In this special episode we ‘Dive in at the Deep End’ and examine in-depth the Inverse Care Law. What is it, why does it matter to medicines optimisation - and what can we do about it?

The Inverse Care Law is a term first defined by the Welsh GP Dr Julian Tudor Hart over 50 years to describe how, perversely, people who most need health care are the least likely to get it. A law that sadly is as true now as it was then. Will we finally get to hear about the day Jamie met Julian Tudor Hart…?

To help us in our discussion we are re-joined by AA Alumni Dr Karen Sankey alongside Dr Beth Winn. Regular listeners will remember Karen from series 2,  a GP who specialises in Health Inclusion and trauma based coaching. Karen is passionate about tackling social justice and health inequalities and we find out what has been happening since we spoke to her last. Dr Beth Winn is a GP working at Charlotte Keel Medical Practice, one of the largest and most deprived practices in Bristol. Like Karen, she is passionate about improving equity in healthcare and has worked with marginalised patient groups in India, Malawi, New Zealand and South Africa.

Charlotte Keel Medical Practice is part of the GPs at the Deep End initiative which strives to reduce health inequalities through providing peer support, advocacy, training and research opportunities to primary care clinicians working in disadvantaged areas. We delve into the experiences of staff working at the deep end supported by the following article from the British Journal of General Practice https://bjgp.org/content/74/749/e797. 

To support our discussion we look at The Health Foundation Paper ‘Tackling the Inverse Care Law’ https://www.health.org.uk/reports-and-analysis/reports/tackling-the-inverse-care-law.

The original article penned by the great man himself in The Lancet can be read here: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(71)92410-X/fulltext  

As with all of our guests, Beth shares with us her Memory Evoking Medicine, a career anthem and book that has influenced her career or life. Is the choice a drug? You can decide, but it is a game-changer for Women’s health. 

The Apothecaries are on the road again! Come and see our next live show at the Clinical Pharmacy Congress on the 10th May in London. Book your tickets and find out more here: https://www.pharmacycongress.co.uk/london 

Don’t forget to check out Steve’s impressive TV debut where he describes the role of a Clinical Pharmacist to none other than Professor Green on BBC Morning Live. This is a must watch for anyone who wants to understand this role and the impact of polypharmacy. A new career beckons… You can watch it here: https://www.rpharms.com/about-us/news/details/polypharmacy-featured-on-bbcs-morning-live. 

You can listen to the Aural Apothecary playlist here; https://open.spotify.com/playlist/3OsWj4w8sxsvuwR9zMXgn5?si=tiHXrQI7QsGtSQwPyz1KBg 

You can view the Aural Apothecary Library here;   https://litalist.com/shelf/view-bookcase?publicId=KN6E3O

Our website is https://www.theauralapothecary.com/ 

To get in touch follow us on Bluesky and X @auralapothecary or email us at [email protected] . Don’t forget to rate us and comment wherever you have got this podcast from. 

What is a Clinical Pharmacologist? Who better to tell us than Professor Lauren Walker, Professor of Clinical Pharmacology & Therapeutics and Honorary Consultant in General Internal Medicine at Liverpool University. 

Lauren is a leading researcher in multimorbidity and AI-driven healthcare and plays a key role in early-phase clinical trials. We chat about her role in ‘First in Human’ trials - what are they, what are the risks and why are they so important? And how does this work reach across to her clinical role which focuses on multimorbidity and polypharmacy. We discuss the role that AI may play in predicting polypharmacy and the development of DynAIRx - an Artificial Intelligence being designed to support medicines optimisation on multimorbid patients. It's a Robotic version of Steve the Chemist!

Our micro-discussion continues with the theme of clinical trials. How can we ensure they are representative of the populations they are supposed to be treating. Is it ever ethical to test new drugs on elderly and frail patients? ‘The current status of inclusion of older groups in evaluations of new medications: Gaps and implementation needs to fill them' https://pubmed.ncbi.nlm.nih.gov/38600697/

As with all of our guests, Lauren shares with us her Memory Evoking Medicine, a career anthem and book that has influenced her career or life. Fans of pharmacology will not be disappointed. 
Check out Lauren's impressive full bio here, with further details of all of her research: https://www.liverpool.ac.uk/people/lauren-walker

This week we also discuss Steve’s impressive TV debut where he describes the role of a Clinical Pharmacist to none other than Professor Green on BBC Morning Live. This is a must watch for anyone who wants to understand this role and the impact of polypharmacy. A new career beckons… You can watch it here: https://www.rpharms.com/about-us/news/details/polypharmacy-featured-on-bbcs-morning-live. 

Our website is https://www.theauralapothecary.com/

You can listen to the Aural Apothecary playlist here; https://open.spotify.com/playlist/3OsWj4w8sxsvuwR9zMXgn5?si=tiHXrQI7QsGtSQwPyz1KBg 

You can view the Aural Apothecary Library here;  https://litalist.com/shelf/view-bookcase?publicId=KN6E3O  

To get in touch follow us on Bluesky and X @auralapothecary or email us at [email protected] . Don’t forget to rate us and comment wherever you have got this podcast from.

What is Deprescribing? Why is it so important? And the big question... who invented it?! We present a masterclass in deprescribing from pharmacist Dr Emily Reeve from Monash University in Australia who is also Chair of the Australian Deprescribing Network.

The need to review, reduce or stop medicines has been a regular topic of conversation here on the Aural Apothecary. But how do we do it? Deprescribing should be an integral component of appropriate prescribing and is defined as the systematic process of dose reduction or discontinuing a medicine under the supervision of a healthcare professional. We chat to Emily about the difficulties faced, advancements in practice and her research into the topic. What help is available for prescribers? Do patients actually want their medicines stopped? And who is the world leader in Deprescribing...?

There is no one better with whom to discuss this topic. Dr Emily Reeve, as well as being Chair of the Australian Deprescribing Network, is a Senior Research Fellow and Deputy Theme Lead for the Centre for Medicines Use and Safety, in the Faculty of Pharmacy and Pharmaceutical Sciences at Monash University in Australia.

Should information on how to stop a drug feature in guidance on how to start it? In our micro-discussion we delve deeper into the guidance available for prescribers when we look at one of Emily’s papers 'What do clinical practice guidelines say about deprescribing' https://qualitysafety.bmj.com/content/34/1/28  

As with all of our guests, Emily shares with us her Memory Evoking Medicine, a career anthem and book that has influenced her career or life. We learn that it is hard to dance with the devil on your back.

Want to get your papers published? Jamie mentioned the site https://gettingpaperspublished.com/

You can listen to the Aural Apothecary playlist here;
https://open.spotify.com/playlist/3OsWj4w8sxsvuwR9zMXgn5?si=tiHXrQI7QsGtSQw Pyz1KBg

You can view the Aural Apothecary Library here;
https://litalist.com/shelf/view-bookcase?publicId=KN6E3O

Our website is https://www.theauralapothecary.com/ 
       
To get in touch follow us on Twitter and Instagram @auralapothecary or email us at [email protected] . Don’t forget to rate us and comment wherever you have got this podcast from.

Pull up a chair and join the Three Apothecaries around the fire as we wrap up the year with a lively chat featuring friends and colleagues Clare Howard and Jonathan Underhill. Together, we reflect on an exciting and dramatic year in the ever-changing world of healthcare and medicines.

From groundbreaking developments like weight-loss drugs and debates around assisted dying to critical issues such as polypharmacy and exploring new career paths, we dive into the stories that shaped 2024—and how they’ve impacted us personally and professionally.On a lighter note, What does the weight of the British National Formulary reveal about the history of medicines? What drink smells like a pharmacy? And how measuring Prostate Specific Antigen can be fun!

For this episode’s micro discussion, we travel back 60 years to explore the 1964 classic, "Patient's View of Admission to a London Teaching Hospital." This fascinating study sheds light on how patient experiences have evolved—and in some cases, stayed the same—over the decades. (Read the paper)

This year has been one for the record books, with the Three Apothecaries travelling to Bordeaux and performing for a sell-out audience in Cardiff. We’re so grateful to our incredible guests and loyal listeners for making it another unforgettable year of stories, conversations, and medicines-related fun.Merry Christmas and Happy New Year!

Check out our website www.theauralapothecary.com  for a searchable database of all episodes, blogs and bonus content for your enjoyment and education.To get in touch and interact follow us on Blue Sky @auralapothecary.pharmsky.app , Twitter @auralapothecary or email us at [email protected] . Don’t forget to rate us and comment wherever you have got this podcast from. 

You can listen to the Aural Apothecary playlist here; https://open.spotify.com/playlist/3OsWj4w8sxsvuwR9zMXgn5?si=tiHXrQI7QsGtSQwPyz1KBg 

You can view the Aural Apothecary Library here;  https://litalist.com/shelf/view-bookcase?publicId=KN6E3O

Welcome to the second in our series of ‘The Aural Apothecary Analyses’, where we will be delving a bit deeper into some of the recurring themes from our first series. This week we are joined by Dr Matthew Jones and Angela Carrinton to discuss medicines safety and how we can help clinicians & patients make better decisions. 

Healthcare professionals rely on guidelines to help them make the right choices. But do they work? Is the way we write and use guidance in practice actually harming patients? And what can we do about it? Join us as we discuss the balance between prescriptive guidance and the flexibility required to navigate complex systems, all while considering the critical role guidelines play in providing assurance and safety in healthcare.

Angela will be well known to regular listeners, featuring as a guest in series 1. She is Lead Pharmacist for Medication Safety, Health and Social Care Northern Ireland and a Human Factors enthusiast. Mathew is a senior lecturer in medicines safety, medicines information and pharmaceutics at the University of Bath. He has coordinated the development of the South West Pharmacy Research Network and is the co-author of our discussion paper today - “Exploring the Role of Guidelines in Contributing to Medication Errors” https://pmc.ncbi.nlm.nih.gov/articles/PMC10954937/ 

In our discussion we dig into the role of guidelines and their real-world impact on patient care. From the pitfalls of laminating to the importance of user-testing, we explore how the design and writing of guidance can influence outcomes - sometimes with unintended consequences. Do digital systems actually make things better? Are guidelines themselves contributing to errors? And how can human factors expertise improve how clinicians interact with these tools in practice?

As well as getting deep into the issue of medicines safety we also ask the important question - why on earth would anyone put mouthwash in a public toilet? Tune in to find out more on this important topic…

As with all of our guests, Matthew shares with us his Memory Evoking Medicine, a career anthem and book that has influenced his career or life. 

Angela has already shared her choices in a previous episode which you can find our more about here where we discuss Medicines Safety in more detail and the World Health Organisations ‘Medicines Safety Challenge’  https://www.theauralapothecary.com/episode-9-angela-carrington-the-world-health-organisations-medicines-safety-challenge/

You can listen to the Aural Apothecary playlist here; https://open.spotify.com/playlist/3OsWj4w8sxsvuwR9zMXgn5?si=tiHXrQI7QsGtSQwPyz1KBg 

You can view the Aural Apothecary Library here;  
https://litalist.com/shelf/view-bookcase?publicId=KN6E3O

Our website is https://www.theauralapothecary.com/ 

To get in touch follow us on Twitter and Instagram @auralapothecary or email us at [email protected] . You can now also follow us on LinkedIn (https://www.linkedin.com/company/auralapothecary/) and BlueSKy @auralapothecary.pharmsky.app) 

Don’t forget to rate us and comment wherever you get this podcast.

Freedom from Command and Control was the very first book choice on the Aural Apothecary and its themes of failure demand, systems thinking and value have featured heavily on the show ever since. It is a real pleasure therefore this week to welcome its author, John Seddon. 

John Seddon is an occupational psychologist and author, specialising in the service industry. He is the managing director of Vanguard the inventor of 'The Vanguard Method', the means by which his organisation helps service leaders transform their organisations from conventional command-and-control designs to systems designs, achieving remarkable results. Seddon’s prominence grew following attacks on conventional management thinking, sometimes referred to as New Public Management, including: the belief in economies of scale, quality standards and much of public sector reform including 'deliverology', the use of targets, inspection and centralised control of local services. The Daily Telegraph described him as a "reluctant management guru".

As expected, our conversation with John was thought provoking and challenging. John does not hold back in his analysis of the current state of healthcare in the UK and the often failed attempts to fix it. How do we fix our broken medicines management systems? How much do our attempts to fix things actually make things worse? What can we do to ‘unlearn’ what we think we know in order to understand the system from the patient's perspective? Can we really save the NHS in 10 weeks…?

In our micro-discussion we discuss Operational failures in general practice: a consensus-building study on the priorities for improvement (https://bjgp.org/content/74/742/e339). The discussion offers Paul and Jamie the opportunity to reflect on their own attempt to apply systems thinking to a GP practice in South Wales. As with all of our guests, John shares with us (albeit reluctantly!) his Memory Evoking Medicine, a career anthem and book that has influenced their career or life. 

Can this method reduce costs by 75% ? Here is the video referenced by Gimmo and John that highlights a real-life example of the systems approach in action https://vimeo.com/943283319. 

John has recently published a Manifesto on Re-Thinking Regulation https://beyondcommandandcontrol.com/wp-content/uploads/2024/10/Manifesto_bk.pdf which promises to improve public sector productivity and morale. 

You can listen to the Aural Apothecary playlist here; https://open.spotify.com/playlist/3OsWj4w8sxsvuwR9zMXgn5?si=tiHXrQI7QsGtSQwPyz1KBg 

You can view the Aural Apothecary Library here;   https://litalist.com/shelf/view-bookcase?publicId=KN6E3O

Our website is https://www.theauralapothecary.com/  To get in touch follow us on Twitter and Instagram @auralapothecary or email us at [email protected] .

Don’t forget to rate us and comment wherever you have got this podcast from.

This week, when we return to our normal format we are joined by Community Pharmacist Dr Berwyn Owen. Berwyn is a pharmacy proprietor and prescriber in North Wales. Formerly a Chief Pharmacist and a member of the General Pharmaceutical Council he is well placed to discuss what the future of medicines management looks like through the lens of community pharmacy. 

Drawing on his wide ranging experience which includes stints in pharmaceutical research and as Programme Director for the Medicines Management programme for the NHS, we explore how the NHS is going to cope with the growing burden of chronic disease, and how pharmacies at the heart of communities could develop to provide so much more care.

This is a joyous meander through Berwyn's career and his own plans for the creation of a healthcare hub at the heart of his village in Penygroes. “You’ve lifted this town” is how one of his patients described the effect the developments are having.

Steve is away this week and so we are joined by the Fourth Apothecary, Clare Howard. As a basis for our discussion we reference the recent report by the Bevan Commission ‘The Future Foundations for the future of healthcare’ https://bevancommission.org/the-future-foundations-for-the-future-model-of-health-and-care-in-wales/ as well as the current pharmacy strategy in Wales ‘Pharmacy: Delivering a Healthier Wales’ https://www.rpharms.com/wales/pharmacy-delivering-a-healthier-wales. 

As with all of our guests, Berwyn shares with us his Memory Evoking Medicine, a career anthem and book that has influenced their career or life. 

Dr Berwyn Owen - Biography Berwyn Owen is the former Chief Pharmacist at Betsi Cadwaladr University HealthBoard, North Wales. He is also a former Council Member at the General Pharmaceutical Council, the UK independent regulator for pharmacy. He was a member of the UK Commission on Pharmacy Professional Leadership and chaired the sub-group on education and training and is an Independent Expert Member on the UK Pharmacy Professional Leadership Advisory Board.

Since retiring from the Health Board he has recently become a pharmacy proprietor and is a practicing prescribing pharmacist at Penygroes and the Nantlle Valley near Caernarfon. He is a regular contributor to Pharmacy Management and presented nationally on pharmacy leadership. He commenced his career in pharmaceuticals as a research assistant with Beecham Pharmaceuticals at Worthing in 1986. Studied pharmacy at Brighton University followed by a PhD on Orphan Disease at the Royal Victoria Infirmary, Newcastle upon Tyne and Sunderland University. He was appointed Honorary Senior Lecturer with the School of Medical Sciences at Bangor University which is progressing to become the third School of Pharmacy in Wales. He has published on orphan disease and more recently on bilingualism within healthcare.

He is the past Programme Director for the Medicines Management Programme for NHS Wales and Welsh Assembly Government which led the agenda to reduce harm, waste and variation with medicines across Wales. He is also past chair of the Welsh Pharmaceutical Committee, was a member of the Ministerial Pharmacy Strategic Delivery Group and led on Medicines Management for the Chronic Conditions Framework Demonstrators. He is a member of the Llanrug Silver Band, the oldest band in Wales, and governor of the local primary school and a member of Clwb Mynydda Cymru. 

You can listen to the Aural Apothecary playlist here; https://open.spotify.com/playlist/3OsWj4w8sxsvuwR9zMXgn5?si=tiHXrQI7QsGtSQwPyz1KBg 

You can view the Aural Apothecary Library here;   https://litalist.com/shelf/view-bookcase?publicId=KN6E3O

Our website is https://www.theauralapothecary.com/ 

To get in touch follow us on Twitter and Instagram @auralapothecary or email us at [email protected] . Don’t forget to rate us and comment wherever you have got this podcast from. 

Welcome back to The Aural Apothecary! For our first episode we bring you an exciting new format, where we’ll be diving deeper into some of the recurring themes from our first six series. The Aural Apothecary Analyses!

In this episode, we focus on statins and the importance of shared decision making in healthcare. Inspired by a recent paper in the BMJ by Sam and Brian et al, we explore their argument that guidelines should move away from population-level risk thresholds and focus more on individualised risk and patient preferences.

But how does this work in practice? We’ll explore the challenges faced by busy healthcare professionals when trying to balance shared decision making with the realities of daily practice. And, perhaps most importantly, we’ll ask: do patients actually want shared decision making?

Dr Sam Finnikin is an academic GP with an interest in shared decision making. Brian Finney is an active patient representative.

Links to some of the articles discussed:
Statins, Risk and Personalised Care BMJ article https://www.bmj.com/content/384/bmj-2023-076774
Lipid Lowering to Prevent Cardiovascular Disease Clinician Decision Aid https://gpevidence.org/conditions/lipids/
PEER Simplified Cardiovascular Decision Aid from Canada https://decisionaid.ca/cvd/
Disutility of Statins: Patient-Accessible Tool for Shared Decision Making in Cardiovascular Primary Prevention https://www.ahajournals.org/doi/10.1161/circulationaha.113.007595  

As with all of our guests, Sam and Brian share with us their Memory Evoking Medicine, a career anthem and book that has influenced their careers or life. 

You can listen to the Aural Apothecary playlist here; https://open.spotify.com/playlist/3OsWj4w8sxsvuwR9zMXgn5?si=tiHXrQI7QsGtSQwPyz1KBg 

You can view the Aural Apothecary Library here;  https://litalist.com/shelf/view-bookcase?
publicId=KN6E3O

Our website is https://www.theauralapothecary.com/ 

To get in touch follow us on Twitter and Instagram @auralapothecary or email us at [email protected] . Don’t forget to rate us and comment wherever you have got this podcast from. 

Join us for the last episode of series six and a joyful exploration of the importance and reality of person centred care. 

For five years Tommy Whitelaw was a full-time carer for his late mother Joan who had Vascular Dementia. In 2011 he undertook a walk around Scotland’s towns and cities to collect hundreds of life stories and letters detailing the experiences of individuals who care for a loved one living with dementia. It was a journey that taught him the importance of gentle honesty, that Civility really does Saves Lives and that listening really is the best drug available. 

We find out how an intervention by his local community pharmacist ‘gave him his Mum back’.  We discuss the concept of ‘intelligent kindness’ and how the impact of being busy affects our ability to care. ‘When we are busy we do less of the beautiful stuff first…’

We delve deeper into the topic of Intelligent Kindness when we discus Effecting Change - Evidencing Culture Change in Compassionate Care https://www.alliance-scotland.org.uk/blog/news/effecting-change-evidencing-culture-change-on-person-centred-care/

Tommy highlights the importance of music for people with dementia (and those caring for them). Check out Playlist for Life, a music and dementia charity. The charity was founded in 2013 by writer and broadcaster Sally Magnusson after the death of her mother, Mamie, who had dementia. Their vision is simple: For everyone with dementia to have a unique, personalised playlist, and everyone who loves or cares for them to know how to use it. https://www.playlistforlife.org.uk/

As with all of our guests, Tommy shares with us a Memory Evoking Medicine, a career anthem and book that has influenced his career or life.

Tommy works for Person Centred Voices, an ALLIANCE project that works to promote person centred practices in public sector organisations in Scotland; that is, to advocate for personalisation, empowerment and shared decision making across all areas of care and support. He has also had a fantastic career on the road as a tour manager for many of the Worlds best known bands. This has inspired him to hold a bi-annual ‘Concert for Carer’s’. Find out more here; https://linktr.ee/personcentred

You can listen to the Aural Apothecary playlist here; https://open.spotify.com/playlist/3OsWj4w8sxsvuwR9zMXgn5?si=tiHXrQI7QsGtSQwPyz1KBg 

You can view the Aural Apothecary Library here;  https://litalist.com/shelf/view-bookcase?publicId=KN6E3O

Our new website is now live https://www.theauralapothecary.com/ and as well as being a searchable database of all episodes, we will be uploading transcripts and extra content for your enjoyment and education. Have a look and let us know what you think! 

To get in touch follow us on Twitter and Instagram @auralapothecary or email us at [email protected] . Don’t forget to rate us and comment wherever you have got this podcast from. 

Pain in the eye? It is a red-flag all healthcare professionals are trained to be aware of. But when spotted, who deals with it? We are joined by Specialist Head and Neck Pharmacist Ann Marie Goacher. Ann Marie describes her journey from a local community pharmacist in Ireland to being the lead pharmacist for the head and neck directorate at University Hospitals Sussex. What does an ophthalmic and specialist uveitis pharmacist do?

We talk to Ann Marie about her passion for eye care, and the importance of getting back to basics with the simple act of administration. Glaucoma can be better managed simply by ‘knowing your drops’ yet it is a neglected area of care. We discuss how off-licence use of drugs for a common eye condition has saved the NHS millions and the controversies that surround this.

For our micro-discussion we look at The burden of acute eye conditions on different healthcare providers: a retrospective population-based study,  a paper that looks at the public awareness of community eyecare services in a world where the demand for acute eyecare exponentially outstrips capacity. https://bjgp.org/content/74/741/e264

Further information on the ‘Know your Drops’ campaign can be found on the website of Moorfields Eye Hospital https://www.moorfields.nhs.uk/for-patients/information-hub. 

Ann Marie was spotted as a guest for the podcast after having the misfortune to sit next to Jamie on a plane. The topic of the conversation was the book she was reading - which happened to be written by her Father. “Once there was a boy who survived” by Maurice Heffernan which tells the story his early days in an orphanage in Ireland to his tumultuous journey through foster care, institutionalisation, and forced labour https://www.amazon.co.uk/Once-There-was-Boy-Survived/dp/1915502667. 

The “statistics made simple and relevant” podcasts with James McCormack mentioned in the episode can be found here https://therapeuticseducation.org/podcast-episode-list/

As with all of our guests, Ann Marie shares with us a Memory Evoking Medicine, a career anthem and book that has influenced her career or life. 

You can listen to the Aural Apothecary playlist here; https://open.spotify.com/playlist/3OsWj4w8sxsvuwR9zMXgn5?si=tiHXrQI7QsGtSQwPyz1KBg 

You can view the Aural Apothecary Library here;  https://litalist.com/shelf/view-bookcase?publicId=KN6E3O

Our new website is now live https://www.theauralapothecary.com/ and as well as being a searchable database of all episodes, we will be uploading transcripts and extra content for your enjoyment and education. Have a look and let us know what you think! 

Our latest blog posts talks about our first live public show - ‘Music, Memories and Medicines’ - have a read here; https://www.theauralapothecary.com/blog/the-three-apothecaries-music-medicines-and-memories/. 

To get in touch follow us on Twitter and Instagram @auralapothecary or email us at [email protected] . Don’t forget to rate us and comment wherever you have got this podcast from.