Developing and delivering clinical toxicology in the UK National Health Service

Clinical toxicology concerns the investigation, diagnosis and management of suspected poisoning. It is an important discipline because of the frequency of suspected poisoning, including drug overdose. In the UK, most episodes are managed by nonspecialists, with support provided online or by telephone from the National Poisons Information Service. Leadership and clinical support for this is provided by a small number of clinical toxicologists, who are almost invariably accredited specialists in clinical pharmacology and therapeutics. Priorities for maintaining and enhancing clinical toxicology as a subspeciality in the UK include: 1 Maintaining funding for poisons centres. This is essential in spite of current budgetary pressures. 2 Formal training in the discipline. The 1 year optional training module in clinical toxicology approved in 2011 as part of the clinical pharmacology and therapeutics curriculum represents important progress, but funding for appropriate programmes and accreditation for trainees from other relevant disciplines is needed. Arrangements for registration and revalidation are also required. 3 An improved evidence base for management of poisoning. Priority areas include continued surveillance of the epidemiology and outcomes of poisoning, including syndromic surveillance, more rapid characterization of the human toxicity of newly introduced medicines and better clinical evidence on use of antidotes and other treatments; for example, acetylcysteine and lipid emulsion therapy.