Clinical governance was still very much on the agenda and remained central to the Government's health strategy, Mr JIM SMITH (regional pharmaceutical adviser, Yorkshire and Northern region) told the conference, and pharmacists had to remember that they were far from immune to system failure.
Compared with the medical profession - with incidents such as the Harold Shipman case and the paediatric heart surgery cases in Bristol - pharmacy had been relatively lucky. "We have not really had experiences on that sort of scale", Mr Smith said.
Serious incidences of failure of care were usually isolated, although the media tended to see them as the tip of the iceberg. Mr Smith estimated that in pharmacy there was about one case a year. He asked the question, "Why don't we learn from experience?"
Local professional self-regulation, such as critical incidence reporting, accessible complaints procedures and professional performance procedures were areas where Mr Smith felt pharmacy had been weak.
He went on to suggest that there should be a national clinical governance framework for pharmacy and that the process needed to be both professionally and managerially led.
In Mr Smith's opinion, the Commission for Health Improvement (CHI) would become increasingly important in monitoring quality standards. He urged the profession to find ways of ensuring that there was an effective pharmaceutical input to the National Institute for Clinical Excellence, the CHI and the national service frameworks.
Mr Smith insisted that engaging in clinical governance was not optional. Pharmacists needed to do it, and the profession needed to ensure that the standards of practice were improved generally. Eliminating bad practice was not enough.
"It will take time. Nobody expects us to become experts in clinical governance overnight. But they do expect us to move on this", Mr Smith insisted.
One problem with implementing clinical governance in community pharmacy, in the view of Mr BOB CALVERT (consultant in pharmacy practice and prescribing, East Riding health authority), was that pharmacists worked in isolation, in a secretive and competitive professional environment that inevitably resulted in experiences and best practice not being shared.
He suggested that a similar approach to that of a medical model in a specific health authority might be the way forward. The model included training based on identified needs, the development of plans to improve practice organisation, data collection and audit against set standards as well as schemes introducing measures to enhance quality in a defined clinical area, such as antibiotics or coronary heart disease. Importantly, it set out standards that had to be attained for payment, which started with £1,000 for a single-handed practice and an additional £250 per partner. That was the sort of model pharmacy should be thinking about, he suggested.
A simple audit of 120 pharmacists had already been carried out in his health authority on health and safety issues. It had been encouraging to find that pharmacists tended to respond very honestly to audit, and he was now thinking of adopting a similar approach to find out about continuing professional development in community pharmacy.
Summarising, Mr SMITH emphasised the role of the individual in implementing personal clinical governance, "doing the right thing and doing things right". He also saw a role for health authorities in monitoring the quality of the service. "The Government is not going to be satisfied with professional self-regulation. We will see a move towards regulation through health authorities", he concluded.