After leading a landmark review of pharmacy support for intestinal failure services, Uchu Meade speaks to Saša Janković about the workforce gaps uncovered, the moves to create national standards and learning modules, and the vision for a more connected, research-active pharmacy community across England.
Significant workforce disparities in the pharmacy services supporting patients with severe intestinal failure across NHS England-commissioned intestinal failure and home parenteral nutrition (HPN) centres have been flagged in a new national scoping analysis.
While 96% of England’s 25 intestinal failure and HPN centres (n=24) took part in the study, only 75% of centres were found to have dedicated pharmacy services for intestinal failure.
The centres collectively manage around 2,300 HPN patients and 260 in-patients with type 2/3 intestinal failure, yet pharmacy staffing levels varied widely. Pharmacists were mainly focused on clinical work such as parenteral nutrition, prescribing and discharge planning, with limited involvement in research or service development.
Only three centres employed dedicated pharmacy technicians, while centres without dedicated services relied on generalist pharmacists and dietitians, underlining workforce inequities.
Strengthening intestinal failure services
The research was led by Uchu Meade, consultant pharmacist for intestinal rehabilitation at St Mark’s National Bowel Hospital, part of London North West University Healthcare NHS Trust, and Simon Harrison, deputy chief pharmacist at Bolton NHS Foundation Trust and former lead intestinal failure pharmacist at Salford Care Organisation – part of the Northern Care Alliance NHS Foundation Trust.
It was presented at the British Association for Parenteral and Enteral Nutrition (BAPEN) Annual Conference in November 2025, where the duo won the Professor RG Clark Award for the conference’s best poster.
Uchu’s involvement in the research goes back to 2020, when Salford Royal and St Mark’s hospitals were awarded national reference centre status for intestinal failure.
‘As part of that remit, the centres were required to strengthen services for people with chronic and severe intestinal failure receiving home parenteral nutrition,’ she explains. ‘But we quickly realised we didn’t know who we all were, we didn’t know what was going on in each centre and we also didn’t know what the learning required needs were for those pharmacists and pharmacy technicians working in intestinal failure.’
That realisation became the catalyst for a national scoping exercise to establish exactly who was working in intestinal failure and HPN pharmacy, what capacity existed in each centre, and what pharmacists and pharmacy technicians were doing in their day-to-day roles.
The work gathered momentum in 2023, when Uchu met colleagues at the BAPEN conference in Edinburgh who agreed to initiate a workforce scoping analysis and a parallel learning-needs assessment.
Collective action
The findings have already prompted collective action within the intestinal failure pharmacy community, particularly around strengthening research capability. ‘The Royal Pharmaceutical Society (RPS) has long recognised that research is the weakest domain for pharmacists seeking core, advanced or consultant credentialling, and my own experience mirrors this,’ Uchu explains.
As a result, she says intestinal failure consultant pharmacists, such as herself, are now working to create better support structures. ‘At the BAPEN conference this year, a number of us decided to set up a message group for the seven consultant-level pharmacists in nutrition and intestinal failure across the UK to collaborate more closely with colleagues at other grades,’ she says. ‘Our aim is to support pharmacists through credentialling, share research expertise and help embed research activity into everyday practice, and we know that other specialties already use this model successfully.’
Building a stronger professional network is essential not just for research but also for service development. ‘The scoping project itself has already brought pharmacists and pharmacy technicians together and has led to the formation of two national working groups: one to co-develop RPS learning modules, and another to use the scoping data to create workforce standards,’ Uchu says. ‘This is an important step towards ensuring a clearer shared understanding of pharmacy’s roles, expectations and development pathways across intestinal failure and HPN centres.’
Categorising intestinal failure pharmacy activities
A national working group of pharmacists from intestinal failure centres has now been established to begin drafting these standards, with early discussions already underway with NHS England. Uchu says the body is ‘supportive’ of the initiative, but she emphasises that the workforce standards ‘must be a multidisciplinary effort, involving not only NHS England but the RPS, the national intestinal failure pharmacy community, and colleagues from centres that contributed data’.
‘The standards will synthesise what pharmacists and pharmacy technicians currently do across England and will categorise activities as essential, non-essential or desirable,’ she explains. ‘This is how we create a level of clarity that will allow any centre, including those developing new intestinal failure services, to understand what pharmacy support should look like from day one and to construct job plans accordingly.’
Nonetheless, Uchu acknowledges that the process presents several challenges. One is the diversity of existing service models. ‘Different centres, depending on the strengths of the people they have, operate differently,’ she says. ‘This means the standards must be flexible enough to reflect legitimate variation while still defining a common national baseline.’
Another challenge is ensuring that pharmacists are empowered rather than constrained. ‘When I joined St Mark’s, I was repeatedly told certain roles belonged to dietitians, nurses or doctors, and I had to find my feet by myself,’ she recalls. ‘Our hope is that the standards will help avoid this for future recruits by clearly articulating what pharmacists are trained in and expected to do across the intestinal failure pathway.’
As for the timeline, Uchu says the working groups are now refining drafts and gathering further feedback. ‘We hope to publish that by this time next year,’ she says. ‘The standards will then give centres a practical, evidence-based platform for strengthening pharmacy input, reducing unwarranted variation and improving outcomes for patients with severe intestinal failure across the NHS.’
Practice outcomes in intestinal failure care
Uchu says the scoping analysis highlights just how critical specialist pharmacy input is for safe, high-quality intestinal failure care, and she believes that strengthening and standardising the pharmacy workforce will have clear benefits for both clinical practice and patient outcomes.
‘Centres with dedicated pharmacists were already delivering all of this amazing stuff, from medicines optimisation to complex parenteral nutrition decision-making and liaison with homecare providers. But the 25% of centres without a pharmacist were relying on nurses, dietitians or doctors to fill gaps,’ she says.
This means certain patients were missing out on the unique specialist knowledge that pharmacy can offer as part of this multidisciplinary team (MDT).
‘After all, some of pharmacists’ main strengths are that focus on the correct medicines management, parenteral nutrition and supporting prescription review and formulation, as well as counselling our intestinal failure patients; supporting them with travel and holidays; liaising with GPs; and managing the interface between hospital, homecare and primary care,’ Uchu says.
‘In practice, this means pharmacists often prevent unnecessary treatment changes, avoid drug-nutrition interactions, and ensure accurate medicines reconciliation during transitions of care, which is particularly complex in intestinal failure patients because you’re looking at the medications that they’ve tried and that they’ve failed, as well as current regimens.’
A clear blueprint of pharmacy contribution
For Uchu, new national workforce standards will translate these insights into practical application by providing centres with a clear blueprint of the pharmacy contribution required for safe and effective intestinal failure services.
With defined essential tasks, expected time commitments and indicative banding, the standards will also allow Trusts to design posts, build business cases and embed pharmacists into MDT structures from the outset.
Ultimately, improving the workforce infrastructure will strengthen the quality of care delivered nationally, while being able to support increased pharmacist involvement in research, which Uchu says ‘correlates with better patient outcomes’.
‘This is another reason why developing research capability is essential rather than optional,’ she concludes. ‘The more somebody’s involved in research, the better the quality of the care that they give to the patients. By pairing a stronger workforce with improved research engagement and a well-connected national network, we will create more efficient pathways, better-informed clinical decisions and safer, more consistent management for our patients with severe intestinal failure across the NHS.’
