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The European Foundation for the Advancement of
Healthcare Practitioners (EFAHP) has organised two previous meetings for
hospital pharmacy technicians. These meetings presented many examples
of how the role of the hospital pharmacy technician was being extended
and expanded. One issue that was frequently referred to in the two previous
meetings was the professional registration of pharmacy technicians. The
meeting reported here was held to explore the public policy, sociological
and ethical issues involved in professional registration of pharmacy technicians.
The meeting was attended by 180 pharmacy technicians and pharmacists.
Published literature on the professions
The meeting was opened by Dr DAVID GERRETT (senior lecturer, pharmacy
academic practice unit, University of Derby), who described the literature
on the professions. He described the differences between a profession
and an occupation.
Occupations were simply activities that were undertaken by people who
grouped themselves together under a particular description that was loosely
understood by society. Occupations could be carried out by a variety of
people. For instance anyone could call himself or herself a pharmacy technician
whether or not they had the appropriate training, qualifications and experience.
Professions, on the other hand, restricted their titles in law, and it
was illegal for someone who did not have the appropriate training, qualifications
and experience and who was not a registered member of a profession to
claim that they were a member of the profession and provide certain roles
and services. This was described in the literature as “social closure”.
Dr Gerrett explained that sociologists’ observations of professions were
fundamentally important for pharmacy technicians because they provided
a template for how other “occupations” became professions and how others
had manipulated social and government systems to maintain their position.
A profession could be defined in terms of a group of attributes. These
attributes were:
- A skill based on theoretical knowledge
- Integrity, maintained by adherence to a code of conduct and registration
- Defined training and education
- Competence testing in order to enter on to the register
- The provision of a service for the public good
- A professional organisation
- Community sanction
Other actions ascribed to professions were political lobbying, policy
development and implementation, lobbying and marketing.
Dr Gerrett asked pharmacy technicians the following questions:
- Who were their customers? Patients, pharmacists or the government?
- Who would represent their needs?
- Who would register them?
- What exactly was their role?
- How would society understand and recognise their activities?
- Who would decide what education requirements “made” a pharmacy technician?
Dr Gerrett said that the key ideological change and challenge facing
pharmacists was a move back to appeasing the customer rather than relying
on Government to mandate a role. It was not enough to rely on Government-backed
“social closure”. The key lesson for pharmacy technicians was not to make
the same mistake.
Dr Gerrett described two cases from the literature of other professions
gaining professional recognition.
In 1703, the College of Physicians had taken the apothecary William Rose
to court for the supply of “medicines proper for distemper” to one John
Seale, “a poor butcher”. The Queen’s Bench jury, realising that Rose had
acted in accordance with accepted practice for the period, had asked for
a definition of “practice”. Having defined “practice”, the law necessitated
the conviction of William Rose. However, the judgment had been reversed
on appeal by the House of Lords. Critically, this had been based upon
the opinion that it was “in the public interest to allow apothecaries
to give advice as well as to sell medicines”. Thus, until the Act of 1815,
apothecaries provided “advice gratis” and only charged for medicines.
Only a new Act of Parliament could abrogate the legal status of London
apothecaries. The London apothecary practising in 1704 could continue
his business of the preparation and sale of medicines, or compete with
the physicians on their own ground. No exact figures were available to
indicate how many changed to medical practice, but gradually the medically
orientated apothecaries and physicians merged to become medical practitioners.
So the general practitioners of today was the pharmacist of yesterday.
The question was, would the pharmacy technician of today be the pharmacist
of tomorrow?
Larkin in 1983 had published an account of four British occupations’ attempts
at professionalisation under medical domination. Critically, radiologists
had only become “free” to pursue activities for which they were trained
when radiographers evolved to become responsible for X-ray imaging. Could
the same be true of pharmacists? Could pharmacists become “free” to pursue
activities for which they were trained if pharmacy technicians were to
become more responsible for routine supply of medicines to patients?
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NHS policy and the implications for emerging professions
Dr KAREN ROSENBLOOM (senior lecturer, pharmacy academic unit, University
of Derby) reviewed what drove the pharmacy agenda, and posed four questions:
- Who decided what needed to be done?
- Who decided if the things being done were the right things?
- Who decided if the right things were being done by the right people?
- Who decided if the right people were doing the right things right?
Who decided what needed to be done was frequently the Government. Government
policies, such as “The new NHS: modern, dependable”, the NHS plan, and
“Pharmacy in the future - implementing the NHS plan”, outlined changes
for health care and pharmacy. Dr Rosenbloom wondered whether pharmacy
technicians were being represented fully to the Government in order in
influence government policy. For the first time, the role of the pharmacy
technician was being supported and encouraged in the report “Pharmacy
in the future - implementing the NHS plan”.
Regarding the question of who decided if the things being done were the
right things, Dr Rosenbloom said that, for pharmacy, practice was often
compared with statements on good practice which were published by the
Royal Pharmaceutical Society. These included practice guides on dispensing,
clinical pharmacy and pharmaceutical care.
A response to the question of who decided if the right people were doing
the right things right could often be made by comparing practice to the
requirements contained in legislation (Medicines Act 1968, Misuse of Drugs
Act 1971, etc) or Royal Pharmaceutical Society statements on good practice,
or using the new clinical governance framework in the NHS.
How could pharmacy technicians have more influence on the future? As well
as ensuring that they were well represented at Governmental level to influence
health policy they should also be represented at local level to health
commissioners who purchase health services. Information should be presented
to persuade the commissioners of health services that more services delivered
by pharmacy technicians would benefit the health of the local population.
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Professions in the current health service environment
A presentation by Dr GEOFFREY HARDING (senior lecturer, department of
general practice and primary care, Queen Mary College, London) concerned
the professions in the current health service environment and was subtitled
“From professionalisation to McDonaldisation”.
Dr Harding observed that before the NHS was formed there had been very
few professions working in health care. Following the foundation of the
NHS, there had been a proliferation of effective, organised professional
groups in health care, with clear demarcation lines and unequivocal roles
and responsibilities.
Until the 1970s, the health care professions had been considered to be
vocations characterised by commitment to a universal standard of service,
which was delivered in a neutral, non-profit making way. They made professional
judgments on behalf of patients without explanation. They were able to
foster a clinical mentality that was based on personal knowledge and experience
rather than published evidence.
Over the past 20 years, health care professionals had had more opportunities
to strengthen their positions, frequently following the introduction of
new technology and their ability to control patient access to this technology.
This had led to increasing claims of exclusive knowledge and arguments
concerning the risks of “deprofessionalisation” of tasks and functions.
Dr Harding recommended that aspiring professional groups in the 21st century
needed to capitalise on (i) social change and the changing role of service
users, (ii) political change and Government-led challenges to the traditional
order, and (iii) technological change with access to and control over
emergent technologies.
For the professions in the 21st century, traditional values would no longer
be enough. Users of health services were now “consumers”, and would no
longer accept an “I know what’s best for you” attitude from health professionals.
The old value system was being challenged: mystical professional judgment
was now replaced by rational evidence base. The passive patient was now
being replaced by the active consumer. Old mechanical technologies were
being replaced by new computer technologies.
Dr Harding observed that pharmacists appeared to be changing their role
and wished only to provide advice on medicines. Their relegation of technical
duties, in his opinion, was a high-risk strategy. He thought that, in
the future, privileged occupational status would belong to those controlling
the new technologies.
He went on to explain what he meant by “McDonaldisation” or “McPharmacy”
as descriptors of new ways of delivering health care which increasingly
were being favoured by the Government and general public.
The characteristics of the new “McProfessionals” who would be delivering
health care services in the future were high levels of technical competence,
the use of highly rational and supremely cost-effective methods, and standardisation
of services. Would pharmacy technicians be able to deliver these types
of services and expand their roles into areas being left by pharmacists,
Dr Harding asked.
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Issues, feedback, action
Following the presentations, participants divided into groups to discuss
some of the issues raised. The topics for discussion by these groups were:
professional autonomy, education and training for new and existing roles,
social closure of specific roles and responsibilities, beneficence, registration
and a code of conduct.
Feedback from the groups revealed that although the pharmacy technicians
in the audience wanted expanded and more autonomous roles, improved education
and training, a code of conduct and registration, they did not want social
closure or the exclusive rights to practise or control of these roles.
They continued to wish to work in partnership with and support pharmacists.
They did, however, want greater recognition of their value and role by
pharmacists, health care staff, patients, health purchasers and the Government.
As an action resulting from the meeting, Dr David Cousins (honorary secretary
of the European Foundation for the Advancement of Healthcare Practitioners)
announced that the foundation intended to award a professional development
grant. The grant would be to enable two senior pharmacy technicians to
develop a draft code of conduct for consideration at the next meeting
in May, 2001. Once this code of conduct had been discussed and finalised,
all that remained was for pharmacy technicians to determine the most appropriate
body to provide professional registration.
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