The importance of differentiating professional and technical aspects of pharmacy

The PDA wants to encourage more debate about the role of pharmacy technicians. This comes after several pharmacists based in GP surgeries wrote to voice their concerns about a muddling of the pharmacy technician’s role and responsibilities in GP practices.

Wed 8th December 2021 The PDA

As a solely pharmacist organisation, the PDA does not have pharmacy technicians in its membership. However, the PDA fully appreciates that pharmacy technicians are valued colleagues who work alongside pharmacists every day. Pharmacy technicians are often friends, family, and fellow employees working together as a team. If skill mix is to work, then it is important that pharmacy technicians have rewarding jobs with career development, job security, respect at work and fair reward, just as these things are important for pharmacists. To enable this all to be achievable and effective, a clear understanding of roles and professional responsibilities is necessary across all parties involved.

In 2019, the PDA published the outcome of a three-year research project into the role of pharmacy technicians. That 250+ page report went into significant depth about the challenges and opportunities associated with an enhanced role for technicians. However, there appears to still be attempts by some employers to interchange the appropriate responsibilities and activities for pharmacists and pharmacy technicians without fully considering the consequences.

Letter from members

The following letter was recently received by the PDA from a group of GP practice pharmacists.

Pharmacy technicians are required to complete a 2-year course BTEC or NVQ level 3 in pharmaceutical sciences and pharmacists complete 5-year Master’s degree including 12 month pre-registration training, and many pharmacists now have a postgraduate clinical pharmacy diploma completed over 2 years, and an independent prescribing qualification to expand on the Master’s in Pharmacy.

What is alarming is that, despite the extensive academic requirements for a pharmacist, the pharmacy technician is expected to complete the same Primary Care Pharmacy Educational Pathway (PCPEP) training course as a clinical pharmacist which is based on postgraduate clinical pharmacy diploma content. This is something which we feel is inappropriate.

As pharmacists we have seen that technicians on these courses are unable to participate clinically and really should have their own CPPE pathway course tailored for their level of education not as an expansion of the Master’s in Pharmacy as this course is based on accredited postgraduate clinical pharmacy diploma content. It makes no sense for pharmacy technicians to jump from NVQ level to a course based on postgraduate clinical pharmacy level content that builds on the Master of Pharmacy knowledge.

It is unfair for pharmacy technicians to have the same courses as they seem to be finding it difficult and unable to contribute to clinical discussions during teaching sessions. This course, which is inappropriately geared for both pharmacists and technicians, has worryingly also led some GP surgery teams to believe pharmacists and pharmacy technicians have the same level of education and expertise.

Some pharmacists were asked by the CPPE tutors during the pathway sessions if they are happy for the technicians to conduct medicines reviews too. We do not feel that technicians have the expertise to make professional judgement and for the safety of patients should be allowed to conduct clinical medicine reviews.

Technicians do not have in depth clinical knowledge in medicines pharmacology, side effects, interactions, doses in renal impairment (which touches upon specialist renal doctor knowledge), blood results interpretation, critically assessing clinical articles to make evidence based professional decisions which pharmacists gain through their Master’s in Pharmacy degree and some with postgraduate clinical pharmacy diplomas, and through their work experience. Pharmacists are experts in medication and the new changes to the pharmacy technician role expansion is leading some other health professionals and employers to believe pharmacy technicians are the equivalent of a pharmacist.

The pharmacy technician role is better suited for compliance/concordance reviews, audit work via extracting prescribing data but not medicines reviews and their work needs to be conducted under the supervision of a pharmacist. The “Network Contract Directed Enhanced Service Contract specification 2021/22” mentioned that part of the “Clinical responsibilities of the Pharmacy Technician”: “The supporting medication reviews, and medicines reconciliation”. This seems to be misinterpreted by some technicians and managers as conducting medicines reviews. There is an Arden template on GP prescribing computer systems which is further adding to this ambiguity as it states an option from the drop-down list “medication review done by pharmacy technician”.

Currently pharmacy technicians seem to be asked to transcribe hospital clinical letters and hospital discharge reconciliation. We feel that their work must always be double checked by pharmacists/GPs as we notice they make errors (for example some letters do not state a specific drug and instead a drug class where the technician will choose a random drug in that drug class without having a clinical understanding of the patient which can be harmful to the patient via a drug interaction for example, frequency errors, dosing errors, adding every medicine on the discharge letter to the patient’s repeat medicines list without being able to critically and clinically assess potential discharging doctors’ mistakes, drug interactions, and what should not be on repeat such as addictive pain or sleep medication.

For example, we know a pharmacist witnessed a technician adding ibuprofen and omeprazole to an elderly patient’s repeat list which were for a short-term course and would have been added to their dosette box; luckily the pharmacist checked the technician’s work and rectified the error which could have led to a stomach bleed.

Some technicians have apparently been telling the PCN managers and other surgeries’ staff that “they can do everything pharmacists are able to do with the exception of prescribing”. This is a highly dangerous assumption as we have highlighted in the previous paragraph where actions which seem of negligible risk of harm such as not knowing which medication should be repeat or acute can dramatically escalate to damage patient health and even cause death.

In summary, we are happy for our colleagues, the pharmacy technicians, to conduct medicines compliance/concordance reviews while referring any issues to the pharmacists. To transcribe hospital discharges/clinic letters as long as their work is always double checked by pharmacists/GPs, alongside other duties as devised by the Network Contract DES.

We would be very grateful if the PDA could support GP surgery pharmacists, by asking the CPPE who deliver the same “Primary Care Pharmacy Educational Pathway (PCPEP)” training pathway to pharmacists and pharmacy technicians to deliver a bespoke CPPE course specifically tailored for technicians separate to that for pharmacists.

While this letter is specifically about a CPPE course, it also reflects other concerns raised about a trend towards muddling the different, but both valuable, contributions made by pharmacists and by pharmacy technicians.

The PDA is raising these particular concerns with CPPE and would also like to hear from other members with their views or experiences on this issue. Comments can be emailed to enquiries@the-pda.org quoting “The role of Technicians” in the subject heading.

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