Nina Buchan, Editor of Specialised Medicine, introduces the February 2021 issue of the journal, which will be our last in this format
Welcome to the February 2021 issue of Specialised Medicine, the publication that champions best practice in specialised healthcare. As we prepared to go to press, NHS England Chief Executive Sir Simon Stevens described the NHS as ‘in the most precarious position in its 72-year history’ as a result of the second wave of COVID-19.1 The health service is under immense pressure: with deaths per day due to COVID-19 now higher than they were at the start of the pandemic, the NHS is engaged in a race to vaccinate the public.
What does this mean for the millions of patients whose treatment has been postponed as a result of the resurgence of COVID-19? In this issue, we continue to examine the consequences of the pandemic for specialised services. In our Hot Topic article, Tamsyn Crane, Network Education Lead, Kent, Surrey and Sussex Operational Delivery Network, discusses the impact of COVID-19 on neonatal services and the babies and families who rely on them, emphasising that restricted parental visiting, limited physical contact with babies, and reduced support with breastfeeding may have negative consequences for health that far outlast the COVID-19 pandemic.
Continuing the paediatric theme, Neli Garbuzanova, Senior Procurement Manager, NHS Arden & GEM Commissioning Support Unit, and her colleagues Bernie Stocks and Dr Ayesha Ali of Highly Specialised Services at NHS England and Improvement, Fiona Marley of Highly Specialised Commissioning at NHS England and Improvement, and Kate Steele of the spina bifida and hydrocephalus charity Shine, describe the establishment of a highly specialised service providing open fetal surgery for spina bifida. This complex procedure has the potential to significantly reduce disability relative to surgery after birth, improving quality of life for both babies with spina bifida and their parents. Our cover story for the issue, this article features a case study and contributions from fetal surgeons involved in the delivery of the service.
Also in this issue, Johnny Skillicorn‑Aston and Jeremy Hooper of Conclusio Limited explain that citizens should be central to the data‑driven transformation of healthcare. In this Working in Partnership article, the authors evaluate the NHS Test and Trace programme, and demonstrate how data were used to assess and modify the care of the shielding population. With reference to multiple sclerosis, the authors argue that learnings from the pandemic around the use of data for the common good can and should be applied elsewhere.
In addition, the Specialised Medicine team bring you highlights from a range of recent virtual conferences. Alastair Whitington, Consultant Editor for Specialised Medicine, reports from the Westminster Health Forum on stroke prevention, care, and treatment, where it was agreed that action must be taken to ameliorate effects of the pandemic such as delayed access to treatment for stroke. Claire Green, Editorial Consultant for Specialised Medicine, Guidelines, and Guidelines for Pharmacy and former Editor of Specialised Commissioning, summarises highlights from the Westminster Health Forum on diagnostics and pathology, which charted the key learnings and achievements of the sector during the pandemic. Lastly, I attended the Pharmaceutical Industry Network Group 2020 Conference on genomics, personalised medicine, and artificial intelligence, which showcased the technology underpinning some of the most cutting-edge approaches to diagnosis, drug discovery, and treatment.
In Oncology Corner this quarter, Alastair Whitington recounts the views of Dr Anne Rigg, Chair of the NHS England Chemotherapy Clinical Reference Group, on the impacts of COVID-19 on patients and staff. Although rapid development of interim treatment changes allowed treatment to continue for many patients with cancer, the sustained demand of the pandemic has left many staff exhausted and distressed. Dr Rigg also expressed concerns about the effects of delayed cancer diagnoses and treatments on mortality rates.
In Medicines Corner, Martin Bradley, Formulary and Interface Pharmacist, Guy’s and St Thomas’ NHS Foundation Trust, discusses the NHS England policy on pharmacogenomic testing for DPYD polymorphisms prior to fluoropyrimidine-based chemotherapy. Specific genetic polymorphisms in the DPYD gene—which encodes an enzyme that converts 5-fluorouracil to an inactive metabolite—put carriers at risk of severe fluoropyrimidine‑associated toxicity; thus, dose reduction is necessary to avoid adverse reactions that can, in rare cases, prove fatal.
Goodbye from Specialised Medicine
Finally, it is with great sadness that I must inform you that this bumper issue of Specialised Medicine will be our last in its current format. By way of a thank you to all of our staff and contributors, here is a summary of the key events in the life of the journal.
Specialised Medicine started life as Specialised Commissioning, a quarterly print journal for healthcare professionals and managers with a role or interest in specialised commissioning. In the first issue in November 2017, Julia Van Danzig, then Editorial Director at MGP, and Alastair Whitington, then Consultant Editor for Specialised Commissioning, defined the journal’s aims: to showcase innovation and best practice in specialised healthcare and draw attention to this important but under‑recognised area of healthcare.
Specialised Commissioning was published quarterly until November 2019, covering subjects such as barriers to the funding of medicines through specialised commissioning, shortfalls in the uptake of specialised medicines relative to clinical trial predictions, and challenges around patient access to advances in treatment. In May 2018, Claire Green became the Editor of Specialised Commissioning, underlining in her first editorial the journal’s commitment to ‘promote best practice in specialised commissioning, which at heart means that people with rare and complicated conditions get the best treatment and the smoothest patient journey possible’.
The November 2018 issue of Specialised Commissioning included the first Medicines Corner, a regular column in which Martin Bradley and David Erskine of Guy’s and St Thomas’ NHS Foundation Trust discussed key issues and challenges related to the use of specialised medicines. In March 2019, the Specialised Commissioning website was launched, paving the way for a host of online resources, such as the NHS England Tariff-Excluded Drugs List and databases of patient access schemes, clinical commissioning policies, and clinical commissioning work programmes. Later in 2019, Specialised Commissioning assembled a panel of experts—including lead clinicians, a pharmacist, and a patient representative—to participate in a round-table discussion on the barriers to uptake of new treatments and actions necessary to overcome them.
In 2020, I took over as Editor, and Specialised Commissioning was rebranded to Specialised Medicine. The focus of the journal shifted to incorporate more articles on clinical guidance and best practice, and its audience expanded to include consultant oncologists, haematologists, and neurologists. When the pandemic struck, Specialised Medicine provided a range of content, both in print and online, to support healthcare professionals on the front line, such as our COVID-19 Advice Hub collated by Alistair Scott, Production Editor for Specialised Medicine. As it became clear that the health service’s focus on COVID-19 was having a negative impact on patients with other health conditions, Alastair Whitington interviewed experts in oncology, haematology, transplantation, and stroke to determine the impacts of the pandemic on their specialties and actions necessary for recovery.
MGP is committed to improving patients’ lives by promoting best practice in healthcare. Although this is the final issue of Specialised Medicine in its current format, take a look at our other publications—Guidelines, Guidelines in Practice, Guidelines for Pharmacy, and Guidelines for Nurses—and watch this space to see what we do next. If you have enjoyed reading this journal and would like to be involved in helping us to shape our future offering, email firstname.lastname@example.org.
- Stewart H. NHS in most precarious position in its history, says chief executive. www.theguardian.com/world/2021/jan/17/nhs-in-most-precarious-position-in-its-history-says-chief-executive (accessed 26 January 2021).