Claire Steele says protectionism within pharmacy needs to be eroded and pharmacy technicians must be trusted to work independently if their profession is to realise its potential. The president of the Association of Pharmacy Technicians UK talks to Neil Trainis…

It feels like pharmacy technicians are enjoying unprecedented recognition. Governments, policy-makers and regulators now hold them in the same esteem as they do pharmacists. And one might argue pharmacy technicians have come quite a long way in a relatively short space of time.

After all, it was not too long ago that people were questioning the validity of their training and opening up a debate on what they should and shouldn’t be allowed to do in a pharmacy. It was only about three-and-a-half years ago that the Pharmacists’ Defence Association published its constructively critical report on the roles and capabilities of pharmacy technicians in the UK. But the profession now seems to have widespread respect.

Claire Steele is optimistic about its future but she is cautious too. She has been a pharmacy technician for 24 years and spent most of her career in hospital pharmacy. Shortly after taking over as the president of the Association of Pharmacy Technicians UK (APTUK) in February, she justifiably said “the profile of pharmacy technicians is greater than ever before.”

And yet when she is asked if we really have moved past all the old debates about whether pharmacy technicians should be allowed to oversee the supply of medicines to patients in the absence of a pharmacist, whether their education and training needs to be, as the PDA at one point suggested, “substantially revised,” and whether they deserve the same recognition as pharmacists as a fundamental part of the pharmacy team, she is circumspect.

“There’s always going to be a pocket who will see pharmacy technicians as a threat,” she says. “The APTUK didn’t formally respond to (the PDA) report because it wasn’t something that we felt we did formally want to respond to. From my perspective, there has been a shift though in those traditional views of a pharmacy technician in that role.

“Has the Covid pandemic accelerated that? Probably, to some extent. But I think you need to recognise the sectors that are important here. If you think about pharmacy technician practise in community pharmacy versus hospital pharmacy, they’re significantly different in terms of scope of practice.”

At one time there were concerns that pharmacy technicians were gaining entry to the register through a “grandparent clause” created before the launch of the General Pharmaceutical Council in 2010. Claire, however, says she does not see that “as a barrier” and is confident that changes to the initial education and training (IET) of pharmacy technicians will go some way to alleviating any anxieties about the abilities and competencies of pharmacy technicians.

“For me, the education of pharmacy technicians has changed. We’re seeing pharmacy technicians qualifying with the new IET standards. There are pharmacy technicians who will (have) the traditional bolt-on qualifications and they’re going to be at the point of qualification and registration.

“I think it’s the same with pharmacists and other healthcare professionals when there are changes to IET. There’s always going to be that cohort that are pre-that, had different qualifications, who might need to do some bridging qualifications or training. That’s the same for any profession and it’s certainly true for pharmacy technicians.”

Protectionism needs to be eroded

She says there is still a degree of “protectionism” within pharmacy and you can understand why. For instance, in November 2020 the PDA accused the APTUK of attempting a “landgrab” on primary care pharmacists’ roles through its draft national competency framework for general practice pharmacy technicians. The framework focused on areas such as clinical governance, medicines optimisation and leadership.

The PDA said it had “the potential to cause patient harm” because it set out a professional role for individuals “whose training and experience has prepared them for a level 3 technical role.”

“This seems to want to bypass due process in its rush to landgrab as many roles as it can for a membership which is not adequately trained or ready. By being overly ambitious, it may have serious patient safety implications and over the longer term it may hinder the development of roles for technicians,” the PDA said.

Claire says protectionism should be “eroded” because “at the end of the day, this is about patient care. This is about what’s right for patients.” She insists with utter conviction that “every patient, every citizen, would benefit from an interaction with a pharmacy professional, whether that’s a pharmacy technician or a pharmacist.”

And yet it sounds as though she thinks there are sceptics of pharmacy technicians outside of the PDA. “I think you could say (protectionism exists) about most healthcare professionals and to be fair, pharmacy technicians are no different when you talk about what our role was 20 years ago to what it is now.

“You could say that about every profession. Do I still see it? Unfortunately, yes. Not so much professionally. Given my role, I’m very fortunate that I work in a truly integrated pharmacy service with very supportive colleagues. The marker for me, and I challenge organisations a lot on this, is more than ever before, we’re being asked to be around tables, involved in discussions but actually, it’s never really been equal representation and that’s something I challenge quite a lot because it becomes tokenistic.

“I still think there’s a little bit of fear there about what pharmacy technicians do. To my mind, we’re a team with different knowledge, different skills, and we need to use the best of each profession to really start to deliver what we want to deliver. I feel like that attitude is really holding us back.”

Criticism is not something I lose sleep over

Claire, who is also head of pharmacy medicines supply and quality at NHS Fife, is asked if all the noise the PDA has been making threatens to hold her profession back.

“I think the crux of the question here is the fact that the PDA is a union. The APTUK is not a union, we’re a professional leadership body, so I would expect any union to actively and vocally support only their members who are pharmacists and pharmacists only. I accept that. Does it affect me or the profession? I think probably not.

“The primary care example, I’m sorry, in Scotland we’re a little bit further advanced. It’s written into the GP contract. Pharmacy technicians are specifically named because there was a real recognition there that the pharmacist workforce would not be available to support everything that needs to be done in primary care. And actually, I think pharmacy technicians are well-placed to undertake quite a number of functions that have traditionally been undertaken by pharmacists.

“If you’re talking about medicines efficiency work for example, I don’t understand why there would be criticism of a framework which is intended to support individuals to develop. I’m a little bit unclear about that. It’s not something I lose sleep over if I’m being honest.”

Progressing the pharmacy technician profession has not been a smooth process across the UK. In fact, it’s a pretty mixed picture. In Wales, it has been supported by an advanced practice framework developed by Health Education and Improvement Wales to help pharmacy technicians develop their career pathways. In Northern Ireland, though, it’s a different story. There, it’s taking a long time for pharmacy technicians to secure recognition for their profession.

It was only in June that Northern Ireland health minister Robin Swann approved work to start bringing them under professional regulation by the Pharmaceutical Society of Northern Ireland. It may not be until 2025 that pharmacy technicians achieve professional status in the country and that is disappointing.

“I haven’t been involved in discussions but I know APTUK has been working with PSNI for a few years now on this,” Claire says. “As we’ve seen with other pieces of legislation and regulation, there is a tendency for that bureaucratic process that slows things down. I was just really pleased to see that recognition there. I’ve heard Cathy Harrison, the chief pharmaceutical officer for Northern Ireland, speak a few times. She speaks very passionately and supportively about pharmacy technicians. I can’t comment on the process too much but it does seem bureaucratic.”

There has been some support for pharmacy technicians in England. Last year, the Department of Health and Social Care pledged to put an additional £15.9 million towards training initiatives for pharmacists and pharmacy technicians through the pharmacy integration programme. It was designed to, among other things, improve access to clinical training courses for primary care pharmacy technicians. Claire ponders whether they really are in a strong position in England.

“It's probably too early to tell until the integrated care systems are fully formed. We’ve just advertised for a professional lead for England for APTUK and that’s in recognition of that changing landscape in England because we had professional leads for Scotland, Wales and Northern Ireland previously. There’s a lot of change. England is a much bigger beast than the other home countries and that brings with it its own challenges. I think it’s sometimes much easier to make changes in much smaller areas.”

Pharmacy technicians must work independently

Despite the development frameworks and funding, the pharmacy technician question tends to come back to a central theme; independence. Shortly after taking over at the APTUK, Claire said “we need to…amplify our lobbying for legislative change to enable pharmacy technicians to practice independently and optimise the care and services we offer to our patients.” She wants pharmacy technicians to work without being shadowed by pharmacists.

“That was me alluding to the supervision question and PGDs because they’re the two areas that APTUK has been lobbying on quite a lot over the past number of years,” she says. “The law is the law but the challenge we have is that it seems to be open to interpretation, so you could work in one pharmacy and have a very different interpretation of what that supervision actually means compared to another and I would like pharmacy technicians to be able to have the knowledge, training and skills to be able to advise patients independently and not have to go and check with the pharmacist.

“When I worked in community pharmacy which is a very, very long time ago, the extent of supervision was me selling a pharmacy-only medicine and shouting into the back room ‘I’m selling that!’ What interaction is there? It was me advising the patient on how to take that medicine safely, it was me who was answering any questions and that’s the example I use. Tell me what benefit that actually had in terms of the patient because I still to this day don’t understand that.”

In hospital pharmacy, she says, if there’s a high-risk medicine that requires “counselling,” that could be undertaken by an “appropriately trained pharmacy technician.” If it’s a “bog standard antibiotic,” then a pharmacy technician is “well placed to be able to counsel on that.”

“That does not need referring on to a pharmacist and they should have the confidence in their ability to do that,” Claire insists. “Now of course, if the patient says they want to speak to a pharmacist or there’s a very clinical question that the pharmacy technician doesn’t know the answer to, I would be expecting them in that scenario to refer because that’s the safe thing to do. But why we still have these archaic practices, I have no idea because they don’t add any benefit.”

She does not know how much support there is within the pharmacy profession for pharmacy technicians to supply medicines to patients and carry out other tasks with complete independence, but she insists she “would need to speak to our members to get a true grasp of how they feel in community pharmacy at the moment and how they feel in GP practices.” A study by the PDA in 2019 claimed most pharmacy technicians did not want the responsibility of overseeing the supply of medicines or supervising staff in the absence of the pharmacist. It found 86 per cent, 80 per cent and 87 per cent of pharmacy technicians would not supervise prescription-only medicines, pharmacy or GSL medicines and other pharmacy staff respectively without a pharmacist.

Claire reveals the APTUK gets asked questions by its members about best practice and what they should be doing “quite a lot” but concedes many queries would be better handled by a union. She also says pharmacy support staff get in touch with questions.

“That’s a tricky one for us because we’re the professional leadership body for pharmacy technicians, not pharmacy support staff, so that’s quite interesting. We can give advice as best we can but actually, pharmacy support staff don’t form part of our membership and it’s whether we might look at that in the future, perhaps associate membership.

“It’s something we’re kind of thinking about. It will be interesting to see how the landscape changes in the next few years. I think the skill mix and the role is going to change quite significantly because I think it needs to. If pharmacy is going to be fit for the future, we’re going to have to see some significant changes because are there enough pharmacists and pharmacy technicians at the minute? I don’t think so.”

That brings us to the public row between the PDA and the Company Chemists’ Association (CCA) over the reasons behind pharmacy closures which has generated intense debate and no doubt caught the government’s attention. The CCA said closures have been caused by a workforce crisis. The PDA rejected that. Claire agrees with the CCA.

“Certainly, that’s correct in my experience. We’ve seen in Scotland, the same in Wales and we’re starting to see it in England, the primary care role expand so rapidly. In Scotland, there was a huge demand for pharmacists and pharmacy technicians but we weren’t training enough to meet that demand and so we were pulling from other sectors.

“When GP practice in Scotland really took hold, we saw a drain of pharmacy professionals from community pharmacy and hospital pharmacy. You can understand that. But in my experience in Scotland and Wales and I’m hearing from NHSE that it’s the same in England, there’s a shortfall of pharmacy technicians and pharmacists.

“So I would side with the CCA which might be unpopular with the PDA, but hey-ho.”