Survey to identify barriers and enablers to implementation of genomics in pharmacy practice across healthcare sectors in a rural community
Authors: McClay H , Palmer R 
Published: November 2024

Abstract

Introduction
The potential for genomics to improve patient outcomes is being harnessed via national strategy to embed genomic testing into NHS practice, and drive use of precision medicines and pharmacogenomics1. The national pharmacy genomics education and training strategic framework aims to empower the pharmacy workforce, across all sectors, to use genomics to support medicines optimisation2.
Cornwall, a rural and coastal county, has areas of marked deprivation with poorer health outcomes3 and challenges in recruiting and retaining healthcare professionals. It is key that rural/coastal communities have equitable access to genomic services and expertise to avoid exacerbating pre-existing health inequalities.

Aim
To identify barriers and enablers to the implementation of genomics into pharmacy practice in a rural community.

Methods
Pharmacists and pharmacy technicians working in Cornwall were eligible to participate. An anonymised survey was compiled via Microsoft Forms of closed, multiple choice and optional open questions. Following piloting, the survey link was disseminated via email by pharmacy leaders in community pharmacy, primary and secondary care in May 2024. Responses were stored securely via NHS password protected IT systems and analysed via quantitative and thematic analysis.
As this project is defined as a service evaluation, according to the UK NHS Health Research Authority, ethical approval was not required.

Results
Fourteen pharmacists and 7 pharmacy technicians participated, from primary and secondary care and community hospitals, with no participants from community pharmacy. Seven had received prior training in genomics (teaching sessions (n=5), webinars (n=1), podcasts (n=1), articles in journals (n=2)). One participant had received formal undergraduate training.
Key barriers to the implementation of genomics included a lack of education and training (n=5), perceived cost of genomic testing (n=2), difficulty in accessing genomic services (n=1) and lack of expert panels (n=1). It was also felt that genomics services were limited to secondary/tertiary care (n=2). Respondents stated that the rural location impacted the availability of face-to-face training and resources to support training (n=17).
Key enablers were the opportunity for precision prescribing (n=8), and improved patient outcomes (n=7). Genomics education and training (n=5) and resources to support training (n=11) were viewed as being pivotal to supporting the mainstreaming of genomics.

Discussion and conclusion
Participants were keen to further their genomics knowledge, with a preference for face-to-face training. Respondents also highlighted the need for allocated resources to support training. As emphasised in the strategic framework2, workforce upskilling is vital to the successful mainstreaming of genomics, particularly when the majority of pharmacy staff had not received any formal training.
There were no participants from community pharmacy, indicating a requirement to further explore barriers and enablers in this cohort. Community pharmacy staff may be reluctant to participate if they perceive genomics to relate solely to secondary/tertiary care. Survey methodology also limited the detail that could be obtained from respondents.
This provides helpful preliminary insights on barriers and enablers to genomics implementation into pharmacy practice in rural/coastal areas. Themes could be further explored via semi-structured interviews, with the aim of shaping interventions necessary to ensure equitable provision of genomics services and expertise to these communities.

References
1. NHS England (2022). Accelerating genomic medicine in the NHS: a strategy for embedding genomics in the NHS over the next 5 years. NHS England » Accelerating genomic medicine in the NHS [accessed 04 June 2024].
2. NHS England (2024). Pharmacy Genomics Workforce, education and training strategic framework. https://www.england.nhs.uk/publication/pharmacy-genomics-workforce-education-and-training-strategic-framework/ [accessed 04 June 2024].
3. Department of Health and Social Care (2021). Chief Medical Officer’s annual report 2021: health in coastal communities. Available via https://www.gov.uk/government/publications/chief-medical-officers-annual-report-2021-health-in-coastal-communities [accessed 04 June 2024].