Implications of technician registration
Pharmacists have always been held responsible for the staff that they supervise, but how will this change once they are registered with the RPSGB?
The situation with the RPSGB
The RPSGB intends to take on Statutory Registration of Pharmacy Technicians within the next two years. In the interim, and in preparation of Statutory legislation, the Society plans to open a voluntary register in January 2005. This register will be open to all technicians who have some form of qualification plus work experience. It is understood that such qualifications will include Pharmacy Services S⁄NVQ3, BTEC (Pharmacy), City and Guilds, Certificate of the Society of Apothecaries, and some company schemes. Evidence of recent pharmacy work experience will also be required.
The technicians register will be separate from that of the pharmacists, two technicians will sit on the RPSGB Council and professional discipline over technicians will be the same as that for pharmacists namely through the Statutory Committee.
It appears that consideration is being given at present as to what other procedures will be necessary to incorporate technicians into the normal workings of the Society, bearing in mind that pharmacy technicians will become an integral part of pharmacy.
Professional responsibility and accountability
The Society's view is that accountability, and thus professional responsibility, depends on the competence for the role which the technician is undertaking. It is generally acknowledged that the appropriate standard of qualification for pharmacy technicians should be NVQ3 and this is reflected in the minimum criteria for statutory registration. At this level it is accepted that a pharmacy technician may be in control of and give guidance to staff at a lower level. In this situation the NVQ3 technician has accountability for other staff and can themselves be held responsible under standard operating procedures (SOPs) and in professional discipline.
Pharmacists will still have the overall responsibility for NVQ3 technicians even if certain roles are delegated to the NVQ3 using, for example, standard operating procedures. If the NVQ3 has complied with the provisions of the SOP the pharmacist would still have that responsibility. Should the NVQ3 technician be in breach of the SOPs then it can be argued that the professional responsibility will be shared. To a great extent the manner, and proportion, in which the professional relationship is shared will depend on the circumstances existing at the time of the breach. It may be that in certain situations, the technician will take full professional responsibility as following an investigation of an incident, the pharmacist may be exonerated.
If a dispensing error occurs the person making the error is primarily responsible be that a pharmacist, technician or dispensing assistant although it is possible, depending on the specific circumstances, for all three to appear before the Statutory Committee. Generally speaking, the current convention is that the pharmacist will always be interviewed to assess the extent of his⁄her involvement in the error. It is likely, that after registration, it will become much more routine to involve the technician in these initial interviews.
The legal liability can fall into two distinct areas, namely, criminal and civil. In both circumstances the person primarily at fault and liable will be the person who made the mistake. In a dispensing error that can be the pharmacist, pre-registration graduate, the technician or dispensing assistant. In recent criminal cases action in court has normally be taken against the person primary at fault e.g. the technician or dispensing assistant plus the pharmacist who has been held responsible for the overall control of the pharmacy. This does not preclude action also being taken against the owner of the business. Most cases will normally be taken under the Medicines Act 1968 for dispensing errors or in legal terms -- supplying to the prejudice of the patient a medicine not specified in the prescription.
In very serious cases, for example, a dispensing error which leads to the death of a patient, a recent trend has emerged which has seen the Crown Prosecution Service charging the offender(s) with manslaughter. On one occasion charges of manslaughter were preferred against the pre-registration graduate, who made the mistake, and the supervising pharmacist.
In civil cases different criteria apply. It is held that the pharmacist has a duty of care to the patient. If the pharmacist breaches that duty and damage ensues then the patient has legal rights in the tort of negligence and may sue for damages. Nothing precludes in these circumstances the patient also suing the owner of the pharmacy and, if the pharmacy technician was involved, suing the technician. Where the courts consider that both the pharmacist and the pharmacy technician are jointly liable then damages can be apportioned between the two defendants depending on their respect professional responsibilities. Upon registration, it will be shown that registered technicians are holding themselves out to be individuals with a specific skill, consequently, their exposure to liability will be greatly increased.
It is almost certain that statutorily registered pharmacy technicians at NVQ3 will have a increased role in pharmacy, probably within Standard Operating Procedures and will therefore assume increased professional responsibilities. This may also make them liable not only criminally but also, civilly and professionally. It is interesting to note that, after seeking a legal opinion and in recognition of these enhanced risks, the Association of Pharmacy Technicians has advised its members to take out personal professional indemnity insurance.