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Chapter 10: Staff training and qualifications
Headlines from this chapter
- There is no standard training for needle exchange workers in Scotland. Consequently, staff competency and qualifications vary. This was considered by some participants in this study to be an impediment to good practice.
- Many services employed very highly-qualified staff: nearly half of non-pharmacy services employed a worker with academic qualifications in drugs work, and a large proportion also had staff with formal nursing or social work qualifications. However, half also employed staff who had only in-house harm reduction training, and over two-fifths employed a worker with no formal qualifications, but with relevant experience.
- Regular training and good on-going support were seen to be especially important for pharmacy needle exchange providers. This must be provided not only for the pharmacist, but also for counter staff. High staff turnover among counter staff means that on-going training is necessary.
This chapter focuses on the training and qualifications of staff employed in needle exchange services across Scotland. The subject of training was raised by a number of survey respondents in their comments at the end of their questionnaires. The lack of standardised training for needle exchange workers in Scotland was clearly considered to be an impediment to good practice by some survey respondents.
Staff competency and qualifications in non-pharmacy services
Non-pharmacy services were asked to indicate whether staff currently working in the service had any formal qualifications or training in relation to needle exchange. The results are shown in Figure 10.1 below.
Figure 10.1: Number of Scottish services employing needle exchange staff with certain qualifications / training
These findings indicate that:
- Nearly half of services in Scotland employed a staff worker with an academic qualification in drugs work (for example, a certificate, diploma or degree).
- Nearly half also employed a staff worker who had only formal in-house harm reduction training.
- A substantial proportion had staff with formal nursing or social work qualifications.
- Eight services employed staff with a relevant vocational qualification ( NVQ or SVQ).
- Just over two-fifths (19 out of 45) employed staff who had no formal qualifications, but who had relevant experience.
- Five services had staff with other qualifications - such as a degree / diploma in Community Work or Community Education.
It was clear from these responses that needle exchange services frequently employ a number of different staff, all of whom may have different qualifications. Furthermore, in some cases, staff may have more than one qualification - for example, a Registered Mental Nurse ( RMN) and a Registered General Nurse ( RGN) qualification - or in-house harm reduction training and a diploma in community development.
Police custody suite exchanges were generally delivered by support workers or police officers with no formal harm reduction training.
Training for pharmacy needle exchange staff
Training for pharmacists prior to service delivery: Pharmacy co-ordinators were asked in the survey whether pharmacy staff are required to undertake any specific training before they can run a needle exchange facility. Nearly every co-ordinator (9 out of 10) said they were. Only one co-ordinator indicated that the pharmacists in his scheme were not required to receive training before delivering a needle exchange service.
Training for counter staff prior to service delivery: Seven (out of 10) pharmacy co-ordinators said that training was also provided to pharmacy counter staff involved in the delivery of needle exchange. Unfortunately, because of the way the question was asked, it is not clear whether staff were required to undertake this training before they could deliver the service. Only one pharmacy co-ordinator indicated specifically that counter staff were required to attend a 2-3 hour training session before they can provide needle exchange.
On-going training: Two (out of 10) pharmacy co-ordinators said that on-going training was not provided to needle exchange pharmacists in their area. Eight co-ordinators said that on-going training was provided. However, the nature of this training varied from one scheme to another, and in some cases, from one pharmacy to another. For example, on-going training might involve:
- An annual or bi-annual update session and monthly visits from the pharmacy co-ordinator or harm reduction staff
- Face-to-face training delivered within the pharmacy
- Instruction in safer injecting techniques
- Information about overdose and injecting wound recognition
- One-off optional training events on blood-borne viruses.
Other forms of support: All ten pharmacy co-ordinators said that support was provided to needle exchange pharmacies over the phone. Nine said they provided their pharmacists with written policies and procedures, and eight said that pharmacy staff were supported through regular visits to the service.
The training of pharmacy needle exchange staff was discussed at length in all three of the Scottish focus groups. One DAT respondent made the point that pharmacists often require more support and training for needle exchange provision than they do for supervised methadone dispensing.
Concerns were voiced about the negative attitudes of some pharmacy staff towards drug users. This was seen to be a particular problem in rural areas, but was not necessarily restricted to rural areas. However, focus group participants also had experience of pharmacy staff attitudes becoming more positive when they were given regular training and good on-going support. Both Fife and Tayside (see Box 10.1) were cited as schemes where pharmacist exchange providers were well-supported. Focus group participants pointed out that training has to be provided not only for the pharmacist but also for counter staff. Moreover, because of the high turnover of counter staff, it was felt that training had to be an on-going process, not just a once-a-year event.
One specialist service provider made the point that through their involvement in needle exchange and supervised methadone dispensing, pharmacies have become front-line drug services. Therefore, they need to be treated as part of the multi-disciplinary team that works with drug users, and they need adequate support to provide these services.
Box 10.1: Good practice in providing support to pharmacy needle exchange staff
In Tayside, the nurse-led harm reduction service has fostered close working relationships with local pharmacy needle exchange staff. This has been done in a variety of ways.
First, all Tayside pharmacies are supplied with injecting paraphernalia by the harm reduction service, and these supplies are delivered to the pharmacies by a nurse from that service. This face-to-face contact provides an informal opportunity for pharmacists to get specialist support and advice on a regular basis.
Second, the harm reduction team also provide formal training to all new pharmacy counter staff involved in the delivery of needle exchange. This training is provided on a rolling basis, as and when new staff come into post. The training generally involves small groups of no more than four people, and is delivered in pharmacy premises immediately after the working day.
Finally, one of the busiest Tayside pharmacy exchanges - a pharmacy in Perth - holds a weekly harm reduction session in their consultation room. During this session, service users have the opportunity to meet with a harm reduction nurse on a drop-in basis, to receive treatment for injecting injuries, referral to other services, and advice about safer injecting techniques.
Because of their regular face-to-face contact with the harm reduction nurses, pharmacy needle exchange staff in Tayside feel very supported.
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