Volume 21.4 
Oct 2005

Regulation of Health Care Staff in England and Wales

Introducing new legislation to regulate health care staff without adequate funding for training would 'cause chaos'. for general practices, warns DDA Chairman Malcolm Ward.

The DDA wishes to see a system of selfregulation for employed practice staff, and would oppose regulation of dispensing practice staff unless the government gives a firm commitment to fully fund the development and running costs of necessary training programmes - and that any new legislation would not take effect until such programmes are fully rolled-out.

"To do otherwise will cause chaos for general practices," said DDA Chairman Malcolm Ward in response to the government's consultation exercise. "While the Association fully appreciates that the public has a right to expect high standards of competence and care from all health care support staff, we believe an extension to existing regulatory powers should only be considered if there is 100% commitment to do this.

"The government must also be prepared to fully fund appropriate increases in remuneration if support health care staff have to undergo more intensive training and achieve better qualifications."

The examples of health care staff outlined in government papers such as Pathology Assistant Practitioners seem appropriate groups for regulation consideration. But no doubt the consultation process will throw up many other groups of workers, and it may prove difficult to know where to draw a line, added Dr Ward.

For example, the roles of primary care reception and administration staff are becoming ever more complex, with increasing responsibility. "At present they are unregulated and have no mandatory training standards beyond the vicarious responsibilities of the employing General Practitioner(s). Will this and should this remain the case? If legislation were to be rushed in to regulate such staff the potential to cause chaos within primary care is huge."

Much thought would also need to be given on the nature of any new training standards. NVQ courses would need to be created and large numbers of assessors and verifiers trained up to meet demand. Transitional arrangements would need to be extensive, with an adequate timeframe to allow training to roll-out whilst allowing staff to continue work.

"Practices would need to be funded in order to employ additional staff to cover time-out for training. Consideration would have to be given as to the nature of 'grand-parenting' criteria to allow, for example, those who are considered competent to do their jobs, but are nearing retirement, to continue to work without having to undertake further training."

The DDA is also concerned that regulation may lead to demands for re-accreditation for staff which would be too bureaucratic, time-consuming and unnecessary. "Practices have a vested interest in identifying failings of employed staff and are fully capable of taking appropriate action," said Dr Ward.

Dispensing practice

Although the RPSGB has set out training standards for the regulation of dispensing technicians and dispensing assistants who work in community or hospital pharmacy, it does not have jurisdiction over dispensers in dispensing practices.

The Association believes that it would not be appropriate for the RPSGB to gain regulatory powers for dispensing practices, due to the differences between dispensing practice and community/hospital pharmacy, and also because of the existing conflict of interests.

"We would prefer to see a continuation of selfregulation, with the employing general practitioners responsible for ensuring appropriate training and competency of employed dispensing staff," said Dr Ward. "But we recognise there may be a call from other agencies for our dispensing staff to be formally and independently regulated."

If the government decides this is appropriate, the DDA believes the Health Professionals Council (HPC) would be an appropriate Body for the regulation and registration of our dispensers. "But our general comments are particularly pertinent. The nature of dispenser training in dispensing practice is diverse. Many staff have been trained solely by the employing practice, others will have undertaken formal training, eg our own level 2 or level 3 distance learning courses, run in association with the People's College Nottingham; some have previously been employed in pharmacies and have BTEC, Boots or NPA qualifications.

"If formal training standards are to be set in relation to the regulation of our dispensers, the Government should be prepared to help fund the necessary training and course development costs."

It would not be appropriate simply to apply the same training criteria for our dispensers as for community and hospital pharmacy staff since the roles have distinct differences. For example, hospital dispensers have a fairly extensive product manufacture/extemporisation role, and community pharmacy dispensers an extensive role in relation to the sale of over the counter medicines.

These roles are in the main not relevant to dispensers in dispensing practice, which are not able to sell over the counter medicines, and virtually all medicines are bought by the practice in original packaging. Where special orders are required, these are almost invariably made and supplied to the practice by special order from specialist suppliers or hospital pharmacies.

Dispensers in dispensing practice work closely with the prescribing/authorising doctor(s) in the practice. Most dispensing practices have computer systems that integrate dispensing with the clinical system, so dispensers tend to have a much greater interaction with the patient and the patient medical records. The dispenser also needs to have a working knowledge of issues specific to the particular practice such as the practice formulary, chronic disease management, repeat prescribing protocols, prescribing budgets and PACT data etc.

Many dispensers in dispensing practice live and work in a rural setting and would not easily be able to access formal training in a college setting. Many work part-time and some may also have reception duties. Training our dispensers in community pharmacy is not practical for a variety of reasons, including a general lack of cooperation from pharmacists, and also because the training needs are different.

"The DDA is working with the People's College to convert our current courses to conform to NVQ requirements. This is a huge undertaking, involving the redesign of the course, rewriting much of the underpinning knowledge course material, and ensuring sufficient tertiary education colleges across the UK have the necessary number of trained NVQ assessors and internal verifiers - and are willing to run the course to ensure that an effective training programme is achievable within the time constraints of any subsequent legislation.

"If the government determines that dispensers in dispensing practice should be regulated by the HPC it is essential that the DDA and the GPC be consulted extensively to ensure that legislation does not come into force until the necessary training programmes are fully developed and running. Grand-parenting transitional arrangements would need to be agreed to ensure that those dispensers who lack formal qualifications, but are competent to do their job, can continue to do so."