Hayley Wickens, genomics and microbiology specialist pharmacist, on pharmacogenomics

We talk to Hayley Wickens, a genomics and microbiology specialist pharmacist at University Hospital Southampton, about her role at NHS Central and South Genomics and all things pharmacogenomics. 

Hi Hayley, you are a Consultant Pharmacist in Genomic Medicine at Central and South Genomics - can you tell us a bit about your role and the Service? 

NHS England set up the Genomic Medicine Service (GMS) network a couple of years ago, and Central and South Genomics is one of seven regional organisations in England. We are the biggest in terms of population and we cover a patch from the West Midlands through the Thames Valley down into Wessex.  It’s a multidisciplinary team that brings together lab scientists, clinicians, researchers and project management specialists to make genomic medicine ‘business as usual’ in the NHS in our region. 

Each service employs two pharmacists; a chief pharmacist for strategic oversight, and a specialist clinical pharmacist lead, which is my role. After many years as an infection specialist pharmacist, I studied for an MSc in genomic medicine in 2017 and became absolutely convinced that it was going to change the way that we practise pharmacy and medicine. 

My role is focused on trying to make medicines optimisation using genomics part of everyday practise and to upskill our population of pharmacy staff across primary and secondary care to be ready for the new technology. Whilst the majority of genomics currently happens in secondary care and in cancer, once we start seeing the expansion of pharmacogenomics this will be something that could become part of the medicine reviews that pharmacy teams do every day.

Tell us a bit about the work you are doing in pharmacogenomics?

 We work with our colleagues both locally and nationally to drive implementation of commissioned pharmacogenetic tests, as well as working out what future services might look like.  We also teach colleagues in primary and secondary care about pharmacogenomics and work with our local university schools of pharmacy to ensure that their pharmacy undergraduates graduate with the skills they will need to use pharmacogenomics in their working life. 

We are working on research proposals to gather ‘real world’ data on pharmacogenomics implementation within NHS organisations in primary and secondary care, and we are recruiting GP surgeries locally to take part in the PROGRESS   pharmacogenomic implementation trial later this year.  We are also investigating the role of electronic prescribing systems in support of pharmacogenomics, and how the results from pharmacogenetic tests move through hospital systems, with the University Hospital Southampton Pharmacy team.

Another exciting new piece of work involves using metagenomics in diagnosis of infection in critically ill patients; from a pharmacy point of view this opens up lots of interesting potential in making sure antibiotics are prescribed appropriately. Less pharmacogenomics per se but also direct use of genomics to drive medicines optimisation. 

Why is Pharmacogenomics ‘the solution to the problem’? 

We know thousands of admissions to hospital every year are down to adverse drug reactions, and in – addition to the impact on the patient –  this has a huge monetary cost, estimated in the billions. We could potentially use pharmacogenomics to predict some of those adverse reactions before they happen, which would be good for patients and save money.  An example of this that’s already in place in the NHS is DPYD genetic testing, which is given to patients receiving certain types of cancer chemotherapy and can tell us if they are at risk of severe side effects – we can then reduce the dosage or change the drug altogether.

Pharmacogenomics also has the potential to allow us to tailor drug dosage to patients according to how quickly, or slowly, they metabolise particular medicines.  This could mean better results for patients, with fewer side effects. 

What do you see is the future for Pharmacogenomics? 

It’s very hard to predict exactly what services might look like, but I think the use of pharmacogenomics to predict drug response will ultimately become part of the everyday medicines review and prescribing processes, much in the way that renal and hepatic function tests are.   We will continue to see genomics used in personalising cancer treatment, and rapid genomic testing in infection is promising to improve outcomes by getting the most appropriate antibiotics into patients more quickly. 

Thank you so much Hayley!