Technicians could oversee POM supply under ‘sensitive’ proposals to DH

Exclusive
The proposals have been “accepted in principle” by a Department of Health programme board
The proposals have been “accepted in principle” by a Department of Health programme board

Detailed proposals for pharmacy technicians to supervise prescription-only medicine supply have been produced for the Department of Health (DH), C+D can exclusively reveal.

A working group established by the UK’s four chief pharmaceutical officers has suggested amending current legislation to allow a “registered pharmacy professional” – such as a pharmacy technician – to “take responsibility for” the sale and supply of pharmacy (P) and prescription-only medicines (POM), according to confidential documents seen by C+D.

The working group – co-chaired by chief pharmaceutical officer for England Keith Ridge and his Scottish equivalent Rose Marie Parr – has laid out several proposals (see below) to enable pharmacy technicians to supervise medicines preparation and supply.

The proposals have been “accepted in principle” by the DH programme board responsible for “rebalancing” pharmacy legislation, according to the documents, which are marked “sensitive” and “not for wider circulation”.

Contractors' fears confirmed

The group’s proposals lend credence to concerns – raised by contractors in a letter to Royal Pharmaceutical Society assembly candidates last month – that the programme board plans to “empower pharmacy technicians to supervise pharmacies”.

In the documents, the working group said the changes to supervision legislation are designed to “optimise” the “skill mix” in pharmacies and maximise the use “of the whole pharmacy workforce, especially pharmacy technicians”.

This means “ensuring that pharmacy professionals are available in the right place at the right time – not necessarily in a pharmacy”, it said.

“As in hospitals, greater use will need to be made of registered pharmacy technicians, while pharmacists increasingly use their clinical skills to deliver support to patients in a range of settings, underpinned by more effective and efficient use of the whole pharmacy team.”

What is being proposed?

In order to “enable a registered pharmacy technician to take responsibility for the sale and supply of POM and P medicines”, the group proposes to amend the wording of regulation 220 of the Human Medicines Regulations 2012 so that the phrase “pharmacist supervision” is replaced with the broader “registered pharmacy professional”.

This would allow a technician “to determine not only that a single medicine sale or supply transaction can go ahead, but also [the] type of medicine”, as long as they are “acting in the course of their profession”.

While the requirement for a responsible pharmacist to look after the day-to-day running of the pharmacy would remain, the group suggested that a pharmacy technician could, 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”.

The working group even outlined in detail the “type of transactions” pharmacy technicians could supervise in practice, including repeat prescriptions and the sale of “family packs of analgesics”.

Read more about the group’s recommendations for both of these scenarios in C+D’s accompanying article here.

Competent to supervise from “day one”

The group stressed that consideration would have to be given to “any competence, training and regulatory implications” of its proposals.

It referred to the General Pharmaceutical Council’s (GPhC) overhaul of education standards for technicians – agreed at the regulator’s council meeting last week (September 7).

“It would seem appropriate that any new qualifications developed should take into account any changes to legislation,” the working group said.

This would “ensure pre-registration trainee pharmacy technicians are competent” to supervise medicines preparation and supply “from day one of registration”, it said.

“Consideration should be given to developing a national UK competency framework/training programme to upskill pharmacy technicians to take on these functions,” the group added.

“Reasonable” concerns

The group recognised there would be kick-back to its proposals: “There are likely to be concerns about the competency of some registered pharmacy technicians to undertake this new function,” it predicted.

“Those with responsibility for the overall governance [of a pharmacy]…can be expected quite reasonably to ask: ‘How do I know that my registered pharmacy technician is trained and competent to undertake this new function?’”

The group suggested setting up “workshops to assist the board in becoming fully familiar with the proposals and testing them out for practical application”.

The board’s response

In a summary of the programme board’s discussion of the working group’s proposals – which took place on April 7, 2016 – the board “indicated it was content with the direction of travel”. But it admitted “there [is] still much to be done to give people the confidence to keep with us”.

According to the documents, the board “agreed unanimously” at the meeting that these proposals “should not be discussed publically by board members”.

Read more about the specific medicines supply scenarios the board envisaged pharmacy technicians overseeing in C+D’s additional coverage here.

The confidential documents explained...

confidential files technician supervision
 

Who are the working group that produced the proposals?

The “short-life” working group was established by the UK’s four chief pharmaceutical officers to inform the DH programme board’s proposals on pharmacy supervision.

According to the documents, as well as its co-chairs – chief pharmaceutical officer for England Keith Ridge and chief pharmaceutical officer for Scotland Rose Marie Parr – its membership consists of one representative from each of the following:

  • General Pharmaceutical Council
  • Royal Pharmaceutical Society
  • Pharmaceutical Society of Northern Ireland and its Pharmacy Forum
  • Association of Pharmacy Technicians UK
  • Pharmacy Voice (nb this organisation disbanded in April 2017)

What is the programme board?

In 2013, the Department of Health brought together a board of pharmacists, regulators and patient representatives, and tasked it with "rebalancing" medicines legislation and pharmacy regulation. According to its website, the board's current members are:

  • Ashok (Ash) Soni – president, Royal Pharmaceutical Society (RPS)
  • Paul Bennett – chief executive officer, RPS
  • Nigel Clarke – chair, General Pharmaceutical Council (GPhC)
  • Duncan Rudkin – chief executive, GPhC
  • David Gallier-Harris – pharmacy manager, Asda
  • Christine Gilmour – ‎chief pharmacist, NHS Lanarkshire
  • Tess Fenn – president, Association of Pharmacy Technicians UK
  • Julie Greenfield – forum manager, Pharmacy Forum of Northern Ireland
  • Karen Harrowing – pharmacy consultant, Association of Independent Healthcare Organisations
  • Steve Howard – superintendent pharmacist, Lloydspharmacy
  • Jeannette Howe – head of pharmacy, Department of Health
  • Denzil Lloyd – lay member
  • Lynn Strother – lay member
  • Julie Mathieson – senior pharmacy technician, Wrexham Maelor Hospital
  • Sheelin McKeagney – pharmacist managing partner, McKeagney Chemists
  • Raj Patel – superintendent pharmacist, The Nelson Pharmacy
  • Trevor Patterson – chief executive, Pharmaceutical Society of Northern Ireland (PSNI)
  • Dr Jim Livingstone – president, PSNI
  • Bob Rihal – locum pharmacist
  • Bernadette Sinclair-Jenkins – regulatory assessment unit manager, Medicines and Healthcare products Regulatory Agency
  • Rachel Edwards – director innovation for health, Ellesmere Pharmacy

When were these documents produced?

The “sensitive” documents do not explicitly state when they were produced. They are marked “20/01” – a possible reference to a January 2017 publication date – and refer to the programme board’s previous meeting on April 7, 2016, as well as “the October board meeting”. 

111 Comments
Question: 
What do you make of the supervision proposals?

M Yang, Community pharmacist

I've worked with many technicians who're great people and do a great job. However, the clinical knowledge and experience of a pharmacist cannot be met by technicians. I've asked a number of technicians recently how they'd feel about being given this task and almost all of them are thoroughly opposed to the idea. Most of the responses were along the lines of "why would I want to have the responsibilities and stress of a pharmacist for only a little above minimum wage?" Indeed, I see a scenario where such technicians would be given new contracts and paid a bit more, but not anywhere approaching a pharmacist salary (that would defeat the cost cutting purpose). At performance review time, you'll be judged as if you were a pharmacist manager. Don't think you won't. If multiples can bully their pharmacists, there's nothing to stop them doing the same to technicians. The hidden purpose is to reduce costs and replace pharmacists with employees who're easier to control and intimidate. 

Stanley Grzesik,

Obviously the other 195 countries have got it wrong

Forget your GP the Robot will see you now, Locum pharmacist

Scandalous

Graham Morris, Information Technology

From the outset of developing electronic scripts, it was obvious that government wanted to get a far better grip on the way in which community pharmacy operates. Over the last ten years, we have seen the drip drip of changes slowly but continually applied to the profession which has the effect of playing into the large companies wellbeing as opposed to the independents.

If the statement that it costs 2.8 billion to dispense 7.2 billion of prescriptions is true, then it is a definite target for cost cutting. Whereas safety is uppermost in the mind of the pharmacist at the dispensing bench, decisions made elsewhere by less involved members of the profession, may not reflect the real world situation itself. Government thinking, in my opinion, is that eventually dispensaries will be run by technicians. Scripts sent from the surgery, will need to be checked at prescriber level for any potential harm to the patient, as occurs in dispensing doctors. Electronic transmission, dispensing and bar code verification of the final dispensed products will satisfy a government. The odd occasional fatality will either be blamed on the prescriber or on the techician. The savings made will more than cover any litigation that occurs from errors in the process.

This link takes you to another site that has an article I wrote for the P.J. ten years ago. The writing was on the wall then, not one person commented on my worries.

https://www.pharmacy-forum.co.uk/forum/general-information/pharmacy-news/232545-remote-supervision

Chemical Mistry, Editorial

Just to say to all the pharmacist who have commented on this article well done we are not all apathetic or glory hunters like those above but just doing job to the best of our abilities when the above * want us to be extinct ! Love to be at the pharmacy show to put a protest * Need a protest movement like Corbyn or similar to stop this in tracks. May need a scarificial lamb for the greater good of pharmacy profession.

*This comment has been edited to comply with C+D's community principles*

Mr Pharmacist!, Pharmaceutical Adviser

The pharmacy profession has for too long been taken down a negative trajectory. The honor of the leaders is long gone. The scoundrels * have colluded with the corporate chains to DEVALUE Pharmacists. Fair enough when they try to bring down salaries but a stand needs to be made. *

*This comment has been edited to comply with C+D's community principles*

Chemical Mistry, Editorial

Edit alert ! Edit alert! Moderator where are! Just like mind were edited!

Alan WHITEMANN, Communications

 Those comments weren't derogatory at all. C and D is getting to point where not worth reading if comments are deleted.

Ilove Pharmacy, Non Pharmacist Branch Manager

Just praise the multiples in any of your comments and you should be fine. 

Mr Pharmacist!, Pharmaceutical Adviser

*This comment has been deleted for breaching C+D's community principles*

S Pessina, Pharmacist Director

*This comment has been deleted for breaching C+D's community principles*

Dax Trader, Finance

Fantastico for shareholders!!!  We can get technicians for half the price of pharmacists.  Now to crack those medics.

 

Jonny Johal, Pharmacy Area manager/ Operations Manager

... or so they thought, until the technicians start asking for more ... parity with pharmacists! Hahaha ...

Locum Pharmacist, Locum pharmacist

Don't Boots have some sort of a plan to train up loads of techs? Almost like they knew something before the rest of us..I think current technicians should worry about being replaced by newer cheaper models.

S Pessina, Pharmacist Director

*This comment has been deleted for breaching C+D's community principles*

Julie Friday, Accuracy checking technician

That is exactly what has happened. I know of Pharmacy Technician/ACT's that had been with the company along time that were more or less pushed out of their jobs.

Chandra Nathwani, Community pharmacist

Reminds me of a famous Bhagvad Gita Sloka! 

śhreyān swa-dharmo viguṇaḥ para-dharmāt sv-anuṣhṭhitāt
swa-dharme nidhanaṁ śhreyaḥ para-dharmo bhayāvahaḥ 

BG 3.35: It is far better to perform one’s natural prescribed duty, though tinged with faults, than to perform another’s prescribed duty, though perfectly.

 

 

 

jack The-Lad, Communications

Sorry Chandra, that sounds a bit contradictory.

Chandra Nathwani, Community pharmacist

I too, when I first read this verse was confused. "Locum Pharmacist" has given his/her view which is also valid.

But just imagine what kind of society one would create if we all decided we could do someone else's job. Who would do the job that no one wants to do (though some times I do wonder about if I like what I do!).

Pharmacist's are capable of taking on a lot more on  but the funding model is the block stopping this development.

The interests of pharmacy owners and pharmacists are not aligned.

Sad really.

Locum Pharmacist, Locum pharmacist

Guess it comes down to interpretation. I read it as don't step on someone else's toes and don't take what doesn't belong to you with an undertone of karma bites..which is somewhat fitting. 

Meera Sharma, Community pharmacist

Very sad day reading this article. So, let's see:

- Pharmacists are being asked to upskill - at their own expense, no job guarantees and head-office led corporations breathing down their necks to deliver these so-called clinical services - MURs & NMS. This scenario has still not been adressed by GPhC or RPS. Which means the multiples are happily carrying on - evidenced by the amount of reporting that goes on.

- Then we get pharnacy technicians who should be upskilled to do the job that a pharmacist does - advice, check and supervise. Who's paying for their upskilled training??

- Now put the two scenarios together - I'm a manager literally rubbing my hands together! Get rid of my 2 x pharmacists who are costing me more than minimum wage, replace them with 2 x technicians who I can set targets for ( x items to be cheked per hour), they can pay for their own training (modern work is Personal Development Plan). Oh wait, while I'm at it - let's get back the 2 x pharmacists and double their target of MURs and NMS, and my bottom line just got very healthy.

Really sad, that all our professional bodies who are supposed to safeguard our profession do nothign to combat this modern-day slavery of pharmacists, then proceed to hammer in the final nail in the coffin for the profession. You really should all hang your heads in shame.

On a plus point, please collect your useless fees from the technicians - because being registered means nothign to me anymore. I'm off to "upskill" myself to be an Associate Physician, work in a GP surgery and pay my fees to another organisation who one hopes provides more support for me than you have.

- Then we've got community pharmacy - contractual arrangements/financial arrangements severely affected.

Welcome to the pharmacy world in 2019 - or is it even sooner?!

Tom Kennedy, Pharmacy Area manager/ Operations Manager

This all sounds very exciting.  Just one question though... 

What happens when there's a big word on the prescription and their little minds are blown?

 

Brian Smith, Pharmacy technician

Who's "little minds" are you referring to please?? 

Pharmacist Pharmacist, Community pharmacist

*This comment has been deleted for breaching C+D's community principles*

Brian Perry, Locum pharmacist

The role of the pharmacist in community pharmacy is, imho, a difficult one to defend. Technicians in dispensing doctors practices hand out medication unsupervised.

Many years ago I offered to do some research to determine if there was any difference in clinical outcome between patients who had medication dispensed under the supervision of pharmacists or by technicians in DD practices. My offer was quietly shelved.

OK, so pharmacists do MURS, NMS's, give advice, recommend OTC's etc.

How cost effective is this? will be the question asked by the financiers.

And pharmacists' answer will be....?

Somehow pharmacists have to rigidly, mathematically, justify their cost over that of a technician.

mark straughton, Student

Well said, couldn't have put it better myself. This is exactly the predicament us Pharmacists are in.

Furthermore, try justifying this to the government and tax payer when, in the words of Philip Hammond, £2.8b is spent on dispensing £7.2b of medication. Economically we can't justify ourselves. 

 

Ilove Pharmacy, Non Pharmacist Branch Manager

Amd you're studying pharmacy I presume. Haha. McDonalds are hiring......

Locum Pharmacist, Locum pharmacist

There are worse places- their employees recently pushed for £10/hour and were featured in most publications

jack The-Lad, Communications

Oh Dear, looks like Pharmacists have finally been sold down the river . Still time to get a petition or dare I say strike ( what have you got to lose )

 

Chemical Mistry, Editorial

Funny that the PDA Not  was invited to this meeting whilst we have a ex Boots supertindent - RPS, mr rudkin and mr Clarke who implemented the splitting of the RPSGB and brought in the responsible pharmacist legislation, the two chief   pharmacist's who are just waiting for their MBE and fellowships to pharmacy andprobably never worked in a pharmacy for last 25 years and probably could stand for 12hrs without lunch!

 

 

And also nobody from Numark or Well pharmacy groups , or the pharmacy education such as university's since probably bring their pharmacy degree gravy train crashing down since who would want to a pharmacy degree after reading this!

Also would this scenario be possible for example; In a 100 hour pharmacy open 7.30am to 11.00pm where there was a pharmacy manager and Act and dispensing assistant say after 6.00pm the pharmacy clinically checks all the repeat prescriptions the dispensing assistant then makes up all the prescriptions and the Act as the registered pharmacy professional checks and bags all the prescriptions therefore allowing the pharmacy employer only employ the pharmacist until 6.30 and the Actis in charge until 11.00pm so saving on the pharmacist wages, would this scenario be possible with legislation, since prescriptions etc could still be given out and with possible supervision changes the Act could supervise the sales as well. Thoughts??

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