The Pharmaceutical Journal
Vol 269 No 7223 p672
9 November 2002

This article
Reprint
Photocopy

PDF 75K

Costs and benefits come as pharmacy technicians train for extended roles

Pharmacy technicians in community and hospital pharmacy will need extra training to take on all the extended roles proposed for them. This will bring costs in terms of time and money but benefits can also be expected. Jonathan Buisson (on the staff of The Journal) investigates

Delegation of work by pharmacists to trained support staff, in order that both groups can carry out extended roles, is the key tenet of the Department of Health's recent report, "Pharmacy workforce in the new NHS: making the best use of staff to deliver the NHS pharmacy programme" (PJ, 5 October, p469).

"This would enable pharmacists to deliver extended services such as medicines management, prescribing, medication review or new services that might develop under local pharmaceutical services schemes, while at the same time developing more patient-centred roles for dispensary staff," the report says [Para 38].

But the Department also acknowledges that there will be "both training and administrative costs for pharmacy employers" [Para 43]. It suggests these will be offset by allowing pharmacists to run services for primary care trusts and general practitioners.

The obvious upfront costs are for course fees and time spent by technicians away from the dispensary, either training or completing a portfolio of evidence. These are followed by less obvious costs such as increased salary expectations, the need to rewrite standard operating procedures to take account of new ways of working and arranging appropriate indemnity insurance to cover this.

In hospital pharmacy, training courses for accredited checking technicians (ACTs) and for services such as medicines management have been established. Howard Rowe, chief pharmacist at the Royal Glamorgan Hospital, Llantrisant, explains that for ACTs in Wales there is a two-day group session on the theoretical, legal and ethical background to prescription checking. After this, the technicians build a portfolio of evidence from their work covering a number of modules. The coursework is assessed by the Welsh Centre for Postgraduate Pharmaceutical Education and there is a test pack of prescriptions with known errors to be completed. Mr Rowe says that the costs of the scheme, which are met from central funding, are modest. In terms of salaries, he says that there is no consistency between trusts in Wales with some giving accredited technicians additional discretionary points on their salary scales.

In community pharmacy, there are some courses for ACTs but no agreed national standard. Lesley Johnson, head of education and training at the National Pharmaceutical Association, has been leading a working group within community pharmacy which has been developing standards which could be used by course providers and pharmacy employers. Frameworks for courses for community and hospital pharmacy technicians are currently being considered by the Royal Pharmaceutical Society and are expected to be discussed by the Council in the near future.

In addition, the NPA is developing what it calls a toolkit. This will allow its members to assess whether they have the right environment for using a checking technician and staff with the right capabilities.

"Checking technicians are not suitable for all community pharmacies," Mrs Johnson says. "For a start, there needs to be a permanent pharmacist and at least two members of dispensary staff. The check is an accuracy check and each prescription needs to be assessed by a pharmacist as well. There must be confidence and trust between the pharmacist and the checking technician or it will not work."

The NPA's toolkit is likely to be available next year, depending on the approval of the frameworks by the Society and decisions on whether technicians' work is assessed externally or by employers.

Technicians in place

Several community pharmacy companies already employ checking technicians. These have either been trained through local hospital schemes or have completed one of the college-based courses available.

Dr Wendy Jones developed a checking technician scheme as part of a master of science degree gained through Portsmouth University. "I audited my work as a pharmacist in the dispensary before and after I had trained the technician. I found that I now spend 50 per cent less time physically involved in dispensing and I have doubled the time I spend counselling patients. I find it really satisfying because I can now spend 15 to 20 minutes talking to a patient, rather than one or two minutes. The technician also gets satisfaction from her new role."

Dr Jones says that to work properly the training has to be rigorous and standard operating procedures have to be developed. "It has made everyone more aware of their own accuracies and our error rate has gone down dramatically."

Liz Stafford, professional services and development manager at PCT Healthcare (formerly Peak Pharmacy and Tims & Parker), has been studying how a checking technician can be used because the company has a member of staff nearing the end of the Preston College course.

"We think that in a high-volume dispensary, acting under protocols, a checking technician could check a proportion of the items freeing perhaps half-an-hour to an hour for the pharmacist in a day. This could be used for continuing professional development, staff training, or for preregistration tutors to spend time with trainees."

She notes that the technician in question has been acting as a relief technician and trainer at a number of branches and thus has good working relationships there.

Tariq Muhammad, managing director of Pharmacy Plus, an independent chain in south-west England, is positive about his company's experience with checking technicians and suggests that others should follow suit: "If you have a competent technician with formal qualifications then it is worth exploring checking technician courses with local hospitals. It should not cost more than a few hundred pounds and could be well worth it." Pharmacy Plus has used the technician to allow a pharmacist to make visits to nursing homes.

Lloydspharmacy has also examined the use of ACTs, putting three technicians through the Welsh course. Director of pharmacy Andy Murdock says the trial was positive. He sees a role for checking technicians but notes that there will be costs attached: "We will be pressing through the Pharmaceutical Services Negotiating Committee for appropriate funding."

Pharmacy technicians are expanding their roles and checking technicians are no longer confined to hospitals. Much has still to be defined with regard to their exact work, and on the split of accountability and responsibility with pharmacists, but this role is one that clearly will continue to grow.