Background and Aims Recent RPSGB and Government policy (1) on support staff has re-focussed the skill mix debate within community pharmacy. Extending the role of support staff is considered necessary if pharmacists are to meet the modernisation agenda. Despite this, little is known about the activities of support staff, or their views on their future role. The aims of this research are to clarify and describe the tasks undertaken by community pharmacy dispensary support staff and to identify the factors that are likely to affect their skill mix profile.

Method A case study approach to the research was employed. Six community pharmacy 'cases' have been purposively sampled to include dispensary support staff in different settings in order to enhance variation in the range of tasks, personnel, locations and environments likely to impact on skill mix issues. Data was collected using a range of methods, including, direct observations, semi-structured interviews, documentary evidence and supporting contextual material. One week was spent in each 'case' observing dispensary support staff performing their routine tasks. Data was recorded using written field notes, which were transcribed. The interviews with support staff explored their views about their current and future role. Contextual data about the pharmacy and its staff and where possible documentary material e.g. job descriptions were also collected.

Results
Observations have been conducted at three sites to date. Preliminary analysis of the material suggests that while the pharmacies differed in type, location and staff profile (See Table), common themes emerged.

Table: Pharmacy and skill mix profile

Although some of the more highly qualified staff have overall responsibility for a service e.g. nursing homes, there is no apparent association between the day-to-day tasks undertaken by the staff and their qualifications, with unqualified staff undertaking the same or similar tasks, e.g., dispensing methadone, as the pharmacy technicians. Conversely, pharmacy technicians perform arguably 'unskilled' tasks e.g. unpacking an order. Those without S/NVQ Level 3 expressed mixed reactions about becoming a pharmacy technician. Inadequate support to complete the training was identified as one barrier. Once qualified, the job itself remains the same and there is little financial gain, which can act as a disincentive.

Discussion
The success of skill mix in community pharmacy relies on the appropriate use of pharmacy support staff. This research suggests that while tasks undertaken by different grades of staff need to be more clearly defined and performed by suitably qualified staff, other factors such as the size of the organisation and staffing levels need to be considered. Also, in the process of extending the role of support staff the views of staff themselves need to be taken into account since not all of them may want this extra responsibility.

1. Department of Health. Pharmacy Workforce in the New NHS: Making the Best Use of Staff to Deliver the NHS Pharmacy Programme. London: Department of Health, 2002.