How the enhanced clinical role for pharmacy technicians will help pharmacy owners deliver new services. By Saša Janković

The end of March saw primary care minister Andrea Leadsom announce government plans to give new powers to pharmacy technicians to supply and administer medicines, following two public consultations which found widespread support for giving new powers to these staff to cut bureaucracy and enable more efficient patient care.

As a result, pharmacy technicians will now be able to administer and supply specified medicines under patient group directions (PGDs). The government says the changes will “potentially enable” pharmacy technicians to undertake tasks like administering vaccinations and providing Pharmacy First consultations.

At present, pharmacy technicians are trained to national qualifications framework (NQF) level three in England and Wales and to level six in Scotland’s qualifications and credit framework. A recent General Pharmaceutical Council (GPhC) survey found that 72 per cent of pharmacy technicians felt “well prepared” after undertaking the initial education and training of pharmacy technicians (IETPT) training.

However, at a meeting of its council last month, the GPhC said it would assess whether the current minimum training requirements “remain appropriate, given the developments in pharmacy technician roles”.

Recruitment challenges

There are also recruitment challenges to contend with. The latest NHS Community Pharmacy Workforce Survey (2022) showed a 17 per cent decline in full time equivalent pharmacy technician numbers since 2021, despite the NHS Long Term Plan’s aim of growing the pharmacy technician workforce to support growth and transformation across the pharmacy workforce (although there is no specific commitment to numbers).

So how can pharmacy owners retain the technicians they have, recruit more if they need them, and make the most of their expertise and enhanced clinical responsibilities?

When it comes to recruitment, Mike Hewitson, superintendent pharmacist and managing director of Beaminster Pharmacy in Dorset, says recruiting fully qualified technicians in his area is “near impossible, so we focus on growing our own”.

Since the initial outlay in training technicians is quite expensive, Hewitson worked with his local integrated care board (ICB), which funds the training while Hewitson hosts the trainees in his pharmacy.

“The ICB recognised Dorset didn’t have enough pharmacy technicians and we all need them in pharmacy, GPs and hospital so it’s proven a really good opportunity to develop relationships with the students as they are training and then they are already part of the team by the time they join us,” explains Hewitson, who has one full-time technician and another who works part-time with him and part-time in general practice.

The technician’s view

Pharmacy technicians have also expressed delight at being able to do more in the pharmacy. 

Arunoday Lekkala is a pharmacy technician at Victoria Pharmacy in London, where he has been pharmacy manager since 2020. “Technicians do a great job and take on a lot of work in the pharmacy, especially when so many services are making things even busier,” he says. “But whatever I have achieved is because of some of the greatest pharmacists I’ve worked with. Community pharmacists need all the help they can get, so we welcome the chance to do more through these extended roles with open arms.”

Allaying concerns

The Pharmacists’ Defence Association (PDA) has warned in a statement that “the new Initial Education and Training for Pharmacy Technicians (IETPT), which is supported by a short online course, does not provide the degree-level underpinning education that is needed to support [technician’s] independent role in PGDs”, citing “patient safety concerns”. 

The PDA has taken the step of writing to Andrea Leadsom to express its concerns, warning that the new roles and services being developed by the NHS are “way beyond” pharmacy technicians’ “NVQ level 3 capability”. It draws parallels with concerns raised by the British Medical Association about the emergence of physician associates.

However, Nicola Stockmann, president of the Association of Pharmacy Technicians UK (APTUK), says that since pharmacists and technicians fall under the auspices of the same regulator – the GPhC – there should be no cause for concern. “As scope of practice for the entire pharmacy workforce expands, with examples such as the DHSC’s plans to include pharmacy technicians to operate under PGDs and independent prescribing for pharmacists qualifying from 2026, both autonomous registered pharmacy professions are regulated and will complete continued professional development as stipulated by the regulator,” she says.

Retired pharmacy technician and education consultant Tess Fenn is past president of APTUK. She was instrumental in paving the way for some of these changes and says there is plenty that should make pharmacists feel sufficiently comfortable with delegating to pharmacy technicians.

“The IETPTs, as well as including medicine knowledge, requires the trainee to show they can provide a safe, effective and responsive pharmacy whilst using information from all sources to make effective decisions,” explains Fenn.

“However, many pharmacy technicians undertake additional specific pharmacology, medicines optimisation and medicines safety training as part of their post-registration training, and many achieve additional nationally recognised competency programmes, all advancing clinical knowledge. They are also required to meet the GPhC’s professional standards from the outset of their career.”

As a result, Fenn says: “Being able to use their professional judgement, behaving in a professional manner, working to protocols and standard operating procedures, plus recognising the limits of their knowledge, skills and competence, and knowing when to refer to others when needed are all assessed key components of their initial education and training, and this behaviour would be applied to any delegated task. For example, when supplying and/or administering a medicine under a PGD, pharmacy technicians would follow local organisational policies and act within GPhC standards for pharmacy professionals and local governance arrangements.”

Service success

Green Light Pharmacy Group has at least one pharmacy technician in each of its 17 branches, and director and superintendent pharmacist Sanjay Ganvir says they are crucial to making a success of services.

 “The model we have at Green Light is to have our pharmacists at the front of the pharmacy consulting with patients in a whole range of NHS and private services, and making every contact an approach to medicines optimisation”, he says. “In order for that to work, it means they are not involved in the dispensing process, so we need really good leadership within the dispensary team, which is what our technicians are doing. Then we use ACTs a lot and that drives this process where we are having the dispensary teams being led by technicians, and the clinical service being led by the pharmacist.”

Ganvir agrees that the “robust regulation” of healthcare professionals within pharmacy should reassure pharmacy owners and the public that they are in safe hands. “The GPhC has looked at all of these new plans for technicians in extensive depth, and the regulations have been looked at in terms of the new guidance, and on a practical level. When inspections happen, the inspectors have very robust guidance so any new service is something they look at intensely – and that’s how it should be,” he says.

Hewitson, too, says he wouldn’t have a problem with delegating services such as flu vaccinations to technicians, since these are “very tightly controlled in terms of who can access them and when to refer”. After personally administering 9,000 flu, Covid and travel vaccinations himself last year, he adds: “That took a lot of time, but it is critical to the success of the business going forward that all of us need to get involved in these services. So if we can use the technicians to help supplement those, that is great. There are also some practical skills that the technician workforce may have that may provide a better service than some pharmacists, particularly if they are interested in the service. So it’s about getting the right technicians, giving them the right support and making them feel comfortable with that role.”

Fenn agrees that giving technicians added responsibilities will free up pharmacists’ time to deliver more patient-facing clinical services as well as improving access to primary care services for patients.

A more flexible workforce

“Delegating and entrusting tasks to others who are competent and capable furthers growth, and a more flexible workforce offers the potential to improve value for money,” she says. “This was seen during the Covid pandemic where, although under the legal framework of a Patient Specific Direction (PSD), pharmacy technicians became key to delivering vaccinations to the public.”

Hewitson says the more pressing question is whether community pharmacists can retain or see the value in building this workforce. “The current set up means there is not much the technician can do that a dispenser couldn’t,” he says. “But it is worth thinking about the future now, where you could have the technician running your flu or hypertension clinic, with the pharmacist providing NMS or other clinical services such as a prescribing clinic. We recognise the future is in patient-facing services.

“From my point of view, the pharmacist is the bottleneck in the pharmacy. As a group, pharmacists can do with any help they can get right now. So being able to better deploy our technicians helps us supplement the pharmacists’ capacity so they can focus on the stuff only they can do.”