The Covid-19 pandemic has opened the door for pharmacists to be more involved in clinical research, with several trials over the past two years directly involving community pharmacy. But pharmacist and researcher, Professor Mahendra Patel OBE, believes this is just the beginning of the sector's relationship with clinical research.

The publication of the NHS Long Term Plan in 2019 highlighted the potential for community pharmacy to have a greater role in clinical practice. Dr Patel, who was recognised in the New Year Honours List 2022 for services to pharmacy nationally and internationally, believes this journey could come with more involvement in clinical and applied research.

‘A great role to play’

With a broad-ranging career spanning community pharmacy, health education, health promotion, academia, and research, Dr Patel has been widely involved in promoting clinical trials to community pharmacies in the UK and to the pharmacy profession as a whole.

He believes that pharmacy has a ‘great role to play in clinical research’ and sees it as part of the sector’s increasingly clinical future.

‘As pharmacists are encouraged to embrace their clinical skills by offering more services, they could also be utising their research skills too; it will give pharmacists an even bigger role to play in patient care and in helping to reduce health inequalities,’ Dr Patel explains.

To date, several clinical trials have involved community pharmacies to varying extents, including the Salford Lung Study, which examined the safety and effectiveness of a new treatment for COPD in 130 pharmacies in Greater Manchester in 2016.

More recently, community pharmacies across the UK have taken part in the PRINCIPLE and PANORAMIC trials – both Covid treatment trials that have attracted national and international attention.

‘Both the PRINCIPLE and PANORAMIC trials have really given pharmacy the opportunity to showcase itself in the research world,’ Dr Patel says.

The PRINCIPLE trial, which was launched in March 2020, has been investigating the effectiveness of existing therapies available in primary care, to potentially speed up the recovery of Covid patients in the community and prevent hospital admissions.

Over 8,000 community pharmacy outlets along with pharmacy organisations across the UK are helping raise awareness in recruiting patients for the study by displaying posters and sending out newsletters.

The PRINCIPLE trial found that inhaled budesonide was an effective treatment for early-stage Covid-19 and that this could reduce recovery time by three days when given to clinically vulnerable patients at home.

The trial also went on to report that azithromycin and doxycycline were ineffective as antibiotic treatments for the primary symptoms of Covid-19.

The PANORAMIC trial, launched in December 2021, also focused on treatment for Covid-19 using new antiviral agents that could reduce the need for hospital admissions and help speed up recovery time in clinically venerable patients.

Pharmacists and their teams are again playing an active role in the trial by helping raise awareness of the study and helping to increase recruitment of those testing positive and with early symptoms. 

‘The outreach work where pharmacy can support trials has become very apparent,’ Dr Patel explains.

‘In both cases, pharmacy has helped raise critical awareness of these trials for people so that they come forward and engage which is an example of the power and the strength that pharmacy has across different settings,

‘It has also helped to make such trails accessible to all eligible people, wherever they live, whatever their background is or their ethnicity’,  he added

Pharmacists have a role to play in research

Although there is no conclusive data available on how many patients pharmacies have helped recruit, Dr Patel says their contributions have been ‘vital’ in raising awareness among a diverse range of communities throughout the UK.

‘Uniquely, community pharmacy is ideally placed to reach populations and communities who experience health inequalities who may often require a more tailored and individual approach to support them,’ he says

He points to a public health research paper published in August 2014 in the BMJ which showed that the majority of the UK population (89.2%) can access a community pharmacy within a 20-minute walk and, crucially, access is greater in areas of highest deprivation.

‘It’s important that we all, including researchers, need to improve our efforts in accessing ethically diverse and underserved communities - and who better than pharmacy to help them with this,’ he adds.

As well as being well situated to recruit a diverse variety of patients, this also gives pharmacists the chance to use their research skills gained during their Pharmacy degree. 

‘Pharmacists can use their knowledge and expertise to get involved in research across a variety of platforms,’ he says. 

Why aren’t more community pharmacists involved in research?

Dr Patel says he believes for many community pharmacists, academic research takes something of a ‘backseat’ once they start their pharmacy careers in the community or in PCNs, and they may later feel ‘underqualified’ to conduct research.

However, he argues that the profession should be ‘supporting more community pharmacists to ‘get more involved in research, as it helps their practice as clinicians and their ability to deliver better healthcare.

When asked whether pharmacists are interested in participating in research, Dr Patel says he feels that the ‘appetite is definitely there’.

However, there is currently a lack of funding, motivation and available time for more community pharmacies to be involved in research, he explains.

‘Community pharmacy is in a dire state at the moment: with Covid pressures, people being off ill, rising levels of abuse from the public, mental health issues and insufficient funding. These work pressures mean many pharmacists just can’t find the time [for additional activities such as research].

‘It must be accepted that research is not going to be on there on the front of their pile, particularly under the current climate,’ he says.

Previous research into community pharmacists’ involvement in research in the UK supports the idea that pharmacists are keen to get involved in research, but many do not have the time, or the financial resources, to do so.

According to the 2017 study involving 329 community pharmacists, published in the Journal of Pharmacy Education and Practice, over two-thirds (67.9%) wanted to engage with research, yet only 29% had been involved in non-mandatory research.

The study found that two of the biggest barriers to research for community pharmacists included lack of time (90%) and lack of remuneration (60%).

How can community pharmacists get involved in research?

In the UK, two initiatives have been established that are helping to harness research capacity and capability in community pharmacies.

Dr Patel helped design the Royal Pharmaceutical Society’s ‘Research Ready’ accreditation scheme for pharmacies in the UK.

The scheme requires a pharmacy to have a dedicated research lead and for all staff to have undertaken Good Clinical Practice (GCP) training (which is mandatory for employees who will help to deliver a study).

Since then, the scheme has been paused for potential redesign so it can include a wider range of pharmacists such as hospital, GP and PCN based pharmacists, according to Dr Patel. 

In November, the Associate Principal Investigator Scheme was extended to include pharmacists, giving the sector more opportunities to get involved in research. 

The scheme, which is run by the National Institute of Health Research, is open to all those who do not have research as a core part of their role but wish to gain skills and experience in participating in research. 

Pharmacists who join the scheme will gain valuable enhanced skills and understanding around the delivery of research from the principal investigator who is leading the study.

After the 6 month research period, the pharmacist will also receive certification endorsing the research and accreditation in the paper where the study is published. 

These schemes support pharmacies to become involved in clinical research, and according to Mr Patel, the sector’s relationship with research is set to grow.

‘Pharmacists can add such value to research, we must encourage them more to get involved going forward,’ he said.