The vision for supervision

As 2023 draws to a close, our health policy columnist says pharmacy could be the solution to alleviating workforce issues that continue to plague the NHS.

Unsurprisingly, workforce issues have been towards the forefront for the NHS and the overall system in 2023.

Industrial action among medical professions focused on pay and conditions. The government’s workforce recruitment targets for nurses was hit early, largely by immigration, including recruitment from ‘red list’ countries with nurse shortages.

And there is a big and heated debate underway in the medical professions about the role of substitute roles — particularly those of anaesthesia, nursing and physician associates. Published in the BMJ in November 2023, Partha Kar, consultant in diabetes and endocrinology at Portsmouth Hospitals NHS Trust, provides a level-headed summary.

It is interesting to reflect on why the pharmacy sector does not seem to have had the same problem over the complementary roles of pharmacy technicians in the same way. I looked at this issue in my September column and I haven’t had too much pushback on my hypothesis that the difference has been about the registration and regulation of pharmacy technicians giving pharmacists general confidence that this is not about substitution, but additionality.

It may have helped that pharmacy technicians date back as a recognisable UK profession to the 1950s. Following decades of campaigning, it became mandatory in July 2011 for them to be registered with the General Pharmaceutical Council to practise in England, Scotland and Wales.

In 2013, the Centre for Workforce Intelligence forecast an oversupply of between 11,000 and 19,000 pharmacists by 2040

That introduction of formal pharmacy technician regulation took place during a period when the perception was that the supply of pharmacists in training was plentiful. In the mid-2010s, it was thought that the pharmacy training supply pipeline was going to be in considerable surplus. One driver for this was new university pharmacy courses coming on stream. New schools of pharmacy opened at the University of Lincoln in 2014, the University of Sussex in 2016 (since closed) and Swansea University in 2021.

In 2013, the Centre for Workforce Intelligence, looking at pharmacy student intakes, forecast an oversupply of between 11,000 and 19,000 pharmacists by 2040.

All of this may have made the notion of a deliberate replacement of pharmacists by lower-qualified colleagues (currently very prevalent in the debate over anaesthesia, nursing and physician associates) seem like an improbable threat.

The case for additional workforce capacity, enabling clinical and medical professionals to work at the top of their licence and delegate appropriate tasks, remains a solid one. As The Pharmaceutical Journal reported earlier in December, the Department For Health And Social Care (DHSC) launched an open consultation on allowing pharmacists to supervise pharmacy technicians under more formal delegation arrangements.

The DHSC consultation proposes that pharmacists could authorise any member of the pharmacy team to “hand out checked and bagged prescriptions in the absence of a pharmacist”, and “allow pharmacy technicians to take primary responsibility for the preparation, assembly and dispensing of medicinal products in hospital aseptic facilities”.

The document estimates that the changes could provide efficiencies of more than £380m for community pharmacies over the next ten years. However, it is not clear whether these would be cashable savings available to pharmacies who maximise these opportunities, or pretexts for future funding reductions. The economic case that is being implied here deserves further attention.

The DHSC document says: “Our proposals will enable pharmacists to authorise (without directly supervising) registered pharmacy technicians to perform tasks that would otherwise need to be performed by or under the supervision of pharmacists … proposals are designed to allow pharmacists to spend less time on tasks that can be safely delegated to pharmacy technicians, who are registered and regulated health professionals in Great Britain — capable of working more autonomously, referring to a pharmacist only where necessary.”

Perhaps demonstrating their learning from the mishandling of the clinical and medical associate roles, and their learning from previous discussions on changing supervision legislation, the consultation stresses that “these proposals are not a move towards allowing pharmacists to remotely supervise a community pharmacy”. 

“Physical presence of the responsible pharmacist in a retail pharmacy as the default is enshrined in primary legislation that is not being changed as part of this reform,” it adds.

This is an important guarantee. For the public to develop greater faith that relatively minor health issues can be addressed efficiently and promptly by seeing a pharmacist first, then community pharmacies will need to have a pharmacist physically there who can be seen. 

The fall in ease of access to general practice, despite the sector’s increase in appointments provided even with a declining workforce, has left pharmacists with a great opportunity: this is not to become pretend-GPs (doubtless very few would even contemplate taking on that level of risk), but to offer a meaningful local alternative point of access.

As community pharmacists find ways to work with their GP, ambulance and urgent care colleagues to develop pathways for those who come with more serious pathology, it will be of great use. The numbers who have returned to seek NHS elective treatment, although huge at 7.7 million, significantly lag the predictions of ‘peak waiting list’ of around 12 to 13 million. This (alongside the difficulties with GP access) tells us that there is significant unmet health need out there.

Andy Cowper is the editor of Health Policy Insight

Last updated
The Pharmaceutical Journal, PJ, December 2023, Vol 311, No 7980;311(7980)::DOI:10.1211/PJ.2023.1.205379

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