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RPS warned: Technicians supervising supply would be betrayal

Mike Hewitson's letter also took aim at the push for pharmacists in GP practices
Mike Hewitson's letter also took aim at the push for pharmacists in GP practices

An open letter signed by more than 500 pharmacists is calling for Royal Pharmaceutical Society (RPS) assembly candidates to stand against technicians legally supervising medicines

In the letter, published online yesterday (July 10), contractor Mike Hewitson and pharmacist Ben Merriman state that “many community pharmacists are extremely concerned” that the Department of Health (DH) plans to “empower pharmacy technicians to supervise pharmacies”.

A DH programme board set up in 2013 to "rebalance" medicines legislation – including the decriminalisation of inadvertent dispensing errors – is also tasked with "addressing" legislation on pharmacy supervision, which it considers to "restrict full use of the skills of pharmacists and pharmacy technicians, [and] put unnecessary obstacles in the way of new models of service delivery".

The letter's authors are concerned that the board's direction will lead to technicians being legally able to supervise medicines supply.

“This simply cannot be allowed to happen,” as “the public will be left without access to the knowledge and skills of the pharmacist”, they stressed.

“Anything other than a strong and robust opposition” to this possible outcome, would be seen as a “betrayal” of RPS members, they added.

"Too much emphasis on GP pharmacists"

In their letter – sent to each candidate of the RPS assembly elections yesterday – the contractors also accused the society of placing "too much emphasis" on the "emerging role" of pharmacists in GP practices.

The RPS has supported the concept since it launched a joint proposal with the Royal College of General Practitioners in 2015, but the letter's authors argued that pharmacists in GP practices "are no substitute for on-demand provision of professional care and advice" available from a community pharmacist.

The letter includes 469 contributing signatures, which the authors claim represents "a cross section of community pharmacists". An accompanying online petition had accumulated 511 signatures at time of going to press.

Click here to read the full letter

“Ton of opposition”

Dorset contractor and co-author of the letter Mr Hewitson told C+D yesterday he believes that current RPS president Martin Astbury is a “staunch advocate” of “maintaining the link between pharmacist and pharmacy”, which is “absolutely critical”.

Mr Astbury told C+D in May that it is “totally inappropriate” to legally pass supervision responsibilities to a technician.

However, Mr Hewitson told C+D that “should Mr Astbury not be the president”, he is concerned “we would see somebody with a very different view”, who could give in to pressure to allow technicians to supervise supply.

He also claimed there is a “ton of opposition” to this possibility. “This is just the tip of the iceberg.”

“Active consideration” around supervision

Last week, DH head of pharmacy Jeanette Howe said the rebalancing board and the UK's four chief pharmaceutical officers “are taking responsibility” for the “work programme” around pharmacy supervision.

“I don’t think I’m giving away any secrets when I say there is a range of views on this matter,” Ms Howe told delegates at the Association of Pharmacy Technicians UK's (APTUK) conference.

“Some of the things we have been doing is to look at quality systems…how that works in other regulated professions, and how that might work in pharmacy,” she added.

Ms Howe reassured delegates that “active consideration is still going on and we’re hoping to make progress”.

The APTUK was unavailable to comment on the contents of the open letter.

RPS response

Responding to the concerns raised in the letter, the RPS said it “has always believed that a community pharmacy requires a pharmacist to be present” – see more on the RPS's position below.

The society also argued that its support for investment in new pharmacist roles, in areas such as “care homes, A&E and GP practices”, has helped integrate community pharmacy into the wider NHS.

“These new roles have led to greater referral for medicines use reviews and the new medicine service in England, and discharge medicines reviews in Wales, as well as improving the professional relationships between GPs, social care and community pharmacists,” it claimed.

“We will not shy away from asking for investment in community pharmacy, as we know this service is vital to the safe delivery of quality healthcare,” the RPS said.

“We have listened to our members and they have told us now more than ever the sector should be coming together around a positive, constructive agenda,” it added. “This is where we will be concentrating our energy and focus.”

The RPS position on legal supervision

  1. There should be overarching principles that describe what patients should expect from all pharmacists – but supervision changes should reflect the differences between pharmacy sectors
  2. Supply of prescribed medicines to the public requires a clinical check by a pharmacist to ensure the medicine is appropriate, and this should comply with professional and regulatory standards
  3. Supervision changes must safeguard individual pharmacists’ autonomy in delivering pharmaceutical care and further empower them to exert their professional duty to patients
  4. Innovations that allow pharmacists to concentrate on patient care are welcomed. Such innovations should ensure continuity of, and enhance the quality of, pharmaceutical care.

Supervision requirements should be amended so the direct supervision of prescription assembly can be delegated to a registered pharmacy technician, so that pharmacists can develop their clinical and public health service role.

24 Comments
Question: 
Do you agree with the views in the letter?

Jonny Johal, Pharmacy Area manager/ Operations Manager

Didn't the RPSGB and RPS betrayed pharmacists by promoting technician registrations?

Locum Pharmacist, Locum pharmacist

Yes

janet maynard, Community pharmacist

Seems a bit like "back to square one" At the beginning of my career- many moons ago we fought for the final check!" If technicians are given the final check then we MUST lose our legal obligations! I am not prepared to be given a criminal sentence for someone else's mistake

Locum Pharmacist, Locum pharmacist

I agree but in reality you will have no choice.Everything is forced upon pharmacists who have no voice.

Its a case of either put up with whatever is meted out or leave the "profession".

Ilove Pharmacy, Non Pharmacist Branch Manager

The irony of the RPS making accusations of betrayal. Laughable if not so serious.
 

community pharmacist,

Here's one of a few examples why supervision is important:

Patient picks up their bagged prescription bag and asks pharmacy technician 'I'm getting two steroid creams betnovate and hydrocortisone I was wondering if there was a difference between them and if I can use them all over my body?'

Pharmacy technician: 'Yes, that should be fine. There isn't a difference and you can use them anywhere on your body'. 

*patient looks confused*

Locum Pharmacist, Locum pharmacist

The average technician is at best uneducated .......and they are wanting to take over the pharmacy world!

Pharmacist Pharmacist, Community pharmacist

I do seriously doubt the ability of pharmacy technicians. I've worked with quite a few in my time, and seriously speaking I cannot vouch for them in any court of law.

Stephen Eggleston, Community pharmacist

One presumes this idea of technicians supervising pharmacies would extend to all areas of the pharmacy (I confess I have not read the details of the suggestion or the objection) - does this also mean medicine sales? If the prescriptions have been clinically checked, will this mean a roaming pharmacist "popping in" for an hour or so to do this before zooming off to their next clinical checking appointment?

Seems like a huge undermining of patient safety

Gerry Diamond, Primary care pharmacist

Clear controversy, admiitedly some weeks agp we discussed the dilution of pharmacy support staff training would need to be more robustly addressed. And since enhanced services have been reduced significantly by cutbacks, then the extended pharmacist role is diminished . I think we are back to pre 2000 with all this, sadly.

Ilove Pharmacy, Non Pharmacist Branch Manager

Rearranging deck chairs on the titanic......

Anonymous Anonymous, Information Technology

The final nail in the coffin for the sinking ship that is UK pharmacy!

R A, Community pharmacist

The beginning of the end for community pharmacists this was long overdue. Many of us anticipated this with remote supervision argument. Whatever happens, I hope patients health is not compromised once all those knowledgeable pharmacists are disposed of.

Leon The Apothecary, Student

My first thought would be an outright uncompromising refusal is simply a traditionalist mentality that neither adds nor improves an idea. Pharmacist access would actually be increased for patients, specifically those who are housebound, or unable to visit the premises through the unshackling of the clinical professional - an advocate that the RPS endorses in point three and four.

I think it is also important for anyone reading this article to consider remembering that legally being able to supervise medicines supply, also more commonly known as handing out the packaged bag to a patient, is far less insidious than has been represented in the open letter. That medication still underwent a clinical check by a pharmacist.

Mike Hewitson and Ben Merriman should embrace their professional colleagues, and work together with their closest allies in an altruistic and objectively constructive teamwork to better serve the most important aspect of our work, our patients.

Ilove Pharmacy, Non Pharmacist Branch Manager

But money is first and patients somewhere after. Don't believe me, speak to government ministers, Boots etc...(off the record obviously)

Trudi Ward, Accuracy checking technician

Totally agree! and your last paragraph really hits the nail on the head.

We all want the best for out patients, so lets at least discuss and explore alternative models?

Innovation can not happen in a stifling closed minded environment. I suspect much like your comment, there will be thumbs down galore, since we dont have an MPharm!

 

Paul Samuels, Community pharmacist

If you do the amount of training that is required for an M.Pharm degree & pass that exam then I am sure most of us would have no objection to your supervisory function.

However there is still a lot of wiggle room for you to have a more full role in the general practice situation -- I work with a lot of technicians who I feel could have expanded roles with the backup education & qualifications.

Maybe I am old fashioned but nearly 50 years on the register has hardened my opinions.

Leon The Apothecary, Student

And there is a key point right there, clear lines of referral, industry standardised training and accreditation qualifications, there are many chains of thought to flesh out and address reservations. Nowhere near a complete idea in its current state but one option that should be explored through professional discussion.

Andy Burrells, Community pharmacist

...Says the locum technician.

I've made three critical interceptions today alone JUST through chatting to patients whilst handing out meds. With all due respect to technicians, had I have not had my head buried in Koda-Kimble and Young's for near 5 years I wouldn't have recognised those problems or known how to deal with them.

Technicians are a vital cog in the community pharmacy, no doubt, but the core will always be the pharmacist for that very reason and many more. Removing supervision and control from that one (or more...) skilled, educated and responsible person can, in my opinion, only lead to preventable harm

Trudi Ward, Accuracy checking technician

I do agree, I guess having worked in hospitals and for CPPE for many years with  some of the top Pharmacy Technicians in the country, my view of the average PT may well be skewed. I'm not suggesting that all current PTs have the education and skills to maintain the required level of patient safety. However I do believe that it is possible for Pharmacy Technicians to also be educated, skilled and responsible.

Leon The Apothecary, Student

Well said, and quite rightly so. It's not about simply unleashing people into the role, it's about ensuring that they are qualified and competent to do so. However, we've also a lot of work to do on fleshing out the specifics.

Lyndsey Longden, Pharmacy technician

Well said Trudi! I would suggest PT's are more likely to be educated and skilled enough to handle the responsibility now that we are a registered profession. We realise we aren't Pharmacists and would never pretend to be! We wouldnt over step our boundaries and realise there would always be a need for a responsible Pharmacist but the day to day running/staffing etc of a pharmacy could be undertaken by the PT-Andy, with all due respect, you have made quite a sweeping statement there that PT's wouldnt have recognised the problems you discovered-i have to say there have been times that (shock horror) i have picked up on problems/interactions that were missed by the Pharmacist (even Pharmacists with many many years experience). Don't forget lots of the CPD courses from CPPE are directed at Pharmacist AND Technicians!

Pharmacist Pharmacist, Community pharmacist

Lyndsey, picking up interactions and clinical queries, can you honestly say that you can use your clinical judgement? If there is an interaction, you may think a pharmacist overlooks it, but in his eyes he has used his professional and clinical judgement to allow it to be dispensed, becasue he has years of training behind him. He knows what a serious and non serious interaction is. With all due respect, this is something that a Pharmacy technician will never be able to achieve

Yuna Mason, Sales

Yes there is a patient safety issue there. Who is running for RPS president? I like Martin Astbury he seems to understand the realities in pharmacy and is down to earth

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