The Pharmaceutical Journal
Vol 268 No 7190 p396
23 March 2002

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Getting to grips with modernisation

By Joy Wingfield

At first sight, the Royal Pharmaceutical Society's laudable effort to consult on modernisation is a daunting exercise. It may be tempting to say, "I really can't get my head round this, let alone weigh up the options on offer." This would be unfortunate, since we all will be affected by the changes being discussed and we will not get a better opportunity to challenge the status quo.

There are several additional questions that arise from the Society's consultation document. What does the Society currently do for us (or some might feel, to us) now? Of those functions, which will be done to us (or for us) anyway by a body, whether it be the Society or a Government board? Which would we prefer? Of the remaining functions, could any be done better by someone else? If so, who? And would there indeed be lost "synergies" if some separation were undertaken? Furthermore, what are the related costs associated with the options? A comparison with other health professions in the United Kingdom and, in some instances, with practice in other countries might help to clarify our thoughts.

As I see it, the Society carries out not one, not two, but three distinct roles and therein lies the source of some tension and conflict of interest and also some mutuality of interest and economies of scale. The table sets out the three roles and some selected comparisons.

Regulation Make no mistake, pharmacy will be regulated, with or without the Society. This role will become more onerous and it is questionable whether the already substantial hike in retention fees will adequately fund the escalating demand from Government and public for ever higher and proven standards in professional life.

In taking a position on this, we lack some basic information. How much would be saved if the Society only carried out a regulatory role? In my view, not much. Can we draw any inferences from the fees other health care regulatory bodies demand? How much is this per head? Clearly, the more registered professionals per register the smaller the fee. I would welcome information on the costs for the regulatory functions only for the Society and for comparable regulatory bodies in other health professions, including long-established bodies like the General Medical Council and new bodies established for, say, chiropractic.

Professional representation role Part of the confusion over professional "membership" of the Society arises from a failure to separate in our minds these first two roles. With respect to its regulatory role, the Society is not a membership organisation in the sense that you can opt for "membership" or not. If you want to practise as a pharmacist you must register.

If we consider the true membership roles as set out in the table, then we start to see some areas where the Society could perhaps do more, or less, or lose the role altogether — to other organisations or to a new organisation. Is this what we want? What would such services cost if they were delivered separately? We then start to get complex comparisons, since none of the current pharmacy "membership" bodies is directly matched by similar bodies in other professions. Moreover, we should take care to distinguish between representation of the profession as a whole and a "trade union" role involving representation of individual pharmacists. Although the first could be combined with a regulatory role subject to considerations set out below, the trade union role most certainly could not.

There is undoubtedly synergy between, say, practice development and standards enforcement, but equally there is potential conflict. Professional representation is by definition political, and much more needs to be done to isolate the regulatory roles of the Society from any breath of political influence or self-interested protection. Indeed (although no reference is made to it in the consultation document), the Society is already proceeding down Option 2 as evidenced by the moves signalled in 2000 (see PJ, 11 March, 22 April and 15 July 2000) on discipline, continuing professional development, Council and committee structure and technician registration. It is not clear in the current consultation if, or how, these earlier measures are now to be taken forward.

Law enforcement The third role of the Society has no parallel among other health professions in the UK and possibly worldwide. Because the traditional nature of pharmacy is a supply function, the Society acquired (in 1933) the role of "pharmaceutical policeman", not just against pharmacists but in any situation where medicines are supplied, be it a veterinary surgery or newsagent. Although it is generally acknowledged outside the profession that this role has been assiduously and fairly discharged for many years, this role, too, needs to be rigorously protected from political influence or any suggestion of bias.

Once again, it is pertinent to ask what the law enforcement role costs and from where is the money derived. I would welcome confirmation that the principal source is from premises registration fees with some Department of Health supplementation, as it was when I carried out this role as an inspector for the Society. The continuation of this role does not seem to be strongly in contention although it would be helpful to know who might carry it out if the Society did not.

New developments

The Society acknowledged the need for change several years ago and the 2000 consultation documents were a first response to the changes heralded in the NHS plan. We now need to focus on what further demands will be made of us by the overarching Council for the Regulation of Health Professions and what aspects of the Kennedy inquiry into the Bristol paediatric heart surgery cases have further implications for our profession.

One issue that the consultation has identified for future work is the position of specialist pharmacy practice. In medicine, bodies such as the Royal College of Obstetricians and Gynaecologists or the Royal College of Paediatrics and Child Health assist and support the generalist regulatory body in defining and developing the scope, standards and accreditation of competence in specialised fields of practice. I suggest that the Society cannot and should not attempt to cater alone for the burgeoning demands of specialised pharmacy practice. This role is the remit of the College of Pharmacy Practice which is moving rapidly towards a faculty structure bringing together specialist skills in a coherent way. A faculty for prescribing and medicines management has already been established, a faculty of neonatal and paediatric pharmacy is imminent and other specialties are planned.

Recognition and acknowledgement of the current and potential role of the College of Pharmacy Practice might be a useful step to allow the Royal Pharmaceutical Society to concentrate on its core roles whether they be some form of separation or, more likely, an improved version of the "mixture as before".

Joy Wingfield is a governor of the College of Pharmacy Practice