The Pharmaceutical Journal
Vol 268 No 7204 p925-926
29 June 2002

What will the Council look like in the future? Key points for comment

The Society is the regulatory and professional body for pharmacists in Great Britain. Membership of the Society assures the public that members are in good standing and gives pharmacists the right to practise. The Society provides members with support to help them deliver quality in their practice. It does not undertake trade union functions. The Society has a representative role, promoting the profession's contribution to health and making representations whenever policy or other factors threaten pharmacy's ability to deliver a safe and effective quality service. This helps to influence the climate in which policy affecting the profession is made and implemented.

The Council governs the Society. It determines strategy and major policy. It comprises 21 elected pharmacists and three lay members. There are no reserved places for England, Scotland and Wales, or for specific fields of practice.

Future remit

The Council has decided that the Society should retain its integrated regulatory and professional roles within a reformed organisation, meeting modern regulatory requirements and firmly based on the public interest.

Modern regulation

The Kennedy report and the government's response to it introduced a new approach to professional regulation, going far beyond disciplinary processes to include all the processes that combine to assure competence and fitness to practise:

• Controlled entry into a profession

• Education

• Registration

• Setting and enforcing professional standards

• Promoting good practice

• Training

• Continuing professional development

• Assessing competence

• Support for improvement

• Revalidation

• Dealing with poor performance or misconduct

• Removal from the register

This, with underpinning activities such as research and communications and supporting functions such as finance and information technology, represents the large majority of the Society's activities, including much of what were previously considered "professional" functions.

Lay:professional balance

In 2000, the Society envisaged delegating some regulatory functions to new statutory committees, leaving the Council's composition unchanged. Since then, we have seen:

• Ongoing reform of other regulatory bodies

• A Bill establishing the Council for Regulation of Health Care Professionals to oversee the health regulators and seek consistency between them

• A new, much broader interpretation of professional regulation

The context within which the Society works has changed significantly and we need to look again at the Council's constitution.

If the Council is to retain overall control of the Society, it will need to take responsibility for the modern regulatory role. It would therefore have to satisfy the Government's requirement that regulatory bodies should have a relatively small council with significant lay membership. A lay member would be someone who is not, has never been and is not eligible to be, on the Society's Register of Pharmaceutical Chemists.

If the Council's composition were to remain unchanged, the breadth of modern regulation suggests that a wide range of functions would need to be delegated to statutory committees, well beyond those envisaged in 2000. These committees would need some sort of "board" to co-ordinate their functions. This board would have to meet the government's requirements for regulatory bodies. This board, not the Council, would have power to make rules and to set standards for practice, education and conduct. This board would govern the majority of the Society's activities.

The Council, as currently constituted, could not sit in authority over this board or its committees. In this situation, there would be no governing body in overall control of the Society and the Council would be left with a much reduced remit, little authority and little relevance to most of the Society's functions. It could not set strategy and policy across the Society's activities or control expenditure relating to the Society's regulatory functions. Practical difficulties would arise in the oversight of functions that provide support across the Society's remit, such as public affairs and public relations, the branches and regions, and the library and information service.

A Council with an increased lay input could strengthen pharmacy's voice, ensure that policy is robust and help to reinforce public confidence in pharmacy. It would increase the range of experience and expertise available within the Council. It would have credibility with the public and other professions. A reformed Council would retain overall control of the Society and be able to set strategy and policy across both regulatory and professional functions. It would need a small number of statutory committees to separate policy making from decisions on cases such as screening and determining fitness to practise cases.

The Society also needs to ensure that its work has credibility with pharmacists. A reduced number of pharmacist members of Council could potentially decrease the professional input to some of the Society's work, such as developing the profession's role. Once the Council's constitution has been determined, decisions will be needed on how best to bring in the knowledge and experience that should inform the Society's work — for example, ensuring expertise within committees, having a forum to take forward professional issues, using panels of experts, or liaising with other pharmacy bodies.

The Society could follow the model agreed for nurses, dentists and the therapy professions by proposing a Council with a professional majority of one (52 per cent). Or it might favour a structure closer to the GMC's proposals (professional majority of 59 per cent). The concept of professionally-led regulation, in partnership with the public, supports the need for a professional majority on the Council. The Society's integrated regulatory and professional roles may suggest the need for a professional majority larger than one, so as to assist the Society to engage the profession in its functions.

Size of Council

The Council needs to be small enough to be strategic, effective and efficient. Given the range of stakeholders and the need for a reasonable spread of experience, a Council of 21 to 31 members might be the best solution.

Pharmacy technicians

The Council has agreed to move towards regulation of pharmacy support staff, who make an increasing contribution to pharmacy services. It might therefore be appropriate for pharmacy technicians to be included on the Council.

Government chief pharmacists

Government and the NHS are important stakeholders for the Society. Government chief pharmacists could be invited to Council meetings, to help ensure that the profession and government were aware of each other's views and working together where appropriate. It is also vital that the Society remains independent of government, to allow the Society to make independent representations when necessary in the public interest.

Election or appointment?

Whatever system of election or appointment is used, Council members, because of their collective responsibilities, would not be mandated representatives of particular constituencies or groups. But it would be appropriate for the Council's composition to reflect the stakeholders who have a legitimate interest in the Society's work.

Pharmacist members of Council could be elected, appointed or a mixture of both. Appointments could ensure that the Council includes expertise that might not be brought in through an election system.

Reflecting devolution

Professional regulation has not been devolved from Westminster. The Society will be accountable to the Westminster Parliament for the exercise of its regulatory functions across Great Britain. Nevertheless, both the Scottish Parliament and the Welsh Assembly have health policy responsibilities and are developing their own strategies and priorities. It will be important to ensure that the Society's modernisation proposals are politically acceptable to the devolved administrations.

A reformed Council could include reserved places for pharmacists from England, Scotland and Wales. Extrapolating the Society's membership statistics, a Council with 13 or 16 pharmacist members would include 11 or 14 from England, one from Scotland and one from Wales. There are more pharmacists in Scotland than in Wales and it might be appropriate to reduce the number of Council members from England to allow that difference to be reflected.

Reserved places for pharmacists from England, Scotland and Wales could be filled by appointment or election. If elected, this could be done by pharmacists in those countries, forming constituencies, or by all members of the Society. Both options have pros and cons.

Reflecting fields of practice

Reserved places for specific fields of practice could achieve a more balanced membership and help inform the Council's decisions.

This issue is more complex than that of reflecting devolution. Definitions would be needed of the fields of practice entitled to reserved places and criteria to determine the eligibility of candidates. A practical method of choosing members to fill those places would be needed, either by election or appointment.

Fields of practice are developing rapidly and demarcations are blurring. Attempting to reflect that mix within a relatively small Council might prove quite inflexible.

Reserved places for fields of practice could allow some pharmacists to gain a seat on Council who would find it difficult to do so under the current system. It could also mean that some potentially valuable members would be unable to gain a place

The Council will never be able to include all the specialisms that occur within pharmacy practice. Given that the Council will be focusing on strategic and broad policy issues, the value of this expertise may be greatest at the stage of policy implementation.

Election system

If direct election of pharmacist Council members is to continue, the method will need to be determined: single transferrable vote (STV) or "X" system. Branch representatives' meeting motions have indicated strong views in favour of an "X" system. STV is widely used in professional bodies and is broadly seen as fair. The counting mechanism is complex but there seems to be little evidence to suggest that this feature of STV alone reduces participation.