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If pharmacists are to delegate more to pharmacy technicians, shouldn't they be taking more interest in what they are learning? 

If you are a pre-reg tutor, you will have an expectation of the extent of the knowledge of your recently graduated student. This will to a large degree be based on what you learnt as a student and your subsequent CPD experiences.

If you have a trainee pharmacy technician under your management, how much do you know about the course he/she is taking? The sad fact is that many pharmacists know only that the course takes a long time to complete and occupies many valuable working hours.

€Because NVQ students do not need any formal qualifications to register, I don't think that pharmacists always appreciate the academic ability required for successful completion of a technician's course,€ says Joanne Taylor, a technician working for Vittoria Healthcare, a small group of independent pharmacies in the north west, and secretary to the Association of Pharmacy Technicians.

Student technicians require two qualifications (or their equivalents) before they can register with the GPhC:

• A knowledge-based qualification €“ a Level 3 Diploma in Pharmaceutical Science
• A competency-based qualification €“ a Level 3 NVQ Diploma in Pharmacy Service Skills

Level 3 courses are of a similar standard to A-levels, which is why some training organisations will require potential students to have a minimum number of relevant GCSE passes before allowing them to enrol: it helps filter out those who may struggle academically.

Despite the fact that many students fall out and some question the relevance of parts of the syllabus, Joanne Taylor is adamant that the course is at an appropriate standard for community pharmacy. Tess Fenn, APTUK president and pharmacy NVQ manager at Guy's and St Thomas' NHS Foundation Trust, agrees.

€An A-level standard is appropriate for the responsibility and role that technicians should be taking on. They are able to work on their own under indirect supervision,€ she says. And she dismisses talk of separate qualifications for the hospital and community sectors.

€We still need a single qualification because we need movement across sectors. Any change would be a barrier. With the developments in the pipeline for community pharmacies, if they are expected to deliver more services, then the skill sets of hospital and community could start to merge rather than diverge,€ she believes. 

I don't think pharmacists always appreciate the academic ability required

Fully utilising the capabilities of pharmacy technicians could be important in the future. If the Royal Pharmaceutical Society's 'Now or never' vision of the future comes to pass, pharmacists could be delegating more tasks to such registered professionals.

And don't forget, the GPhC's Standards of Conduct, Ethics and Performance not only requires pharmacists to €contribute to the development, education and training of colleagues€, it also asks that they €make sure that they delegate tasks only to people who are trained to do them€.

Work in progress

There is an acceptance that, for the moment, the register of pharmacy technicians is a work in progress. RPS president Ash Soni has concerns about the competence of those on the register.

€There was no effective mechanism for determining whether people who were grandparented across [to registered status] were competent. Now technicians have to submit CPD records, but there will be a period of up to five years where there might be questions about the competence of the body of technicians on the register. If I delegate to a technician and they say they can do the task, then they have taken on that responsibility.€

It would be helpful to have an outline of the activities that technicians might reasonably be expected to do, he says, adding that there is work being done to clarify their roles and responsibilities.

The GPHC seems to have a very 'hands off' attitude towards the technicians' register, suggests Mr Soni. €It is a concern that the GPhC does not distinguish between pharmacists and technicians. Pharmacists have greater knowledge, and so have greater accountability and a higher level of expectation in the eyes of the public.€

Found wanting

The debate around roles, accountability and competence naturally leads on to delegation, an area where pharmacists may be found wanting. The medical and dental professions have some experience in this area, having integrated other professional groups into their practices.

Good Medical Practice (2006) advises: €Delegation involves asking a colleague to provide treatment or care on your behalf. Although you will not be accountable for the decisions and actions of those to whom you delegate, you will still be responsible for the overall management of the patient, and accountable for your decision to delegate. When you delegate care or treatment you must be satisfied that the person to whom you delegate has the qualifications, experience, knowledge and skills to provide the care or treatment involved. You must always pass on enough information about the patient and the treatment they need.€

Ros Foster, a partner at law firm Browne Jacobson, elaborated on this at a Pharmacy Law and Ethics Association (PLEA) seminar earlier this year. The law imposes a duty of care on healthcare practitioners to take reasonable care to avoid harm to their patients. Employees also owe a contractual duty of care to their employers to act with due diligence, she explained.

Pharmacists have to ask whether the delegation is in the best interests of the patient, she said. Have the risks been properly assessed and has the delegation been properly communicated? She advised that any pharmacist considering delegation to a team member should ensure that:

• The needs of patients are always assessed
• The level of experience, competence and role of the person to whom the task is delegated is appropriate
• Appropriate assessment, planning, implementation and evaluation of the delegated activity is undertaken
• The level of supervision and feedback is appropriate to the task delegated
• Rigorous protocols clearly define the technician's role within a clinical activity
• Protocols should be regularly reviewed
• The competences of the technician to deliver specific delegated clinical activities must be assessed prior to delegation and reviewed at regular intervals

It seems that pharmacists and pharmacy technicians are going to need to explore working together on a different level in the future. Pharmacists need to put in place frameworks that allow for effective delegation. Pharmacy technicians need to understand their responsibilities and limitations, and step up to the plate.