Eight reasons I’m glad pharmacy apprenticeships have come and gone

Charles Odiase

 

Apprenticeships come into existence driven by certain factors, I will comment using the below headings;

 

Demand vs supply

 

Presently the demand for pharmacists is way less than the supply, especially as we have a lot of schools of pharmacy. Therefore a new workforce or route to becoming a pharmacist will only be a negative, as this would further compound the issue increasing the risk of unemployment and/or very low wages and poor employment conditions as we have often seen in community pharmacies in particular.

 

Insufficient workforce via conventional routes

 

As previously mentioned we have more pharmacists in the labour market than we have jobs, so how would a non – conventional route make the profession better? It would create frustration and drive further poor wages which is simple economics; more supply to demand equals lesser financial value attributed.

 

Void in workforce/skill required

 

We already have apprenticeships like the buttercup apprenticeships for dispensary workforce, we have pharm techs so where is the room for further apprenticeship in pharmacy; where was the need identified? This can only lead to further confusion and debates over roles and competences which could harm the already fragile public confidence in the pharmacy profession. Further conflicts within the profession; presently the profession is managing the conflict between Pharm Techs and Pharmacists, and this would only lead to further divide and frustration.

 

Government interference to take more control

 

As funding for pharmacy continues to be cut, giving the government room to boycott the profession only strengthens its position over the profession, leaving the profession helpless as there would no longer be a reason for employers and the government to feel obliged to meet the profession’s needs, disapproval and/or demand, as the conventional professionals become less relevant and the apprentices are loyal to their sponsors who are their employers, to the demise of the conventional pharmacist.

 

Precedence

 

There is no precedence for this idea I am aware of from anywhere else in the world, however, we have precedence for those who want to study a medical related professional degree which is simply applying for a transfer or conversion. Surely setting such precedence can only signify the downgrade of the perception of the pharmacist profession not just to our medical related colleagues but to the public as a whole. This isn’t simply a threat on employment or wages but on our colleague and public perception of the pharmacist professional status. It will no longer be a course viewed on par with medicine and the likes, the ever-struggling profession would simply lose its standing position in the room where others have sitting down positions, we will be sent out to stand outdoors in the cold and fringes for good. This could damage the pharmacist brand and this isn’t an exaggeration, we see this already with community pharmacists fighting the perception of simply being box checkers who pharm tech can replace.

 

Level 7 courses and apprenticeships

 

The uniqueness of medical related level 7 courses is they make emphasis on the combination of technical and non – technical skills = functional skills training. This takes time and experience 12months doesn’t provide, it is why the nurses are moving towards a degree pathway, it’s why we have advanced practice postgrad courses etc. To suggest that 12months is sufficient regardless of the individual having a first degree is simply an insult to the profession, I can only assume those in support probably never did an MPharm degree and to their defence don’t realise the MPharm degree is not the diploma or BSc degree they completed. Apprenticeships are often used in the social sciences and mechanical courses/fields as these fields depend more on technical skills and less on non – technical skills at their baseline postgrad level. However, in the medical related field I am yet to see this become common place for very obvious reasons such as the need to develop much needed non – technical skills which could be the difference between causing harm or preventing of harm to service users. Apprenticeship is good for less fluid crafts and skills, as often what is learnt is reproducibility not versatility.

 

Regulation

 

Regulation exists to provide uniformed standardisation which is much needed especially in medical related professions to assure public confidence in the profession. Apprenticeship regardless of guidelines put in place will further increase variation, as it offers more regulating powers to employers and other stakeholders whose drives aren’t fundamentally quality but labour acquisition cost. What we would see develop is similar regulatory flaws and loopholes observed during the time of the RPSGB leading to its enforced split. This will further compound the challenge faced by the GPhC which could lead to a further increase in GPhC fees.

 

Setting wages

 

How would wages be set as paying the post apprentice the same or more will surely create friction with conventional pharmacists whose training has cost a lot more and been more intense. It would affect the present poor wage structure more negatively.

 

I do hope for once pharmacists can rally together to wave off this threat to our profession, livelihood, public confidence and further professional divide.

 

Charles Odiase is an advanced clinical practitioner and specialist pharmacist in obesity and diabetes.

 

New qualification for pharmacy technicians has been submitted to GPhC

Skills for Health has announced that a new qualification for pharmacy technicians has been submitted to the General Pharmaceutical Council (GPhC).

 

Commissioned by Health Education England (HEE), the development has brought together seven organisations to collectively develop a new level 3 diploma for the pharmacy technician workforce. The qualification development commenced in March 2018 and a consultation was held in July 2018. The final qualification was submitted to the GPhC at the end of February 2019 in the first part of a two-stage recognition process. Awarding organisations will attend a qualification recognition event at the GPhC on 11th April.

 

A successful stage 1 outcome will allow the Level 3 Diploma in the Principles and Practice for Pharmacy Technicians qualification to be submitted to Ofqual by the awarding organisations, after which each one will have their qualifications recognised individually by the GPhC.

 

The qualification has been developed to meet the GPhC Initial Education and Training Standards (IET) for pharmacy technicians published in October 2017 and will support education providers with developing models of delivery to meet local workforce requirements across sectors. This qualification will be delivered over a two-year period to meet the requirements of the statutory regulator and will be available to learners from 1st February 2020.

 

Ellen Williams and Liz Fidler, HEE Project Leads said:

 

“We are delighted that this qualification has been submitted to the GPhC and look forward to the outcomes of the recognition event in April. This qualification will provide a solid foundation for pharmacy technician training, and on recognition by the GPhC, it will enable pre-registration pharmacy technicians to register with the professional regulator.”

We need to talk about codeine

Things have changed a lot with regards to opioids and children and young people over the past few years.  In 2013, the UK Medicines and Healthcare products Regulatory Agency (MRHA) recommended that codeine should no longer be used under the age of 12 years old. (1)

 

To kick off 2019, The American Academy of Paediatrics has published an article regarding the opioid epidemic in young people. (2) These two things actually had nothing to do with each other. The MHRA advice was about side effects and not about addiction.

 

What are we supposed to use instead of codeine?

 

Well, the seemingly contradictory answer that you may or may not have heard is (wait for it…) that we should instead use morphine to provide moderate pain relief to children.  That’s not as crazy at it first sounds but it does require some explanation.  The explanation begins with a bit of pharmacology.  Then by adding a bit of physiology, it all starts to make sense.

 

First the pharmacology:  Codeine is not itself the thing that produces the opiate effect.  Codeine is metabolised to various things, the most important of which is morphine.  Essentially, when you prescribe codeine, you are prescribing morphine via the metabolism of the liver.

 

Secondly the physiology. The codeine-morphine metabolism that occurs in the liver varies in speed and completeness from person to person. It is estimated that about 2% of the population are fast metabolisers.

 

The end result is that when someone takes codeine, there is a variable conversion to morphine. The morphine which results and has a clinical effect is produced in amounts and over a time frame that varies from person to person. While slightly less information exists about Dihydrocodeine, it is similar enough to codeine to make all of the above apply.

 

 

Is this possibility of harm all just speculation?

 

There is some weak evidence that codeine may be to blame for some child deaths, mainly in use as analgesia following tonsillectomy. (3) It was these cases which prompted the ban on the use of codeine under the age of 12 in the UK. Although there are plenty of reasons why the deaths reported here are not generalisable to all children requiring strong analgesia, a recurring theme is that children who died often had a fast metabolism gene.

 

 

Despite concerns and rulings, codeine is still used frequently in children. (4) Now it seems that young people are choosing it themselves more and more. (2)

 

The good news is that opiates are rarely needed in children outside of a hospital setting.  If strong analgesia is required on a temporary basis, oral morphine is often prescribed where codeine would have once been given.  This paradoxical move has come about through a better understanding of how opioids work and the effect they can have in children and certain patient groups.

 

We need to be wary of opiates and opioids in children. These drugs definitely have an important place and we shouldn’t hesitate to use them appropriately when acute analgesia is needed. A good first choice option for oral strong analgesia is oral morphine, while for more rapid onset, intranasal diamorphine works very well.

 

It seems that in the past we were lulled into thinking that codeine, in particular, was a soft and safe option. The evidence of recent years has told us that in terms of prescription use and abuse, this is not the safe drug that it was thought to be.

 

Edward Snelson is a consultant in paediatric emergency medicine at Sheffield Children’s Hospital. He writes gppaedstips.blogsot.co.uk and is the author of The Essential Clinical Handbook of Common Paediatric Cases. This post was originally published on his site and is used with his permission.

 

References

 

  1. April 2015 Monthly Newsletter, Medicines and Healthcare products Regulatory Agency
  2. Sharon Levy, Youth and the Opioid Epidemic, Pediatrics Jan 2019, e20182752; DOI: 10.1542/peds.2018-2752
  3. Kelly, Lauren et al, More Codeine Fatalities After Tonsillectomy in North American Children, Pediatrics May 2012, 129 (5) e1343-e1347; DOI: 10.1542/peds.2011-2538
  4. Chua KP, Shrime MG, Conti RM. Effect of FDA investigation on opioid prescribing to children after tonsillectomy/adenoidectomy. Pediatrics. 2017;140(6):e20171765