Prescribing & Medicines Management
page PM4
March 2004

Features

New avenues for technicians to explore

Pharmacy technician Sandra Wild has never looked back since leaving hospital pharmacy for primary care nearly five years ago. “I would never go back to hospital. The role I have now is just so different and is a completely new way of life — the challenges are a lot different and I feel I have more autonomy,” she admitted. Sandra was one of the first technicians to be employed by a primary care trust (PCT) but today there are estimated to be around 160 of them working in PCTs with their own support group, Prescribing Advice and Support Technicians Association (PASTA). Their roles and responsibilities vary according to the confidence of the PCT in developing the post and its ability to recognise the value of their skills. Some PCTs use technicians to carry out audit — scanning patient records to ensure their medication is up to date — while others have given their technicians greater responsibility including becoming medicines management collaborative facilitators or developing an action plan for medicines management in the prison service.

This new career path for pharmacy technicians reflects the Government’s and the pharmacy profession’s commitment to improve skill mix in pharmacy. It is also a development which is essential if the profession is to meet the demands of “Pharmacy in the future”.

“I think the technicians we have in the PCT are invaluable. They can fulfill many of the roles that pharmacists do, in fact they can work in primary care in exactly the same way as they do in the hospital,” said pharmacist Vivienne Ben-David, head of medicines management at Rochdale PCT in Lancashire, and Heywood and Middleton PCT in Greater Manchester. She added: “They offer good support to both patients and pharmacists and, where they are more senior, they can lead in a particular project.” This can include medicines review where their recommendations have to be signed off by the pharmacist. But they also have a more subtle role to play in medicines management. She said: “They can be the face of medicines management in the practice — influencing prescribing by having a relationship with the practice.” GPs who have been working with the technicians do not see them as a threat, she said. “They are just seen as part of the pharmacy team. I think GPs, like any other health professional, realise their own limits and appreciate having people helping them.”

Mrs Wild, who is employed by Rochdale PCT, said she was not in the practice to perform a prescribing policing role although she admitted that at first some GPs were suspicious: “Practices were a bit wary at first. They thought we were there to check up on them. It took a while to get them on our side. We are there to bring help to the practice — to achieve cost effectiveness and get the best out of prescribing.”

It is this target which can bring the greatest job satisfaction and reflects the biggest difference when compared to working in a hospital pharmacy. Mrs Wild who is chairwoman of PASTA and one of its founder members added: “It can be a satisfying job in primary care because we are there to save money in one area and move it to another.”

Mrs Wild is answerable to the pharmacist in charge of medicines management but her views are taken on board if she can suggest improvements. She said: “I think because my pharmacist works part-time my role is probably greater than technicians in other PCTs.” Her responsibilities also include liaising with community pharmacists. She said: “We try and get community pharmacy involved whenever we can. We send them our newsletters and if there is anything that we are doing in the practices which will affect their stock we go and meet them. We try and fit any changes in around them and the length of time it will take them to get rid of their existing stock.” She also consults the community pharmacists when carrying out medicine reviews of patients in nursing homes. She added: “I do not think they feel we are treading on their toes — we get calls from them asking us for our advice.”

In Rochdale the responsibilities of the primary care technicians are well developed because it was one of the first to use them in this new way. Mrs Ben-David said: “Bury and Rochdale Health Authority, as it was then, had the foresight to employ technicians from the outset when primary care groups were established, but over the years more are taking technicians on board. You can get more pharmacy technicians to the pound than you can pharmacists.”

Project facilitator

Hartlepool in Cleveland is another of the growing number of PCTs which has the vision to see the potential of primary care technicians. For the last year Jayne Parkinson has worked as facilitator for its medicines management collaborative project which has a broad remit to optimise prescribing across the PCT and improve the prescribing experience and outcomes for each patient. She took on the new role after spending three years as a primary care technician in another PCT giving prescribing support to GP practices. That PCT had also drawn up a proposal for a medicines management collaborative and, although the bid was unsuccessful, it made Ms Parkinson realise she had the skills and the knowledge to become a project facilitator and she began applying when the posts become available. She said: “I think that some technicians would be intimidated at the thought of taking on this kind of role. I think as a technician working in practices or hospital it’s quite regimented and you are very much part of a team. In this job as a facilitator I have a blank page — I have targets to deliver but it is up to me how I achieve that and manage my own time. My knowledge as a technician is valuable because I understand about patient compliance and the importance of dosage labels informing patients about how often and how many tablets have to be taken. Having some knowledge about national clinical guidelines has also been an advantage.” Her previous experience working in hospital pharmacy and starting off in retail pharmacy has also given her a breadth of knowledge. She said: “A major aim of the project is to look at medicines management from different environments, and to use community pharmacy skills. Because I come from a pharmacy background in retail and hospital I understand what the limits and the boundaries are in those sectors.”

Ms Parkinson’s decision to become a project facilitator is not unique, according to Richard Seal director of the national medicines management collaborative at the National Prescribing Centre.

He said: “We do have some project facilitators who have a pharmacy technician background but I am also aware of pharmacy technicians working directly with PCTs or GP practices outside of the medicines management programme and, where they are working, they are doing a good job.” Technicians are involved in checking patient computer records to make sure they are up to date and reflect the medicines that the patient is currently taking. They are also involved in searching for types of drugs or groups of patients as part of practice or PCT general medicines management, he said. Others are carrying out the preparatory work for medicines review on behalf of nurses or doctors.

The development of pharmacy technicians in primary care is vital if pharmacists and technicians want to increase their own professional roles and responsibilities which have been outlined in “Pharmacy in the Future” and more recently “A Vision for Pharmacy in the New NHS”. Although not all technicians have the ambition to develop this new career path it is clear that those who are marching with their feet are making it a success. They are determined to show what can be achieved if you have the courage to take on new challenges and the support and vision of others within the pharmacy team. Jayne Parkinson had this advice: “There may be some technicians who don’t think they are capable of doing what I and others have done. But they can — it’s all about having the courage to do something new and the faith in their own skills.”