Changes to supervision in community pharmacy: pharmacist and pharmacy support staff views

Abstract

Pharmacists now offer increasing levels and ranges of clinical, diagnostic and public health services, which may require a pharmacist to be absent from the pharmacy premises. Currently, in the UK, many pharmacy activities legally require the direct supervision and physical presence of the pharmacist. This study aimed to explore the potential for changes to supervision, allowing pharmacist absence, and greater utilisation of pharmacy support staff. Four nominal group discussions were conducted in May 2012 with community pharmacists (CPs), community pharmacy support staff, hospital pharmacists and hospital pharmacy support staff, involving 21 participants. Participants were asked to generate pharmacy activities, which they felt could/could not be safely performed by support staff in the absence of a pharmacist, followed by a discussion of these items and voting using an agreement scale. A written record of the items generated and voting scores was made and the group discussion elements were audio-recorded, transcribed verbatim and analysed thematically. The selling of general sales list medicines, assembly of prescriptions and provision of public health services received a high level of agreement between groups, as activities that could be performed. There was greater disagreement about the safety of support staff selling pharmacy medicines and handing out checked and bagged prescription items to patients. Group discussion revealed some of the main challenges to supervision changes, including CPs' perceptions about their presence being critical to patient safety, reluctance to relinquish control, concerns about knowing and trusting the competencies of support staff, and reluctance by support staff to take greater professional responsibility. The findings of this study aim to inform a future consultation on changes to pharmacy supervision in the UK. The empowerment of pharmacy technicians as a professional group may be key to any future change; this may require clarity of their professional responsibilities, enhanced career progression and appropriate remuneration to match greater responsibility.

The national consultation skills for pharmacy practice program in England

“…5,6 Pharmacy technicians, currently working under the supervision of pharmacists, will also play a larger role in supporting patients. 7 Together, they will face further involvement in patient care. To succeed in carrying out this extended role effectively, pharmacy professionals must move from a product-centric to a patient-centric approach to understand the patient perspective around medication use and support patients in decision-making.…”

Investigating the organisational factors associated with variation in clinical productivity in community pharmacies: a mixed-methods study

“…However, it may force pharmacies to rethink and reorganise the way they work, making better use of pharmacy support staff (particularly pharmacy technicians) in the more technical aspects of the dispensing process and, indeed, other services. Pharmacy technicians and other support staff have been shown in recent studies to be able and, indeed, willing to take on such roles [76][77][78] and this may free pharmacists' own capacity to deliver a wider range of advanced and locally commissioned services and open up new income streams.…”

“…Moreover, changes to existing supervision arrangements and the decriminalisation of dispensing errors may be required to encourage pharmacists to delegate responsibilities to pharmacy technicians and other support staff, something that they are sometimes reluctant to do. 76 An additional source of income for pharmacies could be an expansion of enhanced or locally commissioned services that would be facilitated by increased delegation of technical tasks to support staff to free pharmacists' time to extend their clinical role. However, the study findings suggest that variation in the commissioning of these services, levels of remuneration and, commonly, a short commissioning cycle are further barriers to the investment necessary for the uptake of these services by community pharmacies.…”

Embedding the clinician-researcher pharmacist in healthcare

“…Dispensing activities have already begun to be done by trained technicians and appropriate technology. [25][26][27][28][29][30] "The fact that pharmacists have an academic training and act as healthcare professionals puts a burden upon them to better serve the community than they currently do." 31,32 Increasingly, the pharmacist's task is to ensure that clinicians partnering with patients are achieving QUM.…”

“…It was understood that the United Kingdom (UK) had a welldeveloped technician program which produced highly skilled technicians working independently. 25,26,28,205 Examples of UK training guides, modified for Australia by the EPhR, allowed a technician to have the practical skills required for day to day support (see Appendix 11). An addition to this was to mentor the technician through a Certificate III in hospital/health service pharmacy support.…”