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Technicians hit back over pharmacist PGD snub

Practice Pharmacy technicians have hit back at pharmacists’ rejection of a proposal to allow them to supply medicines under patient group directions

Pharmacy technicians have hit back at pharmacists' rejection of a proposal to allow them to supply medicines under patient group directions (PGDs).

The Association of Pharmacy Technicians (APTUK) said there was "strong evidence" technicians could deliver safe services under a PGD if supported correctly, in response to a PDA poll showing that 96 per cent of pharmacists were against adding technicians to the list of health professionals who can operate under the scheme.

Almost 60 per cent of the 1,300 community pharmacists who responded to the Pharmacists Defence Association (PDA) poll in July cited technicians' lack of an appropriate professional relationship or accountability as the reason why they should not be added to the list.

APTUK claims that pharmacy technicians are 'fully accountable' health professionals, despite the concerns of pharmacists

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However, the APTUK said last week (August 16) that pharmacy technicians were "fully accountable" as health professionals.

"Pharmacy technicians have demonstrated in a number of settings that, given the opportunity, they are perfectly able to have a proper and effective professional relationship with patients and other healthcare professionals," APTUK said.


APTUK also rejected concerns that adding technicians to the list would blur their role with pharmacists and that a lack of training would render the service ineffective.

However, any new role for technicians should be the subject of "rigorous risk assessment and risk management process", the group stressed. It also noted that there may be some PGDs that technicians could not be included in.

The process of developing PGDs would ensure technicians would require appropriate training before they were able to operate under them,  APTUK said.

"Similar concerns were raised at the prospect of pharmacy technicians taking on final accuracy checking and patient-facing medicines management roles. All of these concerns proved unfounded with no negative impact on patient safety," it added.

Pharmacy technician Benjamin Leon D'Montigny said he was disappointed by the "overwhelmingly negative" response by pharmacists, but accepted there were some valid concerns.

"Give technicians the opportunity to prove themselves to the pharmacists we help. If you as pharmacist are not comfortable personally with your technician using a PGD, then you have control to say no," he posted on the C+D website earlier this month.

The PDA said it stood by the concerns raised by its members. "Our members have spoken and we stand by our statistics," PDA director John Murphy told C+D on Monday (August 19).

The Guild of Healthcare Pharmacists (GHP) used its response to draft Nice guidance on PGDs to call for pharmacy technicians to be added to the list of healthcare professionals who can supply medicines under PGDs. The PDA ran the poll to see how many pharmacists agreed with this view, PDA chairman Mark Koziol told C+D in June.



What do you think of APTUK's position on technicians using PGDs?

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60 Comments

Faiz Yusuf, Locum pharmacist

I was in a pharmacy last week & the experienced (50 something) technician would ,had I not seen it given out adult laxative sachets instead of paediatric to a 2 year old child.Potentially very serious.Dispensing technician means just that & with prescription numbers increasing accurate dispensing is even more imperative.As for any holier than thou aspects ,a lot of pharmacists could not get to do medicine as the entry to a dr's course increased from 3 C.s at A level to to 3 A.s in 1970.s ,1980.s & beyond . Faiz Yusuf

Leon The Apothecary, Student

Lets share, I was in a pharmacy last week and and the experienced pharmacist of 20 or so years had allocated some amoxicillin susp for a child of 6 months, as I was amount to constitute it - I had noticed the 1.25ml concentration and the dosage for 125mg/5ml had I not seen it could have caused patient harm through overdosing. Turns out the doctor had prescribed incorrectly because they had been rushed to get through their patients for the day.

How High?, Community pharmacist

Yep and when I make errors it's often my non-pharmacist team members that spot it and prevent harm to patients.
I'm tired of listening to pharmacists say stuff like this when they make some of the worst errors of all through arrogant self checking and the like.
It's time some of the profession got a mirror and had a good long hard look at themselves

How High?, Community pharmacist

Well I for one have met many pharmacists that I wouldn't trust to make a cup of tea, let alone practice when I'm signed is as the RP. The same goes for some technicians I have met over the years.
Having said that the technicians I currently work with are more than capable and I'd be happy for them to administer ANY of the PGDs currently available.
You don't need a degree to administer EHC, Minor Ailments, Smoking cessation, Weight Loss etc. Maybe (and maybe) the only exception would be vaccine administration but I genuinely wouldn't have a concern with that if the training was good enough.
I don't want to be chained to the checking bench but neither do I want to be chained to services and away from the heart of my business.
I need to take a central role as RP and oversee the many activities going on. I'm the hub of the pharmacy and the rest revolves around me. If I'm stuck in a box of a room all day then I have no idea what's going on. I need to be there for my customers and visible to them.
I'm happy to allow appropriately trained and accredited techs to undertake almost any of the tasks that are carried out in a pharmacy.
Unfortunately I can see a long wait for techs, how long did it take for accuracy checking to get approved?

Leon The Apothecary, Student

Ironically I do use PGDs as part of smoking cessation already in a sense whenever I provide an NRT product for one of my clients. Within 12 months there will be PGDs for Champix and Zyban in my area. This is something that is available to a healthcare assistant and above.

PGDs are something that could be used more for many reasons. Another example where it could be used effectively. Patient comes in struggling to use physically their ventolin evohaler. Using a PGD a technician could give aforementioned patient an easi-breathe and also conduct a inhaler usage review. Patient now is using their new inhaler correctly and efficiently, their health improves as a result, they don't waste as many doses, meaning they require less inhalers per month, saving the NHS money.

The PGD Technician is an idea that *must* be championed and explored. Trial it, gather evidence on it, and analyse the results and draw conclusions on the safety and effectiveness on the service. Until then ~ any other opinion, both for and against the PGD Technician will simply be theory.

If the service does well, great! Roll it out and expand it. If not, that's also good, because pharmacy has made an attempt at improving itself and gained insight into it's working practices.

Alison Hemsworth, Primary care pharmacist

I think it's worth commenting that there are other professionals who aren't pharmacists or doctors who already have the rights to issue medicines via a PGD. With that in mind why shouldn't technicians be added to that list providing they have the correct competences to do so. I also thought it interesting that the poll conducted by the PDA was (according to this article) answered by community pharmacists whilst it was hospital pharmacists who prompted the debate.

Dorothy Drury, Locum pharmacist

So hospital pharmacists are telling community pharmacists how to do their job?

Leon The Apothecary, Student

It's important to note, continuing your point, that the work on a hospital technician and and community technician are quite a bit different just due to the setting and the work involved. That's why I would think it's important that a standard would need to be set to ensure competency.

BL E, Primary care pharmacist

A very interesting debate. As things stand the RP is in charge of each pharmacy and it would be their decision as to whether each indivial technician was competent to work under the PGD in question. As with every profession there are very good technicians and some where the standard isn't what you'd want it to be (as is the case with some pharmacists). I think some technician's would be more than capable of working within the scope of PGDs, provided they'd been apropriately trained and that they. My only concern would be, as someone else has mentioned already, if I was held accountable for something the technician had done but I'd had no involvement/input into the situation (this is assuming that any training had been provided externally. If I'd trained them myself, I accept some of the responsibility would be mine).

Disillusioned Pharmacist, Community pharmacist

Can I just throw something else into the mix? I am assuming Techs would want paying more for this extra responsibility? Given that there has just been a job advertised in this very publication for a Pharmacist to work in Nelson 50hrs per week for a salary of £30000p.a (equating to £11.53 per hour) where do yoou think this money is going to come from? The ACT's at the company I work for are getting £11.53p/h!! Increased pressure for decreased wages, why are you techs begging for more responsibility when there is no money to pay you for taking it? Anyone who claims to want to do it for no extra pay or even decreased pay (as with Pharmacists) mustn't have a family to feed or a mortgage to pay in these difficult financial times. Given the choice I would never increase the risk to my family (of being struck off because more responsibility means more risk) of not being able to put food on the table or a roof over their heads because I have lost my registration.
For the record I did my dissertation at uni about ACT's when they first came to the fore and it was very positive. I have also worked with many PT's+ACT's one of which I could trust with any task at all as I was confident that she would only work within her own competence and refer to me when necessary but I have also experienced the other end of the spectrum.

Leon The Apothecary, Student

Your point is perfectly valid. ACTs do fantastic work and enable the pharmacist they work with to focus a lot more on clinical work. Business-wise this is very good for a company too. I'd like to think it's not a case of devaluing pharmacists, it's about re-evaluating and promoting technicians.

Pharmacist Pharmacist, Community pharmacist

This is not a matter of whether technicians can undertake roles of the pharmacist. It is a battle for power. Technicians and dispensers have been struggling and aiming to gain power over pharmacists. Many a times technicians and dispensers argue with pharmacists over clinical or safety issues, not because they disagree, but rather they dont like being told off. How many times have you as a pharmacist been told off by a technician who doesn't really know what she's talking about?

C W, Dispensing assistant

I've never seen a dispenser or technician 'tell off' a pharmacist. It just isn't done, at least not where I work, presumably because the pharmacists I work with can manage their staff effectively. I would only ever speak up if I thought there was a genuine mistake made, because I respect that the pharmacist I'm working with knows a lot more than I.

In response to your other post, agreeing with Dorothy Drury, how can you support the idea of 'if you want to be a doctor, study medicine, if you want to be a pharmacist study pharmacy' in relation to denying technicians the right to dispense PGDs?

Surely you recognise the hypocrisy that is you saying that when pharmacists have actively promoted themselves as having the ability to prescribe, which was formerly a power held only by doctors?

Technicians wanting to take on some of the roles that their supervisors carry out is no different to pharmacists wanting to take on some of the roles that doctors carry out.

I understand why pharmacists would have reservations about it but technicans aren't unqualified or people who - like myself, perhaps - are glorified shelf stackers who do nothing more than tell old women they can only have 32 paracetamol.

I'm sure doctors had reservations about allowing pharmacists to give out POMs when your training is obviously nowhere near as comprehensive as theirs is.

N M, Community pharmacist

Not all pharmacists are allowed to prescibe. You need proper training to be a prescribing pharmacist.

Pharmacist Pharmacist, Community pharmacist

CW I admire your passion. But I'm sure one of the code of ethics states to recognise your professional abilities and refer when necessary (maybe you didnt study that in your healthcare course?) Anyway I back you entirely to prosper in your career, but only in the right direction. I will support you in any way only if you stay away from clinical areas

C W, Dispensing assistant

It almost sounds as if you're saying I don't do my job properly there. I know when to refer a patient to the pharmacist. I'm not entirely sure why you're bringing up the code of ethics on referring to the pharmacist though.

As for the rest of your post - again you descend into arrogant lording your MSc over me because I'm just a healthcare grunt, obviously there's nothing I could contribute to this discussion at all.

I don't plan on getting into the 'clinical area' so don't worry I'll 'stay away'. Seriously, you come across as a very arrogant person. I know my place, I know not to question those above me unless I have a very good reason to, such as clear evidence of a mistake.

It just sounds like you've had a few bad experiences with dispensers or healthcare staff in the past and you feel a little insecure about it.

I'm not questioning YOUR clinical capabilities, nor am I questioning the clinical capabilities of any pharmacist. This was a discussion about whether or not technicians should receive extra responsibilities but you've taken the discussion away from that and went for petty points scoring which is terribly poor form and an indicator of how poor your discussion skills must me.

But of course you know your pharmacokinetics and interactions - I bet you don't even have to look at the BNF anymore - so you know everything. Am I right?

Pharmacist Pharmacist, Community pharmacist

Thumbs up CW ♥

C W, Dispensing assistant

Cheers mate ;)

Another Pharmacist, Hospital pharmacist

To a certain extent your right, which is why expanding the permission for technicians to also "prescribe" is even more foolish. PGDs weren't necessarily highly desired by your run of the mill pharmacists and if I wasn't being told to offer these private services by my employer I probably wouldn't bother. There is nothing exciting about supplying via a PGD and I'm not entirely sure why technicians desire it so strongly, is this agenda being driven by the big companies? A technician who can check, provide drugs via a PGD and do just about everything else may still be cheaper than a pharmacist when remote supervision comes into affect and every pound saved is a bonus to a ruthless company.

Pharmacist Pharmacist, Community pharmacist

Well said Jeff Wilson. And CW, r u sure our training isnt half as extensive as doctors??!! We are much highly trained in disease management and prescribing than doctors. However, doctors are much better at diagnosis than us, I admit that. Whereas technicians need to focus on the dispensing process. I just feel you are not clinically trained to do clinical tasks. No doubt you can excel and prosper in your career, but not down the clinical route unfortunately. Notice how not many people are giving your comments a thumbs up CW? Where are your colleagues who would be willing to stand up with you?!

C W, Dispensing assistant

I don't think pharmacists are more trained in prescribing than doctors are, considering that doctors write prescriptions as part of their job and it is only recently that pharmacists have even been allowed to prescribe medicine.

Perhaps you're misunderstanding my side of this discussion. I'm not a tech, I don't want to be a tech, and I personally wouldn't want the extra responsibility that techs are after. I'm merely agreeing with their side of the argument because it makes sense.

As for thumbs up, considering that this is an online community populated mostly by pharmacists, and nearly 100% of pharmacists surveyed are against technicians using PGDs, I don't expect a million thumbs up. I care more about discussing the topic at hand in a mature and open way than whether or not people click thumbs up.

Another Pharmacist, Hospital pharmacist

To all you technicians if you want to do what pharmacists do then you should do a degree in pharmacy, there are many schools of pharmacy now that you can apply to. Many technicians have upskilled and put themselves through university and completed a pharmacy degree so why not give it a try?

Michael Stewart, Community pharmacist

P.S By denying additional responsibilities for our closest colleagues (in an attempt to protect our own interests) - we are really undermining "pharmacy" itself and preventing a sustainable future for all of us.

Michael Stewart, Community pharmacist

Very dissappointed to see all the negative scores on the comments from pharmacy technicians - particularly as they are all valid comments. Perhaps the 2-3% of pharmacists who responded are also scoring the comments below. It seems that by default a technician gets a thumb down on their comment.

Lets be clear - PTs are highly trained and competent individuals - lets not be scared or threatened by their skills, but embrace and encourage their development.

As I have commented previously - look at the list of who is already allowed to deliver PGDs and ask yourself why technicians should not be on ther too. Is it because you are threatened?

Every pharmacy owner should be in support of this motion - imagine doubling the number of flu or travel vaccines you can achieve in a day. Profit usually sways the argument.

We are a very blinkered bunch if this 96% is truly representative. Stick to your guns all PTs out there and I apologise on behalf of the short-sighted 96%.

Mike Hewitson, Superintendent Pharmacist

Brief comment on this issue (well it started out that way). I am all for utilising my support staff appropriately, which is why I believe that technical staff should be better utilised in technical roles, such as dispensing, accuracy checking, maybe even practice management. The red line which demarcates the Registered Technician from the Pharmacist is the provision of clinical care. That includes supply of medicines against PGDs, supervision of sales of P meds, and provision of (most) pharmacy services and advice.

Protocols are fine, and have a place as part of the overall risk management package for a community pharmacy, but is naive beyond belief to think that they can remove all risk from the activities I list above just by having a policy in place. In ten years in frontline pharmacy practice I can honestly say you cannot produce a definitive algorithm which removes all risk, which leads us back to judgement and accountability. It is inevitable that the pharmacist carries the responsibility for the actions of their support staff, as far as I understand if an ACT makes an error, I would share some responsibility with them, in essence, they are not independently accountable - how many technicians hold their own personal Professional Indemnity Insurance for example? That isn't deriding Registered Technicians, but saying you're accountable, and being accountable are two different things.

Largely community pharmacy employers are disinvesting from training support staff to NVQ3. Don't know if workplace census data shows this or not, but my gut feel is that the overwhelming number of Registered Technicians are employed in hospital, which is probably why GHP was in favour of wider access to PGDs - how often do hospital pharmacists supply against PGDs? Not often I'd wager, so possibly not a big issue for them.

I would really like to hear what my professional leadership body has to say on this matter.

Leon The Apothecary, Student

I really enjoyed your comments there. And it's a very strong argument. Perhaps if Technicians were to advance their roles with pharmaceutical care then accountability should be solely the Technicians to have that independent responsibility should be the first aspect to change before even considering any additional roles.

Personally, I would want the responsibility - to be accountable for my own actions, and independently from anyone else. I think this is the crux of one of the main issues. Honestly, if I didn't have that, I wouldn't want the PGD.

I suspect this may be a major hiccup in regards to remote supervision as well and something that will be on the front of everyone's mind in the future.

Leon The Apothecary, Student

Last time I checked, the pharmacy technician course was a combination of two diplomas and 2-3 years study. Plus a NVQ in Dispensing for 1-2 years, plus an MCA course for a year. Plus an extra 6-12 months for an ACT with a log of 1,000 items checked in a row correctly. Plus re-accreditation on a regular basis and mandatory continuing professional development. Not to mention that they will be doing all this study whilst gaining experience in the day to day running of a pharmacy.

Dorothy Drury, Locum pharmacist

Experience is very important for both pharmacy technicians and pharmacists and indeed all pharmacy staff. Everybody is important. However, pharmacists go through the loops that allows them to be the professional in charge of a pharmacy. This is not elite and is open to anybody who wants to train as a pharmacist. Therefore it should not be an option to train as a pharmacy technician and want to work as a pharmacist.

C W, Dispensing assistant

Well, doctors go through the loops of learning medicine to be able to prescribe. Therefore it should not be an option to train as a pharmacist and want to work as a doctor?

Do you not see the plain hypocrisy that is pharmacists wanting to have prescribing powers that were previously held only by doctors yet deny technicians the ability to give POMs via a PGD?

I'm not saying pharmacists shouldn't be allowed to independently prescribe, because it's been shown that they can - and safely. Give technicians the same chance to prove themselves - they're far from unqualified!

Leon The Apothecary, Student

From today's debate I feel this is going to be a major evolution of the role of the Pharmacy Technician. Remote supervision was touched upon today which is another can of worms and one I'm not sure how I feel about personally.

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