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Government 'back to square one' on technicians supervising supply

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Programme board chair Ken Jarrold: We will carefully consider range of views on supervision

The government board behind controversial pharmacy supervision proposals has “gone back to square one” following backlash from pharmacists, a contractor has claimed.

C+D exclusively revealed in September that detailed proposals for pharmacy technicians to be handed legal responsibility for supervising the supply of prescription-only medicines (POMs) had been submitted to a Department of Health and Social Care (DH) programme board.

A working group, established by the UK’s four chief pharmaceutical officers, also suggested amending legislation to allow a pharmacy technician to, in the pharmacist’s absence, undertake the “supervision role” of determining when medicine supplies can go ahead and “overseeing the activities of other, non-regulated, pharmacy staff”, according to confidential documents seen by C+D.

This highly-emotive subject prompted hundreds of comments from readers on the C+D website in September, and an eventual response from the DH, which stressed that it "will consult...a range of pharmacy stakeholders, including patients and the public" before amending current legislation on pharmacy supervision (see more of the sector reaction here).

“Back to square one”

According to Dorset contractor Mike Hewitson, Ken Jarrold, the chair of the programme board, told a meeting in London last week (February 22) that while suggestions to change pharmacy supervision legislation had been “on the table”, the board had “now gone back to square one”.

While Mr Jarrold chose not to comment on Mr Hewitson's version of events, Pharmacists’ Defence Association (PDA) national officer Paul Day – who also attended the meeting – confirmed to C+D that pharmacy supervision suggestions “didn’t get the support from the whole board”, and the DH “will be rethinking the whole approach”.

Mr Hewitson – who is a National Pharmacy Association (NPA) and Pharmaceutical Services Negotiating Committee board member – told C+D: “We all welcome the fact that [the programme board] has abandoned the previously unworkable proposals. It is a victory for the grassroots voices that came out so strongly against what the board was proposing.”

The meeting Mr Hewitson and the PDA attended was a gathering of a 'partners forum', set up alongside the DH’s programme board in 2013 to allow wider pharmacy stakeholders to “contribute” to the board’s work on “rebalancing” medicines legislation and pharmacy regulation.

In slides from the meeting, published on the programme board’s website on Friday (February 23), the board highlighted that “there are currently no firm proposals on changes to legislation regarding [pharmacy] supervision”.

Mr Jarrold told C+D afterwards that the latest meeting “provided the board with a range of views on the topic of supervision that we will carefully consider as we continue to engage with our partners”.

“Real progress is being made in implementing the board’s proposals – from the approval of new legislation for inadvertent dispensing orders in registered pharmacies to clarifying the roles of superintendent pharmacists and responsible pharmacists,” he added.

PDA: “Unacceptable” delay for stakeholder engagement

The PDA sent three representatives to the meeting – the first in “969 days”, it claimed – and repeated its call for both the PDA and the NPA to be represented on the programme board, Mr Day told C+D.

The “current frequency of partners forum meetings equates to three short meetings per decade, which is unacceptable”, he stressed.

“The PDA is certainly watching what the board does and says,” and will be holding the board to its statement that “nobody wants to reduce safeguards or reduce the distance between patient and pharmacist”, Mr Day added.

Well: Shaping the role of the responsible pharmacist

Also in attendance at the meeting was Lisa McCreesh, professional and regulatory standards manager at Well, who hopes to use the information discussed “to shape [Well’s] future thinking on the role of the superintendent and responsible pharmacist”, she told C+D.

“We want to make sure that any changes act as an enabler to pharmacists playing a wider part in the primary healthcare system,” she added.

Where does the sector stand on technicians supervising pharmacies?

In November, C+D gathered leading industry figures for a heated discussion on the pharmacy supervision proposals. You can listen to the full debate in the podcast below, or click here to find out C+D's highlights from the event.

14 Comments
Question: 
Where do you stand on pharmacy technicians supervising supply?

Gerry Diamond, Primary care pharmacist

The benefits of empowering reg techs to supply POMs and sell P meds will far outweigh the negatives.I think pharmacist should give it their full support, RP issues can be reviewed and updated easily to dispel any problems.

John Smith, Locum pharmacist

What are the positives exactly? An increase in this undefined phrase of skill mix? Pharmacists having more time to perform services that do not exist?

Isn't POM supervision too high risk a process to delegate to people who are neither experienced or qualified for it? I mean, we are literally talking lives here. Do you suggest that supervison is just blindly handed to the unqualified regardless of possible consequences? One can only hold this position if they consider the supply of POMs a mindless, un professional task. It is far from it. It is incredibly demanding and risky. Thats why it requires professional qualification.

 

 

Locum Pharmacist, Locum pharmacist

One positive includes technicians selling potentially harmful OTC medicines to patients because of their lack of understanding of other P/POM medication the patient may be taking. Same goes for clinically checking POMs. Another is the absence of a pharmacist to whom the patient can direct any questions regarding their health/medication. Perhaps they should just make an appointment to see their GP?

I am truly astounded by suggestions that taking the pharmacist out of the pharmacy and delegating clinical duties will in some way benefit patients. Community pharmacists are a vital resource for patients and it is worrying when pharmacists themselves feel otherwise. Especially at a time when we should be arguing for employing more pharmacists in busy pharmacies to provide a better service to patients.

Gerry Diamond, Primary care pharmacist

I thought supplying medicines and checking cartons match a sticky label as mind blowingly boring, relentless and down right drudgery. It is a task easily and equally and sometimes better performed by competent reg techs. Thanks

A B, Community pharmacist

I think you might be missing the point. ACTs can already do these tasks and do them well from my experience.

The debate here is whether a pharmacy can continue giving out POMs and P medication without a pharmacist being present i.e. supervising and taking responisbility. The fact that technicians can accuracy check medication is not being questioned.

These proposals seem to be trying to fix a problem that isn't really there. The real issue is probably where lots of pharmacies don't have ACTs or have them but don't utilise them sufficiently.

A B, Community pharmacist

The whole policy of technician supervision is a non-starter unless RP regulations are altered. With ultimate responsibility for the day-to-day pharmacy activity being on the RP's shoulders, then I can't see how anyone else can supervise POM or P supply.

I'm open to change and forward thinking and I've worked well with ACTs. But I'm not going to take responsibility for medication going out when I'm not present unless rules are changed to protect me.

Seal Patel, Community pharmacist

Thats unfortunate, I was convinced it was the right step foward 

Gerry Diamond, Primary care pharmacist

I think that is very encouraging that serious consideration is given to reg tech having authority to supply PoMs and P med sales in order to free up the pharmacist. It will improve access to medicines, as pharmacist have new skills such as IP, vaccination, meds review and others which they can get on with. Great idea!!!

Valentine Trodd, Community pharmacist

Good one, Gerry! And everyone thinking you were serious...

 

Ilove Pharmacy, Non Pharmacist Branch Manager

You must have quite a sense of  humour. Who is going to pay for these 'services' Gerry? Stop falling for the con-trick espoused by the government and the likes of Boots who are simply aiming for sky high profits. 

Gerry Diamond, Primary care pharmacist

Come on now, it's got to be the way ahead,surely. We need to give it a chance!

Ilove Pharmacy, Non Pharmacist Branch Manager

I agree with most of your posts on here. But the con trick of 'services' is I feel purely to further rid the system of pharmacists as there are simply not enough of these 'services' for the ever growing army of low paid pharmacists. It would result thousands of redundancies for pharmacists which of course the multiples like Boots would embrace.

Ps. The editor remains silent on the dangerous dispensing error at Basingstoke Boots......

Ben Merriman, Community pharmacist

But that's not what would happen in practice.  We've had a move towards services for over 12 years now.  How much of a pharmacy's income from them?  Maybe 10%?  15% at a big old push.  All that would happen is that the pharmacist would be removed from the whole picture, patients would lose their Masters trained healthcare professional (who also happens to be the most accessible healthcare professional available and an expert in medicines to boot). 

As I keep saying, I'm 100% absolutely in favour of being freed up to provide whichever clinical services my patients or the NHS need me to do but as things are, that won't be the case if supervision was to be changed as proposed (in secret, of course!).  With costs being cut due to completely wreckless reductions to the CPCF, pharmacies that don't need a pharmacist on site simply won't have one.

Mike Hewitson, Superintendent Pharmacist

I still don't understand the problem the Government is trying to fix here. Supervision isn't the day to day barrier that people who have not practicsed in a pharmacy for 20 years+ say it is. We can use skill mix today to free up the pharmacist's time, but the current NVQ3 for example is overkill for most community pharmacies, it takes too long to train someone to ACT standard c 2.5-3.5 years depending on your student if you have to train first to tech than checker. This is almost as long as a pharmacist. Use accuracy checkers (non-NVQ3 RTs), and give pharmacy teams the flexibility to say who they feel is competent to complete these sorts of tasks. 

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