The Pharmaceutical Journal Vol 267 No 7172 p642
3 November 2001

This article
Reprint
Photocopy

Comment

Pharmacy technician development — frustrations and opportunities

By Prashant Sanghani and Darren Leech

A significant area of activity in hospital pharmacy over recent years has been the development of pharmacy technicians. Not only have technicians gradually become more involved in the management of distribution, production and dispensaries, there is also increasing interest in areas previously occupied by pharmacists. The pressures and drivers that have lead to such changes and the need to reappraise pharmacy staff and their various roles are well known and include: pharmacist vacancies; a poorly planned fallow-year; the need to set standards, define competency and measure performance; the need to defend activities in the face of clinical governance; NVQ-based training and its emphasis on competence and evidence; and the demands of continuing professional development for all staff.

Analysis of these drivers for change has led to a review of skill mix and attempts to ensure efficient use of all pharmacy staff. The necessity to demonstrate performance and outcome is paramount and so far this has most often been applied to technical functions. For example, we have seen the development of various "accredited" checking schemes and their application to dispensing activities. Many technicians have completed such "accreditation" processes and as a result they have undertaken a greater range of activities. Although lines of responsibility and accountability are usually clear and well defined in hospitals, especially where technicians are undertaking new activities, this increase in the level of responsibility and related accountability has still to be tested in a legal context. Similar uncertainty is illustrated by a comparable definition of a pharmacy technician in the United States. According to the American Society of Health-System Pharmacists, pharmacy technicians "assist licensed pharmacists by performing duties that do not require the professional skills and judgement of a licensed pharmacist and assisting in those duties that require the expertise of a pharmacist".

Until the position of responsibility and judgement is made more flexible, perhaps through registration and regulation of pharmacy technicians, technician development may simply provide a vehicle for frustrated individuals to maintain a steeper learning curve in their ongoing search to fulfil a desire to learn. Anecdotally, there are many technicians who appear keen on developing an "accredited" status in a long list of activities. First, there is local checking accreditation, then regional accreditation followed by patient counselling courses, NVQ assessor's courses, medicines management at ward level and, increasingly, there is interest in a role for clinical pharmacy technicians.

Research has shown that when it comes to extending their roles, a significant number of technicians are motivated almost entirely by financial gain or increased prospects for career progression. Improving services for patients is not a significant motivating factor. However, we suspect that for many technicians engaging in the activities listed above, the learning and personal development achieved in attaining the requisite new knowledge, skills and the application of such, is the most attractive and motivating part of the whole process. How many technicians have completed such courses only to find they are confronted with a new, and yet still clearly defined technical function? This so-called tick-box activity is not surprisingly discovered in any technical job and simply illustrates the meaning of the word "technical".

A concern is that a number of technicians with high personal development and career aspirations may well be seeking to provide more than a technical function. When these "accreditation" schemes are completed and technicians find that their newer activities are still well defined tick-box functions, they will once again become dissatisfied with their role. This feeling will lead to frustration and the process of seeking the next development stage will begin all over again.

It is possible that many of the leading individuals see clinical pharmacy technician posts as a true opportunity to perform not just merely technical functions, but to practise what is desired so strongly — a chance to use their judgement. It is here that perhaps their greatest disappointment may lie. Since pharmacy departments have had to learn to define the processes of distribution, dispensing, checking dispensed medicines, patient counselling, drug history taking, patient's own drugs reviews, patient pack dispensing and transcribing orders, so too will they need to define the process for the clinical screening of patients and prescriptions. This will have to be done not just to allow clinical pharmacy technicians on wards to function effectively, but also appropriately, as these procedures will undoubtedly need to define points of referral to a pharmacist for clinical judgement or further referral. Additionally the application of electronic prescribing will herald significant redundancy in this area. Thus the Holy Grail of our most ambitious technicians will remain stubbornly out of their reach.

If registration and regulation does not occur in the near future, what is to become of our most capable and ambitious pharmacy technicians? We can identify at least two possible career paths. The first, traditional route is to consider undertaking the MPharm degree and become a pharmacist. For some, this path may be the quickest method for attaining the required status to exercise judgement. The second path is to focus on areas of pharmacy where non-clinical responsibility and judgement are essential. Two such areas are in management and in education and training. Both of these domains will always be difficult, if not impossible, to define in terms of tick-box procedures. The necessity of working with people in both of these areas will always require a need for decision-making and sound judgement. It is here perhaps that these pharmacy technicians may get the job satisfaction they crave from essentially non-technical activity.

There are of course wider implications here and many pharmacy managers are no doubt starting to consider the issues. Are capable managers who happen to be pharmacy technicians a threat to pharmacists in senior management positions? If we do not give technicians the opportunity to develop their careers beyond the traditional boundaries, will this ultimately lead to an exodus of quality staff from hospital pharmacy and perhaps from the NHS? To what degree can we define traditionally professional activities, ie, those requiring judgement, in technical terms? In the attempt to meet clinical governance demands and demonstrate outcomes, how long before the use of technicians is seen as a better use of resources and, just as importantly, will pharmacists start viewing their jobs as technical and start seeking jobs that allow them to exercise judgement? And perhaps most importantly, what will these jobs entail other than management and education and training?

Frustrations and opportunities do not apply only to pharmacists.

Prashant Sanghani is senior directorate pharmacist at Barts and The London NHS Trust and Darren Leech is associate director of pharmacy at King's College Hospital NHS Trust, London