How the RPG came into being.

In 1982 I was appointed to the newly established post of staff pharmacist (renal services) at Cardiff Royal Infirmary. I wanted to network (hadn’t encountered the term in 1982!!) with people in similar posts and so over the course of the next year I wrote to the chief pharmacists in those hospitals that had large renal units trying to establish if there was “anyone out there.” I had very few replies but two that I did have came from Birmingham and Taunton, which put me in touch with Dr Dave Scott and Dave Tutcher respectively. Dave Scott and I subsequently did some research together which resulted in us writing a paper for the PJ with editing sessions being done in motorway service stations between Birmingham & Cardiff - no e-mail in those days!!

Around the same time Dr Glenys Drew was appointed prinicipal pharmacist (medicines information) for the SW region. The SW region was the specialist file holder for drugs in renal disease and Glenys became aware that there were a number of pharmacists from around GB who regularly contacted her asking for information on drugs in renal disease. Glenys and I had been in the same year in the Welsh School of Pharmacy and had stayed in contact. At some point we twigged that the very poor response to my letter to chief pharmacists might have been unrepresentative of the real world. As a result, in 1984, the four of us wrote a letter to the PJ stating that we would be holding a meeting for pharmacists with an interest in renal disease in Bristol and we issued a general invitation to people to turn up. We were gob-smacked when over 50 people turned up!!

In the course of the meeting it became apparent that there were quite a lot of people “out there” and they were interested in some way of staying in touch; the Renal Pharmacy Group was born, I was elected chairman and Glenys was elected secretary. There were 3 other committee members - Dave Scott, Dave Tutcher and Janet DeCamp from Alder Hey. All those present stated that they wished to join the new group, so we had a group, a committee, a membership and no money!!

We were concerned that we might be too small to stand alone, so we held discussions with UKCPA (who didn’t want to go down the road of clinical specialities) and the Hospital Pharmacists Group to see whether it would be possible for the RPG to exist under the umbrella of a larger group. When it became clear that was a non-starter we decided we’d go it alone. We recognised that we’d need a funding stream and so we invited around a dozen companies that had large renal portfolios to become corporate members for ~ £250 p.a. for 3 years. Most of them stumped up the money and so the RPG had a 3 year funding stream.

In the first year we held 3 meetings and it became apparent that, by virtue of the location of members, we were best off meeting in Birmingham and London. We therefore met in hospitals in those two cities with the corporate members being invited to display their wares. We subsequently settled into a pattern of 2 meetings per annum. In those early years, topics covered at the meetings included Haemodialysis, Peritoneal dialysis, Transplantation, Pharmacokinetics and the new EPO therapy.

The constitution of the group stipulated that one committee member would stand down in 1985, two would stand down in 1986 and the final two original members would stand down in 1987; committee members would be eligible for re-election. The committee agreed that the chairman and secretary would stand down in 1987 thereby allowing 3 years continuity to establish the group.

Then, in 1986 whilst on holiday in Spain, Glenys Drew and several friends were killed when their car feel into a ravine. The SW region had lost its principal pharmacist for MI and the RPG had lost its secretary. I agreed to stay on as chairman of the RPG but found it increasingly difficult to commit my own time to the RPG as it wasn’t relevant to my new job.

Meanwhile, Ray Bunn, the renal pharmacist at St. Helier Hospital in Carshalton, had joined the group, and in the late 1980s, took over from Dave Roberts as Chairman. Ray was extremely enthusiastic about developing information resources for renal pharmacists, as there was a real dearth of information regarding drug dosing in renal failure. He began by bringing together information on doses and patient counselling tips from the St. Helier Unit. This was edited by the committee and then printed with the aid of an educational grant from Abbott. An A-Z of Drug Use and Guide to Patient Counselling in Renally Impaired Adults was published spring 1994, and nearly 1000 copies were sold, with the RPG donating £1 from every copy sold to the National Kidney Patients Association.

In 1995, Ray was approached by Radcliffe Medical Press, who said that they were very interested in taking over the A-Z and developing it. Contracts were signed, and Ray began updating the A-Z and adding more drugs to the list of those previously covered. However, by this time, he was managing pharmacy and support services across several trusts, and was unable to devote all the time he wanted to the project. In 1998, Caroline Ashley took over working on the book with the help of the other committee members, and in 1999, the first edition of The Renal Drug Handbook was published. The book has been sold worldwide, and the second edition, written and edited by Caroline and Aileen Currie was published in 2004. The third edition has recently been completed, now comprising nearly 800 drugs, and is expected to be on the market in the spring of 2009.

In 1994, Jane Hough, renal pharmacist at the Royal London Hospital, and later director of clinical pharmacy at the John Radcliffe in Oxford, took over from Ray as Chairman, and the RPG continued to work on various new projects. One such development started as an initial two-page list of pro-active renal pharmacists and their areas of interest, and grew to become the 1995 UK Renal Pharmacist’s Directory. For each unit whose pharmacist submitted data, the directory listed contact details for the pharmacist, brief details of the unit and drugs (but not doses) used in various treatment regimens. This enabled pharmacists to contact other pharmacists for further information. For the next decade, this was updated every 2 years, and distributed to each member. It has now become an electronic resource, updated annually and available to members via the RPG website.

Support for those new to the field is a recurring theme. A workshop was held at the 1995 conference to identify the sort of information that would be useful to a new renal pharmacist. As a result, a year later, the first edition of The Beginner’s Guide to Renal Pharmacy was published with the support of an educational grant from Janssen-Cilag. This was in the form of a loose-leaf file, covering an assortment of topics such as acute renal failure, chronic renal impairment, various forms of dialysis, transplantation, renal bone disease, renal anaemia, hypertension and diet. In the intervening years, the guide has been updated several times, and a copy has been given to each new member of the RPG. More recently, the Pharmaceutical Press approached
the RPG saying they had identified a niche in the market for such a book. As a result, the Beginner’s Guide was comprehensively updated and expanded by some 20 members of the RPG, and was published January 2008 as An Introduction to Renal Therapeutics, edited by Clare Morlidge and Caroline Ashley.

One other innovation was the twice-yearly publication of the Newsletter. This carried reports from both the RPG conference, the British Renal Symposium and from other notable renal meetings that members had attended. In addition, there was news of RPG activities, a question and answer forum, and some members submitted articles they thought might be of interest for publication. More recently, the RPG has had its own website (www.renalpharmacy.org.uk), and since the information previously included in the Newsletter is now available on the website, publication of the Newsletter was discontinued in 2006. For several years now, members have been able to post questions via an e-mail cascade and receive useful answers from colleagues around the UK; it is hoped that this system can also be transferred to the website, and allow for more interaction between members.

In 1997, Caroline Ashley, renal pharmacist at the Royal Free Hospital in London succeeded Jane Hough as Chairman. In addition to the continuation of RPG activities already described, the group has lately become involved in several of the renal initiatives being developed nationally. Andrea Devaney from the Oxford Transplant Centre was appointed as a member of the External Reference Group for the Renal National Service Framework, and several other RPG members were involved in the development of individual modules within the NSF. In addition, the RPG has been invited to be a stakeholder in several NICE appraisals, including Immunosuppression in Renal Transplantation, the Treatment of Renal Anaemia and Cinacalcet for the Treatment of Renal Bone Disease. For many years now, the RPG has also been an affiliated group to the British Renal Society and this association has enabled it to forge links with other disciplines within the renal world.

One of the most recent projects of the RPG has been the development of a framework of knowledge and skills required for different levels of specialisation as a renal pharmacist. The working group, led by Rob Bradley, has also defined the competencies expected of a specialist pharmacist as they progress from general level, through specialist pharmacist up to consultant pharmacist. This work parallels that being done by other specialist groups including ITU, Oncology and Cardiology. It is envisaged that eventually is may lead to the national accreditation of specialist pharmacists.

One sign of the RPG’s continued success has been that it has grown to a degree whereby the day-to-day running of the group has become too complex for committee members to carry out in addition to their NHS day jobs. Hence, in 2006, the committee made the decision to hand over this workload to M&M Consultants, who also manage the British Renal Society. This collaboration has proved highly successful, in particular, galvanising the annual conference into a very professionally run enterprise. It has also enabled the group to run much more efficiently, and individual members to devote more time to RPG projects.

2009 sees the 25th anniversary of the birth of the UK Renal Pharmacy Group. Its membership continues to grow steadily each year, the annual 2-day conference is always a great success, and the group is always looking for new projects to pursue for the benefit of its members. Here’s to the next 25 years of the RPG and may it continue to go from strength to strength.