NHS Specialist Pharmacy Service

Penny Daynes, Associate Regional Pharmacy Procurement Specialist at SPS presents a summary of the resources published by SPS between 6th and 12th December.   To easily find a list of newly published pages go to sps.nhs.uk, select ‘search’, click in the search bar, and press enter Quick links to highlighted resources:   Five moments to tackle problematic polypharmacy podcasts In these podcasts we discuss 5 moments to tackle problematic polypharmacy, using examples from community pharmacy practice and expert advice. https://www.sps.nhs.uk/articles/five-moments-to-tackle-problematic-polypharmacy-podcasts/ Preparing to use denosumab 60mg biosimilar Biosimilars of denosumab 60mg (Prolia) are expected soon. We offer general information and implementation advice. https://www.sps.nhs.uk/articles/preparing-to-use-denosumab-60mg-biosimilar-for-osteoporosis/ Preparing to use denosumab 120mg biosimilar Biosimilars of denosumab 120mg (Xgeva) are expected soon. We offer general information and implementation advice. https://www.sps.nhs.uk/articles/preparing-to-use-denosumab-120mg-biosimilar/ Dronedarone monitoring update https://www.sps.nhs.uk/monitorings/dronedarone-monitoring/ Next events – forthcoming webinars and conferences          https://www.sps.nhs.uk/home/events/next-events/         Join our new WhatsApp channel to stay up to date with our latest news and updates    https://whatsapp.com/channel/0029VbBslvuJpe8aH3n7Zu1i    Podcast description:        NHS Specialist Pharmacy Service serves healthcare professionals across the NHS who are involved in all aspects of buying, making and using medicines. Our motto is 'do once and share'.

Kieran Reynolds talks to Fatema Jessa about liver transplant. Discussion includes what liver transplant is, why it is performed, how patients are managed post liver-transplant and the role of pharmacy professionals (both secondary and primary care) in managing these patients. Fatema Jessa - Consultant Pharmacist – Hepatology and Liver Transplant and NCL Digital Pharmacy Network at the Royal Free London NHS Foundation Trust Kieran Reynolds - Advanced Specialist Pharmacist (Medicines Governance), SPS Useful links: The British Liver Trust’s information on Liver transplant https://www.nhsbt.nhs.uk/organ-transplantation/liver/living-with-a-liver-transplant/liver-transplant-medicines/%22HYPERLINK%20%22https://britishlivertrust.org.uk/information-and-support/liver-transplant/ The British Liver Trust’s information on life after liver transplant https://britishlivertrust.org.uk/information-and-support/liver-transplant/life-after-liver-transplant/%22%20/l%20%22Immunosuppression%20medicines The NHS Blood and Transplant’s information on liver transplantation medicines https://www.nhsbt.nhs.uk/organ-transplantation/liver/living-with-a-liver-transplant/liver-transplant-medicines/ SPS Drug monitoring tool https://www.sps.nhs.uk/home/tools/drug-monitoring/ The Pharmaceutical Journal (PJ) article on medicines management in adult patients undergoing liver transplantation https://pharmaceutical-journal.com/article/ld/medicines-management-in-adult-patients-undergoing-liver-transplantation The Green Book: information on vaccines for vaccine preventable diseases  https://www.gov.uk/government/collections/immunisation-against-infectious-disease-the-green-book#the-green-book NHS Business Services Authority information on NHS Prescription Prepayment Certificate (PPC) https://www.nhsbsa.nhs.uk/help-nhs-prescription-costs/nhs-prescription-prepayment-certificate-ppc

Kieran Reynolds talks to Leslie Wong, Advanced Clinical Pharmacist in Hepatology in the Eastern Liver Network and Communications Officer at the British Hepatology Pharmacy Group (BHPG) about alcohol related liver disease (ARLD). Discussion includes what ARLD is, screening tools to help identify possible alcohol misuse, treatment of ARLD; including medicines used in medically assisted alcohol withdrawal and medicines used to help support abstinence, as well as long term vitamin supplementation. Leslie Wong - Advanced Clinical Pharmacist in Hepatology in the Eastern Liver Network and Communications Officer at the BHPG Kieran Reynolds - Advanced Specialist Pharmacist (Medicines Governance), SPS Useful links: The British Liver Trust’s information on alcohol and liver disease https://britishlivertrust.org.uk/information-and-support/risks-and-causes/alcohol/#:~:text=Regularly%20drinking%20over%20the%20recommended%20limit%20increases%20the,their%20health.%20Alcohol%20is%20broken-down%20by%20the%20liver. The British Liver Trust’s information on alcohol-related liver disease (ARLD) https://britishlivertrust.org.uk/information-and-support/liver-conditions/alcohol-related-liver-disease/ MD+CALC AUDIT-C calculator https://www.mdcalc.com/calc/2021/audit-c-alcohol-use Drinkaware’s Drinking Check https://www.drinkaware.co.uk/tools/drinking-check/#/overview DrinkAware information on Cutting your drinking with alcohol-free or low alcohol drinks https://www.drinkaware.co.uk/advice-and-support/alcohol-free-drinks/cutting-your-drinking-with-alcohol-free-or-low-alcohol-drinks/ SPS article on using and prescribing thiamine in alcohol dependence https://www.sps.nhs.uk/articles/using-and-prescribing-thiamine-in-alcohol-dependence/ Regional Medicines Optimisation Committee (RMOC) position statement on oral vitamin B supplementation in alcoholism (PDF) https://www.wyicsapc.co.uk/wp-content/uploads/2020/02/RMOC-Position-Statement-Oral-Vitamin-B-supplementation-in-alcoholism-November-2019.pdf NICE Clinical Guideline 115 on Alcohol-use disorders: diagnosis, assessment and management of harmful drinking (high-risk drinking) and alcohol dependence https://www.nice.org.uk/guidance/CG115 UKHSA Alcohol structured advice tool https://khub.net/web/phe-national/public-library/-/document_library/v2WsRK3ZlEig/view_file/377334553?_com_liferay_document_library_web_portlet_DLPortlet_INSTANCE_v2WsRK3ZlEig_redirect=https%3A%2F%2Fkhub.net%3A443%2Fweb%2Fphe-national%2Fpublic-library%2F-%2Fdocument_library%2Fv2WsRK3ZlEig%2Fview%2F261816192%3F_com_liferay_document_library_web_portlet_DLPortlet_INSTANCE_v2WsRK3ZlEig_redirect%3Dhttps%253A%252F%252Fkhub.net%253A443%252Fweb%252Fphe-national%252Fpublic-library%252F-%252Fdocument_library%252Fv2WsRK3ZlEig%252Fview%252F174103489 e-learning for healthcare Alcohol Identification and Brief Advice programme https://www.e-lfh.org.uk/programmes/alcohol/

Kieran Reynolds talks to Helen Boothman, Lead Hepatology Pharmacist and past chair of the British Hepatology Pharmacy Group (BHPG) about hepatitis C. Discussion includes what hepatitis C (hep C) is, risk factors, diagnosis, treatment and the efforts ongoing to help find undiagnosed patients. Helen Boothman - Lead Hepatology Pharmacist, St. George’s University Hospitals NHS Foundation Trust London and previous char of the BHPG Kieran Reynolds - Advanced Specialist Pharmacist (Medicines Governance), SPS Useful links: The British Liver Trust’s information on hepatitis C https://britishlivertrust.org.uk/information-and-support/liver-conditions/hepatitis-c/ NHS information on free home testing for hepatitis C https://hepctest.nhs.uk/

Kieran Reynolds talks to Helen Boothman, Lead Hepatology Pharmacist and past chair of the British Hepatology Pharmacy Group (BHPG) about hepatitis B. Discussion includes what hepatitis B (hep B) is, incidence, link with hepatitis D, risk factors, diagnosis and treatment. Helen Boothman - Lead Hepatology Pharmacist, St. George’s University Hospitals NHS Foundation Trust London and previous char of the BHPG Kieran Reynolds - Advanced Specialist Pharmacist (Medicines Governance), SPS Useful links: The British Liver Trust’s information on how hepatitis B is passed on and who is risk https://britishlivertrust.org.uk/information-and-support/liver-conditions/hepatitis-b/risk/ The British Liver Trust’s information on how to test for hepatitis B https://britishlivertrust.org.uk/information-and-support/liver-conditions/hepatitis-b/hepatitis-b-tests/ NICE Clinical Knowledge Summaries information on which tests can help make a diagnosis of hepatitis B https://cks.nice.org.uk/topics/hepatitis-b/diagnosis/how-to-test-for-hepatitis-b/ The British Liver Trust’s information on treatment for hepatitis B https://britishlivertrust.org.uk/information-and-support/liver-conditions/hepatitis-b/treatment/ The Hepatitis B Foundation information on patient support groups https://www.hepb.org/resources-and-support/online-support-groups/ The British Liver Trust’s information on patient support https://britishlivertrust.org.uk/information-and-support/support-for-you/ Information on Hep B Companion - a peer led hepatitis B organisation https://www.hepbcompanion.org/

In our final episode, we explore frailty, a state of reduced resilience that makes people—particularly older adults—more vulnerable to adverse drug effects and prescribing cascades. Those living with frailty often have multiple long-term conditions, take polypharmacy, and benefit from a more personalised, “less is more” approach. (12m59s) We discuss what frailty looks like in everyday community pharmacy encounters, which medicines to look out for, and how to identify potentially inappropriate medicines prescribed. Through practical examples, we show how to ask the right questions, focus on what matters most to patients, and collaborate with general practice to reduce overprescribing through Structured medication review referrals. We highlight why, in frailty, taking fewer medicines can reduce harm and improve outcomes. Lelly Oboh, Consultant Pharmacist (Care of Older People) and Older People Lead (NHS Specialist Pharmacy Service) Rakhi Aggarwal, Primary Care Lead (NHS Specialist Pharmacy Service)

Here we focus on non-adherence, which often signals that medicines may no longer be appropriate, wanted, or manageable. The reasons are multifactorial and can include side effects, motivation and beliefs, or cognitive, capacity and physical barriers. We discuss how community pharmacy teams, through everyday interactions with patients, relatives and carers, can use curious, patient-centred questions to uncover the real causes of non-adherence and identify any additional support needed. We also explore how, alongside practical interventions such as adjusting formulations or offering compliance aids, pharmacy teams should recognise when deprescribing may be appropriate, advice and refer for a Structured Medication Review- aiming to ensure that solutions always align with the patient’s changing needs, context and priorities. (13m0s) Lelly Oboh, Consultant Pharmacist (Care of Older People) and Older People Lead (NHS Specialist Pharmacy Service) Rakhi Aggarwal, Primary Care Lead (NHS Specialist Pharmacy Service)

This episode explores repeat dispensing and repeat supply as key moments to start meaningful conversations about medicines. When patients or carers order or collect prescriptions, these touchpoints create space to ask about side effects, check whether medicines are working, still wanted, and being taken as intended We share simple conversation starters, ways to involve the whole pharmacy team, and when to signpost patients for a Structured Medication Review to reduce pill burden, improve adherence, minimise waste, and avoid efficiently dispensing medicines that are no longer needed. (9m52s) Lelly Oboh, Consultant Pharmacist (Care of Older People) and Older People Lead (NHS Specialist Pharmacy Service) Rakhi Aggarwal, Primary Care Lead (NHS Specialist Pharmacy Service)

In this episode, we focus on significant changes, especially after hospital discharge or when new, uncontrolled or worsening symptoms appear. For older people, these are times when medicines often change and when adverse effects, drug interactions or prescribing cascades can easily be missed. We discuss how simple, everyday community pharmacy conversations can uncover medicine-related problems early, how to recognise when symptoms may be drug-related, and why transitions are the ideal time to rethink, review and realign treatment with what matters most to patients as their needs change. (14m08s) Lelly Oboh, Consultant Pharmacist (Care of Older People) and Older People Lead (NHS Specialist Pharmacy Service) Rakhi Aggarwal, Primary Care Lead (NHS Specialist Pharmacy Service)

In this episode, we look at returned medicines as a key moment to spot potential overprescribing. When patients or carers bring back unwanted items, Rather than simply accepting them back, it opens the door to curious, non-judgemental conversations about why medicines weren’t taken and whether they’re still needed, inappropriate or causing harm. Through examples and simple open questions, we show how this everyday moment can reveal prescribing cascades, side effects and unmet needs—and how the whole pharmacy team can frame sensitive conversations to support safer, more appropriate prescribing. (14m52s) Lelly Oboh, Consultant Pharmacist (Care of Older People) and Older People Lead (NHS Specialist Pharmacy Service) Rakhi Aggarwal, Primary Care Lead (NHS Specialist Pharmacy Service)

See Mun Wong, Digital and Quality Improvement Specialist, at SPS presents a summary of the resources published by SPS between 29th November and 5th December.   To easily find a list of newly published pages go to sps.nhs.uk, select ‘search’, click in the search bar, and press enter Quick links to highlighted resources:   November New Medicines News https://www.sps.nhs.uk/wp-content/uploads/2025/12/New-Medicines-News-November-2025.docx#:~:text=November%20New%20Medicines%20News Recent product launches and significant regulatory changes, perfect for staying ahead of what’s coming into practice. Using Standardised Strengths of Unlicensed Liquid Medicines in Children https://www.sps.nhs.uk/articles/using-standardised-strengths-of-unlicensed-liquid-medicines-in-children/ A joint statement from the Neonatal and Paediatric Pharmacy Group (NPPG) and the Royal College of Paediatrics and Child Health (RCPCH) Advising on complementary products and conventional medicines https://www.sps.nhs.uk/articles/advising-on-complementary-products-and-conventional-medicines/ Decision making when advising on interactions with supplements and complementary, herbal and alternative products, including homeopathy, Chinese and Ayurvedic. Prescribing available epidural infusion bags https://www.sps.nhs.uk/articles/prescribing-available-epidural-infusion-bags/ Epidural infusion bags availability varies currently. Check for available licensed and unlicensed products to keep up to date. Emtricitabine and tenofovir alafenamide (TAF) tablets as PrEP https://www.sps.nhs.uk/articles/emtricitabine-and-tenofovir-alafenamide-taf-tablets-as-prep/ SPS PGD template for the supply of emtricitabine and tenofovir alafenamide (TAF) tablets as Pre-Exposure Prophylaxis (PrEP) for the prevention of HIV infection. Next events – forthcoming webinars and conferences          https://www.sps.nhs.uk/home/events/next-events/         Join our new WhatsApp channel to stay up to date with our latest news and updates    https://whatsapp.com/channel/0029VbBslvuJpe8aH3n7Zu1i    Podcast description:        NHS Specialist Pharmacy Service serves healthcare professionals across the NHS who are involved in all aspects of buying, making and using medicines. Our motto is 'do once and share'.

An ‘on the couch’ discussion on the practical implementation of biosimilar insulin in primary care, focusing on hints and tips to consider should your system be considering this, and debunking some of the myths around biosimilar insulin. (50m30s). This is the audio of a webinar that was held on the 30 September 2025. A range of speakers from SPS and other organisations will run this event. Carolyn Barton Head of Medicines Management (Knowsley Place); NHS Cheshire and Merseyside Chris Haigh Deputy Chief Pharmacist; NHS Cheshire and Merseyside Jole Hannan Head of Medicines Management (Wirral Place); NHS Cheshire and Merseyside Georgia Lane Senior Clinical Pharmacist (Knowsley Place); NHS Cheshire and Merseyside Rakhi Aggarwal Primary Care Lead, NHS Specialist Pharmacy Service

Jo Clarke (Advanced Specialist Pharmacist - Palliative and End of Life Care, Medicines Use and Safety in SPS) explores some of the known issues which challenges the safe use of medicines in services and, the impact these have for patient, carers and loved ones. Gaining a better understanding of these challenges can support the implementation of safety initiatives to address some of these issues.

Kieran Reynolds talks to Yun Jung Kim, Senior Specialist Pharmacist in Hepatology about primary biliary cholangitis (PBC). Discussion includes what PBC is, symptoms (and symptom control), diagnosis, treatment and how pharmacy professionals can contribute to the management of patients with PBC. Yun Jung Kim - Senior Specialist Pharmacist in Hepatology University Hospital Southampton NHS Foundation Trust and Vice-Chair, BHPG Kieran Reynolds - Advanced Specialist Pharmacist (Medicines Governance), SPS Useful links: The British Liver Trust’s information on primary biliary cholangitis https://britishlivertrust.org.uk/information-and-support/liver-conditions/primary-biliary-cholangitis/ The British Liver Trust’s information on diagnosing primary biliary cholangitis https://britishlivertrust.org.uk/information-and-support/liver-conditions/primary-biliary-cholangitis/diagnosis/ The British Liver Trust’s information on treating primary biliary cholangitis https://britishlivertrust.org.uk/information-and-support/liver-conditions/primary-biliary-cholangitis/diagnosis/ PBC Foundation website https://www.pbcfoundation.international/ The British Society of Gastroenterology primary biliary cholangitis (PBC) care bundle https://www.bsg.org.uk/clinical-resource/primary-biliary-cholangitis-(pbc)-care-bundle

Kieran Reynolds talks to Sonal Patel, Lead Hepatology Pharmacist about autoimmune hepatitis (AIH). Discussion includes what AIH is, prevalence, diagnosis, treatment and how pharmacy professionals can contribute to the management of patients with AIH. Sonal Patel - Lead Hepatology Pharmacist, Guy’s and St. Thomas’ Trust and Chief Pharmaceutical Officer’s Clinical Fellow 2024/25 at the General Pharmaceutical Council (GPhC) Kieran Reynolds - Advanced Specialist Pharmacist (Medicines Governance), SPS Useful links: SPS article on assessing liver function and interpreting liver blood tests https://www.sps.nhs.uk/articles/assessing-liver-function-and-interpreting-liver-blood-tests/ NHS website information on prednisolone https://www.nhs.uk/medicines/prednisolone/ NHS website information on budesonide https://www.nhs.uk/medicines/budesonide-tablets-capsules-and-granules/about-budesonide-tablets-capsules-and-granules/ NHS website information on azathioprine https://www.nhs.uk/medicines/azathioprine/ The Society of Endocrinology information on adrenal crisis https://www.endocrinology.org/clinical-practice/clinical-guidance/adrenal-crisis/ SPS Medicines Monitoring tool https://www.sps.nhs.uk/home/tools/drug-monitoring/ The Green Book: information on vaccines for vaccine preventable diseases https://www.gov.uk/government/collections/immunisation-against-infectious-disease-the-green-book#the-green-book AIH support website https://aihsupport.org.uk/ The British Liver Trust’s information on autoimmune hepatitis https://britishlivertrust.org.uk/information-and-support/liver-conditions/autoimmune-hepatitis/

Kieran Reynolds talks to Arron Jones, Lead Hepatology Pharmacist about metabolic dysfunction associated steatotic liver disease (MASLD). Discussion includes what MASLD/MASH stands for, prevalence, diagnosis, treatment; including advice to give to patients accessing GLP-1 RAs online, and emerging therapies. Arron Jones - Lead Hepatology Pharmacist, Bart’s Health Trust Kieran Reynolds - Advanced Specialist Pharmacist (Medicines Governance), SPS Useful links: The British Liver Trust’s information on MASLD, NAFLD and fatty liver disease https://britishlivertrust.org.uk/information-and-support/liver-conditions/masld-nafld-and-fatty-liver-disease/ The NHS Eatwell Guide https://www.nhs.uk/live-well/eat-well/food-guidelines-and-food-labels/the-eatwell-guide/ The South Asian Eatwell Guide https://mynutriweb.com/the-south-asian-eatwell-guide/ SPS article on using statins in liver impairment https://www.sps.nhs.uk/articles/using-statins-in-liver-impairment/ The General Pharmaceutical Council’s FAQs on weight loss medications (including a guide for patients on how to keep safe when getting medicines or treatment online: scroll to bottom of page to access) https://www.pharmacyregulation.org/patients-and-public/standards-you-can-expect-using-pharmacy-services/weight-loss-medications-faq

Emma Kirk discusses with Claire Davies her experiences and learnings from speaking with people living with diabetes as part of the NHS SPS insulin safety project. In this podcast Claire shares conversations with Abdul, Sarah, Charlie and Toby including the impact of their diabetes diagnosis, diabetes devices, faith, hypoglycaemia and admissions to hospital on their diabetes journey. (48m 41s) This podcast is part of the Medication Safety Across The System (MSATS) series, aimed at healthcare professionals working in any sector with a role or passion for medication safety and/or involved in medicines use.

In this episode John Oliver speaks to expert guests about evaluating the suitability of unlicensed medicines for the patient. We discuss practical considerations for managing them in dispensaries, performing a quality assessment and good governance frameworks. (29m:55s) Speakers: John Oliver, Quality Assurance Specialist; NHS SPS Dr. Andrew Lowey, Lead Clinician, Pharmacy Preparative Services Leeds Teaching Hospitals, and chair of the NHS Pharmacy Production Committee Penny Daynes, Associate Regional Pharmacy Procurement Specialist; NHS SPS, North East and Yorkshire Katherine Cullen, Divisional Director Clinical Support Services, Chief Pharmacist; Tameside and Glossop Integrated Care NHS Foundation Trust Lynn Morrison, Regional Quality Assurance Specialist; NHS Scotland Amanda Cooper, Assistant Head of NHS SPS Useful links: MHRA guidance https://www.gov.uk/government/publications/supply-unlicensed-medicinal-products-specials (MHRA guidance on unlicensed medicinal products – specials, including Guidance Note 14) SPS guidance https://www.sps.nhs.uk/home/guidance/unlicensed-medicines/ https://www.sps.nhs.uk/articles/understanding-excipients-in-medicines/ https://www.sps.nhs.uk/articles/searching-for-presence-or-absence-of-an-excipient-in-medicines/ https://www.sps.nhs.uk/articles/navigating-a-potential-supply-issue/ (SPS log-in required) https://www.sps.nhs.uk/articles/managing-complexities-of-medication-use-across-care-boundaries/ (Medication Safety across the System providing resources that include valuable real-world examples of safely managing unlicensed liquid medicines)

Audio from our webinar held on the 4 March 2025 which featured a facilitated case-based discussion about the complexities of polypharmacy and deprescribing. This was a follow on from our first webinar, which lays the foundations of some of the deprescribing tools available. (57m02s) Speakers: Lelly Oboh: Older people lead, NHS SPS Jasvir Singh Dhillon: Clinical pharmacist, Shropshire, Telford & Wrekin ICB, & GP practices Rakhi Aggarwal: Primary care lead, NHS SPS

Claire Davies chats with Toby, a person living with diabetes, as to why it is essential that the voice of those with lived experience is heard and is central to any system-wide discussions about insulin safety and what is important to him to ensure his insulin therapy is safe alongside visual impairment.