The Pharmaceutical Journal Vol 267 No 7161 p241-245
18 August, 2001

Main points

Branches and regions The membership of the Royal Pharmaceutical Society is to be consulted on a review of how the Society’s local networks can contribute to the future of the profession [more]

Attendance

Members to be consulted on future role of branches and regions

The membership of the Royal Pharmaceutical Society is to be consulted on a review of how the Society’s local networks can contribute to the future of the profession. A consultation document has been sent to secretaries of the Society’s branches and regions and is shortly to be placed on the Society’s website so that all members can contribute.

At its meeting on 7 and 8 August, the Society’s Council approved a consultation timetable proposed by Mr Nathan, who told Council members that the series of meetings held around Britain in the first half of the year had thrown up a long list of ideas. These had been taken back to headquarters, where a team had translated them into possible actions for the future, which were set out in the consultation document, “Shaping up for the future”.

The intention of the initiative was to increase the involvement of members at the local level and to try to motivate more people to become active and take an interest and attend branches meetings. It was to provide branches and regions with a sense of purpose contributing to the Society’s modernisation agenda. The idea was to allow local flexibility in the system rather than wholesale reorganisation.

The Council was asked to approve the issue of the report to branch and regional secretaries for discussion and consultation. A response would be required in time for the branch and regional secretaries’ meetings in October.

It was proposed that, because the issue was so important, those two meetings should be combined into one and held over a single day. Following that meeting, a final report would be prepared with recommendations that would come to the Council in December. Assuming there was approval, the recommendations would be implemented in 2002.

The PRESIDENT thanked all those who had contributed to the project.

The Council approved the consultation timetable suggested by Mr Nathan.

Special general meeting

Mr TANNA asked what action had been taken with regard to the censure of the Council at the special general meeting. Was the matter finished?

The PRESIDENT replied that he believed that the Council had noted and was aware of the anxiety of the membership as expressed at the special general meeting. The Council had to ensure that arrangements in future were open and transparent so that concerns that the membership had expressed at the special general meeting were avoided so far as was possible in the future.

EC professional recognition

The Council agreed that the Society should prepare a response to a European Commission consultation on the future regime for professional recognition in Europe.

The Council heard that consultation was taking place in the context of the review of the existing directives on professional recognition as part of an initiative for simpler legislation in the internal market. The consultation was preparatory to the presentation of a new directive on professional recognition before the spring European Council in 2002.

The current system had both general directives and sectoral directives. Pharmacists were covered by a sectoral directive, as were doctors, dentists, veterinary surgeons, pharmacists, nurses, midwives and architects. Sectoral directives provided the minimum harmonisation of training and automatic recognition of title throughout the European Union. The initial wish of the Commission was to get rid of the sectoral directives. However, it was coming round to the idea that that might not be acceptable either to member states or to the professions, and the profession was asked to comment.

The Secretary and Registrar suggested that the consultation posed a number of questions and therefore a response should be prepared in the office based upon the analysis of a series of consultation meetings. The office would produce a response that would be circulated for comment and a final submission would be agreed with the Officers. Responses were sought by 28 September.

Honorary fellow and members

The Secretary and Registrar reported that Sir Richard Sykes had accepted honorary fellowship of the Society, and Dr June Crown and Dame Deirdre Hine had accepted honorary membership.

Building a safer NHS for patients

The Council gave consideration to the Government’s plans to establish a National Patient Safety Agency, to facilitate the improvement of patient safety by reducing risks to the patient through error. Examining a summary of the main points in a paper entitled “Building a safer NHS for patients”, the Council noted that one of the main targets was to reduce by 40 per cent the number of serious errors in the use of prescribed drugs by 2005.

The Council considered the impact of the initiative on the Society’s work on quality measures to date and on clinical governance in pharmacy.

The SECRETARY AND REGISTRAR said that much of what was raised in the paper would be taken into account in the Society’s approach to clinical governance and in its response to the NHS plan.

Mrs GLOVER suggested that those taking the work forward should look at something like a model template which individual practitioners could use to help them develop error reporting schemes. The small practitioner was not in the same position as the managed service and the large corporate bodies.

HEMANT PATEL said that the initiative fitted in with the risk management work that was going on. There were other issues also. Clinical governance demanded the open discussion of errors, but a tension existed, particularly in community pharmacy, that needed to be understood and explored. A way was needed to enable people to report errors, which was not in the culture of community pharmacy.

The PRESIDENT said that Mr Patel had raised an important point. A number of large multiples were already working towards setting up systems for reporting errors and near misses. There were systems in hospitals that had been long established. The Society would obviously seek to help and underpin and encourage. It would encourage a no-blame culture.

Mrs HOARE said that in her locum work she saw procedures that she thought could be improved to the benefit of patients. She hoped the document would spur people to change and take more cognisance of matters that were reported to them in a way that did not risk the employment of staff doing the job.

Mr EMSON suggested that it was not helpful to differentiate between multiples and independents. It was an issue where a common terminology was needed. There were common cultural issues and there had to be a common determination to get things right. Those who had made some effort in risk reduction should share it so that all could commit to make progress in the area. Mr Emson added that one could not set a 40 per cent target unless one knew what was going on at the moment. There was a huge amount of work to do to establish the baseline.

Mr CURPHEY agreed that the Society should get on with a proposal for a simple form of error reporting. Around the country people had already devised simple methods of reporting both errors and good practice. So there was less of the blame culture involved. A marker should be sent to the Department of Health and the Chief Medical Officer to say that the Society believed it could make a major contribution in the area. That would be a useful first step before making a considered response.

Miss EWING said that the managed sector was taking the paper on in its entirety. There were some good things to come out of the managed sector that could be applied to community pharmacy, which appeared to be disjointed from the central process. Lessons could also be learnt from the Commission for Health Improvement, which was looking at the health service from the patient’s point of view.

Mr DOVE felt that the action Mr Curphey had recommended was the right way forward. The Society had to get on quickly with the baseline work suggested by Mr Emson in order to see what the error rate was in community pharmacy, because that was not known.

HEMANT PATEL asked what action points they had agreed following their discussions.

The SECRETARY AND REGISTRAR said that discussions would take place with officials at the Department. There was an action plan. The suggestions that had been made in the debate would be taken into account and those points would be included.

Prioritising the Society’s work

The Council approved a strategy for handling the main priorities for the Society’s future work.

The decision was made on the basis of the report of a Council reserve day held on 4 July. Making a presentation on the report, the President said that the “awayday” had looked at the role, responsibilities and the future strategy of the Council, the Society and the profession.

The Council had developed an agreed vision, namely: “The RPSGB leads the profession by working with members in partnership to help them deliver excellence to the public/patients. By serving the public interest well, the Society and its members are recognised and respected by all stakeholders.”

To apply this vision, the Council would, for every proposal, identify and consider what the proposal did for the public and what it did for the members.

The awayday had effectively identified five key priority areas. Those areas were: professional leadership and development; NHS plan implementation; regulation; devolution; and strengthening the Society’s role.

Subsequently, the priority areas had been divided into three work programmes. The first embraced professional leadership and development and NHS plans implementation. The oversight mechanism for that would be Practice Committee approval of the work plan. It had already been discussed at the last Practice Committee meeting.

The second work programme was to strengthen the Society by enhancing its reputation and profile and engaging the membership. The oversight mechanism was the public affairs planning group. This programme had already commenced with the review of the role of regions and branches.

The third work programme was a huge project covering regulation and governance, including devolution. There was a proposal to extend and take forward the work of the Health Act Working Party, bringing forward proposals to modernise the regulatory function and to capitalise on the Society’s dual role of professional regulation and professional leadership.

Infringements Committee

Working while not registered On the recommendation of the Infringements Committee, the Council agreed to refer to the Statutory Committee the cases of two pharmacists who had continued to practise as pharmacists after having been removed from the register for non-payment of fees.

In the first case, the pharmacist had been erased from the register on 14 May 2001, but on 4 June an inspector had found him working as pharmacist-in-charge at one of his employer’s pharmacies. He had said that he was not aware of the erasure, having stopped opening his mail because he was in debt. He had told the inspector that he had paid his retention fee on May 22 and had produced a cheque stub. However, the amount shown was inadequate because it had not included the restoration fee in addition to the retention fee.

The committee noted that the pharmacist’s employer, which had reimbursed its pharmacists for the 2001 retention fee in its February payroll, had subsequently given him a written warning for failure to pay his fees on time. This followed an earlier written warning for poor time keeping. Although there were no adverse reports from staff or customers, the committee was concerned that the pharmacist’s apparent failure to cope with normal day-to-day duties might indicate that he had not overcome a problem he had had with alcohol.

In the second case, the pharmacist had worked for a year while apparently unaware that his name was not on the register and had then worked a further three days knowing that his name was not on the register.

The committee heard that after being removed from the register for non-payment of fees in May 2000 the pharmacist had sent a cheque but had omitted the restoration fee. As a result, the cheque had been returned, but the pharmacist had not read the letter accompanying it until 7 May 2001. Realising that he was not registered, he had visited the Society’s headquarters on 10 May but, having insufficient funds to pay both years’ retention fees and the restoration penalty, he had left without having been returned to the register.

On 15 May an inspector carrying out a routine visit to a pharmacy had found the man acting as pharmacist-in-charge. He had not informed the pharmacy’s owner of his status and had also worked there on 11 and 14 May knowing that he was unregistered. Payment to permit restoration was made on the day of the inspector’s visit and he was restored as of that day.

Health problems On the recommendation of the Infringements Committee, that Council agreed to refer to the Statutory Committee the cases of two pharmacists with health problems that allegedly made them unfit to work.

The first case concerned a pharmacist who had undertaken locum pharmacy duties while suspended from work by his employer because of health problems relating to the abuse of alcohol. The committee heard that on 5 July the pharmacist had arrived about 20 minutes late for his locum engagement. A trainee dispenser had become concerned that she could smell alcohol on his breath and that he appeared dazed and unfocused and was not checking her work properly. In response to a telephone call, the company’s area manager had arrived and had made the assessment that the pharmacist was indeed under the influence of alcohol. The area manager had asked him to leave the pharmacy.

When visited by two of the Society’s inspectors, the pharmacist had confirmed that his principal employer had suspended him from work because of an alcohol problem. He said that he was in the main abstemious but did suffer occasional relapses and had been drinking on the eve of his locum engagement. He agreed to provide an undertaking not to seek work as a pharmacist until he could provide evidence that he was fully fit.

The second case concerned a pharmacist who, following a police investigation, had admitted taking dihydrocodeine from pharmacy stock for his own use. He had admitted that he was addicted to it and took 20 or more tablets a day. He had been released on bail — later to receive an adult caution for the theft — and put in contact with the Pharmacists Health Support Scheme. With some reluctance he had entered Birdsgrove House on 25 May for a five-week residential course of treatment. However, he had discharged himself on 10 June against medical advice, having twice earlier left the house temporarily.

It had later been established that he had gone to stay with his parents and receive treatment under the supervision of their GP. He had undertaken not to work as a pharmacist and had co-operated with the local treatment centre.

Poor pharmacy and practice standards The Council accepted a recommendation of the Infringements Committee that it should refer a pharmacist to the Statutory Committee because of the allegedly poor physical standards of his pharmacy premises and his allegedly poor practice standards. The committee was concerned that, despite continued attempts by the Society’s inspector for the area to improve the pharmacy’s standards, there was a catalogue of deficiencies, some of them presenting potential risks to the public.

The committee heard that the inspector had first visited the premises early in 1998, shortly after the pharmacist had relocated his pharmacy there. The inspector had found that general housekeeping standards were poor and had given verbal advice regarding required improvements. Four months later the inspector had revisited and had left written advice on improving standards.

After the Society received a complaint from a member of the public about the pharmacy in August 2000, the inspector had again visited, finding generally poor standards and subsequently sending a letter detailing required improvements. During a further visit in January 2001, the inspector had found a range of problems remaining. Finally, in June, the inspector had made another unannounced visit, finding little improvement in standards.

The inspector had observed that: the general appearance of the premises remained poor; boxes of stock and other items remained positioned on top of the pelmets above the fixtures; the dispensary and rear areas remained generally unkempt; the drug refrigerator needed defrosting and its temperature was not being regularly monitored; the wall above the dispensary sink remained in poor repair, and part of the ceiling had fallen since the previous visit; a significant amount of date-expired and short-dated stock remained on the dispensary shelves; expired and short-dated stock was also to be found in the sales area; the lavatory and anteroom were in poor condition; the docket system used for medicines owed to patients remained poor; and a container of temazepam was on a shelf outside the Controlled Drugs cabinet.

Nicola Gray

The Council formally agreed to a proposal of the Officers that Dr Gray should remain eligible to retain her Council membership during the period of her Harkness fellowship in the United States (PJ, July 7).

The President said that, at a meeting on 3 July, the Officers had reconsidered the matter of Dr Gray’s eligibility to retain her Council membership. It was clear that her absence from Britain was of a temporary nature; her permanent residence would still be in Britain. Council members had in the past been absent during their terms of office for good reason. Other circumstances were foreseeable that might lead to periods of absence during a Council member’s term of office, for example, illness.

In coming to its decision, the Council noted that the interpretation of “normal residence” had been adjudicated in the courts. The Council acknowledged that as a matter of fact in these circumstances “normal residence” remained in Britain. There were no guidelines in the Society’s Byelaws or elsewhere on the absence of Council members.

The Council decided that, in the circumstances, Dr Gray remained eligible to serve on the Council. The Council also agreed that guidance should be developed for the future.

Registration examination

The Council agreed that proposed revised regulations for the Society’s registration examination should be sent to the Privy Council for approval, subject to any amendments required by legal experts who were currently reviewing the regulations.

The Council was reminded of a previous decision that the Board of Examiners should determine the regulations for the examinations. The examiners had been developing a new set of examination regulations for examination sittings in 2002 onwards. These needed to be finalised as soon as possible for dissemination to potential 2002 candidates well ahead of the summer sitting, and early in 2002 at the latest. Section XXVI of the Society’s Byelaws required that the Privy Council approve the regulations before they became operative.

Welsh Executive secretary

On behalf of the Council, the PRESIDENT thanked Erica Barrie, secretary of the Welsh Executive, who is to leave the Society at the end of August, for all that she had achieved and wished her well in the future.

The President said that Mrs Barrie had been the first Welsh Executive secretary based in Wales — initially part time but rapidly going on to full time. She had worked enormously hard in promoting pharmacy in Wales and supporting the Welsh Executive in its dealings with the Welsh Assembly and others. The Society’s progress in Wales was due in no small part to her work.

Council code of conduct

The Council agreed to adopt a revised code of conduct for Council members which included a requirement that: “So long as they continue to serve on the Council, members of Council cannot, by their actions or behaviour, divest themselves of their role in such capacity in matters concerning the profession.”

The additional sentence had been proposed by the reconvened corporate governance steering group so as to clarify the position of elected members of Council in terms of their conduct. Council members were asked to reaffirm their acceptance of the revised code of conduct by signing a revised statement of undertaking.

Mrs STONE said that the additional sentence was something that had arisen at the special general meeting and also at the debate that they had at the previous Council Meeting. She expressed the hope that all members of Council would sign the undertaking before they left the building that day.

Asked what the implications of the sentence were, Mrs Stone said that persons elected to the Council could not divorce themselves from the fact that they were Council members when they were mixing with pharmacists at professional meetings and at meetings in public. It made it absolutely clear that once a Member of Council, always a Member of Council until no longer re-elected.

Mr ARGOMANDKHAH asked what happened in the case of a Council member who also served on another body whose opinions did not necessarily reflect the views of the Council.

Mrs STONE replied that the view of the corporate governance group — which included an external assessor and a Privy Council nominee member of Council — had been unanimous. It had been strongly put by the external assessor that a member could not divorce himself or herself from her elected position of serving on the Council.

Mrs BANKS pointed out that Item 10 of the code allowed a member of Council to express personal views if he or she also explained the reasons for the Council’s decision. Therefore there should not be a problem. But anyone who belonged to two bodies that were driving in different directions had to consider whether they could continue to belong to both bodies.

The PRESIDENT felt that Mrs Banks had made the point very clearly. If there was a matter relating to a policy that was contrary to the Council’s policy, then one had to explain what the Council’s policy was and, if there was disagreement, why there was disagreement. If, however, the position was untenable then that position would have to be considered with regard to being a member of Council. Everything a Council member said was potentially perceived as being said as a member of Council.

The SECRETARY AND REGISTRAR said that the Council was acting as regulator for the profession. There was provision for declaration of conflict of interest. If the conflict of interest became such that a person could not properly act as a member of Council, then they would have to consider their position.

Mrs HOARE drew attention to the reference to “by their actions or behaviour” and asked what if a member of Council decided to abstain from a vote at a special general meeting.

Mrs STONE replied that the group had not looked back at any individual action. It had looked forward to what would be acceptable behaviour. She did not believe the group had discussed the issue of abstaining.

Mrs BANKS said that aim was to establish the basic principle and obviously the Council could not legislate for every case.

KIRIT PATEL said that in reality the Society tended to go off at a tangent to other bodies. Whatever was decided had to be practical.

Mr CURPHEY welcomed the amendment to the code of conduct. He had always held the view that one could not be a leading member of two organisations that fundamentally disagreed on great issues of strategy. It had not been the Council’s view that they should in any way restrict membership of the Council. The amendment was a sensible way of protecting the profession and its influences.

It was important that people did not hide behind the view that they could be somebody other than what they really were. If they were a Council members they could not speak as if they were not.

Dr APPELBE said that he had had to read the additional sentence four or five times before he understood what it meant. Simpler English could have been used. He asked whether he would be caught by the new requirement if he voted against Council policy at an annual general meeting.

Mrs STONE replied that he would.

Dr APPELBE asked if it was right that a Council member, as a member of the profession, could be disenfranchised from voting as he or she wished to vote at an AGM.

Mrs STONE replied that if a member disagreed fundamentally on a broad enough issue then the member could not participate as a member of Council. If it was a single fairly narrow issue then the course of action might be to abstain from the vote. But a member would go no further than that. A member could not speak against an item unless Item 10 was used. Advice had been given along those lines.

Mrs BANKS said that the whole point of the amendment was that a Council member could not anywhere, including at an AGM, act as if he or she were not a member of Council.

Dr APPELBE said that in that case the answer to his question was that he was disenfranchised. The matter should be clearly understood.

Mr DAJANI said he was very concerned because he believed in freedom of speech and he also believed in being a member of Council and a member of the Society. Although Council members had a duty to the Council and a collective responsibility to each other to work together, he did not think putting something in bold type telling them what they could and could not do as individuals, for the reason that they were elected in the first place, was right.

The SECRETARY AND REGISTRAR said that the point made by Mrs Banks was very pertinent. A person elected as a Council member had responsibilities as a regulator of the profession until such time as he or she was no longer a member of Council.

Mrs GLOVER said that because the Society was a regulatory body the commitment to the Council overrode other views or choices. The Council’s responsibilities superseded individual rights.

Mr DAJANI agreed that the Society was a regulatory body. But it was also a professional body. Members of Council had to take representative actions on behalf of the members who had elected them.

The SECRETARY AND REGISTRAR reminded Mr Dajani that, so far as representation of the members was concerned, the Charter said that Council members represented the members “in the interests of the profession”, not just in their own interests.

The PRESIDENT asked the Council to remember that they had to reflect public interest. The Privy Council looked at whether the Society, through its Charter and its regulations, was serving the public interest through the profession of pharmacy. The Council had a responsibility to uphold that expectation. If it did not do that, it put the Council and the Society in jeopardy.

The President then put the revised code of conduct to the vote, and it was accepted.

Mrs STONE said that, as acceptance had been unanimous, she hoped that all Council members would sign the undertaking form and hand it in before they left the building.

Statutory fees

The Council approved a proposal to seek increases in the statutory fees for 2002 (PJ, 11 August). In agreeing the proposal, the Council noted that increased expenditure on professional development had not been matched by a corresponding increase in membership fees, which had risen only in line with general inflation for many years. In addition, the Council had identified new areas of activity that would commence in 2002. The four main areas were: constitution, regulation and discipline; continual professional development and life long learning; clinical governance; and practice research.

In relation to practice research, the Council had reviewed its need for research following the publication of the National Health Service plans (PJ, 16 June). The commissioned research programme would from 2001 onwards address issues for which the Society had primary responsibility, all of which were pivotal to effecting changes envisaged in the plans. The programme would ensure that the Society established data to support and inform its regulatory functions in line with similar work already done by other regulatory bodies.

Attendance Those present at the meeting were the President (Marshall Davies), the Vice-President (Dr Gillian Hawksworth), the Treasurer (David Allen), Dr Gordon Appelbe, Hassan Argomandkhah, Terri Banks, Andrew Burr, Peter Curphey, Sultan Dajani, Wally Dove, Digby Emson, Dr John Evans, Alison Ewing, Christine Glover, Sally Greensmith, Patricia Hoare, Alan Nathan, Hemant Patel, Kirit Patel, Linda Stone, Ashwin Tanna and the Secretary and Registrar (Ann Lewis).

Apologies for absence were received from Dr Nicola Gray, Helen Remington and Professor Michael Schofield. Apologies were also received from the chairman of the Society’s Scottish Executive (Alison Strath) and the chairman of the Welsh Executive (Andrea Robinson).

Guests Present by invitation were David Thomson (Scottish Executive), Dr David Temple (Welsh Executive), Peter Schofield (Anglia region), Jacki Lamberty (Brighton branch), John Davies (Doncaster branch), Janette Golding (Manchester, Salford and Trafford branch) and Helen McKnight (Manchester, Salford and Trafford branch).

Also present was Sandra Gidley (pharmacist, Member of Parliament and deputy spokesman on health for the Liberal Democrat party).

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