Since April 2020, primary care networks (PCNs) have had access to funding for employing a pharmacy technician through the additional roles reimbursement scheme (ARRS).
However, many GPs will be unaware of what skills pharmacy technicians can bring the table.
Gareth Malson, lead Network pharmacist at Chester East PCN, answers some key questions about the role.
Pharmacy technicians can fulfil a number of roles in a general practice setting. One of the most important and time-saving for GPs is screening prescription queries. This suits the pharmacy technician skill set, because their training makes them very methodical and procedural, gives them a solid understanding of therapeutics and they are well practised at escalating any issues that are beyond their competence.
Other roles pharmacy technicians can fulfil include:
With additional training and experience, they can also do INR clinics and vaccinations (although, at the time of writing, they cannot legally inject medicines under a patient group direction so require a prescription or patient-specific direction).
Pharmacy technicians tend to be strong at following (and writing) procedures, and offering solutions for specific medication-related problems. They can conduct simple medication reviews, and screen patients to identify those who require a GP, pharmacist or practice nurse review. However, they are not able to prescribe in their own right.
Pharmacists are more adept dealing with complex medication reviews, and balancing risks in patients who are less ‘black and white’. Since they can become independent prescribers, they are able to make their own changes to medication regimen and monitor the impact of those changes.
Since pharmacy technicians are not prescribers, they cannot conduct structured medication reviews (SMRs) – a key contractual requirement for PCNs under the new Network DES. However, they could support pharmacists and other prescribers by running searches to identify patients suitable for SMRs. They could also do a pre-screen of suitable patients, requesting appropriate blood tests and documenting the indication for long-term medicines in advance, which would improve efficiency for those actually doing those reviews
Practices employing pharmacy technicians will typically see benefits from the support provided to GPs and, where employed, clinical pharmacists.
Pharmacy technicians could, for example, and with appropriate procedure and support in place, screen all outpatient letters and all medication queries for a surgery (see case study).
GPs will have many medication queries that arise during a day in general practice. While a clinical pharmacist is able to deal with these, a pharmacy technician can also deal with some – thus allowing a clinical pharmacist to spend more time with patients. Furthermore, if pharmacy technicians can identify patients relevant for SMRs, then pharmacists can spend more time doing them.
In Salford, student technicians have been completing a 2-year training programme that involved a 3-month rotation into general practice each year. An audit of their impact suggested the student technician service saved 15 hours of practice pharmacist time each week.
At present, the number of pharmacy technicians with experience in general practice is limited. However, there are many pharmacy technicians with experience in CCG medicines management teams, and many working in hospital and community pharmacy with skills that are transferable to general practice. Since ARRS rules state that a PCN can only employ one pharmacy technician (unless their CCG approves more), this could make it difficult to provide an equitable service across a large PCN with multiple surgeries.
The position is also relatively new, so GPs and practice managers are unlikely to have a blueprint in their heads about how to train a pharmacy technician, or the role they could play. To help with this, a competency framework was launched in September by the Association of Pharmacy Technicians UK and the Primary Care Pharmacy Association, to help guide the development of those working in primary care.
Pharmacy technicians should get indemnity cover, and can do so through organisations such as the Pharmacy Insurance Agency, Medical Insurance Advisory Bureau or the National Pharmacy Association.
Pharmacy technicians must be registered with the General Pharmaceutical Council. To be registered, they must have a relevant qualification, typically a BTEC or NVQ – a list of approved courses can be found on the GPhC website. They must also complete two years of work-based experience in the UK in a student pharmacy technician training role.
This year, Health Education England increased its funding for pharmacy technician training. Hospital or community pharmacy employers are being asked to join forces with general practices and provide a cross-sector training experience. Further expressions of interest for such training will be sought again next year.
Those who are likely to excel in general practice are those who are forward thinking, adaptable to change, willing to analyse and question existing processes. They don’t necessarily need to be fully proficient in all medicines, but they should have a reasonable understand for monitoring the long-term conditions that are normally managed in general practice and the implications of poor control or monitoring of those conditions.
Example job descriptions for GP pharmacy technicians according to experience can be found on the Primary Care Pharmacy Association website.
In hospitals, student technicians are employed on NHS Agenda for Change band 4. Registered pharmacy technicians tend to be band 5, while those with managerial responsibilities may be band 6 or 7.
PCNs can claim up to £35,389 towards the employment costs of a pharmacy technician, which covers a salary below the top of band 5, under the Network DES ARRS. This will need some consideration if PCNs try to entice experienced pharmacy technicians from the NHS, as they will probably already earn a wage that will require some top up to the ARRS funding and may be reluctant to lose their Agenda for Change terms and conditions.
On the other hand, the opportunity to work in general practice may well be very appealing to a lot of existing pharmacy technicians, given the lack of weekend or out of hours working.
Gareth Malson is lead pharmacist at Chester East PCN
Case study: How a pharmacy technician can free up clinicians for patient facing roles and improve safety
Pharmacy technician Salmia Khan joined a 19,000-patient practice in 2017. The practice operated across three sites, caring for six care homes. The training practice employed six GP partners, two salaried GPs, four nurses and a pharmacist. Here Salmia explains her role in improving patient safety while freeing up colleagues for their patient-facing roles.
Why a pharmacy technician? Following a significant event relating to hospital discharge medicines reconciliation, the practice reviewed its medicines management procedures. A key aim was to manage the clinical administrative workload more appropriately. The practice reasoned that the prescribing pharmacist, who is employed part-time, could remain focused on seeing patients face to face, while a pharmacy technician could review and manage some of the clinical administrative tasks.
What was your role? A major part of my role was to redesign the way the surgery dealt with outpatient letters and discharges. With initial oversight from the practice pharmacist, I set up a new process to screen clinical documents and reconcile medicines in a systematic way.
Over time, I became competent in reviewing clinical letters autonomously, only requiring GP input if a medication change was needed, or if I felt there was a new medical, social or safeguarding issue that required their attention.
As a result, the GPs were able to reduce the number of letters they reviewed each day to manageable figures. I would review and deal with up to 100 documents per day; around 50-60 required further action from myself.
GPs would still typically be required to deal with up to 20 letters a day, most of which would not require reconciliation of medication (for example, gastroscopy reports, safeguarding letters, A+E reports, anything requiring urgent action within 24 hours).
Where GPs received letters for other reasons – for example, for a referral to the local primary care multidisciplinary team – and medication changes were required, they would forward them on to me to make the changes.
I would also review the surgery’s ‘repeat prescription requests with queries’ with the prescription clerks each day. For the majority of these, I would re-authorise the prescription in accordance with a protocol and forward it to the GP to sign, with the query resolved.
I was also trained in phlebotomy and began running the INR clinic. This would mean identifying patients needing blood tests from clinic letters and hospital discharges, and patients having an INR check who were due annual blood tests, and arranging the bloods. If there were any clinical concerns about a patient who attended one of her clinics, I would ask the duty GP to review them while they were in the surgery.
How did the practice team benefit? As well as helping the practice improve QOF achievement, and improving the prescribing budget, employing a pharmacy technician saved time for GPs, nurses, and healthcare assistants, which in turn helped improve clinician availability for patients.
The GPs no longer needed to work on their days off to catch up with a backlog of document reviews.
After only a few months, the number of repeat prescription requests that required a GP’s attention was cut from around 250 to around five per day.
Prescribing errors in the practice were logged more frequently, allowing these to be shared within the clinical team for lessons to be learnt and admin staff to be upskilled to identify them earlier.
I was the first point of contact for local community pharmacies with queries about prescriptions, invariably meaning these were dealt with more efficiently and, where possible, without involving GPs.
Upskilling the pharmacy technician in phlebotomy and INR monitoring also increased the depth of cover if there was sickness amongst the nursing and HCA team.
Salmia Khan is a lead pharmacy technician at the Primary Care Pharmacy Association
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