**Definition**

Medicines optimisation is an approach that seeks to maximise the beneficial clinical outcomes for patients from medicines with an emphasis on safety, governance, professional collaboration, and patient engagemen<sup>t</sup> [9]. **Pharmacy Technician activities supporting patient safety include the following:**


To better understand the evolving role in GB, in this article we will look at the main drivers for change of the pharmacy technician role, how the role has evolved in response to this, what needs to change to support the transition (education), and finally, how the role may evolve further in the future.

#### **2. Drivers and Responding to Change in Great Britain**

In pharmacy, as well as all other sectors of healthcare, there never seems a point when the workforce is not under extreme pressure to deliver services. This has led to several NHS 'White Paper' publications including The Interim NHS People Plan [10] and the Interim NHS People Plan: the future pharmacy workforce [11], which state the importance of pharmacy involvement in patient and public care and identifying the support that pharmacy technicians can provide across di fferent sectors, practicing to the 'top of their licence'. The NHS England (NHSE) review on secondary care productivity in NHS Hospitals [12] (commonly known as the Carter Review) and most recently in 2020, the NHS England Update to the GP Contract [13], formally recognise pharmacy technicians alongside pharmacists as part of the skill mix needed to deliver person-centred care. It is through this formal

recognition that pharmacy technicians as healthcare professionals can progress further alongside other healthcare professions.

For changes to be successful, understanding skill mix e fficiency (ensuring the right people, with the right skills, are in the right place at the right time) and what can be achieved by maximising skill mix is critical. Poorly managed skill mix to just 'get a job done' could be counterproductive and a risk to patient safety. McIntosh and Sheppy highlighted that productivity and safety can be enhanced simultaneously by greater use of the skills and experiences of all sta ff and could enhance outcomes both clinically and economically [14].

Arguably, in the UK, there still remains some confusion as to pharmacy technicians' scope of practice, role boundaries, and accountability. This is more prevalent in the community sector, where there is often a blurring of pharmacy technician and pharmacy/dispensing assistant roles. One activity that does separate pharmacy technicians from pharmacy assistants is final accuracy checking, and a major training and development-funded initiative was introduced in 2016 by NHS England (Pharmacy Integration Fund) [15]. The intention of this ongoing initiative is to drive the greater use of pharmacists and pharmacy technicians in new, integrated local care models. Part of this initiative is to broaden the skills of pharmacy technicians working in the community sector by funding final accuracy checking—however, as this is still ongoing, no evaluation of its success is available.

In comparison, in the UK, the pharmacy assistant is an essential member of the pharmacy team and assists pharmacists and pharmacy technicians in both community and hospital pharmacy settings. In the secondary care setting, there is more variety and clarity of the role, whereas in community the role generally focuses on stock maintenance and the assembly aspect of the dispensing process but with less demarcation of responsibilities within the pharmacy team. On-the-job training, equivalent to UK level 2, is provided to meet the GPhC education requirements, however the pharmacy assistant is not a registrant.

Another contributing factor in community pharmacy is the use of locum pharmacists who may not be familiar with the team, and therefore be less forthcoming or possibly less confident in delegating tasks when they are the 'Responsible Pharmacist' [16]. However, this is not always the reason, and sometimes it is time pressures on managemen<sup>t</sup> that prevent implementation of skill mix strategy or sta ff that recognise greater use of extended roles and responsibilities [17] but may not feel empowered to influence any change. Although this is occurring less, it remains a barrier and can restrict flow of patient services. According to West [18], organisational skill mix reviews are key to ascertain what activities need to be carried out, who has the minimum level of skills to undertake them, and if new roles need to be created to fulfil optimisation. Pharmacists spending time on 'traditional' roles do not optimise their skills as they do not need to final-accuracy-check prescriptions, manage the day-to-day supervision of sta ff, or prepare sta ff rotas—which are technical duties. With e ffective communication, robust procedures, and clear understanding of boundaries and lines of responsibility, the majority of pharmacy technicians have the knowledge and skills or the potential to undertake these activities. As many pharmacists are managers, another aspect for making skill mix work is recognising the needs of the pharmacist—pharmacists need developed skills in delegation and managing teams, which some see as their own development requirements [19].

With further regard to skill mix, emerging evidence does not sugges<sup>t</sup> that pharmacy technicians are less safe when taking on extended roles. Rather, it suggests that because they are trained for the specific role, they are likely to have fewer competing demands and have been found to have a higher level of accuracy than pharmacists and other healthcare professionals [20–22]. However, this evidence is still very limited with small scale studies and wider, larger scale research needs to be undertaken to reassure pharmacists and wider healthcare teams that from these roles there is no worsening risk to patient safety or systems.
