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A new pharmacist has been appointed to oversee the prescription of the powerful medication at the centre of a recent critical review of Jersey's rheumatology department.
Published last month, the Royal College of Physicians' long-awaited review of Jersey's rheumatology department "found the standard of care to be well below what the review team would consider acceptable for a contemporary rheumatological service".
The review also noted that in some cases there was “no evidence of clinical examination” and there was “on occasions, an incorrect diagnosis”.
Pictured: Rheumatology deals with arthritis and several other conditions that affect the joints, tendons, muscle, ligaments.
The Royal College of Physicians found that "a recurring theme was the lack of governance, not just in rheumatology but across the healthcare organisation".
One of the key concerns raised in the review was the "lack of understanding about the amount of money spent on high-cost medicine" – namely biologic drugs.
The Health Department last week announced that a new Immunotherapy Lead Pharmacist – otherwise known as a ‘Biologic Pharmacist’ – has been employed to support patients with the appropriate use of biologic drugs, including prescribing.
It comes after an internal audit of rheumatology patient records last year found that approximately one-in-four of the 341 rheumatology patients reviewed had their biologic drugs discontinued because these drugs were not felt to be necessary.
According to the NHS, biological medicines are currently the largest cost, and cost growth, areas in the medicines budget.
Pictured: The Royal College of Physicians found that "a recurring theme was the lack of governance, not just in rheumatology but across the healthcare organisation".
"Biologic drugs have revolutionised the treatment of rheumatic diseases and help millions of people around the world", according to NHS England.
Although they tend to work more quickly than traditional rheumatology medication, biologic drugs are considered more potent and can cause some side effects, such as increased risk of infection.
These high-cost drugs are currently the largest expense in the NHS medicines budget – racking up a bill of over £10,000 a year per patient.
Therefore, the National Institute for Health and Care Excellence (NICE) – which provides guidelines for the NHS – previously recommended biological treatments only for severe rheumatoid arthritis due to the high cost.
However, this guidance was reviewed in 2021 to include those with moderate rheumatoid arthritis because synthetic 'biosimilars' became available, offering near identical treatment at a much lower price than biologics.
Pictured: The review of Jersey's rheumatology department raised concerns about the lack of built-in challenge to prescribing, particularly biologics, by the pharmacy team.
The Royal College of Physicians' review found that rheumatology patients in Jersey "were often tried on numerous high-cost medications within a short period of time, with little or no oversight from pharmacy".
The review team concluded that, "given the high cost of these medications, greater oversight was required".
The Royal College of Physicians recommended that "the healthcare organisation should consider appointing a pharmacist for high-cost drugs".
"This would be to understand the usage and cost of the biologic drugs and assist in producing a preferred order of prescribing for each of the main indications in rheumatology," they explained.
After the review was published, it emerged that the Government changed which patient notes were provided to the external reviewers ahead of the assessment to only include those from a specific group of rheumatology patients who had all had been treated with biologic drugs.
The Health department last week announced that Sarah-Jane Stead has started in the post of Immunotherapy Lead Pharmacist – otherwise known as a ‘Biologic Pharmacist’.
The Government confirmed that she will be responsible for supporting patients with appropriate use of biosimilars, which are classified as a type of biological medicine.
We are delighted to announce that Sarah-Jane Stead has started in the post of Lead Pharmacist, Immunotherapy – otherwise known as a ‘Biologic Pharmacist’.
— Jersey Gov Health & Community Services (HCS) (@GovJsyHCS) February 15, 2024
Sarah-Jane will be responsible for supporting patients with the appropriate use of biologic drugs, including prescribing. pic.twitter.com/LcuRNQTtxn
Chris Bown, Interim Chief Officer for Health and Community Services, said: “HCS is continuing to make good progress on the improvements recommended by the RCP and to ensure that we become a beacon of good governance, not just in rheumatology but across the full spectrum of our health and care services.
"The recruitment of an Immunotherapy Lead Pharmacist was started prior to the RCP review being finalised and aligns with some of recommendations they made."
He added: “Sarah-Jane will be responsible for supporting patients with appropriate use of biologic drugs (including prescribing those drugs).
"She will clinically review and monitor patients’ medication, and ensure compliance with appropriate standards and guidance – providing a key role in clinical audit and governance for biologic medicines.”
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