In recent years, it has not been standard for government proposals on health and care issues to be greeted enthusiastically.
All the more surprise, therefore, at how well the Department of Health And Social Care’s recent consultation on an expanded role for pharmacy technicians has landed on social media.
The consultation, which closes on 29 September 2023, proposes enabling registered pharmacy technicians to supply and administer medicines under a patient group direction.
This is, the consultation notes, in line with the objectives of all of the home nations’ NHS systems “to maximise the use of the skill mix in pharmacy teams, enabling them to meet more of the health needs of their local populations”.
The contrast of the broad welcome for this potential expanded role for pharmacy technicians with the growing furore in the UK medical professions about the introduction of ‘physician associate’ roles as a regulated profession is notable.
Across social media and in various online medical forums, debate about the clarity, safety and value of physician associate roles is live, lively and sharp.
On 27 September 2023, the Royal College of Surgeons, responding to pressure from members, issued a statement making it clear that their leadership are “aware of the concerns expressed by our colleagues regarding the current and planned expansion of non-medically qualified roles, which will inevitably affect the surgical team”.
“We share concerns about the activities that some members of the extended surgical team have anecdotally been allowed to undertake locally,” it adds.
The RCS statement goes on to emphasise that “implemented appropriately, the introduction of [such] roles … provides an opportunity to improve patient care and enhance the training surgical trainees receive”.
The Royal College of Physicians (RCP), tellingly, has created a ‘Faculty of Physician Associates’ (FPA), whose aims are to review and sets standards for:
- The education and training of physician associates;
- Accreditation of university programmes; and
- Physician associate national certification and recertification examinations.
The FPA also oversees and administers the Physician Associate Managed Voluntary Register, and is campaigning to achieve statutory registration of the not-yet-profession. Cheekily, by being part for the RCP, the FPA asserts that “members of the faculty are part of a professional membership body”.
Physician associate trainees usually need a bioscience-related first degree to get onto one of the training programmes available, although conversion courses are available for qualified nurses, allied health professionals and midwives. The physician associate role is supervised by a doctor: training usually lasts two years, with students studying for 46–48 weeks each year, and involves many aspects of an undergraduate or postgraduate medical degree.
Pharmacy technicians have a well-defined and well-understood role, explained by the Association of Pharmacy Technicians as “pharmacy professionals who play an integral part in helping patients to make the most of their medicines … [and] span all areas of pharmacy practice, from the purchasing, manufacture, preparation, supply and final check of medicines; to supporting medicines use reviews and the administration of medicines”.
Crucially, pharmacy technicians are a registered profession. This is not the case for physician associates: the role is ‘direct entry’ and currently they are not subject to any form of statutory regulation.
This seems to be at the heart of the different receptions being given to the two groups. Pharmacy technicians date back as a recognisable UK profession to the 1950s: following decades of campaigning, in July 2011 it became mandatory for them to be registered with the General Pharmaceutical Council to practise in England, Scotland and Wales.
Physician associates are a far more recent role in UK healthcare: the first physician associates were formally introduced in 2003. (The physician associate role was first developed in the United States in the 1960s.)
A longstanding, regulated profession (pharmacy technicians) seems to be far more acceptable to fellow regulated professionals than a direct-entry, unregulated non-profession does to medical professionals.
This probably isn’t surprising. Regulated professionals want those around them to be held to similar standards of accountability (as the debate over regulation for NHS managers in the wake of the Countess Of Chester paediatric serial killing has shown).
But there is another current, very notable difference between pharmaceutical and medical professionals. Medical professions are (mostly) still in the middle of an ongoing industrial dispute over pay with the government.
Relations between medical professions (particularly junior doctors, following the imposition of a new contract in 2016) and the government have been far from warm for years, but the intractability of the current pay dispute has meant that any new initiative that can be perceived as threatening medics’ autonomy, power and status will be perceived in that way.
Concerns over the safety consequences of significantly expanding physician associates are not invalid, particularly as they will require supervision from doctors who may already feel they are not able to give their current medical trainees the level of supervision they might want to.
Many medics also express concerns that this marks the ‘cheap-ification’ of the medical profession: they think this is about saving cost. Cynicism abounds.
While the pharmaceutical profession also remains underwhelmed by the lack of increased pay under the NHS/DHSC contract in recent times, it has not taken industrial action against the government in the same way. This is also, notably, a consultation rather than a fait accompli.
In the case of expanding pharmacy technicians’ roles, it’s thoroughly positive to see a workforce change being introduced thoughtfully. Let’s hope we’ll see much more of it.
Andy Cowper is the editor of Health Policy Insight.