Pharmacogenomics in prescribing: building competence for safer, personalised care
Pharmacogenomics in prescribing: building competence for safer, personalised care
What is pharmacogenomics and why does it matter for prescribing? Learn how genetic variation influences medicines and why competence matters for UK prescribers.
Lead Author of the RPS Pharmacogenomic Resource to Support the Competency Framework for All Prescribers
This was published when the organisation was the Royal Pharmaceutical Society.
Pharmacogenomics — the study of how a person’s genetic makeup affects their response to medicines — is becoming increasingly relevant to prescribing practice. As genomic medicine develops across the UK, prescribers need the confidence to recognise when genetic factors may affect treatment decisions, medicine efficacy or the risk of adverse drug reactions.
The Royal Pharmaceutical Society’s (RPS) Pharmacogenomic Resource to Support the Competency Framework for All Prescribers is designed to support prescribers of all professional backgrounds in this evolving area of practice. Sitting alongside the RPS Competency Framework for All Prescribers, it provides structured guidance to help integrate pharmacogenomic principles into everyday prescribing practice safely and responsibly.
Why pharmacogenomics matters for prescribers
Genetic variations between people can affect how their bodies handle medicines. These differences can influence how quickly or slowly certain medicines are broken down, how well the medicine works and the risk of side effects. In certain clinical scenarios, pharmacogenomic testing can help inform medicine choice or dose selection.
For prescribers, competence in pharmacogenomics does not require specialist training in genomics. Rather, it involves:
Recognising when genetic factors may be clinically relevant
Understanding how to interpret validated information appropriately
Applying that information alongside clinical judgement
Incorporating insights into shared decision-making with patients
Pharmacogenomics aids professional clinical judgement by providing additional evidence to inform prescribing decisions, supporting medicines optimisation and improving patient safety.
Supporting confident implementation across the UK
The RPS Pharmacogenomic Resource is designed for prescribers at all stages of their careers, from those developing their prescribing practice to experienced prescribers expanding their scope.
It reflects the realities of implementation across the UK, including differences in access to pharmacogenomic testing and local service provision. By looking at prescribers’ competencies through a pharmacogenomic lens, the resource supports safe and accountable practice across care settings when pharmacogenomic testing is used.
The need for prescribers to have clear communication with patients remains central. Discussions about genetic testing and treatment options must be handled sensitively, with consideration of cultural and ancestral factors where appropriate. Accurate documentation and information sharing are essential to support continuity of care, particularly as genetic results remain constant even though interpretation may evolve over time.
Looking ahead
Pharmacogenomics is likely to become an increasingly integrated component of prescribing practice in the coming years. By using this resource, prescribers can ensure they are equipped to adapt safely as the use of personalised medicine continues to develop.
By strengthening the understanding of pharmacogenomics within existing prescribing competencies, this resource supports safer, more personalised and evidence-based care.
Where does Pharmacy fit into Scotland’s public service reform agenda?
The new Scottish Government is prioritising public service reform, in their words, to ensure public services are inclusive, sustainable, and effective in improving people’s outcomes.
As the Royal College for Pharmacy, we believe that utilising pharmacy in the most appropriate ways is key to ensuring the success of public service reform in healthcare.
We exist to improve patient outcomes and advocate for thousands of pharmacists across all sectors. We’re very active in lobbying the Government for concrete policy changes which would improve patient outcomes, you can read these in our 2026 Election Manifesto for Scotland.
As a key stakeholder already advocating strongly for public service reform, we recently responded to the Scottish Parliament’s Public Service Reform Committee’s consultation on this topic. However, we are concerned that the Public Service Reform Committee consultation does not create sufficient space for stakeholders to contribute ideas about the fundamental redesign of services.
That’s why we’ve published an open letter to the Scottish Government and everyone with an interest in Public Service Reform in Scotland. In our letter, we call for public service reform to focus on redesigning services, not simply reducing budgets or workforce numbers. Reform should make better use of the pharmacy workforce, accelerate digital transformation through integrated health and care records, expand preventative care, and break down organisational barriers to deliver more joined-up, person-centred services. We know that pharmacists are an underutilised clinical resource that can improve access to care, deliver independent prescribing, deliver appropriate care to reduce pressure on hospitals and other NHS services, and help deliver better outcomes for patients across Scotland.
Fiona McIntyre FRCPharm, Policy and Practice Lead for the Royal College of Pharmacy in Scotland has set out more about what genuine public service reform would look like for pharmacy in her blog ‘Pharmacists must be fully integrated into the NHS’. In this piece, she argues that pharmacists must be fully integrated into the NHS if Scotland is to meet future healthcare challenges and maximise the benefits of recent pharmacy education and legislative reforms. With all pharmacists now qualifying as independent prescribers, pharmacy teams have significant potential to support a focus on prevention, manage long-term conditions and provide care close to home. Achieving this will require better integration of community pharmacy into NHS services, universal access to shared digital health records, greater investment in pharmacy teams, and the redesign of care pathways so that pharmacists can work at the top of their clinical expertise.
We look forward to continuing to work with the Scottish Government, MSPs and other stakeholders to achieve fundamental reform of pharmacy services, supporting the Scottish Government's ambition to improve outcomes for people across Scotland.
Laura Wilson FRCPharm
Director for Scotland
Stability on paper, risk in practice: deprescribing, a leadership challenge for neighbourhood health
A patient who was stable on paper
Rose is 79. She's been married for sixty years, and her son helps manage her medicines. Across her clinical records, she's recorded as taking her medicines as prescribed, clinically stable and well managed.
Take the time to sit down and properly review her medicines, and a different picture starts to form. Rose is taking 21 prescribed medicines, including one she's been on for almost thirty years for an indication that resolved long ago, and an inhaler she's been using at half the prescribed dose because she believes the correct dose makes her feel unwell, a concern nobody had ever explored.
No individual prescribing decision was wrong when it was made. The problem was that opportunities to review whether those decisions still made sense had been missed. That gap has a name: prescribing inertia.
Naming the problem
Prescribing inertia is the continuation of medicines without active reassessment of their benefit, risk and clinical relevance. It builds quietly, one repeat prescription at a time, and if neighbourhood health is genuinely about prevention and independence, it isn't a peripheral issue. It's a leadership challenge.
That's the thinking behind the Staying Well Service, where I work as a specialist prescribing pharmacist embedded in an integrated neighbourhood team. We support adults aged 55 and over living with mild to moderate frailty, identified through risk stratification and the electronic Frailty Index. For Rose, that meant someone finally asking not whether she was taking her medicines, but whether she still needed them.
Why this still feels difficult
None of this is new. Deprescribing has been part of the professional conversation for years, with guidance, frameworks and tools that most pharmacists already know well. In this blog I want to look at why, despite that, so many of us still hesitate to act on it in practice.
Some of that reluctance is understandable. Stopping a medicine can feel riskier than continuing it, even when the evidence points the other way, and nobody wants to be the person who unpicks a decision made by someone else. But some of it also comes down to how we've framed our own role. If deprescribing only happens when a patient looks complicated enough to warrant it, it will always feel like an exception rather than a normal part of the role.
That's the reframe I think we need. Clinical scrutiny of every medicine on a patient's list shouldn't be a special intervention. It should be what a structured medication review is for, working with patients and the wider multidisciplinary team to ensure treatment remains appropriate. If we only ever ask whether a regimen is safe to continue, we'll keep finding patients like Rose years too late.
A snapshot of what's possible
This is what prioritising deprescribing can look like in practice. Over five months, the Staying Well Service reviewed 123 patients and generated 281 medicines optimisation interventions, including 37 structured deprescribing plans targeting longstanding prescribing inertia.
Some of the most consistent gains came from targeting specific drug classes where long-term use had quietly outlived its original purpose. Some patients remained on antidepressants long after the original indication was no longer relevant. Others were taking gabapentin at doses that had crept up over time without the original indication ever being revisited. Some proton pump inhibitors continued well past their recommended review point, often started for short-term symptom control and never stopped. Six patients had their high anticholinergic burden eliminated completely.
In each case, the pattern was the same: the opportunity to revisit whether the medicine was still needed had been missed. Once we did, this kind of deliberate, targeted scrutiny brought measurable reductions in polypharmacy, anticholinergic burden and high-risk prescribing, demonstrating what can be achieved when deprescribing becomes part of routine practice rather than a special project.
Why this matters for the profession
This work speaks directly to the profession’s commitment to put patients at the forefront of what we do. True patient-centred care means looking past the reassurance of a repeat prescription and looking at the person in front of us. Rose was stable on paper, but she was carrying risk that had accumulated over years, and her situation wasn't unusual.
If neighbourhood health is serious about prevention, we need to get better at asking a harder question of treatments that have become routine. Not "is the patient taking this medicine?" but "does this medicine still deserve its place?"
Change like this rarely starts with a new policy. It starts when someone decides that what's become normal isn't good enough, and acts on it. For Rose, that meant a holistic medication review with deprescribing built in as a core function, not an afterthought. It meant treatment that better reflected her needs today, rather than the decisions made decades ago. For neighbourhood health, it means pharmacists willing to take on that leadership challenge.
Read more blogs.