The Pharmaceutical Journal
Vol 268 No 7197 p664-666
11 May 2002

Answers to frequently asked questions on the modernisation programme

Why do we need to change at all?

High profile cases against health professionals have dented public confidence. The Government wants a new approach to the regulation of health professionals and it expects the regulatory bodies to reform themselves. The National Health Service plan, "Pharmacy in the future" and the Government's response to the Kennedy report on children's heart surgery in Bristol all make this clear. The responsibilities of pharmacists and the relationships between professionals and patients are also changing. We need to change so that we can continue to meet our responsibilities to the public and the profession.

What sort of changes does the Government want?

The changes are intended to put the patient at the centre of professional regulation and to give the public greater safeguards. The NHS plan set out the Government's minimum requirements for bodies regulating health professionals. They must have much greater involvement of lay people (for the Society, non-pharmacists), have faster and more transparent procedures and develop meaningful accountability to the public. The Government has also brought forward legislation to establish a body to oversee the health professional regulators and ensure that they all act in a consistent manner.

Why is the Society doing the Government's work?

If we do not produce our own proposals for change, reform will be imposed by the Government. The Government has already implemented its own reforms for the regulatory bodies for nurses and midwives, and for the professions supplementary to medicine, now regulated by the Health Professions Council. Potentially, pharmacy could lose its independent self-regulation body and become one of 13 professions regulated by the Health Professions Council.

Will the Society no longer represent pharmacists?

The Society has an important representative role. It promotes the profession's contribution to health care to the public, to government and to other health professions. It also makes representations whenever policy or other factors threaten pharmacy's ability to deliver a safe and effective quality service. This work helps to influence the climate within which policy affecting the profession is made and implemented. There is no reason why the Society should not continue to represent the profession in this way. However, the Society cannot represent pharmacists' individual or commercial interests, and it cannot pursue interests that are not in the public interest. The Society also cannot become involved in trade union functions such as negotiations on remuneration or terms and conditions of employment.

Is the Society no longer a membership organisation?

It is really a question of what sort of membership organisation the Society can and should be. Membership of the Society is the basis of pharmacists' contract with society as a whole. It shows that they are in good standing and are uniquely competent to provide vital professional services. Membership of the Society is earned and confers a privileged right to practise. Unlike some other membership organisations, the Society is not a club that members join in order to enjoy a range of goods or services, nor is it a business in which members hold shares. Membership does, however, provide access to a professional infrastructure that helps pharmacists to deliver quality in their practice. The Society provides a local network so that pharmacists can share ideas and learning with their peers. It also offers benevolent support to pharmacists and their families in times of need.

If the Society is ceasing some functions, will the fees drop?

The Society's retention fees are, of course, linked to the activities that the Society undertakes. However, we are not expecting the range and depth of the Society's functions to decrease significantly. In fact, the bodies that regulate health professionals are being encouraged to take on a broader remit, encompassing many activities that might previously have been thought of as professional rather than regulatory. Looking at recent government statements on professional self-regulation, it seems likely that, rather than ceasing functions altogether, we will need some changes in focus, structures and responsibilities in order to set those activities clearly within the context of the public interest.

The Society has said a lot about the public interest, but what benefits will modernising the Society bring to pharmacists?

In the final analysis, the Society must modernise in order to be able to continue to meet its responsibilities to the public and to its members, both as a regulator and in developing and leading the profession. But that does not mean there are no real potential benefits for pharmacists. Greater involvement of lay people could help the Society to make more robust policy and to ensure that we do not lose sight of what is important to patients, clients and customers. Closer links with the regulatory bodies for other health professions could help to foster teamworking in patient care. Extending professional regulation to pharmacy support staff can help us to progress the development of pharmacy on a broader front than ever before. The vision of professional health regulation set out in the Kennedy report reflects the way that the Society has evolved, combining the promotion of high quality practice with dealing with those who fall short of acceptable standards. The interests of the public and the profession may differ on short-term issues but, in the long term, no profession will survive that does not serve the public interest. It is essential that we safeguard and maintain public confidence and trust. The Society's obligation to pursue the public interest therefore plays a vital part in helping to ensure a sustainable future for the profession.

What difference will this make to pharmacists and the way they work?

The main thrust of regulation is moving towards helping good pharmacists to remain good — and to become better — while still managing problem pharmacists. The wider scope of professional regulation set out in the Kennedy report, including continuing professional development, promoting high quality practice, training, support for improvement and revalidation, will mean that, whereas most health professionals today might hope to have little contact with their regulatory body, pharmacists of the future will have an ongoing relationship with the Society throughout their professional life. The relationship between pharmacists and patients, and the pharmacy profession and the public, is not static. It changes over time, in ways which reflect changes in the practice of pharmacy and in social conditions and expectations. Consequently, the professionalism of pharmacists and the system of professionally led regulation have to evolve in harmony with these developments.

Is the Society planning to tear up its Charter?

The Society places a high value on its Royal Charter and has no plans to give it up. Of course, the Charter has changed a good deal since it was first granted to the Society in 1843. Further alterations to the Charter may be proposed in order to help make the Society fit for the future but it is too early in the process to know yet whether or not that will happen.

Why should the Society follow the lead of the other regulators? We are a professional body as well.

Alone among the health regulators in Britain, the Society combines its functions as a regulator with those of a professional body. The NHS Reform and Health Care Professions Bill currently progressing through Parliament recognises that the Society has this broader range of functions. Nevertheless, as the regulatory body for the pharmacy profession, the Society must reform its structures and processes to ensure that they are fit for purpose, now and in the years ahead. Unlike other regulators, we have an opportunity to capitalise on our integrated roles of regulation and professional leadership.

What are the other professions doing?

Some of the other health regulators, such as those for the medical and dental professions, have already put forward their proposals for reform to the Government. The regulatory bodies for nurses and for the professions allied to medicine have already been reformed into new structures of the Government's own design. Pharmacy has an opportunity to develop its own proposals for a modern regulatory body managed within the profession. We cannot afford to delay.

Will we have to have 50 per cent lay members on the Council?

The new structures for the regulatory bodies for nurses, dentists and for the professions allied to medicine will all have a professional majority of no more than one on their governing councils. The General Medical Council has proposed a lay membership of 40 per cent for its council. There is a clear trend, and a strong policy drive from the Government, towards much greater involvement of lay people in the regulation of the health professions. No decisions have yet been taken on the future composition of the Society's Council. We will be seeking views on this question from pharmacists and others.

Does the Society not belong to its members? Is it not for the members to decide what happens to it?

It goes without saying that members are essential stakeholders in the Society. However, a member is not a shareholder in the normal sense of the word. The public, patients, government, the NHS and the other health professions also have vital interests in the future of the Society. We need the views of the profession and those of other stakeholders to inform decisions on how the Society needs to change.

We pay for the Society, so should we not get the service we want from it?

Members do not opt to join the Society on the basis of the services it can provide to them. They join in order to gain the privileges, the rights, and the responsibilities, of a health care professional. The retention fees paid by pharmacists help to support all the processes that combine to assure competence and fitness to practise and to help pharmacists deliver quality in their practice. These functions benefit pharmacists but they also provide assurance to the public and help to protect patients from harm. It is essential that we safeguard and maintain public confidence in pharmacy and pharmacists. The Society is accountable to stakeholders beyond the profession and its activities are determined by the needs of all those whom it exists to serve.

Is the Society planning to get rid of some functions?

It seems more likely that, rather than ceasing functions altogether, we will need changes in focus, structures, priorities and responsibilities in order to set our activities clearly within the context of in the public interest and to support the needs of the profession in the future. We will need to look at the detail of our activities once the direction of travel is clear.

Are we getting value for money? How much do other health professionals pay their regulatory body?

The annual retention fees paid by other health professionals range from £20 to £1,000 (see Table). The Society's roles and functions are broader in range than those of any other health regulator and the £186 paid by pharmacists represents good value. The General Dental Council expects its retention fees to rise to around £350 for 2003. It has also been reported that the Nursing and Midwifery Council will seek a rise of 30 per cent in its fees.

Will we no longer be able to call ourselves members of the Society, or use the title "MRPharmS"?

There are no plans to change the name of the Society or to change the use of the term "MRPharmS" to designate members of the Society.

How can the Society continue as both a professional body and a regulator? Are they not mutually exclusive?

Some say that the Society's responsibilities do not sit comfortably with one another and that professional development and regulation should be undertaken by separate bodies. But the Society's span of authority has given it strength in being able to shape a coherent approach across the standards of education and practice, the commitment to quality, and the continuing development and improvement that are characteristic of a profession. Increasingly, this view is shared by others, with the Kennedy report and the Government's response to it supporting a broader, more integrated approach to professional regulation which goes far beyond disciplinary processes.

Whom does the Society exist to serve?

The Society's primary objective is to promote the practice of pharmacy which is in the public interest and, to that purpose, to lead, develop and regulate the pharmacy profession. Hence, the Society serves the public, and serves pharmacists by working with them to help them deliver excellence to patients and the public.

Surely the Government is only looking for reform of the Society's regulatory processes? Why should there be any impact on the Society's other functions?

The Government recognises that the Society has both regulatory and professional roles. However, the bodies that regulate health professionals are being encouraged, through the Kennedy report and through the Government, to take on activities that might previously have been thought of as professional rather than regulatory. The boundary between professional and regulatory functions is shifting and weakening. They all help to assure competence, quality and fitness to practise and therefore benefit from an integrated, coherent approach.

What's the timetable? How soon will change happen?

Our deadlines are linked to the likely impacts of Government policy and the Council for the Regulation of Health Care Professionals on the Society. The new Council is expected to come into existence in early 2003. Some regulatory bodies have already put forward their proposals for reform. Still others have already been reformed according to proposals produced by government. We cannot afford to delay in producing our own proposals for reform. We hope that the major decisions will have been taken by autumn 2002.

How will the modernisation programme affect pharmacists in different sectors of the profession?

The Society's remit covers the profession as a whole, not any particular sector. Because of this, the modernisation programme is relevant to all pharmacists. We also need to take account of the changing nature of pharmacy practice. Pharmacists are more often working across different sectors and working more with other health professionals. Increasingly, as practice becomes more patient-focused, it is also becoming more integrated.

Why do you say that the Society cannot promote sectoral interests within pharmacy?

There is nothing to stop the Society from promoting the contribution to health made by a particular sector of the profession nor from undertaking work which is of greatest benefit in one particular sector, provided that this is in keeping with overall aims and priorities. What the Society cannot do is to promote one sector of the profession at the expense of, or in preference to, another. For example, if the Society were to be asked to describe how pharmacy could best contribute to a new health service, its response would be based on the skills, knowledge and experience that pharmacists could bring to that service, not on promoting the potential input of pharmacists in any particular sector. Other bodies exist to promote sectoral interests within pharmacy.

Why were the Government's requirements for regulation of health professionals announced in the NHS plan for England? Should they not have been announced simultaneously in Scotland and Wales?

The Government has not devolved professional regulation from Westminster. If and when the Bill now before Parliament is enacted, the Society will be accountable to the Westminster Parliament for the exercise of its regulatory functions across Britain. Nevertheless, both the National Assembly for Wales and the Scottish Parliament take a strong interest in health policy. Service delivery differs in the three home countries. Scotland also has separate legislative and education systems. It will therefore be important to ensure that the Society's modernisation proposals are politically acceptable to the devolved administrations. The Society has already begun work in all three home countries to clarify the ways in which devolution is likely to impact on the modernisation programme.

How will the Society's regulatory powers relate to the arrangements introduced by the Health and Social Care Act 2001 such as NHS primary care organisations managing lists of family health service practitioners, including pharmacists?

We are already working with the NHS on this and we will need to continue to work to ensure that these local NHS procedures affecting pharmacists are consistent and do not duplicate or conflict with professional self-regulation by the Society.