A fully revised Code of Ethics and Standards document for the pharmaceutical profession is to be presented for adoption by the annual general meeting of the Royal Pharmaceutical Society on May 16. The new code takes into account comments received from members of the Society and others during the consultation process that took place earlier in the year (PJ, March 10, pp325-332). On this page, the chairman of the Council's ethics working party, Bill Darling, introduces the final version of the revised code, explains the rationale underpinning it and answers the main questions that arose during the consultation period. The code itself is set out in full on the remaining pages of this eight-page pull-out section of The Journal

Right from the start of its work on a new Code of Ethics and Standards, the ethics working party determined that it wanted to seize the opportunity to develop a code that provides a framework for pharmacy to meet the challenges of health care provision in the new millennium. The revised code, in line with trends in government health care policy, puts patients at the centre of care. It seeks to promote improvements in the quality of professional services provided. It seeks to encourage the development of new professional services, empowering pharmacists to respond to the challenges of “Pharmacy in the future”.

Pharmacists will already be familiar with the changes in structure and format of the revised code. The three-tier approach of Principles, Obligations and Guidance supplemented by Standards of Good Professional Practice has gone. In its place we have developed a code that identifies pharmacists' key professional responsibilities of beneficence, competence and integrity, and encourages pharmacists to consider these responsibilities when deciding how to resolve the dilemmas faced in everyday practice.

Inevitably parts of the code will be less relevant to pharmacists working in less common fields of practice (eg, industry or academia) but we believe the key responsibilities should underpin every pharmacist's professional conduct.

The rule book approach of earlier codes of ethics has been replaced by a document which empowers pharmacists to develop their own practice in accordance with the key responsibilities. In short the revised code acknowledges that pharmacists are independent health care professionals who are, and must expect to be, individually accountable for their decisions. It is important for the code to recognise therefore that pharmacists have the autonomy to use their professional judgment and make these decisions for themselves.

The express recognition of the expectations of patients, the public and other professionals in the National Health Service is another fundamental change in approach stemming from the recognition that in order for pharmacy to meet the challenges of the future it must deliver the services that people want and have a right to expect. High quality services require competent staff, trained in the skills they need and with up-to-date knowledge. The service specifications contained in the revised code facilitate their delivery by clarifying the mandatory requirements for the provision of professional services while encouraging pharmacists to build upon these to deliver the best possible level of care.

The revised code identifies specific personal responsibilities associated with particular roles. In so doing it seeks to balance the responsibilities of pharmacists involved in the day-to-day provision of pharmacy services with those of pharmacy owners, superintendents and pharmacist managers in hospitals and trusts or other fields of practice who are responsible for ensuring that appropriate systems are in place and that working conditions, facilities and resources enable services to be provided to professionally accepted standards.

Main issues

The working party has noted that most of the comments received about the revised code concern the same few issues:

The promotion of medicines and the impact of the Competition Act The Competition Act has had an effect on the way medicines can be promoted. Promotion of medicines by price can no longer be prohibited under the code; however, promotions that encourage a person to purchase medicines that are not wanted or in substantially larger quantities than are wanted will continue to be professionally unacceptable on grounds of public safety.

At present almost all proprietary medicines are subject to resale price maintenance controls imposed by contract, and price discounting could result in legal action being taken to secure compliance with contractual provisions.

The requirement to maintain records of the identity of the pharmacist responsible for each activity undertaken As stated above, pharmacists must expect to be held accountable for the services provided by them or under their supervision.

The requirement to report concerns that a pharmacist's fitness to practise may be impaired and put the public at risk The Society has a duty to protect the public from risk. Wherever possible it seeks to address concerns about pharmacists' health or competence by co-operation rather than by resort to disciplinary procedures.

The “conscience clause” The revised code acknowledges that there will be occasions when a pharmacist is unable, for whatever reason (eg, religious belief, personal conviction or lack of training) to provide a service. In such circumstances the patient must be advised of alternative sources for the service. General principles of openness and honesty require a pharmacist who feels unable to provide a service likely to be required to inform an actual or potential employer.

Pharmacists having conscientious objections can therefore refuse to provide certain services, but this must be balanced against employers' rights to determine the services provided by the business. Protection against discrimination in employment is provided for in employment legislation.

Professional indemnity insurance The revised code requires pharmacy owners, superintendents and pharmacist managers in hospitals, trusts and other fields of practice to ensure that all activities undertaken are covered by adequate professional indemnity cover. This is especially important if new services are introduced. Individual pharmacists are required to check that the activities they undertake are covered.

Most employers' professional indemnity cover will extend to employees and other pharmacists working at the premises. However, pharmacists are advised to check with employers that this is the case. Locum pharmacists may consider it appropriate to obtain their own indemnity insurance cover. Hospitals' or trusts' professional indemnity insurance generally covers pharmacists in the course of their employment but pharmacists should verify this if in any doubt.

Workloads The revised code does not give guidance on acceptable workloads. There are too many variables to set meaningful limits. Individual pharmacists have a responsibility to ensure that they do not accept employment where their competence may be compromised and employers have a professional responsibility not to subject pharmacists to working conditions (hours, levels of support staff, work flow or volume) which may put a pharmacist's competence at risk.

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