

implicated in hypoglycaemia include 

quinine, quinolone antibiotics, pentamidine 

and co-trimoxazole — they may be 

insulinotropic. Alcohol can precipitate 

hypoglycaemia by inhibiting 

gluconeogenesis. 

Conditions that can precipitate 

hypoglycaemia, either on their own or in 

combination with diabetes drugs, are endstage 

liver disease, renal failure, starvation, 

infection and adrenal insufficiency. 

Insulinoma is an uncommon cancer that 

can cause fasting hypoglycaemia. This is 

normally managed surgically but treatment 

with diazoxide can help to reduce 

hypoglycaemic episodes. 

Hypoglycaemia is rated as mild, 

moderate or severe as follows: 

● Mild The person is aware of the 

hypoglycaemia and can self treat orally. 

● Moderate The person cannot respond to 

hypoglycaemia and requires assistance, 

but oral treatment is successful. 

Helga1984 /Dreamstime.com 

Evaluate 

Reflect 

Act 

Plan 

Reflect on knowledge gaps 

1. Which antidiabetic agents are most likely 

to cause hypoglycaemia? 

2. How should hypoglycaemia be treated? 

3. What are the sick day rules? 

Before reading on, think about how this 

article may help you to do your job better. 

● Severe The person has impaired 

consciousness and requires assistance and 

parenteral therapy. 

Autonomic neuropathy, drinking alcohol 

and beta-blocker therapy can all mask 

adrenergic symptoms so that a patient is 

unaware of hypoglycaemia. Those with 

recurrent episodes of hypoglycaemia may 

also lose adrenergic symptoms. In such 

patients a period of hypoglycaemia 

avoidance can, in most cases, help restore 

these warning symptoms. 3 

In rare cases, hypoglycaemia can be 

triggered by accidental or intentional 

overdoses of insulin, sulphonylureas or 

meglitinides, and underlying reasons 

should be addressed. Management should 

consider drug half-lives. Where overdose is 

suspected, in order to distinguish between 

endogenous secretion and exogenous 

insulin administration, plasma glucose, 

insulin and c-peptide levels should be taken 

before treating hypoglycaemia (symptoms 

allowing). In endogenous insulin secretion 

Drug/drug group and place in therapy 

Insulins (all types) First line in type 1 diabetes 

but normally last line in type 2 diabetes. 

(Management of type 2 diabetes was recently 

covered in Clinical Pharmacist, 2009;1:475–82.) 

Metformin First line in type 2 diabetes. 

Sulphonylureas (eg, gliclazide, 

glibenclamide) Second line in type 2 diabetes. 

Meglitinides (repaglinide and nateglinide) 

Second or third line in type 2 diabetes. 

Thiazolidinediones (pioglitazone and 

rosiglitazone) Second or third line in type 2 

diabetes. 

Acarbose Third line in type 2 diabetes. 

Dipeptidylpeptidase-4 inhibitors 

(sitagliptin, vildagliptin and saxagliptin) 

Third line in type 2 diabetes. 

Glucagon-like-1 peptide agonists 

(exenatide and liraglutide) Third line in type 2 

diabetes (see specific guidance from the National 

Institute for Health and Clinical Excellence). 

there will be an equimolar rise in plasma 

c-peptide levels because islet secreted 

pro-insulin is cleaved into active insulin 

and residue c-peptide, whereas exogenous 

administration results in no c-peptide rise. 

In suspected sulphonylurea overdose, 

sulphonylurea levels should be found. 

Mild to moderate hypoglycaemia 

The firstline treatment for mild to moderate 

hypoglycaemia is 10–20g of rapidly 

absorbed simple carbohydrates. This 

should raise blood glucose levels in about 

15 minutes. Examples of 10g of simple 

oral carbohydrates include 55ml of high 

energy glucose drinks (eg, Lucozade), 

100ml of Coca-Cola, two teaspoons of 

sugar, three glucose tablets or a tube of 

commercially available concentrated 

Mechanism of action 

Enhanced glucose uptake via actions at type 4 

glucose transporters (GLUT4). Glucogenolysis and 

gluconeogenesis inhibited. (Fatty acid and 

triglyceride synthesis increased. Lypolysis inhibited.) 

Unclear, but likely to inhibit gluconeogenosis and 

enhance sensitivity of muscle and fat to insulin. 

Stimulate release of insulin via activation of 

potassium channels in the islets. 

Similar to sulphonylureas. 

Reduce resistance to actions of insulin in muscles, 

adipose tissue and the liver, by acting as a 

selective agonist for PPAR receptor. 

Inhibits alphaglucosidase, delaying glucose 

absorption. 

Inhibit breakdown of incretin hormones (see GLP- 

1 agonists). 

Mimic incretins to stimulate release of insulin 

(glucose dependent), reduce peripheral insulin 

resistance, delay glucose absorption, preserve 

pancreatic cell mass and prevent post-prandial 

glucagon release. 

glucose (eg, Glucogel, which patients 

treated with short or biphasic insulins or 

sulphonylureas can be advised to carry). 

The tendency to overcorrect 

hypoglycaemia (eg, by drinking a whole 

bottle of Lucozade) should be avoided. In 

the case of sulphonylurea overdose 

overcorrection of hypoglycaemia will 

stimulate further insulin release. 

Overcorrection can also lead to worsening 

glycaemic control. CBG should be 

measured after 10 to 15 minutes. If blood 

Mark Peasley will be available to 

answer questions online on the topic 

of this CPD article until 10 May 2010 

Risk of hypoglycaemia 

High in overdose, when dosage and 

carbohydrate intake are mismatched or the 

wrong type of insulin issued (eg, if short-acting 

insulin is mistaken for long-acting insulin). 

Unlikely — not insulinotropic. 

Insulinotropic so can cause hypoglycaemia. 

Higher risk with longer-acting agents, and in 

elderly patients and those with renal dysfunction. 

Possible risk but short duration of action. 



May increase likelihood of hypoglycaemia when 

used with sulphonylureas. 

May increase likelihood of hypoglycaemia when 

used with sulphonylureas. 

glucose is still less than 4mmol/L oral 

carbohydrates may be repeated and CBG 

rechecked up to three times. If still 

hypoglycaemic, intravenous 10 per cent 

dextrose at 100ml/h or 1mg intramuscular 

glucagon should be considered. 

As soon as the patient is 

normoglycaemic, long-acting carbohydrates 

(eg, two biscuits, a slice of bread, oat-based 

cereal bars, a sandwich, cereals or fruits) or 

a meal (if due) should be given to maintain 

blood glucose levels. 

Severe hypoglycaemia In patients 

with impaired consciousness standard first 

aid measures (ie, airway, breathing and 

circulation) should be addressed. Where 

glucagon is not contraindicated 1mg can be 

administered intramuscularly in 

36 

Pharmacy Professional | May 2010 

May 2010 | Pharmacy Professional 37



CPD 

patients weighing above 25kg or older than 

eight years (0.5mg for those below 25kg or 

younger than eight years). 

Glucagon promotes the conversion of 

glycogen stores in the liver into glucose. If 

the patient does not respond within 10 

minutes, administration of intravenous 

dextrose becomes essential. Response to 

glucagon can be poor in patients with 

hypoglycaemia related to alcohol or liver 

disease and in cachectic patients (they have 

inadequate glycogen reserves). In hospital, 

rapid intravenous access and administration 

of 10 or 20 per cent dextrose is indicated 

until normoglycaemia is restored. The use of 

50 per cent dextrose solutions is discouraged 

due to the high risk of thrombophlebitis. 

Again, complex carbohydrates should be 

given after intravenous glucose to maintain 

blood glucose levels. 

Patients with sulphonylurea-induced 

hypoglycaemia can have prolonged periods 

of low blood glucose due to the longer 

half-lives of these drugs and have to be 

monitored more frequently. Glucagon is not 

indicated in sulphonylurea-related 

hypoglycaemia because it may be 

insufficient to correct the hypoglycaemia 

(because the sulphonylurea will cause 

further insulin release). Such patients need 

intravenous glucose and may require 

therapy with somatostatin analogues such 

as octreotide (unlicensed indication — 

hyperglycaemia is a side effect of 

somatostatn analogues because they inhibit 

the release of pancreatic hormones). 

Contact with the hospital diabetes team 

is recommended to address the cause of 

hypoglycaemia, especially in patients 

without warning symptoms or in severe 

hypoglycaemia. Recurrent hypoglycaemia 

destabilises overall glycaemic control and 

education on avoiding future episodes and 

balancing diet and exercise, and 

multidisciplinary input are crucial. 

Diabetic ketoacidosis 

DKA involves hyperglycaemia, ketosis and 

acidosis. It is usually seen in type 1 

diabetes but can also occur in patients with 

type 2 diabetes, especially in those of Afro- 

Caribbean or Hispanic backgrounds. 

Studies also show that nearly a fifth of 

children and young adults are admitted 

more than once with this complication 4 and 

DKA is the most common cause of death in 

young people with diabetes. Overall 

mortality rates are below 5 per cent, but 

may be higher in the elderly. 

Criteria for the diagnosis of DKA, as 

suggested by the Joint British Diabetes 

Societies (JBDS) 5 , include: 

● Blood glucose >11mmol/L or known 

diabetes mellitus 

● Blood ketones >3mmol/L or significant 

ketonuria (++ or more on urine dipsticks) 

● Acidosis (arterial pH


CPD 


a few days and should not delay transfer 

to subcutaneous insulin in the context of 

an overall clinical recovery. 

Those not previously on insulin can be 

started on a basal bolus regimen (shortacting 

mealtime insulin and longer-acting 

basal insulin) or a twice daily pre-mixed 

regimen, estimating the likely dose from 

intravenous insulin requirements since the 

resolution of acidosis. Patients using an 

insulin pump pre-admission may go back 

to their usual treatment once pump failure 

has been excluded as a precipitant of the 

DKA. Insulin doses in many cases will 

need readjusting in the first 48 to 72 hours. 

The underlying precipitants for DKA 

should be identified and treated. The 

hospital diabetes team should be involved 

to ensure that patients get the relevant 

education to address triggers of DKA and 

minimise further events. Reinforcement 

of “sick day rules” (see Panel 3, p39) is 

particularly important because patients 

often mistakenly omit or reduce insulin 

doses when they are unwell. 

HHS 

Also known as hyperosmolar non-ketotic 

hyperglycaemia (HONK), hyperosmolar 

hyperglycaemic state (HHS) typically 

occurs in patients with type 2 diabetes and 

aged over 60 years but up to 40 per cent 

of cases are people previously unknown to 

have diabetes. 8 Mortality is high — up to 

15 per cent of presenting cases. HHS is 

generally of more gradual onset than DKA 

and can develop over many days, with 

progressive deterioration. Circulating 

insulin levels, although inadequate for 

glucose control, are sufficient to prevent 

lipolysis and ketoacidosis. The triggers are 

similar to DKA (ie, sepsis, myocardial 

infarction or poor compliance with 

diabetes treatment). HHS involves: 

● Hyperglycaemia (often >50 mmol/L) 

● pH >7.3 

● Calculated serum osmolality 

>350mOsm/kg (normal range is usually 

280–300mOsm/kg) 

Ketonuria is absent or minimal, and 

serum bicarbonate is ≥15mmol/L. 

Measurement of laboratory serum 

osmolality is useful. A difference of greater 

than 20mOsm/kg between measured and 

calculated serum osmolality suggests the 

presence of an unionised compound such as 

alcohol, ethanol or glycol. 

Patients can present as unwell, with 

dehydration and other underlying issues 

(eg, sepsis). Because the onset is gradual 

and patients are often elderly with 

comorbidities, treatment is less aggressive 

than in DKA. The basis remains fluid 

resuscitation and insulin infusions, but both 

are given at half the rate of DKA regimens. 

Patients should have hourly CBG 

monitoring, regular electrolyte checks, 

urinary catheterisation and close fluid 

balance charting. Again 0.9 per cent NaCl 

is the fluid of choice but it may be 

appropriate to use 0.45 per cent (“halfnormal”) 

NaCl in some cases where serum 

sodium is above 155mmol/L. Serum 

electrolytes, full blood counts, a septic 

screen, chest radiographs and an ECG 

should be considered in all cases. Plasma 

glucose levels can fall rapidly with 

rehydration, reducing insulin requirements. 

Thromboembolic disease is a significant 

risk in HHS and anticoagulation measures 

are recommended in all cases unless 

Act: practice points 

Reading is only one way to undertake CPD 

and the Society will expect to see various 

approaches in a pharmacist’s CPD portfolio. 

1. Make sure you patients starting 

sulphonylureas will recognise warning 

signs of hypoglycaemia. 

2. Review your first aid training to ensure 

your staff know how to deal with 

hypoglycaemia. 

3. Find out about your local 

management guidelines for 

hypoglycaemia. 

Evaluate 

For your work to be presented as CPD, you 

need to evaluate your reading and any 

other activities. What have you learnt? 

How has it added value to your practice? 

(Have you applied this learning or had any 

feedback?) What will you do now and how 

will this be achieved? 

Record 

Consider making this activity one of your 

nine CPD entries this year. 

contraindicated. As in DKA, education and 

measures to address precipitant factors 

must be a part of the overall management. 

Because many cases of HHS occur in the 

elderly, community support arrangements 

and involvement of family members may 

be needed as part of an overall programme. 

Resource 

● The latest NHS care guideline on hospital 

management of hypoglycaemia in adults with 

diabetes mellitus (Stanisstreet et al),published last 

month,is available at www.library.nhs.uk. 

References 

1.Sampson MJ,Mortley S,Aldridge VJ.The East Anglian 

Ambulance Trust Diabetes emergencies audit— 

numbers and demographics.Diabetic Medicine 

2006;23:P101. 

2.Kearney T,Dang C.Diabetic and endocrine 

emergencies.Postgraduate Medical Journal 

2007;83:79–86. 

3.Fanelli CG,Epifano L,Rambotti AM,Pampanelli S,Di 

Vincenzo A,Modarelli F et al.Meticulous prevention of 

hypoglycemia normalizes the glycemic thresholds and 

magnitude of most of neuroendocrine responses to, 

symptoms of,and cognitive function during 

hypoglycaemia in intensively treated patients with 

short-term IDDM.Diabetes 1993;42:1683–9. 

4.Smith AHK.The National Paediatric Diabetes Audit. 

Annual Report 2001.Diabetes UK ;2001. 

5.Joint British Diabetes Societies Inpatient Care Group. 

The management of diabetic ketoacidosis in adults. 

2010.Available at www.diabetes.nhs.uk. 

6.Morris LR,Murphy MB,Kitabchi AE.Bicarbonate 

therapy in severe diabetic ketoacidosis.Annals of 

Internal Medicine 1986;105:836– 40. 

7. Wolfsdorf J,Glaser N,Sperling MA .Diabetic 

ketoacidosis in infants,children,and adolescents:a 

consensus statement from the American Diabetes 

Association.Diabetes Care 2006;29:1150– 2259. 

8.Savage MW,Kilvert A.ABCD guidelines for the 

management of hyperglycaemic emergencies in adults. 

Practical Diabetes International 2006;23:227–31. 

● Ram Prakash Narayanan, MBBS, MRCP, 

is specialty registrar in diabetes and 

endocrinology, and Mark Peasley, PgDip, 

MRPharmS, is advanced clinical 

pharmacist, education and training diabetes 

and endocrinology, both at University 

Hospital Aintree, Liverpool. 

CPD articles are commissioned by The 

Pharmaceutical Journal and are not peer 

reviewed. 

40 

Pharmacy Professional | May 2010

lifestyle 

contents 

43 Travel 

The highlife and lowlife of Rio 

46 Watches 

Time for style 

47 Gadgets 

To look out for 

48 Fashion 

Hairstyles you can work with 

49 Personal finance 

All the latest on pensions 

50 Health Food 

Bruno Loubet serves mussels 

52 Transport 

Stylish ferries 

55 The Arts 

Pharmacy on TV 

56 Offers/crossword 

For members only 

Glitz and grime 

but there’s nowhere quite like Rio 

It’s the city of Sugar Loaf Mountain; the statue of 

Christ the Redeemer; the beaches at Copacabana 

and Ipanema and the annual carnival, but as 

Jeff Mills discovers it’s not all glamour in Rio 

have been waiting for the best part of 

I an hour outside an enormous building 

which looks as though it may once have 

been an aircraft hangar, somewhere in the 

less than salubrious downtown area of 

Rio de Janeiro, at what I am told is one of 

the best known samba schools in the city, 

waiting for the show to start. 

With plenty of time to kill, the man I 

take to be in charge has already proudly 

shown me sheds full of what he says are 

props used in the parade during past years’ Æ 


43

t r av e l R I O 

Brasilian beauty The statue of Christ the Redeemer (left) towers over Rio and its beaches (above) 

Rio carnivals. There’s the trailer part of a very 

rusty lorry bearing what appears to be a badlybattered 

full-scale model of a cow, or perhaps 

it is a bull. There’s a papier-mâché giant’s 

head, sadly now permanently detached from 

its body and part of the torso of a reclining 

woman, which seems to have done battle with 

the elements in a big way – and lost. 

It’s the sort of thing which could well 

compete for exhibition floor space at some 

avant-garde European gallery, “Reclining 

Nude post Rio Carnival”, perhaps. 

Well-rehearsed routine 

I am about to give up waiting and head back 

to the comfort of the beach and my hotel, 

the Copacabana Palace, in an area actually 

considered safe enough for unaccompanied 

tourists to wander about on their own, when 

there seems to be something happening, 

suddenly a pile of drums of varying sizes 

has appeared just outside the doors to the 

main hangar and what looks like an entire 

football team of smiling youths are piling 

out of a couple of cars, hardly less rusty and 

decrepit than the discarded carnival props 

inside. 

The young men form themselves and their 

instruments into a couple of lines and their 

leader, clearly the conductor, takes his place 

in front. 

As the beat starts up and the drummers find 

their rhythm the door at the far end of the giant 

shed is flung open and half a dozen statuesque 

girls, in glittery bikinis, fishnet tights, massive 

feathers, ultra-high heels and inch-thick 

makeup, strut their stuff in what is obviously a 

well-rehearsed routine. A few minutes later, the 

dismal surroundings seem to fade away and I 

start to understand just what makes Rio and its 

carnival so very special. 

Carnival originally arrived in Brazil from 

Portugal in the form of costume balls and 

parades for royalty and the nobility. Not 

to be outdone, though, the African slaves 

of the time performed their own, rather 

humbler, form of carnival, when one of the 

men would dress up as king for the day. 

The tradition has survived. Even now the 

character known as “Rei Momo” (King of 

Polygamy) reigns over the celebrations. 

The now familiar samba beat started when 

one of the organisers suggested it would be a 

good idea for all the drummers to play at the 

same time. The samba schools, such as the 

one I am visiting, which are more like clubs 

than schools, started in 1920. Now they are 

said to employ upwards of 80,000 people 

full time with another 500,000 joining in 

to help with the preparations in the weeks 

leading up to the annual carnival itself. 

Only in a city such as Rio, perhaps, 

could this massive workforce spend the 

best part of a year toiling away for the mere 

80 minutes of fame they enjoy as they, 

and their lovingly-designed and decorated 

floats, parade along the streets and into the 

Passarela do Samba, also known locally as 

the “Sambodromo”, in the contest to win the 

accolade of ultimate champion. 

But then if you have the misfortune to be 

born poor in a city such as Rio there must 

be worst things to do than join your local 

samba school, which can at least for part of 

the time take your mind off the dismal favela 

(shanty town) in which you live. 

The favelas are on the tourist trail, too, or 

at least some of them are, those deemed by 

the local authorities to be safe enough for 

outsiders to visit. Biggest is Favela Rocinha, 

another is Vila Canoas, where community 

projects have made it something of a tourist 

attraction with the inhabitants well versed in 

welcoming foreigners. 

The favelas, though, are a far cry from 

other, far richer, areas of Rio, the parts 

where tourists can feel safe and well 

insulated from the crime with which this 

city is associated, though it has to be said it 

appears to be less of a problem than it used 

to be. 

Down by Copacabana beach, dominated 

by the wedding-cake style Copacabana 

Palace hotel, the first truly luxurious hotel 

to open in Rio way back in 1923, it is 

considered perfectly safe to take a stroll along 

the promenade, though you would be well 

advised to leave any valuable jewellery or 

watches locked in the hotel safe, just in case. 

The Copacabana Palace, now part of the 

Orient Express Hotels company, is where 

the beautiful, and some not so beautiful, 

people choose to stay. At lunch by the hotel 

pool I think I keep half recognising famous 

faces, though it’s hard to be sure when they 

are hidden behind massive sunglasses and 

surrounded by countless hangers-on. 

Maybe it’s the very cool scene, which 

makes everyone look famous. The food and 

wine are good, though. One of the tenderest 

steak sandwiches I have ever eaten – and 

probably one of the least expensive - and 

very good local red wine. But then Brazil is 

well known for its prime beef and vineyards. 

Copacabana Beach itself (which shares top 

billing with the city’s other major fashionable 

strip of sand, Ipanema) is where young and 

old alike congregate during the daytime to 

soak up the sun, play beach volleyball or 

football, see and above all be seen. 

There are flags flying along parts of the 

beach, which stretches right along Avenida 

Atlantica. Some signify the hippy area, 

still populated by leftovers from the 1960s, 

some mark areas for families, some the part 

where gays tend to congregate, some where 

you can take part in beach sports and some 

simply advertising the presence of a bar or 

ice cream parlour. 

As the sun goes down the street markets 

open up shop selling almost everything from 

the tiniest of beachwear to wooden carvings 

of Christ the Redeemer and the cable cars 

which take you up Corcovado, the mountain 

from which the statue gazes over the city. 

There is plenty of jewellery on offer, 

too, much of it hand crafted from local 

semi-precious stones and costing just a few 

dollars, the preferred currency, even though 

the official currency is the Real. 

At night though it’s a very different type 

of street scene here when party time takes 

over along the beach strip as revellers, 

The favelas are on the tourist trail, too, 

or at least some of them are, those deemed 

by the local authorities to be safe enough 

for outsiders to visit 

some still dressed in their swimwear, some 

in ultra-chic casual clothes, congregate in 

the small bars and restaurants of the area, 

to meet friends, eat and drink, often to the 

sounds of the all-pervasive samba, almost 

until the sun comes up again. n 

More information is available through the 

following websites 

www.braziltourism.org 

www.riodejaneiro.com 



45

p h a r m a c y wat c h e s 

t e c h n o l o g y s p o t l i g h t 

Time for work 

Sue Heady explores the fascinating world of watches 

Gadget roundup 

The latest electronic marvels to watch out for 

It seems fitting to be writing about 

timepieces during a visit to St Moritz, 

given that Switzerland has been renowned 

for its watches since the late 18th century. It 

was, however, the Germans who created the 

first miniature timepieces that emerged in 

the 1530s, not that they were recognisable as 

watches as we know them today, for they were 

small clocks, drum-like in appearance that 

were worn round the neck. 

These first “watches” were unbelievably 

crude and terribly inaccurate so rather than 

being worn to tell the time, they were sold 

as jewellery and curiosities to the nobility. 

Towards the end of the 16th century, Queen 

Elizabeth I, for example, delighted in wearing 

one of the very first wristwatches. 

It was another 300 years or more before 

watches became both more commonplace and 

more accurate. The Waltham Watch Company 

in Massachusetts moved watch manufacturing 

from an assembly business in a watch-making 

shop to mass production, as they needed to 

meet the stringent requirements set out by the 

railroads, which wanted watches that told the 

time with some degree of precision in order to 

safely schedule trains. 

Cross head here please 

Fast forward to the 1970s and watches became 

a reality for everyone when the market was 

swamped with cheap, accurate and reliable 

battery-powered quartz watches – mostly from 

Japan – that often included other functions, 

such as a calculator and even a mini-TV screen. 

These electronic watches, while more accurate 

than their mechanical counterparts, tend to lose 

out on the aesthetic front. 

In the 21st century, both types have 

found their own niche in the market place. 

Companies such as Timex, Seiko and Casio 

fall into the lower-priced bracket, while 

Omega, Tag Heuer and Rolex fill the rugged 

and reliable sporty mid-priced gap, and 

Patek Philippe and Jaeger-LeCoultre make 

eye-wateringly pricey mechanical dress 

watches. A more recent trend has seen the 

emergence of fashion watches by the likes of 

Chanel, Hermes and Tommy Hilfiger that are 

predominantly for women and cover a wide 

price range. 

Baselworld, the world’s largest watch and 

jewellery fair, takes place every March and is 

where the world’s watch manufacturers gather 

On time Stylish watches (from top) Omega 

Speedmaster Apollo Soyuz; Seiko Quartz Astron; 

and Patek Philippe Women’s Chrono 

to unveil their latest creations. This year, given 

the current economic climate, the focus was on 

classic styling, with consumers buying quality 

and lasting value rather than the amusing or 

kitsch. 

Seiko, for example, unveiled a new limited 

edition Quartz Astron, to mark the 40th 

anniversary of the world’s first quartz watch, 

which is entirely new whilst remaining true 

to the heritage of the original. This specific 

limited edition is retailing for approximately 

£3,750, but quartz Seiko watches usually start 

from around £200 and represent great value 

for money for those wanting a watch that will 

provide accuracy for years to come. 

OmeGA, meanwhile, has brought out new 

Speedmasters for both men and women to 

celebrate the 35th anniversary of the Apollo- 

Soyuz Test Project, a mission remembered 

for its political, technological and historical 

significance. The Speedmaster has been 

associated with space trips ever since Buzz 

Aldrin stepped onto the lunar surface in 

1969 wearing his OmeGA Speedmaster 

Professional. The purchase of one of these 

iconic watches will set you back from about 

£1,600. 

At the top end of the market, Swiss 

watchmaker Patek Philippe released four 

brand new chronograph watches at Basel, 

including its debut ladies’ model, the Ref. 

7071R Ladies First Chronograph, reflecting 

women’s growing penchant for so-called 

“complicated” wristwatches (those that have 

one or more functions beyond the basic 

function of displaying the time and the date). 

Inspired by 1930s Art Deco design, the 

beautiful Ladies First Chronograph comes in 

an 18ct rose-gold case, with two asymmetric 

sub dials and a handmade crocodile band. 

With prices for Patek Philippe watches starting 

from £10,000, it’s not surprising that their ads 

boast the line “You never actually own a Patek 

Philippe. You merely look after it for the next 

generation”. 

It is a Patek Philippe that holds the world 

record for price achieved: in 1999, a gold 

Patek Philippe pocket watch made in 1933 

fetched US$11 million in an auction at 

Sotheby’s in New York. Stunning it certainly 

it is, but remember that if you actually need 

to know the time of day, it’s better to rely on a 

£30 Swatch watch. Cheap and cheerful it may 

be, but it’s Swiss Made too! n 

EcoNav 

Want to drive safe in the knowledge that 

you are saving fuel and respecting the 

environment, all while heading to where 

you want to go without getting lost? 

The Vexia Econav Satellite Navigation 

System integrates Econav Technology 

and will indicate to you in real-time 

the optimum speeds, gears, excessive 

acceleration/braking and other data that 

will improve your vehicles capabilities, 

reducing fuel spend, cutting CO2 emissions 

and increasing your safety. Impressively 

Vexia states you can improve your fuel 

consumption by between 20 and 40%. 

For more information visit www.vexia.co.uk. 

Samsung WB500 

Capture your world like never before. The 

Samsung WB500 is one of a few compact 

high-zoom cameras now on the market. 

The 24mm Ultra Wide, Optical 10x Zoom 

Schneider Lens is perfect for shooting 

indoors, landscapes and portraits. A dual 

image stabilizer has been added rectifying 

hand shaking, zooming shake, insufficient 

light so blurred images are a thing of the 

past. The Samsung WB500 has the ability 

to record in HD, more than doubling the 

previous capabilities of a digital camcorder. 

The onboard Smart Album software is an 

easy way to sort through all your photos and 

you can store up to 2000 seven-megabyte 

photos, which you can sort by time, content, 

colour or theme. There’s also a super speed 

sensitive ISO 3200 feature to take perfectlyfocused 

fast-moving images and detailed 

photos even under low light conditions. 

Other features such as frame guide and 

perfect portrait system will make you look 

even more beautiful, by automatically 

indentifying imperfections and retouching 

them so that faces appear brighter and 

smoother, this camera has it all! 

For more information visit www. 

samsungcamera.co.uk 

iPad 

Let your fingers do the surfing! The Apple iPad, due to be 

released in the UK in late April, is an amazing web browsing 

experience, viewing whole pages in portrait or landscape 

and using the multi-touch screen makes it feel like the most 

natural way to explore the internet. As well as the Safari 

browser, the company has included applications such as 

Mail, Photos, Video, iPod, iTunes, Maps, Notes and Calendar. 

There are also over 150,000 apps you can pick up from the 

App Store. 

The high-resolution, 9.7-inch LED-backlit display is good 

for watching movies and viewing photos. It has a wide, 

CardioPod 

This latest device from Telehealth Solutions is designed 

for professionals to carry out an NHS Health Check more 

efficiently and without the possibility of errors creeping in. 

There is a touch-screen version for pharmacies and GP 

surgeries and also a portable one for community use. It 

comes complete with scales and sphygmomanometer – for 

capturing vital signs information. 

A blood chemistry analyser is 

available as an 

option, to add a 

lipid profile and 

blood glucose 

measurement 

in less than five 

minutes. 

What needed a 

lab test two years 

ago can now be 

done at the point of 

care. Health checks 

should, therefore, 

image COUrTESy OF APPLE 

178° viewing angle, so you can hold it almost any way 

and still get a quality picture. It’s very thin and light and 

has up to 10 hours of battery life. It has Wi-Fi built in, and 

automatically detects available networks. It also comes 

with Bluetooth 2.1 so you can sync other devices, such as 

Bluetooth headphones and keyboards. A 3G version is also 

available, so you can reach date speeds of up 7.2Mbps. This 

means if you are without a wireless network you can still 

browse the web and access your emails quickly. 

iPad is available with a choice of 16GB, 32GB or 64GB 

of flash storage. 

For more information visit www.apple.com/uk/ipad 

be able to be completed in one sitting and patients get 

instant feedback. 

Information is uploaded to a secure database for 

appropriate analysis and review. If approved, the 

information will also be accessible from GP practice 

management systems. CardioPod facilitates and records 

the results of discussion with patients on how they can 

improve their risk score, delivering a printout of their 

agreed actions for them to take away, that can 

also be stored on a secure server for follow-up 

when the next check is done. 

For more information you can visit www. 

telehealthsolutions.co.uk. 



47

p h a r m a c y f a s h i o n 

p e r s o n a l f i n a n c e 

Plan for comfortable retirement 

Ruby Neilson looks at some of the better options 

Making waves at work 

People often talk about dressing up an outfit with a pretty scarf or a 

nice piece of jewellery, but a great new haircut is probably the best 

way to update a look. Sue Heady takes a look at the latest trends 

For professional men, convention 

dictates a “straight back and sides”, but 

women have a lot more flexibility and 

the chance to change their hair style with the 

seasons, if the spirit takes them. 

Precision cuts This year, precision cuts – 

or to be more accurate – precision bobs are 

back in fashion, coupled with smooth, sleek 

styling, a blunt fringe and heaps of shine. 

The great thing about a bob is that it works 

at various lengths, from ear level to shoulder 

skimming, so it can be crafted to accentuate 

an individual’s best facial feature. It’s also 

smart for work, presenting a neat structured 

image. 

Long and Wavy At the other end of the 

spectrum, long wavy hair is a hit this summer. 

Worn as natural as possible, either with heavy 

layering, layers around the face or even all one 

length, this style has the advantage of making 

you look younger, so you can keep up with the 

young guns in the office. No wonder it’s Demi 

Moore’s style of choice. 

Straight Classic straight tresses, also known 

as sedu (short for seductive), are fashionable 

this year too, thanks to Jennifer Aniston who 

seems to have made a career out of creating 

hair trends. Ideally, straight hair should be 

parted in the middle, but it’s quite a severe 

look so steer clear unless you have the 

perfectly shaped face. 

Fringes I’ve always thought that fringes 

should be restricted to the classroom, but 

apparently they’re bang on trend this year, 

particularly those of the asymmetrical variety. 

Whether cut blunt or heavily textured, I’m 

told “a sloping fringe adds interest and can 

highlight facial features nicely”. However, this 

hairstyle doesn’t suit all face types: it works 

best for those with an oval-shaped face and if 

you have a large forehead to hide. 

Ponytails If you have long hair – whether 

wavy or straight – the ponytail is a major trend 

this season, which is great for work, as long 

hair does inevitably look neater tied back. 

While pony tails can be tied high or low, I 

would recommend the latter if you want to be 

taken seriously in the office; tie your hair high 

and you could fall into the trap of looking like 

Katie Price. 

Colour Whichever cut you decide on this 

summer, it might be advisable to add some 

artful hair colouring. Strategically placed 

highlights or lowlights can accentuate 

texture and add character to your style, while 

complimenting your features and skin tone. 

Colouring is natural this year, so add deep 

tones of chocolate to enrich brown hair; 

likewise if you are a redhead or a blonde, 

simply enhance your own colour with similar 

warm tones. 

My final word of advice is this: Once 

you find a hairdresser you like and trust, 

don’t ever let them go. My friends never 

understand me when I say I would rather go 

to the dentist than have my hair cut, but the 

fact is this; the pain of visiting the dentist 

wears off after a few hours at most while the 

pain of having to grow out a bad haircut can 

take months if not years. n 

Workers in retail 

pharmacy have the 

least excuse for 

ignoring their pensions. It may 

be 40 or more years before they 

join the retired who comprise so 

many of a pharmacy’s customers, 

but these people should be a 

constant reminder that pensions 

must be addressed now. 

Some of those customers 

are lucky enough to receive 

pensions based on their finalsalaries, 

receiving generous 

sums courtesy of benevolent 

employers including the state. 

But increasingly workers must 

look after their own pensions: 

what they receive when they 

retire will depend directly on 

how much was put into their 

pension scheme and how well it 

was invested. Unlike many of the 

pensioners seen in the pharmacy 

who could ignore their pension 

funds during the decades they 

contributed, today’s workers 

must take a keen and constant 

interest in the fund building up 

over their careers. 

Tax relief 

And three key changes in 

pensions will affect different 

workers in different ways. 

From this year until 2020, the 

retirement age for women born 

after 1950 is being gradually 

raised from 60 to 65 to bring 

them into line with men. Then 

between 2024 and 2046 the start 

date for everyone will rise to 68 

– though retirement ages might 

even be pushed further away still 

before then. 

Secondly, for anyone earning 

over £130,000 this is the last year 

when maximum income tax relief 

can be claimed on contributions. 

Currently people can put a sum 

equal to their whole salary into 

their pension fund each year 

and obtain tax relief, but from 

next April (2011) there will be 

a ceiling on high earners, and to 

stop them using savings to inflate 

their contributions before the 

deadline, the taxmen have tough 

rules to prevent higher than 

usual investment. But because 

the relief is so valuable – 40 % 

taxpayers effectively have £40 

Putting money 

into pensions 

can seem a 

low priority 

when there 

are other calls 

added to their pension fund for 

each £60 they invest – it is worth 

exploiting this opportunity fully 

before it ends. 

Thirdly, from 2012, any 

employee earning over £5,000 

not already in a pension plan will 

automatically be put into a lowcost 

scheme. Some 3% of their 

pay will be invested, with their 

employers contributing 4% and 

the government adding 1%. That 

may look like a cut in take-home 

pay, but all the money belongs 

to the worker and will provide 

an income after middle age that 

would not otherwise be received. 

Yet for many, especially 

the young, putting money 

into pensions can seem a 

low priority when there are 

other calls – from buying a 

home, repaying student loans, 

financing a family or enjoying 

a holiday or new car. Pension 

contributions cannot be cashed in 

prematurely like other savings. 

And while keeping money in 

cash funds gives no protection 

against future inflation, 

putting it into shares offers no 

guarantees: Stockmarket prices 

are lower now than in the late 

1990s, leaving many pension 

policyholders with losses. 

Nor will putting a small sum 

into a pension problem ensure 

an adequate income in old 

age. A single woman retiring 

at 60 needs a pension pot of 

£300,000 to buy an annuity that 

provides about £9,500 a year, 

rising with inflation. That pot 

might be worth more than the 

policyholders’ home and it takes 

so much capital to generate such 

a modest income because living 

longer means we will draw our 

pensions over more years. 

So it is necessary to 

invest a serious part of the 

pay packet now to receive a 

satisfactory pension later, and 

to keep increasing that sum as 

salaries rise and as spending 

commitments ease. Spreading 

the contributions over different 

investment funds – European 

stocks, bonds or FTse shares, 

for instance – will offer some 

protection against the volatility 

in values, especially for people 

not confident or interested in 

forecasting investment markets. 

As your main retirement income 

work depends on the size of the 

pot when employment ends, 

you should not take undue risks, 

especially as ending work draws 

close. Some people think a 

buy-to-let property an alternative 

to a pension, and while it can 

supplement a conventional 

scheme for those prepared to 

be landlords, it is a lot of eggs 

in a single basket and recent 

years have shown that housing 

prices can fall too. But there is 

a case for investing some funds 

for old age in vehicles such as 

ISAs which, although not giving 

the tax relief, can be accessed 

in emergencies and provide a 

further degree of diversification. 

Never too early 

Retirement may seem far away, 

even for people approaching 60, 

but there is no fun having time to 

yourself if you lack the funds to 

enjoy it. The first rule of pensions 

is that it is never too early to start 

saving and the second is that you 

can never save enough. Next 

time you see those pensioners, 

remember you will be among 

them one day. n 



49

h e a lt h f o o d 

Mussels and more 

in the melting pot 

Continuing our series of Pharmacy Professional features in 

which we ask top chefs to come up with healthy yet easy to 

prepare recipes for busy people. This month Bruno Loubet 

Chef Bruno Loubet has recently 

returned to London after spending 

eight years in Australia, where 

he owned Bruno’s Tables in Brisbane, and 

worked at Berardo’s in Noosa and Baguette 

in Brisbane. 

Bruno was born in Bordeaux, southwest 

France, in 1961. He attended the Lycée 

Hotelier de Talence, which led to his first 

job as a commis chef at the Hyatt Regency 

hotel in Brussels. After starting his National 

Service as head chef for the admiral’s 

table, he earned the rank of second maitre. 

Moving to London in 1982, he embarked 

on a commis chef role at La Tante Claire 

with Pierre Koffmann, and then on to 

Gastronome One, in the New Kings Road 

in London’s Chelsea area, as head chef, 

where he was awarded the 1985 Good Food 

Guide’s Young Chef of the Year accolade. 

Bruno then joined Raymond Blanc 

in Oxfordshire as head chef at the two 

Michelin-starred Manoir aux Quat’ Saisons, 

and then moved as chef/manager to Le Petit 

Blanc, in Oxford. He returned to London 

as head chef at the Four Seasons restaurant 

Maintaining the 

standards for The 

Atlantic Bar and 

Grill, Mash, Coast, 

The Admiralty and 

setting up Isola 

at the Inn on the Park, where he earned a 

Michelin star within a year. 

In 1992 Bruno went into partnership with 

Pierre Condou, opening Bistrot Bruno in 

Soho, which earned The Times Restaurant 

of the Year award in 1993. Following the 

success of Bistrot Bruno, he opened L’Odeon 

in 1995, which was awarded The Times 

Restaurant of the Year award in the following 

year. In 1997, Bruno ended his partnership to 

consult for various hotels in the UK and Asia. 

In 1998, Bruno joined Gruppo with Oliver 

Peyton, as Development Chef, where he was 

responsible for maintaining the standards for 

The Atlantic Bar and Grill, Mash (London 

and Manchester), Coast, The Admiralty 

and setting up Isola. He then decided on 

a lifestyle change, and moved his family 

to Brisbane, Australia, where he opened 

Bruno’s Tables, which earned two Gourmet 

Traveller stars in 2005, Good Life Chef of 

the Year 2004, and Restaurant and Catering 

Best Chef-owned restaurant in 2003. He 

then took over at Berardo’s and Baguette, 

before heading back to the UK in 2009. 

Bruno is married, with three daughters, and 

lives in Buckinghamshire. 

Bruno Loubet’s first cookbook, Cuisine 

Courante, was published in 1992 by 

Pavilion, and a second book, Bistrot Bruno, 

in 1995, published by Macmillan. n 

Mussels in tomato and chorizo rice 

Serves 6 people. 

250g Arborio rice 

1.5kg mussels 

400g good quality diced tin tomatoes 

4 cloves chopped garlic 

150g chopped onions 

1tsp dried Provençale herbs 

2 chorizo sliced 

250ml white wine 

50ml olive oil 

50g butter 

60g chopped shallots 

2 pinches of saffron 

800ml hot water. 

Basil or chervil to decorate 

Here’s how 

In a large pot melt the butter, add the shallots, 

one garlic clove and sweat until softens. Add 

100ml of white wine, bring to the boil and 

add the mussels. Stir and cover with a lid. After 

two mins stir again, place lid back on and on 

the heat for a couple of minutes. Remove from 

the heat, leave the lid on and put aside. In a 

thick bottom pan, heat 25ml of olive oil, add 

the onions, garlic and dried herbs. Stir well 

for a few minutes and add the rice. Stir until 

the rice is well coated with the oil and add the 

remaining white wine and the saffron. Bring to 

the boil for a minute then add half the tinned 

tomatoes. Stir well and leave the rice to absorb 

the liquid then add the remaining tomatoes and 

the sliced chorizo. Let the rice absorb the liquid 

again then repeat the operation with 200ml of 

water at a time. Stir continuously. When cooked 

after about 20mins fold the mussels in with a 

few shells for presentation. Share onto plates 

and decorate the top with fresh herbs, such as 

chervil or basil. Drizzle some olive oil. Finish with 

a crack of black pepper and serve with lemon 

wedges. 

Bruno’s tips 

To choose fresh mussels, make sure they do not 

have open shells other than “sea breeze”. They 

should feel heavy in your hands and should be 

closed. 

When serving a dish of mussels with their 

shells, you should organise finger bowls on the 

table. 



51

t r a n s p o r t f e r r i e s 

Away with 

the ferries 

You can relax and take it slow on a classic 

boat, or hop on a waterjet-powered 

supercraft, but it’s still less strain than 

taking the plane says Matt Guarente 

IT may be because we live on an island – or more accurately, a group 

of them. It may be because we love the sea. Or it may be because flying 

for short trips has become, frankly, a bit of a nightmare. Whatever the 

reason, more of us are taking short-sector sea crossings than we have for 

decades – last year, the equivalent of two in every three people that occupy 

the British Isles stepped aboard a ferry – 41m of us. 

Now, ferries come in all shapes and sizes. Tiny passenger-only craft might 

get you across a river or between tiny islands in the Scillies, for example. Or 

massive ships such as Brittany Ferries’ new £100m, 40,000-ton flagship the 

Pont-Aven, complete with pool, two cinemas, and 650 cabins, can deliver 

you and your car to Spain from Plymouth in around 20 hours. 

The Passenger Shipping Association estimates there are 70 destinations 

you can reach from the mainland via ferry, but taking into account local 

services across estuaries, ports, rivers and lakes the number runs into the 

hundreds. 

Representing the 15 major companies that serve Great Britain, the 

PSA has launched a new information site, Sailanddrive.com, listing the 

significant number of pros in taking the ferry. Many, to be sure, are default 

benefits – because taking the plane, with all the check-in time, security 

clearances and limits on baggage is so problematic. 

Onboard offer 

But at the core of the ‘new ferries’ is the vessels themselves. Operators 

have fought a long, hard battle against the removal of duty-free revenues, 

cheap air travel, then the train links to the Continent, and as a result have 

upped their game significantly on the onboard offer. Decent restaurants, 

playrooms for children and of course on-board shopping are on offer on 

even short-hop ferries to France and Ireland. Stena is introducing two new 

ships, together costing £300m, to work the Harwich-Hook of Holland 

route that will include a media room, as well as a space dedicated to that 

very hard-to-please demographic, teenagers. 

Newer, faster ships cut the transport time, with ‘wave-cutting’ multi-hull 

vessels offered by Stena to Ireland, Condor to France and the Channel Æ 



53

t r a n s p o r t F e r r i e s 

t h e a r t s t e l e v i s i o n 

Brother Cadfael – fiction based on fact 

Alasdair Steven reports on the remedies in monastery gardens 

Style afloat Some of the latest ships from Brittany Ferries (above), LD Lines (above right) and Condor Ferries (bottom right) 

Islands, Isle of Man Steam Packet Co. from 

Liverpool, or LD Lines’ new super-fast 

catamaran to Boulogne from Dover – the 

world’s biggest. 

Even the least glamorous route to 

France, Dover to Calais – now has some 

very handsome new ships plying the route, 

Restaurant where 

you might just have 

time for a salade 

Perigourdine, 

blanquette de veau 

and a tarte tatin 

introduced by SeaFrance, that look more like 

cruise vessels – double-height gallery windows, 

and a restaurant where you might just have time 

for a salade Perigourdine, blanquette de veau 

and a tarte tatin before the ship has reached its 

destination. Indeed, the very fact that you can 

download menus and wine lists says so much 

about the attitude to the paying customer has 

changed for the better. Investment in ships, 

price comparison that is now available online 

and through many booking intermediaries, and 

the realisation that the industry has to shape up, 

or literally ship out, has made now a great time 

for consumers to get on board. n 

Five good ferry trips 

Transmanche Ferries, 

Newhaven-Dieppe 

Transmanche is a sister company to LD Lines, and 

runs the Seven Sisters on this route in four hours. 

The ship was launched four years ago, primarily 

for truckers but it’s fast, stable and comfortable. 

The quiet, clean cabins with showers are ideal for 

leisure travellers too. The sailing time is enough 

to enjoy the break from a long drive, but not too 

long to feel like a waste of holiday time. A midsummer 

return for 4 with car was quoted at £210, 

plus £35 for a four-berth cabin each way. www. 

transmancheferries.com 

Scillonian III, Penzance-St Marys 

You can fly be helicopter or small plane, but 

the trip through the bracing Atlantic from the 

rocky shores of Cornwall to the white-sand and 

turquoise waters of the Scilly Isles is magical. And 

something like the start of an adventure. The 

classically-proportioned 1200-ton Scillonian III may 

be comparatively small but still has comfortable 

saloons and a bar and café. The trip helps you 

forget modern-day worries, just as well because 

the Scillies feel lost in time, like some perpetual 

Famous Five summer holiday. www.islesofscillytravel.co.uk. 

Adult flexible return £95. 

Skye Ferry, Glenelg-Skye 

You can take a boat over the sea to Skye, as the 

song commemorating the escape of Bonnie Prince 

Charlie suggests, even if you don’t exactly ‘speed’. 

This is the last surviving ‘turntable’ boat of its kind, 

across to the beautiful island from Glenelg on the 

mainland. It’s totally in keeping with escaping to 

the rugged coast and hills compared with taking 

the boring new bridge. www.skyeferry.co.uk. 

Adult fare £1; cars £15 return. 

Isle of Man Steam Packet, 

Liverpool-Douglas 

The Isle of Man isn’t just a tax haven and a TT 

racetrack – there’s a wealth of outdoor activities 

from quad biking in the hills to coasteering 

(orienteering round the coast on foot and in the 

sea), and some of the biggest salmon and seatrout 

in the rivers you’ve ever seen. The Regency 

seafront parade in Douglas speaks of a bygone ere 

– but the super-fast catamaran from Liverpool is 

strictly 21st century. Cars in summer around £260 

return; www.steam-packet.com 

SeaFrance Dover-Calais 

Route 1 to France. We remember the ‘old days’ of 

the British Rail-run ferries, and it wasn’t pretty. But 

the new ships SeaFrance has invested in make this 

a pleasant trip – there’s fun for kids of all sizes, a 

decent restaurant, and bright, open spaces. Plus, 

when you come back, the white cliffs of Dover 

welcome you home, not an anonymous railway 

cutting or the grinding tedium of a busy airport. 

Summer flexible car returns around £89. www. 

seafrance.com. 

Derek Jacobi’s finely 

judged portrayal of 

Brother Cadfael in the 

ITV series gave a fascinating 

account of the day-to-day life in 

a medieval abbey. Cadfael may 

have been a fictitious character 

but the books and programmes 

highlighted how longstanding and 

detailed the practice of pharmacy 

has been in the UK. 

They demonstrate the 

importance of herbal medicine 

in the Middle Ages and how the 

produce of the monastery gardens 

was administered to the sick. The 

detailed research of the original 

historical murder books by Edith 

Pargeter (under the name of Ellis 

Peters) involved the use of herbal 

remedies for a variety of ailments. 

Cadfael lived at the abbey of St 

Peter & St Paul in Shrewsbury on 

the Welsh borders in the first half 

of the 12th century but Pargeter 

invested him with a charisma 

and authority which provided an 

insight into herbal medicine of the 

era. Cadfael, in fact, gained much 

of his medicinal knowledge from 

his trips – prior to becoming a 

monk – on the Crusades when he 

picked up invaluable knowledge 

about herbs in the Holy Lands and 

while a prisoner of the Muslims. 

Abbots, throughout the series, ask 

him to use these medical skills to 

cure a wide variety of illnesses 

and diseases. 

Pargeter wrote 20 Cadfael books 

(The Cadfael Chronicles) between 

Monastery garden The Abbey of St Peter & St Paul in Shrewsbury 

1977 and 1994 and in them she 

captured the medical conditions of 

the 12th century with a perceptive 

eye. By setting the stories around 

real characters (especially King 

Stephen and Queen Matilda) 

the stories take on an historic 

authority. 

The television series captures 

the tradition in many European 

monasteries of the 12th century 

of the important role played by 

the monk, who was the abbey’s 

appointed herbalist. It was 

that monk’s duty to study the 

many medicinal herbs grown 

in the monastery and prepare 

the ointments and potents to 

administer to the sick. The 

monk-herbalist had a stillroom 

or workshop where he could dry 

and store the herbs and blend the 

various tinctures and salves that 

were a necessary part of daily 

medieval monastery life. 

Jacobi is often seen, as the 

abbey’s apothecary, tending 

his more exotic herbs - many 

of which he had brought back 

from the Holy Land. But one 

fact emerges from the books that 

then, as now, there was a constant 

supply of ‘colicky’ babies, women 

with pregnancy problems, middle 

aged people with aching joints 

and the mortally ill suffering from 

severe pain. All who sought help 

at the monastery were dosed with 

Cadfael’s plant-based remedies. 

The ‘colicky’ baby, for example, 

was usually given a syrup that 

included fennel and mint. 

In the winter, monks with colds 

and sore throats were treated with 

a mixture of horehound - a herb 

that is related to both thyme and 

Russian sage. About half of the 

plants in Cadfael’s garden were 

used to treat digestive problems, 

though there were more than 

a few, such as field peas and 

members of the cabbage family, 

that modern science might suggest 

would create problems rather than 

solve them. 

Significantly Cadfael often 

makes reference to using “poppy 

syrup” or “poppy juice” to treat 

agonizing pain. The seed heads 

of the poppies were made into a 

syrup and used as a sleep potion, 

pain reliever and cough medicine 

The television series was shown 

from 1994 – 98. It was filmed in 

Hungary because the producers 

could not find enough “old” 

landscapes around the Welsh 

borders. Some of the shots in the 

old town of Budapest had to be 

reshot because of the noise of 

nearby trains. In fact the reason 

for their being so few medieval 

buildings available in Britain was 

probably due to Henry VIII’s 

Dissolution of the Monasteries in 

the 15th Century. 

Jacobi much enjoyed “pottering 

around in my Benedictine herbal 

garden” and was sorry when the 

series was not extended. “I found 

Cadfael an intriguing role to play 

– I called him ‘the cloister sleuthsmith’ 

– and I was fascinated by 

the contrasts of his character; 

a man of the cloth, clearly 

attracted to women but with this 

encyclopaedic knowledge of, and 

love of, herbs and their power to 

heal.” n 

l Alasdair Steven is a freelance 

writer on the arts. He has covered 

opera and ballet in the UK as well 

as writing television scripts. 



55

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Pharmacy Professional’s Prize Crossword 6 

Compiled by www.puzzle-house.co.uk 

After solving the crossword, take each letter from the shaded squares (in order) to spell out the Prize Word. 

Email your Prize Word answer and your contact details to ppcompetitions@rpsgb.org by May 10 2010 

Clues Across 

7 Avian affliction? (6) 

8 Jailbird meets dirty old man - primarily an 

advocate of safe sex (6) 

9 Horsey cough? (4) 

10 Examines the head while friends are 

outside (8) 

11 A healthy link between potassium and 

sulphur for travel sickness (6) 

12 Check how the diet’s going, in a manner 

of speaking (5) 

14 A first-time response to pain makes sense (5) 

16 Reacts to smoke and gas catching Hugo 

by surprise (6) 

19 Bone structure is key (8) 

20 Receptive to custom according to the 

window display (4) 

22 Surgical repair for ruptured uterus? (6) 

23 An important date in the world of 

medicine (6) 

Clues Down 

1 Agency management for Martha? No 

thanks (4) 

The prizes this month are copies of two more titles published 

by Pharmaceutical Press: 

Healthcare Communication 

An important part of a healthcare 

professional’s job is to communicate 

successfully with their patients. 

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interactive and engaging guide to 

establishing professional, practical 

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and enhance patient health, safety and morale. It offers a 

challenging vision for excellent healthcare delivery. 

Health Economics 

An introductory discourse of health care 

in America today designed to acquaint 

students with a practical analysis of 

the prominent economic issues. It 

considers health care in terms of cost, 

affordability and historical development 

and assesses contributing factors to 

the economic health crisis, including 

medical technology, prescription drugs and hospital care. 

2 A frequent user of heroin – unofficially, that is (6) 

3 Contraception article by chief pharmacist is 

unfavourable (3,4) 

4 Bacteria involved in ulcerative colitis? (1.4) 

5 Get some air (6) 

6 Oral medicine – one ounce disrupts genes (8) 

11 The smash hit effect of 18 (8) 

13 In-store mathematician? (7) 

15 Thick-skinned type to summon you and me (6) 

17 Our GPs update periodic table sections (6) 

18 Old anaesthetic over there (5) 

21 Canal sites revealed during rehearsals (4) 

WCONGRATULATIONS to Anne Davies of Llanelli, Carmarthenshire who wins a copy of Dale and Appelbe’s Pharmacy Law and Ethics 

April Answers Across: 4. Paracetamol; 7. Balm; 8. Dandruff; 9. Smash; 11. Colic; 14. Botox; 15. Agent; 18. Morphine; 19. Peel; 20. Liraglutide. 

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Issue 6 - Royal Pharmaceutical Society

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