From Genomic Insight to Everyday Prescribing: The Next Phase of Pharmacogenomics

Since our last blog on pharmacogenomic prescribing and integrated clinical decision support, the pharmacogenomics (PGx) landscape has evolved rapidly. FDB has continued to engage with CERSI-PGx, the Network of Excellence, and forums such as the British Pharmacological Society, helping to stay close to both policy and practice as the field develops.

As healthcare policy increasingly centres on prevention, personalisation and productivity, PGx represents a practical evolution in medicines optimisation. With national strategy now making clear that genomics should move beyond specialist services and become embedded within routine care, the task ahead is operational rather than theoretical: translating PGx insight into clinical decision support that works seamlessly within everyday prescribing workflows.

We caught up with Polly Shepperdson, Partnerships Manager and one of our PGx experts at FDB, about the lay of the land.

1. Polly, can you just give us a quick background on PGx?

Of course! Our genes influence how we process medicines: whereas one person may break a drug down very quickly, meaning it never stays in the body long enough to deliver the intended benefit, another may process the same medicine more slowly, allowing it to build up and increase the risk of side effects or adverse reactions.

This is not a single, fixed trait, and one person might be a fast metaboliser for one drug and a slow metaboliser for another, with most of us carrying genetic variations that influence our response to at least one commonly prescribed medicine. If we know what this is at the point of prescribing, it reduces trial and error and offers patients more predictable outcomes from the treatments they receive.

2. Can you tell us about the current landscape in PGx and what’s changing?

Yes, of course. There have been some really important developments in this field. The most significant is the shift away from PGx being seen as a specialist or research-led discipline. In practical terms, that means clinicians are increasingly able to access genomic insights at the point of prescribing, rather than needing to order a test and wait for a result. The conversation is now less about whether PGx has value, and more about how we use it safely, consistently and at scale.

Two key areas the industry is working through are when to test and what to test. Traditionally, testing has been reactive, focused on a single gene at the point where a prescription is needed, which can introduce delays. Increasingly, the evidence supports a move towards pre-emptive, panel-based testing, where multiple drug–gene interactions are assessed in advance and results can be reused across multiple prescribing decisions. This removes the time lag between testing and prescribing, is more cost effective and makes it more likely the results will be available to influence medication choices. Studies such as the PREPARE trial have shown that this approach can significantly reduce clinically relevant adverse drug reactions across multiple drug–gene pairs, and programmes like PROGRESS are helping to show it can be implemented into routine care. In practice, that means fewer patients cycling through ineffective treatments or experiencing avoidable side effects before finding the right option.

Whole genome sequencing at birth could ultimately provide this information across a lifetime, but for now the focus is on targeting investment in high clinical impact or heavily prescribed medications where treatment can be optimised or predictable adverse drug reactions can be prevented. This shift towards more proactive use of PGx is reflected in national strategy. Both the NHS 10 Year Plan and the Life Sciences Sector Plan, published in July 2025, set out an ambition for genomics to play a central role in the future of healthcare.

What this starts to do is shift PGx from a one-off intervention to something that supports safer prescribing over time. Nationally, there is now an ambition for up to 50% of healthcare interactions to be informed by genomic and predictive analytics by 2035, which gives a sense of the bold aspirations and direction of travel.

3. How does the work you do at FDB support this shift towards routine pharmacogenomic prescribing?

Given adverse drug reactions are estimated to cost the NHS up to £2.2 billion per year, the priority now is making this usable in day-to-day practice. That means integrating PGx into the systems and workflows clinicians already use, so they can apply it confidently without needing specialist genomics knowledge.

Our role is to support the NHS ambition to embed PGx into prescribing pathways by 2035. Through partnerships with hundreds of technology partners over 40 years, we bring experience of supporting clinicians to optimise medications at scale through clinical decision support.

The same principles we apply to our wider work apply to PGx: evidence-based content, transparent logic, alignment with national standards, and integration into the systems clinicians already use. FDB is already delivering this through the aforementioned PROGRESS research study led by North West GMSA and the University of Manchester, where FDB OptimiseRx is used in live primary care clinical workflows to surface pharmacogenomic results at the point of prescribing.

Our focus is the interpretation layer: generating a PGx result is only one part of the pathway. The real clinical value comes from translating and presenting that result into clear, actionable prescribing guidance so clinicians know whether to prescribe, adjust or choose an alternative.

As PGx moves towards routine care, genomic information needs to be codified, interoperable and integrated within electronic health records so that it can inform prescribing decisions automatically and consistently. It should not sit as a separate transaction, but be woven into the wider medicines intelligence that supports the patient’s holistic list of medications.

It is not about adding complexity, it is about ensuring that when a PGx result is available, it can safely and reliably influence the prescribing decision in real time.

4. How is FDB aligning its roadmap with the NHS ambition to embed genomics into routine prescribing?

The direction of travel is clear: genomic information is now becoming part of everyday clinical decision-making, with clopidogrel guidance already published and stroke wards building processes to accommodate testing on admission. FDB is working with technology partners to help to translate these emerging clinical processes into digital prescribing workflows.

As PGx test results begin to accumulate, they need to follow the patient across care settings, particularly as a single result frequently applies to multiple drugs. A PGx result should not need to be repeatedly reinterpreted or manually checked against external guidance. When a clinician prescribes, the system should already ‘know’ how that patient is likely to respond and reflect that in the prescribing advice.

Our aim is to ensure pharmacogenomics becomes part of everyday medicines optimisation rather than something additional to manage. If genomic insight influences a significant proportion of healthcare interactions in the coming decade, it needs to work simply, reliably and at scale in everyday practice.

Thank you, Polly!!