Stephen Tomlin is transforming pharmacy at Great Ormond Street Hospital by embedding research into daily practice and putting pharmacists at the forefront of paediatric healthcare innovation. Saša Janković finds out more.
Children are three times more likely than adults to experience a medicine-related adverse event, yet only 14% of medicines are licensed for children when they first reach the UK market. At Great Ormond Street Hospital (GOSH) in London, pharmacy is being reimagined as a discipline where research and clinical care go hand-in-hand to address this issue.
Crucial to this work is the Children’s Medicines Research and Innovation Centre (CMRIC), which is primarily made up of members of the GOSH pharmacy team. It is striving to improve the use of medicines for children through innovation and collaborative work with University College London Great Ormond Street Institute of Child Health and the UCL School of Pharmacy.
Established in 2022, the creation of the CMRIC was designed to improve the use of medicines for children through innovation and research locally, nationally and internationally by acting as a ‘think tank’ for children’s medicines and medicine use.
Pharmacy involvement in paediatric medicines research
Under the leadership of its director, Stephen Tomlin, who is also associate chief pharmacist for research and innovation at GOSH, the CMRIC has become a hub for advancing children’s medicines research, involving the pharmacy team in over 50 publications and abstracts in 2023/24 alone.
Stephen’s fundamental belief is that ‘all hospital pharmacy departments should be based around practice, education and research’. As such, the CMRIC was about much more than just creating a research centre.
‘It was about thinking about pharmacy in a different way,’ he explains. ‘The whole concept was to make a difference, to change the department, and to show that research isn’t optional, it’s essential. As I always say, “you can’t be at the top of your game and stand still”.’
Alongside Stephen, who became the first paediatric consultant pharmacist in 2007, the core of CMRIC is made up of GOSH pharmacy team members. Ofran Almossawi is a research pharmacist who has worked extensively in clinical care and clinical trials, while Professor Joe Standing offers invaluable experience in paediatric pharmacokinetic modelling. Fan Cheng is principal pharmacist in immunology and immunotherapies and has a strong clinical paediatric background, with infection pharmacist Orlagh McGarrity bringing additional expertise in antimicrobial stewardship.
There is also wider input from within the pharmacy department and across the hospital trust.
‘Different staff supervise MPharm students and we’re developing clinical academics who understand research, because of course there’s a big difference between “little r” and “big R” research,’ says Stephen. ‘The smaller projects might be staff doing a literature review or a service evaluation, while the bigger projects need clinical academics who can handle ethics submissions.’
A specialised research focus
Encouraging all staff to embed research into their practice opens up a broad spectrum of projects to explore, and Stephen admits that deciding on projects isn’t straightforward.
‘Essentially, we look at what’s a key focus for Great Ormond Street,’ he explains, ‘so rare diseases are a big topic for us, given our specialisation, and we grow projects organically. If something aligns with our paediatric focus and we can manage it, we’ll explore it.’
Inevitably, there are barriers to overcome. ‘The biggest challenges of hospital pharmacy-led research are definitely infrastructure and time,’ Stephen explains. ‘But research isn’t something you do on the side; it has to be part of your core job. If you’re always saying, “have we got time for research?”, it’ll get cut immediately, so making a success of it is very dependent on your mindset.’
Pursuing innovative solutions
On the subject of successes, there have been many since the centre’s inception. ‘Creating a network, increasing publications and embedding research thinking are some of the key ones that come to mind,’ says Stephen. ‘One of the most exciting projects we’ve done is around medicines information for children.’
The team is developing a system in which patients can scan a QR code on a medicine label to bring up a personalised avatar who explains the medicine depending on their age group.
Technology is also key in their 3D printing project in collaboration with Alder Hey Children’s Hospital in Liverpool.
‘Since most medicines aren’t designed for children, we’re working with the team up there to explore novel formulations using 3D printing and electro-spinning to create personalised dosing,’ Stephen explains. ‘Imagine a future where you put your finger in a machine, get your blood level checked, and a pharmacy prints exactly the dose you need that day.’
He adds: ‘There’s already a licensed medicine made this way in the US, so we’re exploring how we can use it to create personalised medicines for children.’
Research and clinical practice impact
At the heart of all the research for Stephen and the team is reimagining how medicines can work for patients, but he says another real success is changing how pharmacists see and showcase their role.
‘Most pharmacists spend much of their time checking other professions’ work. We need to start relying on digital solutions to do this so that we bring real value added care,’ he says. ‘Most people have a narrow concept of what pharmacy does. They think we just dispense medicines, but we’re the experts in medicines and we need to define our own value. For example, when a new drug is being considered, what’s more important: being a third checker on a drug chart or being the person who really analyses whether it’s the right medicine for the patient? The answer should be obvious. Every drug, every treatment has questions that need answering.’
As a result, Stephen is clear that research isn’t just about big academic studies, and he says having an inquiring mind is the most important factor.
‘It’s about service evaluations, literature reviews, understanding statistics. It’s about challenging what we think we know. Most medicines aren’t designed for children, so we need pharmacists who are constantly asking questions, looking for better ways to deliver care,’ he says. ‘If we’re not researching, if we’re not trying to make things better, we’re not serving our patients. Research should be an essential part of every pharmacist’s role. It’s not optional; it’s how we improve healthcare and make a real difference to patients’ lives and the opportunities are massive – not just here at Great Ormond Street, but further afield.’
Collaborating to improve paediatric care
Indeed, in their mission to spread the message about the importance of pharmacists and pharmacy teams being involved in research, the CMRIC team set up the London Paediatric Research Network in 2023.
The aim was to bring together pharmacy teams from across London to discuss and share learnings. Last year saw the first of what Stephen says they hope will be an annual event allowing members to share updates and network with others either actively involved in the delivery of research or at the start of their research journey. ‘We want to create a one-stop shop where people can bring ideas and we can help develop them,’ says Stephen.
The CMRIC has also collaborated on several projects with University College London Hospitals, Imperial College London, Goldsmiths University, and University College London’s School of Pharmacy. This aligns with the Stephen and the team’s understanding that their work ‘isn’t just for Great Ormond Street, it’s about improving children’s healthcare everywhere.’
Stephen’s passion for research and advancing medicines for children is abundantly clear and he has a thought-provoking message for hospital pharmacy teams, encouraging them to reflect on whether they could be doing more to support their colleagues and patients.
‘If you’re not doing research as part of your job, you’re almost not doing your job,’ he says. ‘All hospital pharmacy departments should be based around practice, education and research. If we’re not constantly asking questions and seeking better solutions, we’re standing still. And in healthcare, standing still is not an option.’
