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Collaboration and resilience: AWTTC adapts to new way of working during COVID-19

During the coronavirus pandemic AWTTC’s multidisciplinary team showed resilience in overcoming new challenges and ensuring access to medicines in Wales was not compromised.

From creating a central resource hub for prescribers to working collaboratively on the monitoring of critical medicines stocks, the All Wales Therapeutics and Toxicology Centre (AWTTC) rapidly adapted in reaction to the challenges of the COVID-19 pandemic.

On 23 March 2020, AWTTC announced it would suspend most of its usual business and join healthcare professionals across the country in responding to COVID-19. AWTTC played an important role in addressing a number of Critical Medicines access challenges, which saw the team collaborate with a number of organisations including Welsh Government, NICE and NHS Wales.

Taking virtual working in their stride, the team had to adjust to a new way of working. One staff member was redeployed part-time to work in the COVID-19 workforce hub at the University Hospital of Wales.

The pandemic created a period of unprecedented pressure and AWTTC went above and beyond to provide guidance to prescribers and ensure that access to critical medicines was not affected. During lockdown, AWTTC undertook a significant amount of work, some of which would not have formed part of the team’s previous core business activity.

Keeping Wales informed

To make sure prescribers could access the latest information about the use of medicines during COVID-19, AWTTC created a central resource hub. This repository of resources was essential in keeping prescribers informed during the pandemic, with the information reviewed on a regular basis. The team put in a huge amount of work to keep this information updated, and the hub generated a high level of engagement from healthcare professionals.

AWTTC received a number of data and information requests; the team were on hand to offer guidance and ensure clinicians, Welsh Government and NHS Wales were kept updated on the changing use of medicines during the pandemic. From giving clarity on the place of specific therapies in cases of severe COVID-19 infection to providing information on the use of steroids for emetogenic chemotherapy, AWTTC helped with decision-making for patients during the pandemic.

Rapid implementation of guidance

To allow greater access and flexibility in the management of oncology patients during COVID-19 and ensure clinicians have additional options, NICE established interim rapid COVID-19 Systemic Anti-cancer Treatment guidelines. The interim treatment regimens were clinically assessed and endorsed by NHS England, leading to a request from the Welsh Government that NHS Wales should take account of these when caring for patients during the pandemic.

To allow for the timely implementation of these medicines in Wales, AWTTC developed an interim process enabling a ‘once-for-Wales’ decision to be made in a fair and timely manner according to the NICE COVID-19 rapid guidelines. AWTTC developed, approved and disseminated the process in a very short time, enabling clinicians in NHS Wales to access the same medicines as their clinical colleagues in England.

Taking a collaborative approach

Collaboration was key in ensuring the access to medicines across Wales was not compromised, with AWTTC working with other organisations to ensure patients received the best possible care.

AWTTC played a crucial role in co-ordinating a national medicine service across Wales to ensure vital palliative care medication reached terminally ill patients during the pandemic. Working collaboratively with organisations such as Clinical Logistics Health Courier Services Wales, AWTTC helped to develop and implement the End of Life COVID-19 Medicines Service. The service, which was set up in just 6 days, provided a single point of access to palliative care medication, ensuring rapid symptom control and allowing dignified care of people as they move towards the end of their life.

From the beginning of lockdown, AWTTC was involved with monitoring critical medicines stocks, working alongside health board chief pharmacists, Welsh Government and the NHS Wales Informatics Service. By monitoring hospital pharmacy stocks of critical medicines, AWTTC has supported national procurement leads in allocating medicines of limited availability to the sites and patients in most need. At the height of the pandemic the team worked 7 days a week to monitor the Top 20 critical medicines; this vital work is continuing on a daily basis.

But the hard work didn’t stop there, AWTTC collaborated with the World Health Organization and Public Health England to provide toxicology support. During the pandemic, Welsh National Poisons Unit (WNPU) staff undertook toxicovigilance work, identifying public health ‘flags’ to advise on the potentially dangerous things people were doing to avoid or cure COVID-19.

Maintaining access to medicines

Whilst focus turned to responding to the health crisis, AWTTC also continued to process appraisal submissions, review advice and assess medicines requiring interim advice. In most cases staff were able to process submissions within usual deadlines and continue a range of projects, including the development of prescribing advice.

AWTTC issued One Wales interim commissioning advice to make the oral prostate cancer treatments abiraterone, enzalutamide and apalutamide available to patients in Wales who were unable to have the standard chemotherapy choice due to the COVID-19 pandemic. The One Wales team pulled out all the stops giving up their weekend to produce the evidence report, obtain Chair’s action and inform the service in just over a week. Clinicians in Wales thanked AWTTC for their support and we are pleased to hear that over 100 patients have been started on treatment so far.

AWTTC also made news headlines as a result of its role in facilitating a review that saw an HIV prevention drug made freely available in Wales. After a successful Welsh Government-funded study, a pre-exposure prophylaxis HIV prevention drug combination was made routinely available to those eligible across Wales. This work, which has been ongoing for more than three years, saw AWTTC work collaboratively alongside Welsh Government, Public Health Wales, clinicians and the Terrence Higgins Trust as part of an independent HIV expert group.

Resilience in the face of new challenges

This is just a snapshot of the work AWTTC has carried out during the pandemic, which is testament to the team’s resilience and diverse skillset. The pandemic has meant services have had to adapt and develop new ways of working, something that AWTTC embraced wholeheartedly to ensure Wales remained informed and access to medicines was not disrupted.

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