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Making skill mix a reality: the advancing role of pharmacy technicians

With pharmacy technicians’ responsibilities in the pharmacy team growing fast, debate around the additional training they need is resurging.

Pharmacy technicians have not had an easy path to recognition for their contributions in pharmacy settings.

A survey of 236 pharmacy technicians carried out by The Pharmaceutical Journal in 2018 revealed that pharmacy technicians felt they were taking on extra work without being properly resourced, with half of respondents considering leaving the profession as a result. Then, during the COVID-19 pandemic, pharmacy technicians felt they were not able to be fully utilised to support delivery of essential frontline pharmacy services.

Yet, expanding the roles of pharmacy technicians has long attracted criticism.

Nearly a decade ago, in April 2015, the Pharmacists’ Defence Association (PDA) said it had patient safety concerns about allowing pharmacy technicians to make the final accuracy check on dispensed items, hand out dispensed prescriptions and sell pharmacy medicines when the pharmacist is away from the pharmacy.

These concerns were echoed more recently in a letter to pharmacy minister Andrea Leadsom in March 2024, in which the PDA argued that the recent increase in clinical roles for pharmacy technicians (see Timeline) was “potentially dangerous” for patients.

“The ambition of senior NHS pharmacy and Department of Health and Social Care leaders that pharmacy technicians should enjoy ‘parity of esteem’ with pharmacists and that pharmacy technicians should be enabled to step into clinical roles, is not only unrealistic, but it is potentially dangerous as they simply lack the underpinning educational context,” the letter from Mark Koziol, chair of the PDA, said.

But with pharmacy technicians poised to take on more responsibility in the coming months, both pharmacists and pharmacy technicians are grappling with the specifics around the training they might need.

Pharmacy technician education

Currently, it takes two years to qualify as a pharmacy technician. Preregistration training for the role combines practical work with study, either through distance learning or a college-based course. The underpinning curricula includes chemistry, microbiology, physiology, dispensing and accuracy checking. During the two years, trainees complete work-based experience under the direction of a pharmacist or pharmacy technician for at least 14 hours per week. 

The General Pharmaceutical Council (GPhC) accredits pharmacy technician courses and qualifications that meet its initial education and training standards for pharmacy technicians. These were updated in 2017 to reflect how some elements of the pharmacy technician role, which were once seen as advanced practice, had become a vital part of the role.

Once training is completed, a pharmacy technician is able to join the GPhC’s register, which lists just over 26,000 pharmacy technicians, as of April 2024.

Training for patient group directions

In response to government proposals to add pharmacy technicians to a list of healthcare professionals that are able to administer and supply medicines under patient group directions (PGDs), the Company Chemists’ Association (CCA) says their current level of training provides “a minimum standard for knowledge and skills needed for pharmacy technicians to supply and administer medicines safely under a PGD”.

Some 62% of respondents to the government’s consultation, which ran between August and September 2023, agreed that the two-year training adequately equips pharmacy technicians to use PGDs, highlighting the potential to expand and capitalise on pharmacy technicians’ existing skillset, allowing pharmacists to focus on more clinically complex tasks.

In a position statement on the changes, Nicola Stockmann, president of the Association of Pharmacy Technicians UK, welcomed the government’s decision to progress with the proposals as “a landmark moment for patient care”, which will “ensure pharmacy technicians are able to safely expand access to pharmacy services in a pressured healthcare landscape”.

However, speaking to The Pharmaceutical Journal, Stockmann adds that a workforce review must consider the workload generated by this expansion in pharmacy technicians’ responsibilities, as well as the opportunities available.

To take on extended roles for one profession without a review of skill mix and roles will increase the workload, reduce capacity and increase pressure

Nicola Stockmann, president of the Association of Pharmacy Technicians UK

With pharmacists able to prescribe from the point of registration in 2026, “it is essential that a workforce skill mix review to ensure the right person in the right role with the right skill set is delivering a quality and efficient service,” she says.

“To take on extended roles for one profession without a review of skill mix and roles will increase the workload, reduce capacity and increase pressure.”

Implemented effectively, enabling pharmacy technicians to supply medicines using PGDs will benefit the wider team and patients, says Claire Anderson, president of the Royal Pharmaceutical Society (RPS), by “increasing capacity for pharmacy teams and creating greater consistency of services provided within pharmacy”.

However, in its response to the consultation, the RPS said that it did not believe the current training for pharmacy technicians was sufficient to allow them to work under PGDs.

“If this amendment is adopted, training needs to be adapted to reflect the legislation change and ensure [pharmacy] technicians are provided with an appropriate knowledge base of PGDs and the governance and accountability that lies with them, in line with training delivered to pharmacists when [they] originally commenced involvement with PGDs,” the RPS said.

Just as pharmacists have to demonstrate their competence to work under PGDs and undergo specific training, so will pharmacy technicians, says Anderson.

“Patient safety is always a priority and, naturally, with an evolving role, any healthcare professional must understand the levels of accountability when delivering a specific service,” she says.

“For example, in primary care, [pharmacy] technicians funded through the ARRS [Additional Roles Reimbursement Scheme] are operating in many primary care networks and GP practices, and have had to undertake specific training to enable them to work. This training has been role specific, and we would expect any new roles for pharmacy technicians would need similar pathways.”

Patient safety concerns

Speaking at a House of Commons Health and Social Care Select Committee hearing in March 2024, held as part of its inquiry into the provision of pharmacy services, Leadsom defended the government’s decision to expand pharmacy technician roles.

“Patient safety is absolutely paramount,” she said, adding that there was “no intention” to enable pharmacy technicians to “start practising above their training”.

“The idea is to improve patient access and patient convenience, while retaining patient safety and therefore to make the maximum use of the training levels of different professional people,” she said.

Leadsom had been responding to committee member Paulette Hamilton, Labour MP for Birmingham Erdington, who said that concerns about “the extent to which pharmacy technicians are being pushed into the frontline of pharmacy clinical practice” were “buzzing”.

“The clinical responsibility being given to [pharmacy] technicians was previously undertaken by pharmacists, who have the underpinning degree that [pharmacy] technicians, no matter how you upgrade them and send them on courses, do not have,” she said.

While expanding pharmacy technician roles has merits, proponents lack clarity on aspects like compensation levels and timelines to ensure appropriate professional development pathways

Jay Badenhorst, director of pharmacy at the Pharmacists’ Defence Association

Concerns largely followed proposals, published by the government in December 2023, that would enable pharmacists to authorise pharmacy technicians to carry out “the preparation, assembly, dispensing, sale and supply of medicines”.

The government has yet to publish an outcome of the consultation, but said in its initial consultation document that the proposals were designed to “enable pharmacy technicians to maximise the contribution they make within multi-professional teams, through more effective use of their skills and expertise in pharmaceutical care” while also allowing “pharmacists to spend less time on tasks that can be safely delegated”.

However, the PDA objected in particular to a proposal within the consultation allowing pharmacy technicians to supervise the preparation, assembly and dispensing of medicines in hospital aseptic facilities, warning that this would increase the “risk of catastrophic clinical error”.

Jay Badenhorst, director pharmacy at the PDA, says it is calling for an “evidence-based approach” to the future development of pharmacist and pharmacy technician practice.

“While expanding pharmacy technician roles has merits, proponents lack clarity on aspects like compensation levels and timelines to ensure appropriate professional development pathways. For example, a clear plan on how to develop the capacity and capability of the pharmacy technician workforce in the community pharmacy sector, and details of additional funding to deliver this given rising costs, is currently absent,” he says.

Potential for pharmacy technicians

In order to develop the funding and support for growing the pharmacy technician workforce, Liz Fidler, senior adviser on pharmacy technicians at NHS England, says a workforce strategy for the profession is needed — and NHS England is working on developing one.

“It is a hugely exciting time for us to be … thinking about what we need to build and one of the most important things to enable us to do that is to have a very clear pharmacy technician workforce strategy that sits under the long-term workforce plan,” she said during a session at the Clinical Pharmacy Congress on NHS England’s pharmacy technician workforce, training and education strategy in May 2024.

Fidler added that this will enable the profession to receive recognition, funding, and support “across all sectors, so we can really grow a pharmacy technician workforce to enable us to provide effective quality services for our patients”.

Phoebe Davies, pharmacy technician workforce, training and education programme lead at NHS England for the south west region, said that “over the next couple of years”, the workforce strategy is looking to create “a more consistent post registration training offer to support [pharmacy technicians’] development across all sectors of pharmacy”, focusing on the changes in legislation around PGDs and the potential changes in legislation for supervision.

This would complement the 840-place ‘Community pharmacy technician: advancing your role programme’, delivered by the Centre for Pharmacy Postgraduate Education, which includes learning modules on consultation skills, therapeutics, clinical decision making and assessment skills.

NHS England is also preparing the workforce strategy to manage an increase in demand for pharmacy technicians from the community pharmacy sector, Davies says, adding that NHS England is therefore looking to identify “appropriate, sufficient and sustainable funding models available to employers to support the growth of the pharmacy technician workforce”.

“All funding models will support the growth of the pharmacy technician workforce across all sectors of pharmacy, but there will be a specific focus on the community pharmacy workforce,” she says.

As Fidler describes, both the updated PGD legislation and proposals around pharmacy supervision are “a key enabler” and a “great opportunity” to grow the pharmacy technician workforce, particularly on the way to 2026, when all newly registered pharmacists will be independent prescribers.

Training and supporting the pharmacy technician workforce will be imperative to seize “an opportunity during the next two years to grow our pharmacy technician workforce … to support pharmacists to deliver independent prescribing and grow [pharmacy] technicians as a profession”.

Last updated
The Pharmaceutical Journal, PJ, May 2024, Vol 312, No 7985;312(7985)::DOI:10.1211/PJ.2024.1.316977

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