In her first interview since becoming president of the Association of Pharmacy Technicians UK, Liz Fidler tells Neil Trainis that greater awareness of her profession is needed…
“Do you know, I am a glass-half-full person,” Liz Fidler says jovially as she ponders whether pharmacy technicians have been given a rough ride in the press and by pharmacy bodies recently.
“I think we have to take a step back and understand why those challenges are being made.”
There has been much to occupy her since she took up her role as president of the Association of Pharmacy Technicians UK (APTUK) in February.
Shortly after her appointment, the Pharmacists’ Defence Association (PDA) published a 250-page report containing eight chapters, each of which had been released chapter by chapter over previous months, that addressed a variety of issues including the education and training of pharmacy technicians which the PDA said needed to be “substantially revised.”
That was prompted by concerns over the qualifications of pharmacy technicians who gained entry to the register through a “grandparent clause” created before the launch of the General Pharmaceutical Council (GPhC).
The clause allowed pharmacy technicians to voluntarily register with the previous regulator, the Royal Pharmaceutical Society of Great Britain, between January 2005 and December 2007 so long as they had a pharmacy services S/NVQ Level 3 or equivalent qualification. Registration then became mandatory.
The PDA also used its report to draw a clear distinction between pharmacists and pharmacy technicians in the wake of government plans allowing the latter to oversee the supply of pharmacy and prescription-only medicines to patients. Those plans caused a rumpus in community pharmacy.
Liz is unflustered at the mention of the PDA report and, in a small office in Stewart House, the University of London’s international programmes administrative building, is clear that she is keen to move on constructively from those debates.
“From my perspective, people tend to forget that actually, the profession is quite a new profession in terms of regulation. We’ve come from a point where we’ve had a plethora of qualifications and education routes, (to) a kind of skills-based vocational role that has evolved over the years to a point of registration to the point of becoming a profession.
“I think there’s a piece of work that needs to be done about understanding what the educational needs are of grand-parented technicians and how employers understand their role. And there’s something about embracing the new profession and the opportunities that’s provided.
“My view is that although it’s important to have debate and it’s important to understand where each of the organisation’s view are, but we need to move forward because there’s enough work for everybody and I think we’ve got to work collaboratively.”
Liz views the report as instructive even though she admits she was not impressed with the “style in which it was released.”
“My reflections are that I will not comment on behalf of my role as president of the APTUK on that particular report. It’s an interesting report and there are other reports out there and they need to be looked at in balance.
“I personally didn’t like the style in which it was released. (But) we’re different organisations with different approaches. There were some (chapters) that actually help us to understand the journey we need to go on as a profession.
“So things around entry qualification and understanding the baseline, I would absolutely agree with. I also think there’s something about understanding the role of the pharmacy technician, particularly in different sectors, and we’ve got evidence to support that. There is a difference with the role in community pharmacy or in an acute setting.
“But where we are now is we’ve been in a situation where we have new initial training and education standards, so we have a qualification that will do that baseline, and we are now embarking on a foundation piece of work, so those gaps will close.
“So I think there’s some interesting points in there we can use to move progressively forward. I personally will not get into any debate around who does what. I think it’s based on skills and competency and legislation.”
The PDA was not completely critical in its report. It highlighted that pharmacy technicians employed in community pharmacy earn the lowest wage of any healthcare technician while the average annual salary of a community pharmacy technician is comparable to a retail cashier, checkout operator and travel agent. The PDA appeared to suggest that pharmacy technicians are undervalued.
“I agree with that,” Liz says. “Within the report there are nuggets such as that which, fundamentally, no-one would disagree with. For me, it’s about how we move together as organisations to remedy that.
“If we recognise the value of pharmacy technicians in that sector, what is it we need to do from a professional leadership body to grow the trust and encourage the understanding of the role and accountability and how that complements the wider pharmacy workforce team rather than ‘they’re in the same category as… we’re not going to move forward from that.’
“So I would thank the PDA for highlighting some of the evidence behind these challenging situations but I’m really keen to move forward in terms of taking that learning and who do we need to engage with strategically to support and recognise a valued workforce.”
Liz is asked if she personally thinks pharmacy technicians should oversee the supply of medicines.
“I think that overseeing the supply of medicines is a really broad term. We need to drill down into what’s the right skill with the right competency in the right person in terms of supporting patient care. So I wouldn’t give a personal statement about that as a blanket statement.
“I think there are certainly things, particularly when you look in the new community pharmacy contract, that there are key roles that pharmacy technicians could engage with.
“When you look at the role of automation and how fast-paced things are moving, we have to move with the times but what we need to be clear on is where clinical responsibility lies in terms of supporting a patient with their medicines and where other regulated healthcare professionals can contribute to that system.”
A study by the PDA claimed most pharmacy technicians do not want the responsibility of overseeing the supply of medicines or supervising staff in the pharmacy in the absence of the pharmacist.
It found that 86%, 80% and 87% of pharmacy technicians would not supervise prescription-only medicines (POM), pharmacy medicines (P) or general sale list (GSL) medicines and other pharmacy staff respectively without a pharmacist.
“I think you’ve got to put it in context. The numbers were very small that responded to the survey. Let’s not forget there’s 22,000 pharmacy technicians approximately on the pharmacy register and the sample size is quite small,” Liz says unmoved.
“Again, it’s in the messaging around what does that mean? What does overseeing the supply of medication mean? Am I encroaching on another clinical professional’s role? Or is this within my scope of practice?
“The profession…its status is eight years old, so there is a significant proportion of the register which is what we band as grand-parented and legacy, individuals that went in to work in a pharmacy and have had the necessary knowledge and skills to do that but weren’t necessarily embraced with joining a profession and what that means and (the) differences with that.
“There’s plenty of work from the GPhC around what it means to be a professional. It depends on which sector of the register you would ask that question to.
“If you were looking at future generations of pharmacy technicians and the education they undertake, there’s a lot of professionalism built in there, a lot more law and ethics, ethical decision-making, so it’s about supporting that journey as we move forward.
“There will be a significant number of pharmacy technicians who are not potentially in the same space and we need to recognise that.”
PDA chairman Mark Koziol said pharmacy technicians working in community settings are not equipped “to take on additional clinical roles” because they have suffered from years of underinvestment in training and remuneration and lack of a structured career framework.
He urged the GPhC to address situations where pharmacists are compelled to pass on tasks to accuracy checking technicians regardless of whether they are confident in their ability.
Liz says she “absolutely” concurs with Koziol’s remarks on pharmacy technicians’ training, remuneration and structured career framework.
“But,” she adds, “I also feel that with the professional registration and with the positioning of the role of the pharmacy technician and the identification with it UK-wide policy, particularly the NHS England long-term plan, we now have a clear lever to enable those pieces of work to be done.
“One of my visions when I took on the role of president in February was around how we support this. The challenges (are) around ensuring there is adequate access to a quality education framework and that there is an opportunity to discuss funding and pipeline of pharmacy technicians.
“We know they have skills and knowledge to enable a lot of the work in a complementary way but what we don’t have is clarity in terms of a career.
“Many people would’ve fallen into the role of a pharmacy technician, certainly in my experience. How do you encourage school leavers with the correct attributes and skills to support what is a fantastic role (in) healthcare?
“Hopefully, what you would have seen in my early months in this role is a clear shift from APTUK to work with partners to deliver against those particular key points.
“The key to supporting trust and confidence with patients and wider healthcare is having structured, quality education that’s very clear to understand and some help understanding what the scope of practice is at the different levels that pharmacy technicians can practice.”
Work is currently being undertaken on the competency of pharmacy technicians. The Royal Pharmaceutical Society and the Work Psychology Group are analysing and reporting on the roles of early career pharmacy technicians.
The APTUK said it would use the analysis to inform its UK-wide foundation framework for pharmacy technicians, which it said would help establish the professional capabilities that will need to be tested at key stages of training programmes.
It is put to Liz that as things currently stand, a pharmacy technician would not be able to step in and do what a pharmacist does because they don’t have the same skills.
“I absolutely agree,” she says. “It’s all about skill-mix and utilising that in an effective way. I look at previous roles that I’ve had within pharmacy and the pieces of work we’ve led on around optimising skill-mix, so in particular, the role of final accuracy checking and how that can enable clinical services to move on.
“Also, in terms of health champions and more of a public health role and function as well as medicines optimisation in care homes, etcetera…the professions have been on quite a huge change with lots of impacting drivers on the outside of that and sometimes, there hasn’t been the opportunities to have the conversation to really understand the skill-set and knowledge that pharmacy technicians contribute.
“There’s a lot of misunderstanding about the difference between a pharmacy technician, a dispenser, a medicines counter assistant, a pharmacy assistant. It’s a huge piece of work that I’d be delighted to work with other pharmacy organisations to understand.”
Liz says it is her “understanding” that pharmacy bodies do not understand the role of a pharmacy technician.
“It’s about understanding the context in the registration arena, which is relatively new in terms of healthcare, and understanding the scope of practice.
“Pharmacy could learn from other professions in how they’ve managed that transition. I look to colleagues in nursing…a new role in terms of nursing associates has been developed and there was a challenging period when people didn’t understand the role of the nursing associate versus the registered nurse.”
It is not unreasonable to think the public is largely unaware that pharmacy technicians exist within a pharmacy team. That includes youngsters who may go on to consider a career in pharmacy.
One of Liz’s missions as president is to increase awareness of pharmacy technicians.
“I’m certainly keen to work with NHS Careers, NHS England and our colleagues in Scotland, Wales and Northern Ireland. Many pharmacy technician education leads from an England perspective have done a lot of careers talks in schools linked to the apprenticeship opportunity.
“The apprenticeship opportunity has given us the chance to spread the word about the profession and what it will look like in five to 10 years’ time.”
Her mind drifts back to the work of the RPS and Work Psychology Group.
“They are under way in terms of a desktop review and evidence base around the plethora of roles that are out there. (It is about) gathering information about the roles and speaking to various levels of staff and professions to understand what their interpretation of foundation practice is for pharmacy technicians.
“We will go out and do the traditional survey as far and as wide in terms of a public consultation and that will be analysed into a draft report around January time.
“The governance for this piece of work feeds through the APTUK partners engagement group which we set up in February. The group has representation from all key pharmacy stakeholders.
“That’s key for us because one of the challenges the pharmacy technician profession has had is we’ve developed things but we’ve developed things in isolation.
“We’ve developed pharmacy technician training for pharmacy technicians (but) people don’t understand how that sits in a career pathway. So we need to work with our partners.
“In addition to that, it will go to the Education Governance Oversight Board and that is around ‘what does that look like in practice, what does it need to make it sustainable and understandable.’”