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Company Chemists’ Association chief executive Malcolm Harrison says the GPhC’s proposals for pharmacy technician qualifications would set the sector back 

Community Pharmacy policy is starting to feel like a game of snakes and ladders. Just as pharmacists finally climb the ladder towards liberation from dispensing and to delivering more clinical care, proposed regulatory changes risk landing them on a snake and sending hard-won progress sliding backwards.

Pharmacists are at risk of finding themselves stuck in a contradictory loop of expectations - their clinical workload keeps rising, yet they are consistently pulled back to the dispensing bench.

The recent supervision reforms promised a way out. Changes would give pharmacists the freedom to focus on patient-facing clinical work, whilst recognising pharmacy technicians as capable registered professionals who can receive the delegated authority to supervise the safe and effective supply of medicines.

But the General Pharmaceutical Council’s (GPhC) proposals to raise Initial Education and Training (IET) for pharmacy technicians to Level 4, risks undoing the very progress the reforms were meant to deliver, undermining eight years of work the CCA has led on.

How the proposals are a risk to progress

Raising standards would appear to be a sound reason to propose any regulatory changes. However, when do we reach a point when the quest for perfection becomes the enemy of delivering “very good”?

We are led to believe that the GPhC’s push to increase the IET for Techs from Level 3 to 4 largely stems from concerns that the current cohort of level 3 qualified technicians cannot safely discharge the responsibilities of assembly and supply without the direct supervision of a pharmacist. 

When did they come to that position?

During the Department of Health and Social Care’s (DHSC) consultation on changes to Supervision laws, the competence and safety of level 3 pharmacy technicians were not presented as a central concern. The premise of the proposals at the time was that the system needed to make better use of the ‘skill mix’ of the registered professionals it already has (which includes level 3 technicians).

If competence there wasn’t a problem then, it’s hard to see why it suddenly is now.

Supervision reforms

The supervision reforms were long-awaited and widely welcomed because they recognised that pharmacists’ time is a valuable clinical resource.

It was understood decades ago that if pharmacists were to continue their journey of providing increased clinical contributions, through commissioned services and, in time, independent prescribing, the legal tether tying them to the dispensing desk needed to be loosened.

The supervision changes acknowledge that technicians can supervise the sale and supply of medicines as the ‘registered professional’ on site. This is a great step forward, meaning pharmacists will no longer need to directly oversee every step of the dispensing process.

That’s why the proposed changes to pharmacy technician IET feel so frustrating. It’s like the rules of the game have suddenly changed: ladders removed, snakes added, and all our hard-earned moves erased.

Other concerns of raising IET to level 4

Raising the IET for pharmacy technicians to level 4 not only risks stopping the benefits of the supervision changes but also brings other, wider concerns of its own.

There is a real risk that the proposed changes will exclude a significant number of people from entering a professional career.  Community pharmacy has always offered progression for people from a wide range of backgrounds with work-based learning. For employees who perhaps saw training to a level equivalent of 2-3 A-Levels (Level 3) a challenge, but one they could achieve.  The need to go further and attain a qualification the same as first-year undergraduate level could be a step too far for many.  Higher entry requirements limit access and risk social mobility and diversity.  A harder course also increases the likelihood of dropouts during training, which wastes both talent and investment.

Fewer technicians in community pharmacies will impact on patients. In addition, if technicians cannot be recruited or trained to level 4, pharmacists will be pulled back into supervising and checking dispensing, thus reducing their capacity for delivering clinical care.

Another concern is the cost. We estimate the change would cost the sector up to £150 million per year.

If the IET standard is raised to level 4, training times for those who can be recruited would become longer, more complex and therefore more expensive. At the same time, pharmacy technicians who have achieved a level 4 qualification would understandably expect higher pay and clearer clinical progression. With pharmacies already on extremely tight margins, many would struggle to not only fund the course but also absorb the resulting employment costs.

If the Level 4 proposal goes ahead, community pharmacies will find themselves unable to attract, afford, train or keep technicians. These would all exacerbate the significant workforce shortages already found across the sector.

Undoing progress

The supervision reforms were a great moment where there was alignment both across the sector and between policy ambition and the operational reality. The reforms offered a way to unlock the clinical capacity of pharmacists.  This would significantly improve access to primary care for patients, support independent prescribing and modernise pharmacy practice in a way that reflects how patients want to receive their care.  The government’s election manifesto commitment, to introduce a community pharmacy prescribing service, will be dependent upon the successful implementation of the supervision laws into every day practice.

The Level 4 proposal risks rolling the dice on hard-won progress, by shrinking the technician pipeline, increasing costs and making the delegation of supervision harder just when the sector needs it the most.

Any changes to the IET for technicians should not introduce barriers that effectively cancel out the reforms the profession has been waiting many years for.

Neither community pharmacy or the NHS cannot afford anything that promises progress but quietly does the opposite. By all means develop advanced and enhanced qualifications for pharmacy technicians, but I implore the GPhC not to pull up the drawbridge on level 3 entry to the professional register.