The Council of the Royal Pharmaceutical Society has approved a number of measures
to aid best practice in the supply of emergency hormonal contraception (EHC)
following the expected reclassification of levonorgestrel to allow pharmacy
sale.
At its meeting in London on October 3 and 4, the Council agreed that a range
of measures recommended by its expert advisory group on EHC as a pharmacy medicine
should be worked up into a practice guidance document to assist pharmacists
throughout Britain.
The Council also approved a document setting out standards for the supply of
emergency hormonal contraception as a pharmacy medicine, prepared by the ethics
working party in consultation with the expert group (see p546).
On the recommendation of the expert advisory group, the Council agreed that
pharmacists should personally deal with sales of EHC, although training should
be extended to involve other staff because of the need for all to be aware of
key issues and recognise that EHC should be referred to the pharmacist early
in the consultation.
Pharmacists and their staff should take up the training opportunities offered
both nationally and locally, as required under the code of conduct for the sale
of products that had recently been reclassified as pharmacy (P) medicines.
Pharmacists should also explore the availability of support from national resources
such as the Family Planning Association and manufacturer helplines or websites.
Pharmacies would be supplied with, and encouraged to use, a sign indicating
that EHC was available for purchase.
It was also agreed that pharmacies should display a notice encouraging customers
to inform a member of staff if they required consultation in a more private
area. Pharmacists should consider advertising that all advisory services and
consultation were confidential.
Pharmacist would be asked to consider using a printed card as an aide-mémoire
in EHC consultations. They would not be required to seek evidence of age, since
this was not usual practice before supplying P products.
They would also not be required to treat EHC differently from other P products
in regard to record-keeping.
The Council agreed that repeat sales of emergency hormonal contraception within
the same menstrual cycle should be allowed where appropriate. Pharmacists should
not supply EHC to third parties except in exceptional circumstances.
| Main points | |
|
The Council also accepted a recommendation that community pharmacies should
link into local networks for family planning services and that pharmacists should
take the lead in establishing such links, which should be monitored by pharmaceutical
advisers.
Information on local family planning services (including location, hours of
opening and services) should be made available in every pharmacy, and a leaflet
containing the list of local services and contact points should be produced
so that health care professionals could provide consistent information to clients.
Local networks should establish simple routes for feedback from community pharmacists
on any family planning issue.
The Council made its decision to adopt the advisory group report after receiving
a presentation from one of its members, Dr Connie Smith (faculty of family planning
and reproductive health care, Royal College of Obstetricians and Gynaecologists).
Introducing Dr Smith, Mr CURPHEY (chairman of the advisory group) said that
EHC prescribing would continue and its supply under patient group directions
would grow rapidly, and pharmacy sale was a classic “third way”. The
profession had to ensure that it was equitable for patients.
The expert group had produced a simple, straightforward report, indicating the
strength of support for pharmacists to handle the subject — not just the
medicine but all the surrounding circumstances. The next step would be to turn
the document into practice guidance, so that pharmacists would be left in no
doubt as to how they should behave and how they would be supported.
The training would be intensive and comprehensive. It was significant that the
Department of Health was to fund training for an OTC product.
Dr CONNIE SMITH began by giving a detailed summary of current knowledge about
the safety, efficacy, side effects and acceptability of levonorgestrel in emergency
hormonal contraception. On safety, she said that it was the advent of progestogen-only
EHC in the 1990s that had given impetus to proposals for pharmacy supply, since
the oestrogen and progestogen mix was contraindicated in certain medical conditions
and also had an appreciable level of side effects. Evidence suggested that the
levonorgestrel progestogen-only regimen was very safe indeed for use by almost
every woman. The only contraindication for use was established pregnancy —
not because of safety concerns but because it would be ineffective.
Nor did the evidence support concerns that increasing availability of EHC might
lead to a decrease in the use of regular contraception, Dr Smith added.
On efficacy, Dr Smith said that research evidence showed that progestogen-only
EHC was more effective than combined hormonal emergency contraception, although
less effective than regular ongoing methods. It was important to understand
it was not 100 per cent effective, and women receiving it would need advice
in terms of follow-up and ongoing contraception.
In terms of acceptability and unwanted effects, evidence had shown that women
were quite prepared to answer the very few necessary questions in order to establish
whether it was safe to provide them with emergency contraception. The initial
concern of pharmacists about embarrassment and anxieties for both themselves
and the clients had not been borne out in pilot studies.
On side effects, Dr Smith said that the incidence of nausea, vomiting, dizziness
and a few more effects seemed not much greater than a placebo effect. It was
reassuring that most women taking emergency hormonal contraception would have
their next period at the time they would otherwise expect it. However, use of
emergency contraception repeatedly after each episode of coitus was not acceptable
because it led to menstrual disruption.
Moving on to the practical aspects outlined in the document, Dr Smith said that
there had been concerns about certain groups of very vulnerable women, but it
was not these women who tended to use EHC. Most women who used it were in their
20s and early 30s, women who had learnt and who understood quite a bit about
themselves and contraception in the older age group.
When approached for supply of EHC, the pharmacist had to be able to establish
a few key elements of clinical history, but no physical examination or blood
pressure measurement was needed. It was necessary to explain the effectiveness
and the limitations of the product and it would be necessary to give information
about ongoing contraception advice. Experience from pilot studies showed that
this would take no more than about 10 minutes.
On training support, Dr Smith said that the Centre for Pharmacy Postgraduate
Education was preparing a distance learning pack. There would also be an aide-mémoire
and a structured checklist for pharmacists to use in one-to-one consultations.
There were also initiatives from the manufacturer, including meetings, a help
line and a number of offers of support with written material.
Emergency contraception provided by pharmacy supply would increase timely access
to a safe and effective method and thereby decrease unwanted pregnancies. It
would build on the strength of pharmacists in their professional training and
their ability to communicate, and would bring them recognition in terms of the
wider NHS trying to reorientate care among the people that it served.
Asked by Mr NATHAN about supply to people aged under 16 years, Dr SMITH said
that the issue was whether the person understood the situation, was able to
give the pharmacist clear information and had the competency to understand what
was being done. It could be decided by nobody except the people in the consultation
at the time.
Mr NATHAN said that there was a difference in freedom of action between a doctor
who exercised clinical responsibility and a pharmacist selling a pharmacy medicine
who had to remain within the licensing conditions. If it was stated that a medicine
should be sold only to women aged 16 and over, a pharmacist could not supply
it to anybody under that age.
Dr SMITH replied that health care professionals worked within a scope of practice
that they were trained for and understood, but sometimes they all went beyond
that boundary. When they did that they had to know what they were doing and
they had to know why they were doing it. If one accidentally supplied to a 14-year-old
it was hoped that the pharmacist had ascertained her individual case in the
same way as one would for a 48-year-old who had staggered into a pharmacy blind
drunk.
Mr NATHAN said that he did not think that pharmacists had that level of professional
discretion.
Asked by Mr HEMANT PATEL about the collection of data, Dr SMITH said that for
pharmacists working to patient group directions there would be requirements
in terms of recording information so as to allow evaluation. But with supply
as a pharmacy medicine, the advisory group could not see any need to ask for
that from on high, although some pharmacists might do it anyway as an extension
of their practice. Many things would be better understood by designing specific
research rather than requiring everyone to collect pieces of paper and employing
people to study them.
Ms STRATH said that she was concerned about the display of signs because of
religious problems and militant pro-life groups.
The PRESIDENT said that it was up to the pharmacy whether to use such a sign.
Dr SMITH said that there had been rumblings from patients involved in the patient
group directions, but there had been no repercussions. On the other hand, there
had been gratitude from women who had obtained EHC.
The PRESIDENT said that the report would be taken on for a further group to
work up the practice guidance and iron out any wrinkles. It would include Scotland
and Wales.
Standards for the supply of EHC as a pharmacy medicine
| Standards for the supply of emergency hormonal contraception as a pharmacy medicine |
|
|
The Council agreed to adopt draft standards for the supply of emergency hormonal
contraception as a pharmacy medicine, in anticipation of the reclassification
of levonorgestrel to allow pharmacy sale. The standards had been produced by
the ethics working party in consultation with the expert group on the supply
of emergency hormonal contraception as a pharmacy medicine.
The Council noted that standards were not required on pharmaceutical grounds
since levonorgestrel was considered to be safe, with little risk to users. The
standards had been prepared because of the sensitivity of the indications for
use and the specific social, moral and ethical issues that were raised by its
availability for supply without prescription.
The panel below) sets out the agreed text of the standards.
“Pharmacy in the future”
The Council carried without dissent a proposal calling on it to ensure that
the Society’s response to the document “Pharmacy in the future: the
NHS plan” was appropriately informed by the views of other relevant pharmaceutical
bodies throughout Britain.
Mr ARGOMANDKHAH moved that the Society, as the leading body in pharmacy, “will
ensure that its response or possible negotiations with the Department of Health
are co-ordinated by adequate mechanisms for consultation with all other relevant
pharmaceutical bodies in England, Wales and Scotland”.
He said that the aim of the motion was to ensure that the whole profession talked
to the Department in the same language and with a united front. The Community
Pharmacy Action group had shown how different groups in the profession could
come together and be effective.
Some might regard the pharmacy plan as a threat, but it provided many opportunities
and if handled properly could achieve a great deal for the profession. Some
might argue that the Society should work independently of others, but that would
not achieve maximum benefit from the document. The President, at the British
Pharmaceutical Conference, had said that the future of the profession was too
important for the profession to indulge in division.
Seconding the motion, Mr DAJANI said that an unco-ordinated approach would eventually
disunite the profession. The motion was forward thinking.
Mr CURPHEY said that the Society represented all pharmacists, whose interests
were not the same as those of pharmacy contractors. If the Council did not recognise
that, then it would be letting down the 28,000 pharmacists who worked within
community pharmacy but were not contractors. The interests of contractors were
important, but they were not identical.
Dr APPELBE said that he did not share Mr Curphey’s fears, since the motion
made clear that the Society was the leading body in the profession of pharmacy.
It was not a question of the Society being overruled by anybody.
Mrs STONE said that the Society always endeavoured to collaborate with other
organisations. But it needed to move quickly to respond to the Government, and
prolonged dialogue could cause unhelpful delay.
Mr ALLEN supported the spirit of the motion but was concerned that the wording
might tie the Society’s hands. He urged Mr Argomandkhah to withdraw the
motion on the understanding that Council would work within the spirit of the
motion.
Mr KIRIT PATEL said that the welfare of employee pharmacists depended on the
contractors. It was important that the Society should learn from other pharmacy
bodies. The plan affected them all.
Mr EMSON said that co-operation was a positive action. Other organisations had
resources that the profession as a whole could use to make progress in the time
available.
The VICE-PRESIDENT said that the discussion had related to community pharmacy,
which was understandable, but the plan also included the re-engineering of hospital
pharmaceutical services. The Society would also wish to work with bodies within
the hospital sector. The motion was eminently sensible.
Mr ARGOMANDKHAH said that supporting the motion would not take any powers from
the Society but would enable the Council to move the agenda forward and achieve
something for the profession.
The motion was then agreed.
Confidential information
The Council agreed that its corporate governance steering group should be asked
to examine the issue of the disclosure
of confidential information to Council members.
The decision arose from debate on a motion put by Mr DAJANI: “that in future
all members of Council will be privy to all information they so choose, in representing
the membership, of course subject to caveats being that information is passed
on in the strictest of confidence, that the information is required during the
course of Council duty, and it has been requested in writing.”
Mr Dajani said that the motion had arisen because, in following up questions
put at the annual general meeting, he had been unable to gain specific information
about staff salaries. The issue had moved on from there to the issue of Council
members being denied information.
Sensitive information had to remain confidential. But when members were elected
to represent and to lead the profession, then they should not be denied information
by others who were not elected. The motion would not only help Council members
to represent the membership more effectively, but would also give them a better
idea of what happened in the building. Had he been given the information he
had requested in a discretionary manner, he could have gone back to members
and reassured them.
Mr ARGOMANDKHAH seconded the motion. He said that every Council member should
have the right to access information that was essential in carrying out their
duties, or be given a very good excuse why they were not privy to the information.
Mrs STONE said she was confused by the wording of the motion. Who chose? The
individual or the collective? How did they justify the choice? How could one
use information acquired in the strictest confidence? And what were the caveats?
Mr DAJANI replied that a Council member would put it to the Secretary and Registrar
why it was valid to seek information. The caveats would be why the information
was wanted in the first place. Anything to do with representing the membership
would be a reason to access information. Although the Council member would not
be able to use the confidential information, he or she would be able to give
reassurance to the membership.
The SECRETARY AND REGISTRAR said that there might be constraints on giving information
in terms of existing policy or the law. There had to be some identification
of the need and reasonableness of need for particular duties, not just all information
at all times. There had to be recognition of reasonableness in terms of the
time spent collecting the information.
Mr NATHAN said that Mr Dajani’s interpretation of the facts had been worked
up in the letters pages of The Journal and elsewhere so that it brought the
Council and the Society’s staff into disrepute. Unlike members of Council,
the staff had little opportunity to defend themselves. He commended the staff
for their stoicism and their devotion to the job while under such attack.
Dr GRAY said that many Council members had sympathy for Mr Dajani’s position,
but his methods were in dispute. It would be more productive to have robust
policies regarding disclosure of information, rather than Council members being
in a position to know everything but not being able to tell anybody about it.
The Council elected a group of officers each year and had made great leaps forward
in the transparency of that election. Council members should trust the officers
they had elected, and any Council member asking for sensitive information should
be prepared to sign up to the Council’s code of conduct before being allowed
the information.
Mr KIRIT PATEL said that some Council members had easier access to information
than others, but all should be entitled to any information necessary for making
the right decision.
Mrs BANKS said that the idea that elected members should have access to any
information did not work. From her Civil Service experience, Ministers of a
Department did not have access to a great deal of information, particularly
information about individual members of staff.
Council members needed information that helped them do their job. Because the
matter was important, it should be referred to the corporate governance steering
group. Perhaps Mr Dajani could be invited to a meeting of the group to help
formulate a clear policy.
Dr APPELBE said that to fulfil its Charter role of directing and managing the
affairs of the Society, the Council had to receive information. The problem
in recent years was a perception that the proper information rested in the hands
of very few Council members. Council members should be able to ask for information
and get it unless it concerned particularly sensitive areas.
Mr CURPHEY said that he did not think the motion would help, although somewhere
there was a legitimate, noble motive and intention. It might be helpful if they
could work out what information was reasonable for Council members’ duties
and perhaps have a list of things that were not reasonable for them to know,
like the personnel files of the staff or with regard to the information on students.
What bothered him was the perception that a clique of people within the Society
knew things they did not want other people to know.
Regarding Dr Appelbe’s remarks about the Charter, Mr Curphey said that
the Council might direct the Society but it delegated its management to the
senior directors within the organisation. The Society had to be run by a dedicated
group of expert people.
Dr HAWKSWORTH said that the Council should take forward Mrs Banks’s idea
and incorporate Dr Gray’s comment about Council members signing the code
of conduct.
Mr DARLING hoped that Mr Dajani would accept Mrs Banks’s suggestion.
Mr DAJANI agreed that the motion should be referred to the corporate governance
working group.
| Attendance | |
|
| Council briefs | |
|
Registration certificates
The Council agreed by a narrow majority that in future the signatures of the
President and Secretary and Registrar would be electronically reproduced on
members’ registration certificates.
Placing the proposal before the Council, the SECRETARY AND REGISTRAR said that
modern techniques made it virtually impossible to distinguish an electronically
reproduced signature from a real one. She added that a certificate with electronically
reproduced signatures was available to any member of Council who wished to examine
it.
Mr CURPHEY felt that the idea was ludicrous. There were many past Presidents
sitting on the Council who had regarded it as a great honour to sign individually
1,000 certificates. It hurt one’s hand but it was done over a couple of
weeks or a couple of months. The matter had been argued some 10 years previously
and had been ridiculed. He hoped Council members would ridicule it now.
The PRESIDENT said that electronically reproduced signatures had improved since
three years previously. She did not think most people would know whether she
personally had signed or whether it was an electronic signature.
Mr CURPHEY said people would be deceived. He hoped the President would tell
every member that the signature was a fake.
The change in procedure was then approved, by 11 votes to 10.
Corporate governance
The Council approved a recommendation of the corporate governance steering group
that a remuneration committee should be established to ensure fair remuneration,
recruitment, retention, rewards and incentives to enable the Society to attract
the right calibre of staff to carry out its functions. The committee would take
on the duties of the Staff Committee, which would be disbanded.
The recommendation was one of 24 contained in an interim report produced by
the steering group. So far as the other 23 recommendations were concerned, Council
members were asked to submit comments, which would be used to inform the group’s
final report.
British Pharmaceutical Conference 2001
The Council approved proposals from the Conference Committee for the organisation
of the British Pharmaceutical Conference in 2001.
The event would take place at the Scottish Exhibition and Conference Centre,
Glasgow, from September 23 to 26, 2001, with the theme “Global pharmacy:
science in the service of patients” and a focus on infectious disease (including
AIDS and tuberculosis), coronary heart disease and cancer.
Professor Dawson (chairman of the committee) told the Council that the science
content of the conference would be put together by the Science Chairman (Professor
Peter York) and members of the Academy of Pharmaceutical Scientists. The practice
content would be considered by a group chaired by Professor Dawson and with
members representing the main areas of practice. A small group of Conference
Committee members would then consider the overarching professional and political
sessions, pulling together the scientific and practice sessions within the overall
theme of the conference.
Professor Dawson said that the principal business objective was for the conference
to be cost-neutral. The strategy for achieving this objective included sponsorship
and a pharmacy exhibition run on commercial lines but controlled by the Society.
Future direction of The Pharmaceutical Journal
The Council decided that control of The Pharmaceutical Journal and its sister
publications should continue more or less on existing lines, with the editorial
director remaining managerially responsible to the Secretary and Registrar and
editorially responsible direct to the Council. Editorial freedom would continue,
within the constraints that applied to any professional publication, and the
editor and editorial team would continue to develop the strategic course for
The Journal.
The new editor would be assisted in his or her role by the appointment of an
editorial advisory panel, and by the drafting of clear criteria and a code of
practice to ensure that advertising and other commercial activities did not
reduce The Journal’s credibility as a prestigious publication.
In making its decisions, the Council endorsed the report of a brainstorming
meeting on the future direction of The Journal following the retirement of Mr
Douglas Simpson from the editorship on September 1.
Introducing the report, the VICE-PRESIDENT, who had chaired the brainstorming
meeting, said that the participants had been people with knowledge of editing
worthy journals, including people who were members of the Society and who practised
in the hospital and the community sector, and including the acting editor of
The Pharmaceutical Journal. Mr Hemant Patel had been invited to be present but
had been unable to attend at the last moment.
Fundamentally, the group had considered first whose journal was it and had decided
that it was there for the membership. Therefore that decision should influence
the arrangements with The Journal. It had also also felt that it should be a
high quality journal — that it should be a journal of repute and standing
not only in Britain but on a world-wide basis.
The group had felt that The Journal should publish views of the editor, that
there should be editorial freedom without influence of the Council but that
the editor would hold a unique position in the Society in being accountable
to the Council. In practice that had always been the case. For as long as the
Vice-President had been on the Council there had never been any debate about
issues associated with The Journal.
The group had decided that there needed to be a framework within which the editorial
director should operate. The first suggestion was that an editorial board should
be established to provide help, guidance and assistance to the editor, but not
to instruct the editor. An editorial position was a lonely position, and the
previous editor had in effect had an informal editorial board, using people
of knowledge and repute. The group had thought that there should be a more formally
constructed editorial board.
It had been felt that there should not be members of Council on the editorial
board. Although some members had felt that that would be a good idea, others
had said that whoever was chosen might be in some difficulty about representing
his or her views and not the views of Council overall.
The editorial board would agree with the editor the broad structure and framework
of operations and activities — the overall framework within which the editorial
direction that should operate.
There were two other matters. First, the editor would have accountability for
The Journal but in terms of the commercial aspects, the group felt that marketing,
print buying and so on should continue to fall under the ambit and accountability
of the director of publications. That meant that the director of publications
and the new editorial director would have to work hand in hand.
The final point was the lines of accountability of the editorial director, who
was in a unique position different from any other member of staff in as much
as he
was personally accountable to the Council but in terms of management accountability
he was accountable to the Secretary and Registrar.
There had been some debate about the issues relating to conflict of interests.
An editor was entitled to publish anything that he or she might determine appropriate.
Yet there was the issue of at what stage were policy developments such that
they should or should not be in the public domain. It was felt that it was appropriate
that the editorial director should not be a member of management team, the group
chaired by the Secretary and Registrar, which included the directors. But to
ensure that the editorial director was kept up-to-date, the suggestion had been
made by the Secretary and Registrar that the agendas of the meetings should
be provided and also the minutes. There would also be regular meetings between
the editorial director and the Secretary and Registrar on matters of briefing,
communication, and so on. But that would not impinge upon the editorial freedom
of the editor.
The Vice-President drew attention to a number of specific recommendations within
the document. These were:
Mr ARGOMANDKHAH asked how the editor’s accountability direct to Council
sat with editorial freedom.
The VICE-PRESIDENT replied that what the group had envisaged was that the editor
would report to the Council the general framework and policy that was going
to be adopted. It might well be that the editor would say to Council that over
the next six months the thrust of his editorial activity would be to pursue
the interests of the pharmacy plan. The form it would take would be up to the
editor. If, as an exaggerated and impossible example, the editor were to say
he did not think that pharmacy had much of a future and he intended to highlight
its deficiencies, the Council might well express concern.
The editor would also have to answer for what he had done previously, explaining
what he had done and why, thus enabling members of Council to question and to
get a response.
Mr HEMANT PATEL apologised for not having been able to attend the brainstorming
meeting. He said that his sincerely felt view was that The Journal was a world-class
publication. Having to travelled the United States, India and Australia recently,
Mr Patel knew how highly The Journal was valued in those parts. To produce such
a world-class journal required dedication and training, and Mr Patel thanked
the staff
for getting to that stage. What the Vice-President had described would enable
them to build on that very good platform.
Dr GRAY felt she still had a dilemma about the role of The Journal. There were
difficulties about having editorial freedom and yet being accountable to Council.
 |
| Council member Bill Darling was presented with a Royal Pharmaceutical
Society keepsake during the Council dinner on October 3. The gift of a trinket
box bearing the Society’s arms was in recognition of his services to
the Conference Committee, on which he has served for many years. The photograph shows, left to right, Lord Hunt (Parliamentary Under-Secretary of State for Health), who attended the dinner as guest speaker, the President (Mrs Christine Glover) and Mr Darling. |
Regarding a reference in the report to publishing high quality papers, Dr Gray
said that, having been immersed in the academic sector, she felt that The Journal
was not the first port of call for academic pharmacists to publish their best
papers. That was because of the factors which impacted on the research assessment
exercises. They should tackle that aspect in a big way.
Mr NATHAN said there had been talk about the editor going to the Council to
outline plans over the following few months. Mr Nathan did not think that the
Council should have any role at all in knowing in advance even in the most general
terms what the editor intended to put in The Journal. That was to an extent
an infringement of editorial freedom. The editor should be trusted to do his
job properly.
Mr Nathan agreed that the editorial director should be editorially responsible
to the Council, so that if he did step seriously out of line, he would have
to account to the Council, The Council would have the option of disposing of
his services if he did something that seriously undermined the Council, the
Society and the profession.
Mr Nathan added that The Pharmaceutical Journal had been an excellent journal
under Mr Simpson and had remained so under the acting editor.
Dr APPELBE endorsed everything that Mr Nathan had said. Dr Appelbe was concerned
at the reference “continue to be accountable directly to Council for content”.
He did not consider that to be editorial freedom. That was putting the control
of the content into the hands of the Council. That should not happen.
The SECRETARY AND REGISTRAR replied that Mr Simpson had supplied a paper to
which was attached a letter from the director of the Centre for Journalism Studies
at Cardiff university (Professor Ian Hargreaves), who was a former journalist.
The point was that any editor had to work within the framework of his employer.
That did not impinge on freedom. The freedom for comment was not impeded.
Dr APPELBE said a little phrase had been slipped into the report stating that
letters published in The Journal should be restricted to “those that were
informed and were not personal or offensive.” The Vice-President had said
that the journal belonged to the membership, but it was now stated that there
was going to be some control over the letters that would be published. That
was not editorial freedom. The tone of the document suggested that the Council
was going to control the editor and that if he stepped out of line and did something
that the Council did not like, then the ultimate action would be either that
he would be dictated to and The Journal would become censored or that the editor
would leave.
Dr Appelbe endorsed Mr Nathan’s remarks: the Society had had a fine journal
under two successive editors, Robert Blyth and Douglas Simpson, and it was continuing
in a similar vein. He wondered what the members’ perception of the brainstorming
document would be.
Mr EMSON said that he supported the recommendation relating to advertising.
There was a potentially difficult interface between the editorial director and
the director of publications in terms of the commercial content of The Journal.
There were two good reasons why a code of practice should be drawn up. The first
was the increasing commercial pressures to raise revenue, which would get worse.
The second was an increasingly likelihood of pressure groups, companies and
various organisations wanting to rent and buy space to express political views
using The Journal. Some sort of code was needed to manage that.
Professor SCHOFIELD felt that the important thing was to differentiate between
what was the product of the editorial freedom and what was the policy of the
Society. He hoped there would not be too much difference, but where it was different
it should be quite clear which was which.
Mr KIRIT PATEL asked whether the Council could see Mr Simpson’s paper.
The PRESIDENT agreed and said that the letter from the professor of journalism
would also be available.
The VICE-PRESIDENT said that what had been discussed within the group had been
rather broader than the conclusions that had resulted. They had also looked
at options such as whether The Journal should be a strictly commercial journal,
where the principal driver was to make money and increase the revenue of the
Society. The group had rejected that.
The group had not seen its recommendations in any way as curtailing or impairing
editorial freedom, despite what had been said by some Council members. The letter
from the professor of journalism at Cardiff stated that in practice all editors
worked within the constraint of some institutional framework. The group was
seeking to provide such a framework. The group had had the good fortune of having
in its membership at least two editors of worthy journals. They had both independently
highlighted the fact that in their roles they also conformed with a similar
arrangement, and indeed considered themselves to have complete editorial freedom.
The purpose was not to impose, curtail or reduce in any way the editorial freedom
but to establish a framework which would be of help in dealing with any matters
which might or might not emerge.
Mr KIRIT PATEL strongly supported the remarks of Dr Appelbe. He did not think
that there should be any restriction on freedom of speech.
Mrs STONE welcomed the brainstorming group’s document. It covered all the
areas that had raised anxieties in the past. She did not share the concerns
of Dr Appelbe or Mr Kirit Patel about editorial freedom. It was perfectly reasonable
for an editor to have complete freedom within an overall policy.
The Vice-President had said clearly that the decision was that The Journal would
not be a purely commercial publication but it would be a high standard, world-class
journal. That set the policy framework within which the editor had complete
freedom.
Mr CURPHEY was anxious that the debate would not be misinterpreted. The editor
had always been accountable to the Council and there was no suggestion of changing
that. It was mischievous to imply that the Council was about to change something.
Dr EVANS said he was not concerned about the definition of editorial freedom
in the paper because such definitions were always subject to interpretation.
What the outcome was in the long run would depend on the integrity and the guts
of the editor. A good person would be able to work within the framework.
Dr Evans regretted the reduced access by the editor to the management team.
Access to the agenda and the minutes of meetings was not the same as being able
to attend meetings.
The PRESIDENT pointed out that the editor could attend by invitation or request.
Dr EVANS felt that, while the intention in the paper was entirely proper, the
effect might in the long run be to make The Journal more politically correct
in the sense of generally fitting in with the ideas of the top table.
The PRESIDENT then asked the Council to take a vote on the acceptance of the
brainstorming meeting paper.
The proposals in the paper were agreed to.
Health Act: Reform of legislation
The Council agreed that its Health Act working party should concentrate its
immediate efforts on the areas of discipline and competence because of the Government’s
intention to move forward swiftly with disciplinary reforms for the health professions
by Order under the Health Act 1999.
The Council noted that, because the Department of Health was giving priority
to disciplinary reform, it might not be possible at present to address matters
such as the introduction of mandatory continuing professional development as
a condition of practice. It also appeared that, wherever possible, the Government
wished to see commonality of powers and procedures between the different health
professions. The Society would therefore need strong grounds if it wished to
depart from Government policies applying to other professions.
| Looking to the future | |
|
Policy Support Unit programme
The Council approved a proposal from the Policy Support Unit for a refocusing
of its work in the light of the implications of “Pharmacy in the future:
implementing the NHS plan”. A detailed analysis of the document and its
implications for the Society would be produced for the December Council meeting.
This would draw attention to relevant work that was already proceeding and areas
where further policy development was needed.
The Council agreed that policy development should be divided into two streams.
The faster stream would include the National Health Service strategy for pharmacy
and other matters relating to the national policy agenda. The other stream would
include strategic policy development in relation to the longer term needs of
the profession.
Public health The Council also agreed that the findings and recommendations of a Policy Support Unit project on public health should be incorporated into future work to implement “Pharmacy in the future”, rather than be taken forward as a separate project.
PSU governance programme
The Council accepted a report on governance arrangements in pharmacy, which
had been commissioned from Professor Robert Dingwall (professor of sociology,
University of Nottingham) to inform Council members’ thinking on governance.
It was agreed that the report would also be drawn to the attention of relevant
directorates and divisions within the Society and appropriate working groups.
Patient group directions
The Council approved a working group’s proposals for the development of
a resource pack to assist pharmacists involved with preparing patient group
directions or operating within them. The pack would include standards for pharmacists
involved in PGDs, a fact sheet summarising and explaining the legislation, model
PGDs for primary and secondary care settings, sample audit tools related to
the model PGDs, and suggested areas for PGDs.
Shared preregistration training
The Council approved a proposal for the phased introduction of its new performance
standards for preregistration trainees.
The Council had approved the new standards in October, 1999 but, following discussion
with representatives of the major employers of preregistration trainees, it
had become clear that some serious practical difficulties needed to be resolved
before arrangements could be made for shared training, with each trainee having
a main placement in either community or hospital pharmacy but with a period
of training in the other sector.
While the Council recognised the difficulties for employers, it reaffirmed shared
training as a long-term goal, noting that all parties had agreed to work towards
it. The Council therefore resolved that shared training should be phased in
over the three training years from 2001, with a target that all trainees in
2003-04 would have shared training. The Council recognised that not all trainees
would experience both sectors of practice in the training years 2001-02 and
2002-03 and made clear that those unable to get shared experience would not
be disadvantaged. The aim was for training providers to arrange a minimum of
two weeks — preferably longer — in the sector other than the main
placement.
The Council also agreed that a small steering group should be established to
monitor and review progress towards shared training. Its membership would include
representatives from the main preregistration training providers. The representative
group of employers would also meet approximately three times a year.
The Council agreed that it would support the efforts of hospital and community
employers to secure additional funding to cover the costs involved in shared
training.
Disclosure of information
The Council approved a draft framework document on the disclosure of information
about the Society’s members to parties with a legitimate interest. The
mechanism would be used to allow information, in appropriate circumstances and
under strictly controlled conditions, to be shared with those having responsibility
for the quality of professional services provided to the public (for example,
health authorities).
Among other things, the framework document set out criteria to be used in determining
whether disclosure was appropriate. The criteria included the reliability of
the information held by the Society, the level of significance of the allegation
against the pharmacist concerned, and the relevance of the information to the
functions of the recipient body and its discharge of duty to patients under
its care.
The Council agreed that, subject to legal advice received, the document should
form the basis of discussions with those with a legitimate interest.
Guidance on information protection and security
The Council approved a document of guidance on information protection and security
and agreed that it should be added to ‘Medicines, ethics and practice:
a guide for pharmacists’. It would also be added to the Society’s
website shortly.
The guidance suggested that information systems and the data they contained
should be afforded protection and vigilance to the same degree as money or Controlled
Drugs.
It went on to set out the legal background to information security and give
advice on risk assessment, security measures and practical considerations.
Its final section considered security issues relating to different types of
computer networks and different methods of electronically transmitting information.
Infringements Committee
On the recommendation of the Infringements Committee, the Council agreed that
the Society should take action in relation to a number of alleged legal and
ethical infringements by pharmacists or pharmacy companies.
Personal use of pharmacy computers The Infringements Committee
agreed that pharmacy employers should be advised that if they wished to ban
employees from using company computers or internet access for personal purposes,
then this should be stated in their terms and conditions of employment.
The decision arose from the committee’s consideration of a complaint about
a pharmacist who, while employed in charge of a pharmacy, had used the pharmacy
computer after hours to access the internet. In addition, to register for access
to a website, the pharmacist had used another person’s credit card details,
without consent, and a false address. As a result of the pharmacist’s action,
the other person had been charged a three-month rental to use the site.
When interviewed by Society inspectors, the pharmacist had asserted that he
had been offered a week’s free registration for the website and had only
used the credit card details as proof of being aged over 18 years.
On the committee’s recommendation, the Council agreed that the pharmacist
should be warned about the breach of trust in using another person’s credit
card details and making unauthorised use of the pharmacy computer system.
Lack of a superintendent pharmacist The Council accepted a recommendation
of the Infringements Committee that a complaint should be made about a pharmacist
who was managing director of a company that had allegedly operated for 14 years
without a superintendent pharmacist.
The committee heard that a person whose name was on the Society’s records
as being superintendent pharmacist had in fact left the company’s service
in June, 1986. The Society had not been notified of his resignation and no other
person had subsequently been registered as superintendent by the company, even
though trading without a superintendent pharmacist rendered unlawful all activities
carried out by the company that required registration as a pharmacy.
The committee also heard that, as of September 19, no replacement superintendent
pharmacist had been appointed, even though a letter had been sent to the pharmacist
on July 28 enclosing a notification form for the appointment of a superintendent
pharmacist.
Damaged stock The Council agreed to make a complaint to the Statutory
Committee about a pharmacy company and its superintendent pharmacist in relation
to the presence of inadequately labelled stock and damaged stock.
The Infringements Committee heard that the pharmacy had had an arrangement with
a pharmaceutical wholesaler to purchase stock with damaged packaging. In the
pharmacy sales area, one of the Society’s inspectors had found products
that had lost their outer cartons and their patient information leaflets. In
the dispensary the inspector had found a number of inadequately labelled bottles
containing loose tablets or capsules.
The committee resolved that the wholesaler’s practice of selling damaged
stock to the pharmacy company should be brought to the attention of the Medicines
Control Agency.
Excessive supplies of substances liable to misuse The Council
agreed to make a complaint to the Statutory Committee about a pharmacist who
had allegedly dispensed excessive supplies of substances liable to misuse.
The pharmacist was alleged to have supplied dihydrocodeine, diazepam and temazepam
in the knowledge that they were not all being consumed by the patient named
on the prescription. The prescriptions had been written by a doctor who had
subsequently been suspended by the General Medical Council and had then retired
from practice.
Life peerages
The Secretary and Registrar reported to the Council that she had received a
letter from the House of Lords appointments commission, which was seeking nominations
from local environments for non-party political life peers.
The letter would be copied to the Society’s Scottish Department, Welsh
Executive, regions and branches.