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KNOWLEDGE AND SKILLS OF CLINICAL PHARMACOLOGISTS CURRENTLY UNDERUSED, SAYS REPORT

May 19, 1999

Key recommendations from the report

The NHS

The report notes the increasing need for cost-effective prescribing and co-ordinated drug prescribing policies. It suggests that clinical pharmacologists could be at the forefront in evaluating cost-effective prescribing and the development of drug formularies. With the advent of the NICE, the need for co-ordination between national, regional and local policies on the prescription of new and existing drugs will be paramount, and the report recommends that the expertise of clinical pharmacologists should be accessed more at all these levels. (p.11)

In the university setting

This chapter covers undergraduate education, postgraduate education and research. In relation to undergraduate education, the report suggests that a national core curriculum in pharmacology, clinical pharmacology and therapeutics needs to be agreed to reduce variations or lack of structure in training and teaching methods (p.14). Appendix 2 sets out a proposed core curriculum. The report also identifies the merger of university departments of clinical pharmacology with larger departments of medicine as having an impact on the career progression of staff and recommends that this issue must be addressed (p.14).

The report recommends that postgraduate education needs to be more targeted and integrated between primary and secondary care, and must also serve the needs of physicians working in the pharmaceutical industry. In addition, CME for all doctors and the construction of guidelines and protocols are seen as areas which are particularly suitable for the further involvement of clinical pharmacologists.

The recommendations relating to research recognise the close relationships clinical pharmacology has with other disciplines, and the need to maintain a stream of young researchers in the specialty. The research base must be made secure, and the new epidemiological aspects of research in clinical pharmacology must be integrated into the existing research programmes.

The pharmaceutical industry

The major changes occurring in the pharmaceutical industry have implications for the training, work patterns, and staffing levels of industrial clinical pharmacologists. They will have to keep up-to-date with the new regulatory requirements for safety testing biologically produced materials and the ethical and practical issues arising from the subsequent changes to Phase I studies (p.21).

The increasing use of genetic and molecular techniques are likely to mean more early testing of agents on people rather than animals. This will need to be reflected in the curricula of both higher medical training in pharmaceutical medicine and the examination for the Diploma of the Faculty of Pharmaceutical Medicine, particularly in relation to the knowledge and skills needed to run Phase I trials. The industry will need more clinical pharmacologists, and arrangements need to be made to increase the interchange of specialists between the NHS, academia and industry, including where appropriate, joint appointments (pp21, 25).

Training

Training programmes need to maintain flexibility, and there should be opportunities for trainee clinical pharmacologists to develop a special interest in specialties other than, or in addition to, General (Internal) Medicine eg. Cardiology, Geriatrics. Training programmes leading to triple specialist certification will be essential to this objective (p.29). Joint programmes for training between industry, the NHS and academia should be established to maximise experience, potential and flexibility in the career market (p.30).

Advisory role to Government and its agencies

Clinical pharmacologists often find themselves at the cutting edge of policy-making, advising Government departments such as the DoH, MAFF, and Government agencies such as the Medicines Control Agency and the National Institute for Clinical Effectiveness. The report suggests that this role will increase as new technologies and developments place increasing demands on healthcare delivery systems. The report also advocates the exploration and encouragement of more formal links between academic departments, NHS physicians and agencies such as the Medicines Control Agency (p.34).

Relationships with other health care professionals

The report recognises the existing links which clinical pharmacology has with other medical specialties, and other healthcare disciplines such as pharmacy and nursing and recommends continuing collaboration in both training and service provision with these specialties, and further development of professional relationships (pp37,38).

Appendices

1 Useful information on doctors working in the pharmaceutical industry
2 Core content of an undergraduate course in clinical pharmacology
3 Clinical pharmacology and pharmacoeconomics
4 Curriculum for higher specialist training in clinical pharmacology and therapeutics
5 Four job descriptions for physicians in clinical pharmacology
6 Job plan for a consultant physician in clinical pharmacology and therapeutics

Dr Nick Bateman, Secretary of the Working Party which produced the report, said:
"This report gives a new impetus to clinical pharmacologists, who will be able to use the recommendations to build a stronger research base for the development of new drugs and treatments and will enable them to contribute to more cost-effective prescribing in the NHS."

Dr Bateman can be contacted at the Scottish Poisons Unit on 0131 536 2303, or via the Edinburgh Royal Infirmary switchboard on 0131 536 1000.

"Clinical Pharmacology and Therapeutics" costs £17.50 including UK p&p and can be ordered from the Royal College of Physicians on 0171 935 1174 ext.358.

For further information or for a copy of the report please contact Linda Cuthbertson, RCP Press and PR Manager on 0171 935 1174 ext.254 or e-mail Linda.Cuthbertson@rcplondon.ac.uk.



Royal College of Physicians