Main points
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At its meeting in London on October 5 and 6, the Council of the Royal Pharmaceutical Society emphasised the need for the Society to ensure that its deliberations and decisions always took into account the devolved political structures in Scotland and Wales. The matter was discussed during a debate arising from the Council's consideration of resolutions made at the 1999 branch representatives' meeting.
The debate was initiated by the chairman of the Society's Scottish Executive (Mr Graeme Millar) during consideration of the Council's response to a resolution, made on the motion of the Glasgow and West of Scotland branch motion, "that the Society recognises the reality of political devolution, by devolving further responsibility in a manner which will maintain the unity of the profession in Great Britain."
Mr MILLAR said that, as expected, devolution had served to heighten and extend the differences that already existed between the National Health Service in England and Wales and the NHS in Scotland. Such differences should not lead to rifts between the countries' policies and strategies but should be addressed by strengthening the collaboration between Lambeth and York Place.
The Society had an interest in promoting collaboration in order to instill harmony in the production of corporate policy applicable across Britain, but this would only come about if due recognition and weight were given to the readily identifiable different needs of the two health services.
The Scottish Department had to be the final arbiter in assessing these differences and therefore should be consulted before the construction or issuing of any documents that purported to have implications across Britain.
In order to retain a British Society, clearer and closer ways of working had to be put in place across the border. It was, therefore, essential that, at the inception of a decision taken in Lambeth to prepare any paper, be it on policy, strategy, guidelines or research, York Place was included in the scheme of things. A single corporate document could then be produced that served Scotland as well as England and Wales, or if necessary a separate document could be produced to meet Scotland's needs, and issued at the same time north of the border.
Occasionally a Lambeth report would have no bearing in Scotland, and it was important that this was made clear - not only in the report but also when the report was subsequently quoted from - for example, in The Journal. Equally, there would be occasions when Scotland would independently have to prepare documents.
It was imperative that the issues were addressed immediately and that all such documents issued to members or to other professions in Scotland should be issued through the Scottish Department. Without enforcement of such an agreement, the Scottish Executive would have to consider other ways of protecting the Society's standing and reputation in Scotland.
THE SECRETARY AND REGISTRAR said that, along with other organisations, the Society was learning to manage its affairs in a new environment and they had to learn together. Mr Millar had mentioned a concordat to help the Department and the Scottish Department to understand things. The concordats would have to be accepted by the Scottish Parliament and the Assembly in Wales.
She added that a day had been set aside when senior staff would consider what the implications were. The message should go out that the Society was seriously working through the best processes and reviewing what was needed to produce policy and how they had to organise to meet the changes.
Clinical governance
MR PATEL raised the topic of clinical governance. He had heard the clinical governance presentation on four occasions. It was a very good presentation. The previous evening Mr Pruce had attended the Barking and Havering local pharmaceutical committee and everyone was enthusiastic. However, if pharmacists were going to make a contribution to clinical governance they needed to free up time to prepare for clinical governance arrangements at a local level. What was Council going to do to make representations to the Government? Central pressure was necessary for payments to pharmacists. Most health authorities were saying that they were not in a position to provide funds for pharmacists, whereas there were quite a lot of funds available for the doctors. He felt they were in the same position as opticians and dentists.
Did the Council have an opinion on what they should be doing? Mr Patel believed that they should be writing to the Department of Health and pressing as hard as possible so that pharmacists were included from the outset in clinical governance arrangements.
MRS REMINGTON said that the hospital pharmacists group had developed a paper on clinical governance which went into more detail about the medicines management aspect. Mrs Remington recommended that the paper should be resurrected and published. It had been sent to Mr Pruce and to the editor of The Pharmaceutical Journal with the intention of having it integrated into the clinical governance paper (PJ, September 25, p479) or separately published in The Journal. She felt the hospital sector could find use for a product which looked more particularly at some of the work done in association with medicines management.
Policy formulation
The Council approved a decision of the Officers that a paper prepared by Mr Patel on increasing effectiveness in policy formulation and public affairs should be referred to the working group on New Ways of Working.
Mr Patel had prepared the paper because of concern that, at a time of "intense, high velocity change", traditional approaches to the management of change were inadequate. The aim of the paper was to build on the successes of the Policy Support Unit and the Public Affairs Directorate and to clarify the Council's role and involvement.
Internet pharmacy
THE SECRETARY AND REGISTRAR thought members might wish to see the internet brochure which had been produced by the Pharmaceutical Group of the European Union (PGEU).
MR ALLEN felt the brochure was particularly weak. He felt the arguments for not ordering medicines through the internet were extremely weak.
He asked for a reminder of where they were at PGEU in terms of e-commerce and also in terms of where they were with e-commerce in this country.
THE SECRETARY AND REGISTRAR replied that the British delegation to the PGEU had been in discussion with the Department of Trade and Industry and a briefing paper had been produced. That paper could be circulated to the Council.
MR DARLING said that the UK PGEU meeting with the Department of Trade and Industry had taken place the previous week. Mrs Sharpe was having preliminary thoughts in regard to the ethical implications for the profession. Those matters would be looked at by the Ethics Working Party. Within the building and within the organisation in Brussels there was significant activity at professional level and governmental level.
Mr Darling said the paper was not a PGEU document alone. The third paragraph read: "Medicines are promoted on the internet. The doctors and pharmacists of Europe want to warn you . . .". The initial drafting of the document was done by the doctors' equivalent of the PGEU.
The UK delegation to the PGEU and the UK doctors' representatives were meeting next Friday in order to see what other areas of common ground could be made to Government both in this country and within Europe. The PGEU had taken a decision within the past two years that much greater benefit would accrue to patients if the doctors and the pharmacists went together to the Commission and to ministers.
Mr Darling felt there had been a very welcome change in attitude within the two professions in Europe and he hoped that that would be expanded.
MR ALLEN expressed appreciation to Mr Darling for his clarification.
MR EMSON said the issue was a worldwide one. He wondered whether Mr Darling could say something about the planned distribution of the document. He welcomed the joint doctor/pharmacist collaboration but wondered whether there were any plans for the PGEU also to consult with industry and wholesalers or other people who might well have a view and an interest.
MR DARLING replied that it was something that should have been done although it had not been raised. Within the very near future there would be opportunities in relation to both prescription-only medicine manufacturers and the over-the-counter medicine manufacturers for the PGEU to raise the matter to seek sympathy and support.
MRS PARKIN said that within Public Affairs they were tracking the progress of the Government's Bill and its intention to put Britain at the centre of the e-commerce market because of the implications for the profession. They were also working through their contacts on the Health Select Committee to see whether or not it was an issue that the Select Committee would want to take forward. Early indications were that it would. The Select Committee would be talking to the Society to gain views. She had been talking to the Policy Support Unit regarding the need to bring forward some of the wider issues to the Council for discussion as a matter of urgency on e-commerce specifically and the allied issue of advertising of medicines on the internet.
MR ARGOMANDKHAH felt they should address the sale of medicines of any sort on non-pharmacist sites on the internet. They had little or no control over non-pharmacists. Perhaps the only way they could ensure that would be for Governments to put a block on the sale of medicines through the internet.
THE SECRETARY AND REGISTRAR said that the Medicines Control Agency would be very glad to hear from anyone who surfed the net and found sites in this country which were acting illegally. There were controls and the Secretary and Registrar felt it would be better to defer further discussion until they had a paper before them. As Mr Darling had said there would be consultations and opportunities when the matter could be discussed.
Foundation programme for Council members
The Council agreed in principle to introduce a foundation programme for new Council members with the aim of strengthening the Council's strategic impact. The programme would be designed to allow all new members to identify and develop their individual abilities and expertise. It would also be offered to existing members to update their skills.
It was agreed that a provisional programme would be piloted by volunteers from among existing Council members in time for a final version to be offered to new members elected to the Council in 2000.
An induction programme piloted in May, 1999, would form the first part of the foundation programme. It would be followed by elements on effective leadership, working together for effective solutions, and zero-based budgeting. Additional, optional, elements would include public policy structure, information technology skills, media and public relations, presentation skills, and continuing professional development updates on legal and ethical issues.
Skill mix
The Council approved in principle a revised set of proposals for implementing the recommendations of its "Skill mix" working group, which had been set up as part of the "Building the future" stage of Pharmacy in a New Age to look into how to make the best use of pharmacists and their support staff. The recommendations had been made in a document prepared in the light of the response to a consultation paper (PJ, May 23, 1998, p743) and proposing a new framework of qualifications for support staff involved in dispensing operations.
The Council had before it the report of a meeting held with representatives of the NPA, which had expressed some concerns about the original proposals for implementing the "skill mix" report. The two organisations had agreed to work together to assess the effects of the proposals in practice, to identify training needs, using SOPs as a basis, to identify minimum training needs, and to consider logistical issues.
As a result of the meeting, revised proposals for implementing the recommendations of the skill mix report had been drafted that took account of some of the concerns that had been expressed.
The preamble to the revised proposals noted the case for the introduction of the measures was strengthened by the passing of legislation providing for regulation of those working in support of a profession, the advent of clinical governance and the move to the culture of continuous improvement within the NHS.
The Society's proposals reaffirmed that the appropriate qualification for "pharmacy technicians" was the Scottish/National Vocational Qualification level 3 in pharmacy services or equivalent. It was noted that pharmacy technicians were predominantly employed in the hospital sector, where their roles could be extensive. The function performed by "qualified dispensing technicians" in the community were of a different kind, but for some tasks a level NVQ3 or equivalent qualification should be required, it was decided.
The Society also reaffirmed its view that all of the staff involved in dispensing activities - ie, anyone involved in the assembly of a prescription, including the generation of labels - should be trained to an accredited standard. It noted that dispensing activities would need to be defined as part of the work on SOPs.
For "experienced but unqualified dispensing assistants", the Society now proposed that pharmacists be required to make a personal assessment of competence based on standards that were to be defined. Those staff would have to meet additional criteria, for example, in relation to length of service and/or experience. Staff who could satisfy the criteria and had been assessed as competent by a pharmacist would be deemed to have met the Society's requirements.
The Society would issue further guidance on staff called on to work in the dispensary occasionally. This would require an assessment by the pharmacist of the competence of each member of staff concerned.
The Society proposed that further discussions should be held on minimum training standards and how the requirement for SOPs should be implemented. Account would be taken of feedback from the National Training Organisation's pharmacy sector committee during the course of development of S/NVQ level 2.
The Society noted that it or another body might have a role in accrediting courses which met or exceeded the minimum standard, particularly if that was not linked to an NVQ. Accreditation criteria would have to be transparent.
Finally, the Society made it clear that it hoped to work with the National Pharmaceutical Association and hospital pharmacists at all stages of implementation. Input from others would be particularly welcomed in developing SOPs for dispensing, criteria for assessment of experienced but unqualified staff, guidance on the use of occasional staff, time lapse before new staff commenced training, and on assessment requirements (if any) for experienced but unqualified staff who changed employers.
When, during discussion, the advisability was questioned of permitting pharmacists personally to assess experienced dispensing assistants, the President pointed out that, under the Code of Ethics, the pharmacist was accountable for the work of staff in the dispensary. The wording should be changed to reflect that.
Complementary medicine
The Council agreed that a response should be submitted to the House of Lords science and technology committee's inquiry into complementary and alternative medicine. Council members were asked to consider a draft response prepared by the Council's Science Committee and submit comments in time for them to be considered for inclusion in the final report.
Among other things, the draft response called for: protection of the public from bogus claims; more objective and impartial advice for the public; high quality clinical trials, practice research and health economics research; adequate training for all complementary medicine practitioners; regulation to protect the public from risks associated with complementary therapies; a licensing system that would regulate all herbal medicines for appropriate evidence of efficacy as well as safety and quality; and greater integration of complementary medicine into health care.
Registration examination
The Council agreed to seek an amendment to the Society's Byelaws to remove the possibility of candidates having a fourth attempt at the registration examination. Candidates who experienced pre-existing adverse circumstances that might affect their ability to pass the examination would have the option of postponing the third attempt or appealing against the result. Candidates who developed illness or some other problem on the day of the examination would be able to ask for the third attempt to be declared void so that they could undertake another "third" attempt.
This agreement was subject to further consideration to ensure that there were no unsurmountable practical problems.
Preregistration training
The Council agreed in principle to revise the requirements for the preregistration year so that all trainees would spend some time in both hospital and community pharmacy. The lengths of the two periods would be flexible, subject to a specified minimum period in the secondary field of employment.
The Council also agreed that the Society should no longer stipulate sector-specific experience. Provided trainees covered enhanced core performance standards, training programmes would be able to vary to take advantage of different experiences available at different training establishments, allowing trainees to choose programmes most suited to their needs and interests.
The Council decided to wait until after the Industrial Pharmacists Group Committee had had a chance to discuss the matter before making a decision on whether trainees should in future be able to spend a portion of the total period in the industry or other "non-standard" settings.
The Council made its decision on the recommendation of the education division, confirmed by the Education Committee, which had consulted representatives of the main training providers about ways of implementing a 1996 decision of the Council to introduce a new programme of preregistration training that would put the patient first, produce pharmacists fit for practice in any sector of the profession, promote seamless care and foster co-operation and understanding among different sectors.
Presenting the education division's proposals to the Council, Mrs VIRGINIA WYKES (education officer) told the Council that the consensus view at a meeting with representatives of the main training providers on September 28 had been that the proposals were practicable, although some local logistical problems would arise.
Mrs Wykes said that the view of the education division was that the proposal should be implemented in the summer of 2000, which would be the first preregistration year after the "fallow" year.
Asked about the implications for sandwich course students, Mrs Wykes said that discussion had been held with the Bradford school of pharmacy, which felt that it could fit in with the proposed new scheme.
NICE and CHImp
The establishment of the National Institute for Clinical Excellence and the Commission for Health Improvement raised new policy-related challenges and opportunities for the Society, the Council was told by Professor David Taylor (Policy Support Unit).
Presenting a document on the development and likely impact of the NICE and the CHImp, Professor Taylor said that the Policy Support Unit had identified four principle strategy issues.
The first was that the profession should seek to participate constructively, and at the earliest possible stages, in the work of both the NICE and the CHImp. The Society ought to act as an "honest broker" in what were likely to be prolonged and contentious public debates on medicine availability via the National Health Service and ensuring care standards.
Secondly, the Society should further develop its dialogue with the NICE and the CHImp. It should back up its contacts with practical suggestions for co-operative activity in areas such as the preparation of consumer-focused guidelines and support instruments, and consultations on new models of professional and clinical governance in primary and secondary care.
Thirdly, the Council should support members of the profession wishing to extend their competencies in quality management and health economics, and consider the extent to which such topics should be included within the undergraduate syllabus. One option would be to publish an explanatory review of (or practical manual about) health economics and pharmacoeconomics, tailored to the needs of pharmacists and pharmacy students.
Fourthly, the Society should produce other original contributions to public and professional debate on NICE- and CHImp-related topics. Another option was for the Council to examine whether or not the discussion paper should be adapted for separate publication or use in connection with the ideas expressed.
The Council agreed that the strategy issues identified in the paper should be worked up by the Policy Support Unit and considered at the annual strategy review. It was also agreed that copies of Professor Taylor's document should be made available to members of the Society on request from the Policy Support Unit.
Accreditation of aseptic preparation units
The Council agreed that the Society should look into the possibility of developing a national accreditation system for non-licensed aseptic preparation units in hospitals. It did so at the suggestion of the Hospital Pharmacists Group in the light of the identification of quality assurance issues in aseptic preparation. It was noted that the Medicines Control Agency was not considered an appropriate body for such a function, given its orientation towards non-clinical areas and practices, whereas the Society, as well as representing the entire profession, had extensive experience in independent quality assurance and inspection procedures.
Byelaw amendments
The Council approved the submission to the Privy Council of proposed amendments to the Byelaws in relation to the statutory fees. It was noted that no comments had been received from members during the 60-day period from publication of the proposed amendment in The Pharmaceutical Journal.
The Council also agreed to seek a Byelaw amendment designed to speed up the handling of Byelaw amendments. Currently, the decision on whether or not to submit a proposed amendment to the Privy Council for approval was made by the full Council after considerating a report of observations made during the 60-day period following publication of the proposal. The Council agreed to seek an amendment such that, where no comments were received, the Officers alone would be able to approve the submission of a proposal. They would inform the Council that they had done so.
Infringements
On the recommendation of the Infringements Committee, the Council agreed to take action against a number of pharmacists for alleged infringements of legal or professional requirements.
Sale of Dermovate The Council agreed that the Society would prosecute a pharmacy company, its superintendent pharmacist and an employee pharmacist in connection with the alleged sale of Dermovate without a prescription. The Infringements Committee heard that one of the Society's inspectors had allegedly been able to buy Dermovate from the employee pharmacist without a prescription in circumstance that did not meet the emergency supply provisions.
Personal control The Council agreed to refer to the Statutory Committee the case of the pharmacist owner of two pharmacies who allegedly had allowed one to operate without a pharmacist in personal control, had allowed repackaging of medicines into inadequately labelled containers and had intentionally reused medicines returned by patients.
Alleged unsupervised sale and poor practice The Council agreed that the Society would prosecute a pharmacist in respect of an alleged unsupervised sale of pharmacy medicines. The pharmacist would also be referred to the Statutory Committee for alleged poor practice, which included operating the pharmacy without a pharmacist in personal control, having patient-returned stock on the dispensary shelves with other medicines and failing to ensure the cleanliness of the premises.
Expense claims The Council agreed to refer to the Statutory Committee the case of a locum pharmacist who had admitted deliberately overclaiming mileage expenses from an employer. An analysis of more than 170 return journeys had allegedly indicated an average claim for payment for 49 miles more than as calculated using Routefinder.
Sales in locum's absence The Council agreed to refer to the Statutory Committee the case of a pharmacist who had allegedly allowed the unsupervised sale of pharmacy medicines from one of two pharmacies he owned. A warning letter would be sent to a locum pharmacist who had been employed at the premises. It was reported to the Infringements Committee that the locum had allegedly been in the habit of leaving the premises at intervals for short periods and that unsupervised sales had been made during his absence.
| Those present at the meeting were the President (Mrs Christine Glover), the Vice-President (Mr Marshall Davies), the Treasurer (Dr Gordon Appelbe), Mr David Allen, Mr Hassan Argomandkhah, Mrs Terri Banks, Mr Peter Curphey, Mr Sultan Dajani, Mr William Darling, Professor William Dawson, Mr Digby Emson, Dr John Evans, Dr Gillian Hawksworth, Mrs Patricia Hoare, Mr Mark Koziol, Professor Clare Mackie, Mr Alan Nathan, Mr Hemant Patel, Mrs Helen Remington, Professor Michael Schofield, Mr Ted Smith, Mrs Linda Stone, Miss Joanne West and the Secretary and Registrar (Miss Ann Lewis). Also present were the chairman of the Society's Scottish Executive (Mr Graeme Millar) and the chairman of the Welsh Executive (Mr Colin Ranshaw). |
| An apology for absence was received from Mr Andrew Burr. |
| Present by invitation were Ms Wendy Grosvenor (representative of the Society's Coventry and Warwickshire branch), Mr Stephen Foster (chairman of the Society's Durham branch), Miss Natalie Griffith (representative of the Society's Enfield branch), Mrs Hazel Baker (chairman of the Society's Cardiff and Vale of Glamorgan branch) and Mrs Mildred Keating (representative of the Society's South East of England region). |
| Among the guests of the Council at dinner on October 5 were Dame Deirdre Hine (president elect, Royal Society of Medicine, and chairwoman, Commission for Health Improvement), Professor David Johns (chairman, Prescription Pricing Authority), Mrs Jeannette Howe (acting chief pharmacist, NHS Executive), Miss Tessa Brooks (director, NHS leadership programme for chief executives), Dr A. Christine McCartney (deputy director, Public Health Laboratory Service), Dr June Raine (director, post-licensing division, Medicines Control Agency), Lord Perry of Walton (chairman, House of Lords subcommittee of the Cannabis Select Committee), Professor Mike Pringle (chairman, Royal College of General Practitioners), Dr Colin Hunter (chairman, Scottish council, RCGP), Dr Roger Allen (president, British Association of Dermatologists), Mrs Lorna Muirhead (president, Royal College of Midwives), Dr Simon Fradd (chairman, Doctor Patient Partnership), Mrs Margaret Edwards (head of strategy, Sane), Mr Eoin Redahan (director of public relations, Stroke Association), Mrs Judy Wilson (director, Long-Term Medical Conditions Alliance), Mr Michael Bailey (president, Association of the British Pharmaceutical Industry), Dr Joe Blaker (president, United Kingdom Chemical Industries Association), Dr Franz Heffi (vice-president, Merck Research Laboratories), Mr Mike Wallace (managing director, Schering Health Care Ltd), Mr Ulf Winberg (managing director, Wyeth Laboratories), Mr Jonathan Harris (founder and chairman of board, Institute of Continuing Professional Development), Professor John M. Midgley (professor of pharmaceutical and medicinal chemistry, University of Strathclyde), Miss Judy Cantrill (clinical senior lecturer in pharmacy, University of Manchester), Dr Soraya Dhillon (director, taught postgraduate studies, School of Pharmacy, University of London), Professor Robert Kerwin (professor of clinical neuropharmacology, department of psychological medicine, Institute of Psychiatry and Maudsley hospital), Mr Tony West (chief pharmacist, Guy's and St Thomas's hospital trust), Ms Patricia Oakley (director, Practices Made Perfect), Professor Sir William Asscher (chairman of the Society's Working Group on Cannabinoids), Professor Ray Rowe (Science Chairman, British Pharmaceutical Conference, Cardiff 1999), Mrs Jean Trainor (organiser, British Pharmaceutical Conference, Cardiff 1999), Mrs Irene Gummerson (member of the Society's pharmacy diabetic taskforce), Dr Michael Jepson (a Pharmacy in a New Age co-ordinator), Lord Newton of Braintree (Parliamentary adviser to the Society), Mrs Enid Lucas-Smith (president, British Society for the History of Pharmacy), Dr John Hunt (immediate past president, BSHP) and Mr Patrick Grice (editor, Chemist & Druggist), along with Ms Grosvenor, Mr Foster, Miss Griffith, Mrs Baker and Mrs Keating. |