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The issue of supervision is rarely far from the pharmacy headlines, but the views of those actually doing the job at the grassroots have never really been heard. Asha Fowells looks at a recently published study that gave frontline pharmacists and their support staff a chance to air their views

Supervision. Just the word can make pharmacists groan. The topic has been debated for years, with some citing patient safety as a reason for maintaining the status quo that requires a pharmacist to be physically present during opening hours. Those calling for the rules to be relaxed have an equally convincing argument of wanting to better use pharmacists' skills and knowledge without restricting them to a set location.

While the topic rages on at conferences and seminars, these events tend to be the preserve of the profession's thinkers and strategists. Pharmacy undoubtedly needs these leaders but it is important that the opinions of those actually doing the job on a day- to-day basis are not overlooked.

Fortunately, this belief is shared by Pharmacy Research UK, which made the subject matter a priority several years ago. To this end, Manchester University School of Pharmacy undertook a study that aimed to explore the views of pharmacists and support staff working in community and hospital.

Study design explained

There were two stages to the study:

• Stage 1 involved visits to five community pharmacies, then four group discussions with pharmacists and support staff about the risk and feasibility of support staff conducting various activities in the absence of a pharmacist. This stage also involved telephone interviews with six superintendent pharmacists.
• Stage 2 built on the qualitative data collected in stage 1 by asking 1,500 pharmacists and 1,500 pharmacy technicians to complete a questionnaire that asked how safe and feasible they thought it was for support staff to undertake various pharmacy activities, as well as more general thoughts on supervision, support staff roles, competence, responsibility and accountability. The response rates for pharmacists and pharmacy technicians were 43.2 per cent (546) and 57.3 per cent (774) respectively.

The findings

The results were both predictable and unexpected. Few could be surprised that those working in hospital appeared more relaxed than their community colleagues about support staff undertaking a wide range of tasks when the pharmacist was absent, particularly if they could be contacted in the event of a query.

Similarly, it seems unremarkable that community pharmacists felt their presence was key to the pharmacy operating safely, especially because it provided an opportunity to intervene when they felt it necessary.

What was a little more unanticipated was the fact that many community pharmacists were reluctant to relinquish control, citing concerns about whether their staff could be trusted.

Familiarity was very important, says Ellen Schafheutle, principal investigator of the study. €Pharmacists who didn't know what the staff could do, for example occasional locums who hadn't worked at that particular pharmacy before, were much more cautious than those who worked in the same place regularly. It shows how trust comes from the understanding that builds from the experience of working closely in a team.€

There was also a marked difference between the way participants in hospital and community pharmacy distinguished between different types of support staff roles, she says. €Other than accuracy checking technicians, staff in community found it difficult to define how the role of a pharmacy technician differed from a dispensing assistant and so on. The issue is further muddled by the fact that some pharmacies have accuracy checkers who aren't registered pharmacy technicians.

€Community pharmacy could look to hospital pharmacy in terms of support staff role delegation and structure,€ continues Schafheutle, who lectures on pharmacy law and professionalism at Manchester University's pharmacy school. €Among our community pharmacy respondents, there was a sense that it simply isn't worth doing all the studying involved to become a technician and take on so much extra responsibility for what is often only an additional 50p an hour.€

Safe and unsafe activities

The activities that were considered €safe€ to take place in the absence of a pharmacist included taking in prescriptions, selling GSL medicines, signposting to other services, providing healthy living advice to patients, signing for deliveries, and assembling and labelling medicines (except CDs).

Activities considered €unsafe€ for support staff to perform in a pharmacist's absence included provision of certain services (minor ailments, patient group directions, MURs and NMS), and giving advice on POMs or clinical counselling.

Perhaps more interesting is the list of activities considered €borderline€, which include handing out checked and bagged prescriptions not requiring intervention or advice, putting away items in the CD cupboard and dispensing established repeat prescriptions that have already had a clinical check.

€I think there is always a concern that any errors made will come back on the pharm- acist who is in charge at the time, particularly if they are an occasional locum,€ says Heidi Wright, RPS practice and policy lead for England. €But there is a counter-argument that the regular pharmacist trusts their staff to do something, and in turn another pharmacist should trust their judgement as a professional colleague. Just as pharmacists are now recognised as experts in the use of medicines because of their five-year training, pharmacy technicians demonstrate their commitment by completing an in-depth course that takes two years and they need empowering to use their skills and knowledge.€

There is also a danger that pharmacists' reluctance to delegate could hold them back, Wright warns. €Having well trained support staff and making use of technology means that pharmacists can be more patient-facing than ever. Not trusting support staff to perform more dispensary-based tasks could stand in the way of progress,€ she says.

A culture change needs to take place

Next steps

As is often the case, education and awareness has a significant role in helping those working in community pharmacy overcome some of the issues highlighted by this study. Pharmacists and support staff need to have a clear understanding of the training every member of the team undertakes. Such an initiative should ideally be led by the professional regulator, although the GPhC declined to comment for this article.

But changing hearts and minds is always difficult. If possible, a culture change needs to take place, whereby the next generation of pharmacists and support staff understands from the outset what their work colleagues can do. A good way to do this is via interprofessional education, says Ellen Schafheutle.

€This would see pharmacy undergraduates undertake joint learning with student pharmacy technicians in some subjects, promoting from the very start of their careers that there are two professional groups working in pharmacy.€