By Ian Caldwell
What a fascinating mixture of opinions we have seen from Anthony Cox and Howard
Fox (PJ, August 19, p263),
John Ferguson (PJ, August 26, p293)
and Gordon Appelbe (PJ, September 9, p361)
about the future of the Royal Pharmaceutical Society! But where does one begin
to dissect their arguments? It may be best to begin with the myth that the sole
original aim of the Society was self-protection. It did aim to protect the interests
of chemists and druggists but it also targeted, through its original constitution,
“the advancement of pharmacy by a uniform system of education”. This
was such a novel and popular approach to protecting the public interest that
the first Pharmacy Act of 1852 was designated “an Act for regulating the
qualifications of pharmaceutical chemists” and started with the words:
“Whereas it is expedient for the safety of the public that pharmaceutical
chemists in Great Britain should possess a competent practical knowledge.”
Can this be said to be pure self interest?
Since then, the profession has repeatedly driven up the level in education from
“minor” and “major” examinations to a taught master’s
degree. Is this pure self-interest or a fair dynamic between increasing the
safety of the public and the interests of the profession?
Any organisation with restrictions on access, such as an educational hurdle,
needs rules with which all members agree to comply; in other words, regulation.
We have been granted self-regulation which Appelbe, Cox and Fox view as an albatross
and Ferguson as the jewel in the crown. So, are we good at self-regulation?
You bet we are. Given that we are almost unique in that we have the largest
sector of our profession subject to random checks of its professional activities,
it can be shown that around 1 in 10,000,000 client interactions result in referral
to the Statutory Committee which, under the chairmanship of an eminent, non-pharmacist
lawyer, has not in my memory had a decision reversed on appeal. We are good
as a profession and we are good at regulating our actions. We would be even
better if we enjoyed the advantage of a health route similar to that of the
General Medical Council.
What are the alternatives to self-regulation? Both Appelbe and Ferguson are
widely travelled and are familiar with structures in the Commonwealth, Europe
and the United States, yet they reach different conclusions on the most desirable
model. Basically, our colleagues overseas are regulated by boards of pharmacy,
some of which are part elected and some of which are quasi-governmental bodies
and, as such, could possibly become political footballs. In the main it is these
boards which define entrance qualifications, licence pharmacists, accredit courses,
define practice and apply sanctions, all outside the professional body. No contributors
to The Journal have yet set out to prove that the public are better served by
such systems. And I suspect that each and every pharmaceutical society or association
operating under the board system would give its eye-teeth in order to acquire
the responsibilities of the Royal Pharmaceutical Society of Great Britain.
If self-regulation such as ours is as bad as some would have us believe, why
is there no clamour from other professions who share our model to escape from
it? The legal profession is the most widely represented within Parliament, so
surely it would be the leader. Do I hear a tumult? A chorus? A whimper? No.
Not a cheep! Is the legal profession better at administering self-regulation
than we are? I doubt it. Earlier this year, on March 29, the then president
of the Law Society of England and Wales was constrained to reply to press criticism
of his society’s procedures in a letter to the Financial Times in which
he announced that the Law Society was spending £10m of its members’
money and employing 155 extra staff in order to reduce the backlog of unheard
complaints against its members by 4,000 per year. Admittedly, those with a grievance
against National Health Service professionals can use the alternative procedures
available within the service, but the number of serious professional complaints
is still remarkably low.
Cox and Fox suggest (PJ, September 16, p394) that there is potential for conflict
of interest without substantiating their suggestion. Far from there being conflict,
what we now have is continuity of design, development, implementation and enforcement
of realistic regulation by our peers for the benefit of the public. If this
were not the case, big daddy Government and uncle Privy Council would have taken
our toys away long ago.
Cox and Fox also suggest (PJ, August 19, p263) that, after splitting, the voluntary,
mutilated rump of the Society merge with the Pharmaceutical Services Negotiating
Committee/Scottish Pharmaceutical General Council and the National Pharmaceutical
Association/Scottish Pharmaceutical Federation (the addition of a UK element
is mine) to advance the interests of pharmacists. Really? The PSNC and SPGC
are the NHS negotiating bodies for contractors, some of whom are pharmacists
and some of which are public companies. Public companies are charged in law
with fostering the interests of their shareholders, not those of the public
and certainly not those of any profession. Increasingly these companies and
their shareholders are not British but, through takeovers such as that by Walmart,
are American or European and do not necessarily share the ethos of their British
counterparts. In a similar vein, the NPA and SPF represent pharmacies and again
they concentrate on pharmacist proprietors and limited companies, not individual
pharmacists. These four organisations do the job required of them by their members
and, given their aims and membership, it is difficult to see how unification
with the Society could be attained without stances that are inimical to the
interests of pharmacists.
The fact that the Secretary of State for Health sneaked a threat to self-regulation
into the recently published NHS national plan for England need not be evidence
of failure of self-regulation. It is equally likely that it is a knee-jerk reaction
to the tragedies of the Bristol and Shipman cases and may merely reflect the
views of those sociologists and politicians who cannot accept the concepts of
self-discipline and self-regulation. Curiously, both Houses of Parliament could
be considered to be self-regulating, and yet no one has challenged that since
Guy Fawkes.
Cox and Fox are clearly radicals and we always need some radicals. Could I suggest
they apply themselves to considering how the European Convention on Human Rights
could be applied to the problem of bringing UK pharmacy into line with the rest
of the European Union, where pharmacies are pharmacist-owned and pharmacists
alone provide medicines and pharmaceutical services. If that could be achieved,
it would be so much easier for the Society, the negotiators and the commercial
bodies to work together in the public interest. It might almost make it worthwhile
to sell the jerseys of self-regulation. It would certainly bring the radicals
each a Charter gold medal!
Ian Caldwell is a retired community pharmacist from Larkhall,
Lanarkshire,
and is a past President of the Royal Pharmaceutical Society