In his opening remarks, Professor BRYAN VEITCH (chairman of the board of governors, College of Pharmacy Practice) drew attention to the interdependent and symbiotic relationship that existed between pharmacists and technicians.
There were now opportunities to develop the role of the pharmacy technician, but several grey areas and controversial issues existed. These included the registration of technicians and, in community pharmacy, the nature of the current contract which placed constraints on the shared role of dispensary technicians and pharmacists.
The first speaker, Mr Darren Leech (chief pharmacy technician, William Harvey hospital, Ashford, Kent) stressed the need to discard the traditional model of work in which people were allotted particular tasks according to their station or rank and to adopt a more task-oriented, multidisciplinary approach so that available resources could be optimised to produce more effective delivery of care. Various incentives currently existed which favoured expanding the technician's role, including staff shortages, the general underuse of pharmacists' skills and the public's expectation of a high standard of service.
Traditionally, hospital dispensing had involved the pharmacist at three stages: performing a clinical check, dispensing the medicine and then making an accuracy check. In Mr Leech's hospital, pharmacists now performed only the clinical check. The accuracy check was performed by a technician and the dispensing was done to a large extent by support staff, including assistants. Technicians were also involved in patient counselling on wards and in anticoagulant clinics, drug history-taking and co-ordinating arrangements for discharge medicines. They were also members of drug information and wound care teams, as well as directorate pharmacy teams. As the role of technicians expanded, it was necessary to extend the function of pharmacy assistants, and they were now involved in dispensing, distribution, prepackaging and medicine returns.
Like other speakers throughout the day, Mr Leech reminded participants that it could not be assumed that acquiring a qualification was equal to competency. Competency, he said, was "being able to perform ‘whole' work roles to the standards expected in real working environments". Standards of service and performance had to be introduced and training needs identified to enable these standards to be met. The process of changing roles of pharmacy staff could only be effectively moved forward through a process of good, "inclusive" communication, so that everyone understood the rationale for the changes, and jobs, responsibilities and accountability could be clearly defined.
"The process of introducing extended roles and competency and optimising the skill mix in a department could be an enjoyable journey," he said.
A member of the audience reminded those present that one restraint to extending the roles of non-pharmacist staff was the lack of motivation of some pharmacists to extend their own roles. In the community, the present system of remuneration was a disincentive for pharmacists to come out of the dispensary. However, another member of the audience added that two reports from the Royal College of Physicians and the Royal College of General Practitioners were both supportive of the clinical and extended roles of pharmacists. In answer to a question about accuracy checking of prescriptions, Mr Leech said that about 300 technicians in the South Thames region were now carrying out such checks.
Mr Trevor Beswick (regional pharmaceutical adviser, South West), described the experience in his region, with particular emphasis on medicines information departments. A technician development officer had been appointed in 1999 to undertake the strategic development of technicians. Competency-based training programmes were being developed and implemented and assistants were being trained to carry out functions previously performed by technicians. In medicines information, technicians were able to maintain databases, perform systematic literature searches, receive and answer certain categories of inquiry under supervision and co-ordinate audits of inquiries. There were shades of grey between some "technical" roles and "clinical/interpretive" roles in medicines information and an overlap existed between the two. It was, however, necessary to distinguish between them. For example, searching for appropriate publications of clinical trials was a technical task, whereas evaluating and reporting the results of such trials was a clinical task (and, therefore, required a pharmacist to do it).
A comment from the floor emphasised that to find the necessary skill mix required for some jobs, of which medicines information was a good example, it might be useful to consider people from backgrounds outside of pharmacy.
Speaking about experience of a ward pharmacy technician service at the Northern general hospital, Sheffield, Miss Amanda Rogers (clinical services manager) said that technicians on wards were capable of undertaking many tasks traditionally performed by pharmacists, including counselling patients, taking drug histories and co-ordinating discharge medication plans. At her hospital, 12 technicians made daily visits to 24 wards. In an evaluation of a ward technician service to an admissions ward, it was found that there was an increase in the number of patients counselled, a reduction in the number of urgent requests for discharge medicines in the dispensary and a decrease in the number of out-of-hours calls. There was also a 66 per cent increase in the number of patients seen by a pharmacist after introduction of the service. Job satisfaction of all pharmacy staff was enhanced and the skill-mix improved.
Three workshops dealt with the pros and cons of accreditation of technicians on the ward, in the dispensary and in technical services. Ms Sarah Goodson (technician training and development officer, South Thames region) described a clinical training course for technicians which was running in her region. After successfully completing the course, technicians received accreditation in such skills as counselling, consultation and drug history taking. She highlighted the relatively longer periods of study spent on drug action in pharmacy technician courses compared with nurse training, and suggested that this made technicians more competent in counselling patients about their medicines on wards.
Mrs Helen Dalrymple (education officer, Association of Pharmacy Technicians, based at Wrexham Maelor hospital) and Mr Steve Willis (regional quality assurance pharmacist, London region) led workshops on technicians' roles in the dispensary and in technical services. The workshops emphasised the strengths of accredited technicians, including their knowledge of medicines and supply and dispensary systems, their cost-effectiveness and their effect of freeing pharmacists' time and maximising staff resources. Not only was job satisfaction enhanced, but also tasks and standards could be defined, standards raised and risk management improved. In technical services, the current climate suggested that technicians would not be in a position to carry out final checks and release aseptic products in unlicensed units.
Closing the meeting, Mr Andrew McKendrick (director of pharmaceutical quality assurance, Guy's and St Thomas's hospital trust) highlighted recent events where mistakes had been made by staff who had been assumed to be competent (because of their qualifications) but who, in fact, had been inexperienced in particular tasks. These included errors by nurses in calculating paediatric doses, failure to identify the drug constituents of a combination product for a patient on a ward, and a dilution error during the dispensing of an unfamiliar preparation in a dispensary. Systems needed to be evaluated to see the whole picture, and well-trained technicians could be accommodated within those systems. Mr McKendrick reflected the general tenor of the day when he asked that the concept of an extended role for technicians be accepted. Acceptance would provide a partial solution to recruitment problems, enabling pharmacists, technicians and other pharmacy staff to use their skills more effectively and thus improve the service delivered by pharmacy departments.