**3. Results**

#### *3.1. Participant Characteristics*

A total of 83 questionnaires were fully completed, which represented approximately 10% of the PT population in Wales. Participant characteristics are presented in Table 1.


**Table 1.** Participant Characteristics (*n* = 83).

The number of years which participants had been qualified varied considerably from 1 year to 38 years, with an average of 13 years. The majority of participants (69%) qualified prior to the introduction of professional registration in 2011. The majority of participants (89%) had worked as a dispenser prior to becoming a PT.

All four participants who indicated their consent for a follow-up interview were contacted by telephone. Two male and two female participants were interviewed. Interviews lasted 29 to 52 min, with an average of 37 min. As the purpose of the interviews was to provide further explanation, relevant summaries of the interview data and verbatim quotes are presented alongside the questionnaire results.

Figure 2 displays the type of community pharmacy in which the participants worked. The majority of participants worked in a large multiple pharmacy (60%).

**Figure 2.** Category of pharmacy in which participants worked.

Figure 3 illustrates the delivery method of initial education and training (IET). The majority of participants studied via distance learning for BTEC and NVQ qualifications. A quarter (25.3%) of participants selected 'other'—where there were multiple references to studying via distance learning.

**Figure 3.** Delivery methods for Initial Education and Training (IET). Key: BTEC = Business and Technology Education Council; NVQ = National Vocational Qualification; FE = Further Education.

Figure 4 presents the post-registration training undertaken by participants. The total number of responses exceeds 83, as participants were able to select as many options as applied. Two thirds (*n* = 54) of CPTs were trained as accuracy checkers and a third (*n* = 27) had undergone stop smoking training. A fifth of participants (*n* = 15) had received advanced inhaler technique (AIT) training.

**Figure 4.** Post Registration training undertaken by participants.

Of the 54 trained accuracy checking pharmacy technicians (ACPTs), 26 reported that it had enabled them to final accuracy check prescriptions. Of the 27 stop smoking trained participants, 4 reported that they were enabled to deliver smoking cessation services. Of the 15 AIT trained participants, four reported that they were enabled to deliver smoking cessation services. Two of these took part in the semi-structured interviews. Interviewee B (independent pharmacy) reported,

The smoking [training] certainly did [enable me to undertake the role effectively], because we've go<sup>t</sup> a lot of patients on the program, so we do a lot of that in our area, which is good. I—it was just myself and the two pharmacists that—in our two stores and my—the pharmacist here is usually quite busy with other things. So, I tend to take the smoking cessation patients, which is fine with me, because I quite like the—being able to do that service, so—and the training was quite extensive and really in-depth. So, I was able to take that up from day one.

In contrast, Interviewee A (large multiple) stated,

"Well with the independent [previous employer] I did the smoking with him, did that extra training, so I was certified for that".

Interviewee A wasn't involved in the smoking cessation service at that time of the interview and went on to explain,

It's lapsed. It's lapsed, I just haven't used it for so long working with the company I work for now, they just—you know most of the pharmacists kind of deal with that, so there are technicians that do do it in the company, but as for me it just never happened.

#### *3.2. PT Roles*

Qualitative free text comments describing current roles were categorized to identify core roles. Participants were asked to assign a percentage of time to each role they described—only 40 responses were correctly recorded (i.e., percentages were recorded and totalled 100%). Figure 5 is based on 40 (48%) responders, which shows that the dispensing of medicines remains a core role for CPTs. The data further highlight that CPTs who final accuracy check and spend over half their time engaged in the checking role. The data shows that few CPTs are working in leadership, managemen<sup>t</sup> and/or training roles, and those who are, spend less than 20% of their time engaged in the role.

The interview data further support the above findings. Interviewee A, C and D's roles related mainly to the sale and supply of medicines, e.g., dispensing and stock management. Interviewee A also described a limited supervisory role, e.g., training new sta ff and overseeing workload when locum pharmacists are present, and Interviewee C undertook blood pressure checks periodically. In contrast, Interviewee B's role was split between final accuracy checking and supporting delivery of enhanced services, e.g., targeting appropriate patients and administration of the Medicines Use Review (MUR) service. Interviewee B also reported that they were accredited to deliver the Level 3 Smoking Cessation and appeared more involved in the professional aspects of this service.

Participants were asked whether they had previously worked as a dispenser, where 74 (89%) reported that they had. Of those, 64 participants provided further comments, where 13 (20%) reported little or no di fference between the two roles, 3 (5%) reported no di fference other than the final accuracy checking role and 48 (75%) described important di fferences. Di fferences mainly related to a change in level of responsibility, final accuracy checking role, greater knowledge to provide advice and deal with queries, involvement in training, leadership and managemen<sup>t</sup> and more respect and value for the role.

More responsibility and more respected as a team leader.

> (P83, large multiple, 2017)

As a PT have the knowledge to answer questions / queries from customers with confidence. (P75, large multiple, 2005)

The pharmacist starting delegating more responsible roles to me. The knowledge I gained was used more e ffectively and I was allowed to demonstrate how my competence had improved. I felt I was trusted with more responsibility, because I worked in a more professional manner.

> (P53, medium sized multiple, 2003)

More responsibility—more involvement in problem solving.

> (P40, small chain, 2004)

#### *3.3. Perceived Barriers and Enablers*

Table 2 summarises the number of items, Cronbach Alpha, ranges, mid-points and scores for each of the five scales within the questionnaire. Each scale is illustrated and discussed further below.


**Table 2.** Summary of scale scores.

Figure 6 presents participants' views about the efficacy of their initial education and training (Q27, 28, 29, 30 and 32R). The Cronbach alpha for the 'Efficacy of Initial Education and Training' scale was 0.775, with scores ranging from a minimum of 7 to a maximum of 25. The results indicate that two thirds of participants felt their initial training had enabled sufficient development of the knowledge and skills required of the pharmacy technician role, with 68.7% scoring above the mid-point scale score of 15.

**Figure 6.** 'Efficacy of Initial Education and Training' scale scores.

Figure 7 presents participants' views on their colleagues' understanding of IET (Q33 and Q34). The Cronbach alpha for the 'Colleague Understanding of IET' scale was 0.703, with scores ranging from a minimum of 2 to a maximum of 10. The results show a wide range in scores, which suggests that there may be a lack of understanding around the IET curriculum and the role of a pre-registration pharmacy technician, with 43.4% scoring at or above the midpoint scale of 6.

**Figure 7.** 'Colleague Understanding of IET' scale scores.

Participants were invited to make additional comments about their IET. Twenty-three participants provided qualitative comments and four themes were identified; the need to improve the relevance of IET and opportunities to apply it; the importance of experiential learning to develop skills; the need for workplace support and the challenges of learning in the workplace.

"Whilst interesting most of what I learnt for the NVQ 3 has never been used in my current position".

> (P15, large multiple, 2002)

"The training was a base for a pharmacy tech, the skills needed are learnt through experience, it's not an easy job to do and definitely needs in depth training to fully cover all aspects of the job role".

> (P49, large multiple, 2011)

"Would have liked an on-site visit to assess my work, found the assessment was not portraying my work, instead of paperwork through my course".

> (P46, independent pharmacy, 2012)

Figure 8 presents participants' views about workplace support (Q11, Q12 and Q13). The Cronbach alpha for the 'Workplace Support' scale was 0.663, with scores ranging from a minimum of 3 to a maximum of 17. The results sugges<sup>t</sup> that two thirds of participants felt supported in the workplace, with 72.7% scoring above the mid-point of 9. The results also indicated that CPTs receive most support from pharmacist colleagues and that a quarter (*n* = 23) of CPTs do not have PT colleagues in their workplace.

**Figure 8.** 'Workplace Support' scale scores.

Figure 9 reports participants' views on professional identity (Q15, Q16 and Q18). The Cronbach alpha for 'Professional Identity' was 0.700, with scores ranging from a minimum of 5 to a maximum of 15. The results sugges<sup>t</sup> that the majority of CPTs have adopted a professional identity, with 88% scoring above the mid-point score of 9.

**Figure 9.** 'Professional Identity' scale scores.

Figure 10 illustrates participants' views on delegation in their workplace (Q20 and Q21). The Cronbach alpha for 'Delegation' was 0.666, with scores ranging from a minimum of 2 to a maximum of 10. The results sugges<sup>t</sup> that although delegation is utilised there, there could be scope to utilise it more effectively, with 68.7% scoring at or above the mid-point score of 6. This is consistent with interview data, in which Interviewees A and D reported that only pharmacists or managemen<sup>t</sup> staff delegate work, whereas Interviewees B and C reported that they could delegate unscheduled tasks. Interviewees C and D reported that Dispensers and PTs undertook similar tasks, though Interviewee C

stated that the dispenser refers any issues to a PT. Interviewee A reported that the PT role was intended to focus on running the pharmacy, but in practice, they often ended up covering dispensers' role, e.g., retail sales. Interviewee B (independent pharmacy) stated,

So the ACT dispense a lot less that what they used to, because we have people who dispense and then the ACTs do the checking. We—there's a lot more of a defined role now. I mean, I think we could still be better and there's still a lot we could do, but I think we're definitely moving in the right direction.

**Figure 10.** 'Delegation' scale data.

Participants were asked to describe factors which enabled them to undertake their role effectively. Fifty-three (64%) of participants provided qualitative responses and the main theme which emerged was support, i.e., team working, pharmacist support and managerial support. Adequate and on-going training was also highlighted.

Support of the superintendent pharmacist which enables me to lead and develop my team.

> (P6, independent pharmacy, 2009)

A strong supportive non-pharmacy manager plays a huge role in my pharmacy. Colleagues who work together in a very busy pharmacy.

> (P10, medium sized multiple, 2015)

My pharmacy manager gives me the encouragemen<sup>t</sup> and confidence for me to undertake my role effectively.

> (P38, large multiple, 2016)

Quality of training. The right person in the right task. Clean and efficient working environment. Good managerial team.

> (P66, large multiple, 2006)

I have continual trading [training] from my pharmacist to ensure I'm up to date with what I'm checking.

> (P73, medium size multiple, 2001)

The interview data provided a contrasting picture, with all four interviewees reporting limited workplace support. Interviewees C and D suggested they accessed support from specific pharmacist colleagues with whom they had a good relationship, whereas Interviewees A and B suggested that the only guidance or support received was from SOPs and annual performance reviews, respectively.

Participants were also asked to describe factors which were barriers to them undertaking their roles effectively. Fifty-nine (71%) participants provided qualitative responses and two key themes were identified. The first was staffing issues, i.e., inadequate staffing and lack of qualified or competent staff. The second was business pressures, i.e., busy environment, insufficient time and the prioritisation of targets.

We don't have enough staff for me to do my job role. I am the only qualified technician in our dispensary.

> (P7, large multiple, 2016)

Enough staff to have more time to take on the roles I would like to do.

> (P36, large multiple, 2003)

The pressure of a very busy pharmacy sometimes means you don't have enough time to interact with patients.

> (P9, large multiple, 1993)

Pharmacists having to take on too many services. Not enough time for them to do any prescription checking.

> (P58, large multiple, 2002)

Finally, participants were asked to identify any roles which they felt confident to do but did not currently undertake. From the thirty-one qualitative responses, four key themes emerged; enhanced services (e.g., weight loss, stop smoking and medicines usage review); extended roles (e.g., final accuracy checking); training and development and counselling and advice. The reasons given for non-engagemen<sup>t</sup> in these roles included; lack of relevant training, lack of time, staff shortages, minimal pay increase, domain of the pharmacist, demands of repeat dispensing, automation of dispensing process, lapsed accreditation and health board restrictions.

Offering weight loss service and stop smoking device [service] in pharmacy, unable to at present as not undertaken relevant training yet.

> (P77, independent pharmacy, 2013)

More enhanced services, specifically DMR (discharge) and flu jabs. I see no reason why fully qualified technicians can't learn and provide the service. Also we should be carrying out MURs in the home to the patients who need more assistance. Technicians should somehow be able to assist with that and be able to do the home visits and the medicines management.

> (P60, independent pharmacy, 2008)

There are lots of service roles that are aimed at pharmacists—no smoking, weight control etc. that both technicians or pharmacists could do but both are hampered by the continuous and increasing demands or repeat dispensing.

> (P56, independent pharmacy, 2009)

Checking prescriptions which I can no longer do due to the introduction on [of] advance dispensing and robot dispensing.

> (P55, large multiple, 2002)

Mentor staff when doing courses. I do this but only in a casual way. The pharmacist does this officially.

> (P45, independent pharmacy, 2001)

#### *3.4. Relationship between Type of Pharmacy and Barriers and Enablers*

There were no statistically significant di fferences between the category of pharmacy and the median responses to the sets of questions relating to e fficacy of IET (H (df = 5) = 4.249, *p* = 0.514), colleague understanding of IET (H (df = 5) = 6.645, *p* = 0.248), workplace support (H (df = 5) = 6.751, *p* = 0.240), professional identity (H (df = 5) = 7.514, *p* = 0.185) and delegation (H (df = 5) = 4.410, *p* = 0.492).
