NHS England (NHSE) is has issued an update on potential changes to its service specifications in light of recent legislative amendments that allow pharmacy technicians to supply medicines under patient group directions (PGDs).

In a primary care bulletin sent last night, NHSE said it was ‘developing processes’ to ‘consider updating’ NHS service specifications ‘in light of the new legislation for the maximum benefit for patients’.

This would include NHS advanced and nationally agreed enhanced clinical service specifications for community pharmacy, the update suggested.

But ‘this does not prevent registered pharmacy technicians from delivering services via a PGD outside of nationally commissioned services, as long as requirements are met,’ NHSE clarified.

Some private PGD providers have already begun enabling pharmacy technicians to use their protocols.

Graham Thoms, chief executive of pharmacy services provider Pharmadoctor told The Pharmacist that all 60+ of its services became active for pharmacy technicians to deliver from Wednesday (26 June) when the changes came into force.

'Over the last two days our partner pharmacy technicians have already treated and vaccinated hundreds of patients across our range of services including our travel clinic service, weight management service, vitamin B12 injection service and private Covid vaccination service,' he said.

He said that many pharmacies had already been preparing for the change in the lead-up to this week, by ensuring that their pharmacy technicians were upskilled and trained appropriately.

And he added that because of Pharmadoctor's step-by-step guided consultation software and training, he had no concerns about the suitability of pharmacy technicians carrying out these services.

'It's a bit different from [just having] paper-based PGDs, where they've got to interpret what those inclusions and exclusions and conditions are. Whereas, our e-tool will basically guide them through absolutely everything. So there's no room for misinterpretation, because the rules within the tool will pick up [any issues],' he told The Pharmacist.

Mr Thoms said he thought the change was 'long overdue' and highlighted the opportunity for pharmacies to increase the services they provide to patients due to increased capacity.

Meanwhile services provider Charac told The Pharmacist that its PGDs co-developed with accredited training provider ECG could be ‘assigned to an individual pharmacy, which will be named and set up on the PGD, and are ready to be used by pharmacy technicians’.

In general practice and primary care networks, pharmacist Graham Stretch, president of the Primary Care Pharmacy Association (PCPA), told The Pharmacist that there was ‘no reason’ why pharmacy technicians ‘once trained appropriately, and signed and named on [the] PGD’, couldn’t start using them in a primary care setting.

But he said that ‘in all likelihood’ the change ‘will be most utilised for immunisations in general practice come autumn’.

He added: ‘Since we widely use patient specific directions (PSDs) currently to facilitate pharmacy technician immunisations, it isn't initially likely to transform pharmacy technician practice overnight, but I'm hopeful more and broader roles will be facilitated over time.’

When the changes came into effect this week, community pharmacy negotiators in England and Scotland clarified that nationally negotiated NHS PGDs will need to be reviewed before pharmacy technicians can use them to supply medicines.

The Pharmacists' Defence Association (PDA) has also issued guidance to its members suggesting that 'only pharmacists should be delivering any PGD that involves an element of clinical assessment'.

It noted that in work around supervision, the sector identified that medicines supply that included the undertaking of a clinical assessment was 'reserved solely for pharmacists because of their more appropriate and comprehensive training and qualifications'.

'A study of the PGDs indicates that with few exceptions, the delivery of medicines via a PGD requires there to be a clinical assessment of the patient. This is to not only to establish a diagnosis and therefore to choose the right PGD, but there is also the need to ensure that there are no wider concerns such as an interaction with a potentially extensive and complex polypharmacy regime or associated co-morbidities,' the PDA said.

'Unlike a dispensing process, a PGD cannot be broken down and delivered in small distinct pieces. Under PGD regulations, they are designed to be delivered as one episode of care by one person. Consequently, when the patient safety consideration logic on medicines supply carries through to PGDs it dictates that only pharmacists should be delivering any PGD that involves an element of clinical assessment.'

And it said it would provide an update once the NHS service specification was agreed and available.