These commentaries by John Macgill represent his opinions only and not those of any Ettrickburn client.

Medicines shortage – a new prescription for an old problem

Ettrickburn commentary - Labour's plans to radically shake-up the pharma industry (part 2)

Ettrickburn commentary - Labour's plans to radically shake-up the pharma industry (part 1)

Cost of medicines falling

Three Nations Three Practices

Community Pharmacy Eliminating Hepatitis C

Homeless People make Glasgow

Heart Failure – we can get treatment right for everyone

Bundles of Safety

Community Pharmacy’s Leader in Scotland

CPO: On the Road to Achieving Excellence

Pharmacy technicians may become prescribers

Profile: Dr Norman Lannigan OBE

Profile: Jonathan Burton MBE

Profile: Clare Morrison MBE

Deep Dive Pharmacy

Mind the Gap - Diagnostic Skills for Pharamacists

Bundles of Safety

Supporting Excellence - Alison Strath Interview

2018 Pharmacy Forum Agenda Launched

Which Referendum to Choose

Three Perspectives on Pharmacy and Mental Health

Pharmacy and the New GP Contract

Bordering on Problematic

Recognised by the Queen and her community

VACANCY Reporter/Researcher: Health and Care Policy in Scotland

Prescribing in Mental Illness – A Practice Pharmacist’s Perspective

What Matters to You? Communication in Pharmacy

Prescribing in Mental Illness – A Patient’s Perspective

Focusing the Vision: Dr Rose Marie Parr on the new strategy for Scottish pharmacy

All the things that could go wrong - looking ahead to the SNP conference

Ask Once, Get Help Fast? Pharmacy and Mental Health

Automation and Delegation in Pharmacy: Understanding the Moving Parts

Pharmacy First in Forth Valley One Year On

Initiatives Highlight Potential of Community Pharmacy

Trying to concentrate on the day job

Health and the Local Elections – a strange silence

The Pharmacist Will See You Now – The Growth of GP Pharmacy

Montgomery’s Review – Dr Brian Montgomery answers questions on access to new medicines in Scotland

An afternoon with SMC

Pharmacists at SMC

SMC – are drug firms voting with their feet?

Radical Surgery on the Horizon for Scotland’s NHS

The Future’s Bright – in General Practice

Community Pharmacy in a Changing Environment

Disclosing payments to doctors – has Sir Malcolm done the pharma industry a favour?

Health and Care in the First Minister’s Programme for Government

CMO: Scotland’s pharmacists “absolutely ideally placed” to practice Realistic Medicine

Profile: Maree Todd – MSP and Pharmacist

Scottish Parliament Health Committee Work Programme

Scotland’s new NHS – a Summer of Speculation

Scotland’s New Health Committee

Two million voices in Scotland – is integration the big opportunity to listen?

Medicines – levelling the playing field

Key appointment raises the bar for health & social care partnerships

What did our new MSPs do before?

SMC says no then NICE says yes – three times

SNP promises single formulary and a review of Scotland’s NHS

More Generous than the CDF – but less transparent

Comparison of Funds: New Medicines v Cancer Drugs

Bonfire of the Boards? SNP signals NHS Review

A tribute to five retiring MSPs

New Medicines Review - Health Committee sends findings to Government

Medicines New & Old in the Scottish Cancer Strategy

Great Ambitions, Slow Progress – New Models of Care in Scotland

Scottish Minsters Demand Up-Front Medicine Price Negotiation

Opportunity and Disappointment: MSPs Investigate New Medicines Access

Scottish NHS Strategy calls for 'Realistic Medicine'

The Scottish Model of Value for Medicines: Taking Everything into Consideration

When SMC Says No: An Access to Medicines Lottery

Reviewing the Review: Access to New Medicines in Scotland

A day of psephology and kidology

Insulting the Lifesavers

Worthy of Mention – Health and Science in the Honours List

News Silence from North of the Border

A Christmas PPRS Present from Pharma

Wednesday, February 20, 2019: Heart Failure – we can get treatment right for everyone

This article was published on the Pharmacy in Practice website

Heart failure is the most malignant form of heart disease with outcomes comparable with most of the common cancers. The main way of improving a patient’s prognosis and symptoms is through medication. Paul Forsyth, a heart failure specialist at the West Glasgow Ambulatory Care Hospital, is one of a small but growing number of pharmacists specialising in the condition across the UK.

He has been telling Pharmacy in Practice, getting the medicines right for every patient every time is possible in heart failure – but needs a population-level approach and the help of pharmacists across the NHS.

“There’s a very well-established evidence base for improving survival and decreasing hospitalisation risk for people with heart failure. We have half a dozen different drugs to choose from, from loop diuretics, ace inhibitors, beta-blockers, mineralocorticoid receptor antagonists, ivabradine to sacubitril valsartan, depending on the severity and symptom burden of a patient’s illness.

We know that the way in which we use these medications in heart failure can be improved. Both local and national audit data shows that we underuse prognostically important disease-modifying drugs. Of course, any single pharmacist can identify an individual patient and improve that patient’s care. But the challenge for the pharmacy profession and the NHS is to improve population-level cohorts of patients in an equitable and consistent way.

We need a public health approach – trying to reduce unnecessary variation in care and ensuring every patient every time is offered the appropriate care. It should not be that difficult in heart failure, where we have clear measures of good care. But delivering this is a challenge for Scotland and the whole of the UK. I sit on a number of strategic national heart failure groups, including the Board of the British Society for Heart Failure, and this is the challenge that we are trying to improve from Dingwall to Cornwall.

Our ambitions, of improving public health, are recognised by the latest update of the Scottish Government strategy Achieving Excellence in Pharmaceutical Care. Our pharmacist-led clinics are cited in this document as one of the exemplar projects. The pharmacy profession needs to show that in definable problems with a medicine focus, pharmacists can offer population level solutions as part of a multi-disciplinary team. We must try to get it right for every patient every time.

After fifteen years of practice in a heart failure specialist role, I see my job as being about guiding and mentoring others. As well as my clinical commitments, I spend a lot of my time developing the infrastructure needed to support other pharmacists to do more with cardiac patients, regardless of their role. Scotland is a small country and we should be aiming to support best practice regardless of geographic boundaries.

Increasingly, pharmacists are becoming independent prescribers. Our small team also clinically examined patients, including venepuncture and chests auscultation. While this may be deemed advanced practice, we are trying to support the development of these skills in other generalist pharmacists, for example those with in general practice. This type of upskilling will allow straightforward patients to be managed, up titrated and supported in primary care nearer their own home. Our team is working with NHS Education for Scotland to try and deliver this vision, through a programme called Teach & Treat.

I also think there is a role for pharmacists working in communities to make sure that patients have access to medicines at the right time, know how to use them and adhere to therapy. Someone with heart failure potentially sees a community pharmacist more often than any other healthcare professional, and therefore community pharmacists and their teams may be ideally placed to identify patients who are starting to physically and functionally decline. The challenge is, however, that without access to their medical records, a community pharmacist can only guess whether someone has heart failure – the medicines on their own aren’t enough to be sure. So, until we have that, it’s going to be challenging for community pharmacists to be a key provider of additional interventions.


Paul Forsyth will be leading a session on heart failure pharmacy at the Celtic Conference for Pharmacy in Scotland, Wales and Northern Ireland, being held in Edinburgh on Tuesday 26 March.  Registration is free for healthcare professionals at