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No time to deliver new services? ACT now!

by Gareth Malson

Pharmacists are being asked to deliver more clinical services, but with prescription numbers rising, who can find the time to deliver them? Gareth Malson describes how some pharmacists are using accredited checking technicians to free their time

Business insight | Implementing a new service| Getting the best from your workforce

 

Weight management consultations, medicines use reviews, diabetes monitoring, supplementary prescribing — the list of opportunities for pharmacists to be involved with clinical services is exhausting.

However, many pharmacists argue that, with prescription numbers rising, they do not have the time to deliver such services. Fair point. So why not train one of your support staff to be an accredited checking technician (ACT)?

“Approximately 80 per cent of prescriptions received by community pharmacies are repeats,” says John D’Arcy, commercial director of Rowlands Pharmacy. “An accredited checking technician could take responsibility for checking all repeat prescriptions. This would free up a lot of the pharmacist’s time.”

Some community pharmacies are already seeing the benefits of employing checking technicians. Such pharmacies include Regent Pharmacy in Shanklin, Isle of Wight, Rowlands Pharmacy in Lever Chambers, Bolton, Parade Pharmacy in Havant and Boots Pharmacy in Horncastle, Lincolnshire. The dispensary workflow for these pharmacies is described in the panel (below).

Working with an ACT

The following are examples of how accredited checking technicians (ACTs) are used in four pharmacies across the UK.

Regent Pharmacy, Isle of Wight

Prescriptions are dealt with as follows:

  • Prescriptions are labelled by the pharmacist, who performs a clinical check on the prescription while doing so
  • If, after reviewing a prescription, the pharmacist wants to counsel or have a discussion with the patient (eg, when the dose of a regular medicine has changed or a new medicines interacts with an old one), the prescription is marked
  • A dispenser assembles the prescription
  • An ACT checks the prescription and hands it to the patient (unless it has been marked for pharmacist counselling)

Boots Pharmacy, Horncastle

The pharmacy has two dispensaries. When a prescription is received, a pharmacist clinically screens it and annotates it if a prescribed medicine is new or altered.

Prescriptions are then separated into four categories:

  • Nursing homes
  • Community trays (ie, compliance aids)
  • Prescriptions for delivery
  • Normal (all others)

One of the dispensaries deals with all nursing home and community tray prescriptions. An ACT is responsible for checking all of these, and also helps a pharmacist to check prescriptions in the other dispensary.

Rowlands Pharmacy, Bolton

A pharmacist checks all prescribed medicines for suitability, interactions with other medicines and dose changes, and identifies new treatments.
If the pharmacist wishes to counsel a patient, he or she performs the final check on the medicines before handing them out with appropriate advice. An ACT checks all other prescriptions.

Parade Pharmacy, Havant

A pharmacist performs a clinical check on all prescriptions when he or she is available. If counselling by a pharmacist is required, the prescription is annotated or the pharmacist talks to the patient immediately, before the medicines are dispensed.

An ACT checks each prescription after a dispenser has assembled it. The only prescriptions not checked by the ACT are those that the pharmacist has not clinically checked first (eg, because he or she was in a consultation when the prescription was brought in) — these are checked by the pharmacist when convenient.

The pharmacist also checks prescriptions that the ACT does not feel comfortable checking (this sometimes occurs with handwritten prescriptions).

Benefits for pharmacists

Gary Warner, proprietor of Regent Pharmacy, performs a clinical check on all prescriptions while producing the labels for them. He can do this standing at the shop counter. He believes this makes him more accessible to customers and he is happier being distracted from this task than if he were performing a final check. “I can spend more time speaking to patients, which is what I’m good at,” he says.

Also, he no longer goes home at night worrying about whether the wrong item has been dispensed. “I’m more confident now that prescriptions are correct when they leave the pharmacy than when I was checking,” says Mr Warner.

“I feel that my clinical checks are better because I am able to focus on that aspect, rather than conducting an accuracy check at the same time.” He believes that since putting an ACT in place he has saved approximately 1.5 hours of his time per day.

Since training an ACT, Keith Seston, proprietor of Parade Pharmacy, finds he is able to spend between three and three and a half hours in the consultation room every day. “We can now complete more MURs, offer smoking cessation and diabetes screening services, and I can spend more time with patients — which generates loyalty,” he says.

Matthew Ngara, pharmacy manager at Rowlands Pharmacy, estimates saving 30–45 minutes per day, which has benefited his business. “Before I had a checking technician, I was struggling to complete any MURs,” he says. “Now, I have the time to complete at least one MUR each day.”

Different mindsets

Ann Avison checks a prescription at her pharmacy

When she works with a locum pharmacist for the first time, Ann Avison, ACT at Boots Pharmacy, explains the branch standard operating procedures and invites the locum to view her portfolio (which contains a log of the number of prescriptions she has checked and any errors identified).

“Most locums are happy for me to check prescriptions, but there are the odd one or two who decline my offer,” she says.

“However, because the shop is so busy, many of these pharmacists buckle at the knees by 3pm and reconsider my offer of assistance.”

Ms Avison believes that successful checking technicians adopt a professional attitude to work: “You may not be fully accountable as a technician, but you should approach the task as if you are.”

This mindset has resulted in Ms Avison making only six errors in four years — no mean feat, considering she checks 200–600 items per day.

Leanne Bushnell, checking technician at Mr Seston’s pharmacy, agrees that a serious approach to work is essential for checking technicians. “Keith is ultimately responsible for what happens in the pharmacy, but I consider my job and career to be on the line if I get something wrong,” she says.

Which shops benefit?

Samantha Butler, checking technician at Regent Pharmacy, believes that although employing ACTs in busy dispensaries is particularly useful, there is no reason why they would not suit all pharmacies. “Some pharmacists may not wish to employ an ACT because it may mean they have to dispense.”

She explains that the standard operating procedure at Regent Pharmacy prohibits her from having any involvement in the dispensing of a prescription that she needs to check. Mr Seston believes that all but the quietest of pharmacies can benefit from an ACT.

“Customers like to have a private chat with a pharmacist,” he explains, “so pharmacists need to free up their time to do this.” He adds that the career development resulting from implementing an ACT benefits both pharmacists and technicians.

Ms Avison does not believe every pharmacy will benefit from a checking technician. However the decision of whether or not to train an ACT should be based on several factors, not just a pharmacy’s prescription turnover.

“A decision should be made for each business individually,” she says. “If a business would benefit from its pharmacist having more free time, then an ACT should be considered.”

She urges pharmacists and pharmacy managers who would like to offer more advanced or enhanced services, but do not believe they have enough time, to consider training an ACT.

“Prepare a business case for your area manager stating how much it costs to train an ACT, and set this against how much your business could benefit from the additional services you could offer.”

Training costs

A framework for checking technicians has been endorsed by the Royal Pharmaceutical Society as good practice. Qualifications in accuracy checking prescriptions that adopt (or are based on) this framework are run by the National Pharmacy Association, Buttercups Training and several colleges of further education.

Training courses last about nine months and cost about £270 (+VAT). Currently, there is no national standard for these checking qualifications and they are not required by support staff to perform a final check.

However, the Society is reviewing its position regarding support staff qualifications, so this situation may change.

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Citation: Retail Round-upURI: 10034492

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Supplementary images

  • Checking technicians are considered a worthwhile investment for many contractors (Rowlands Pharmacy)

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