Modernisation debate must focus on realistic and
workable options
The President: The Society
has a great opportunity to build on its success and create a dynamic
organisation that is second to none |
It is good to see that the debate about the future of the Society is
gaining momentum and has brought forward a wide range of analysis and
opinion from individuals and organisations.
Over the past six months or so, we have taken forward the process of
considering how we should best progress. Members of the Society's Council
and staff have been engaged in a programme to communicate the complex
issues involved. A key vehicle for communications is, of course, the consultation
papers that have been issued to all pharmacists to set out the background
and possible options and to seek views. We have also been working to promote
the debate through branches and regions, which have hosted a number of
well-attended meetings. We have held a series of meetings of pharmacist
opinion formers and of other stakeholders in health, including patients'
and consumers' organisations. We have produced articles and responses
for the pharmacy press.
Timetable
Throughout this process, there are some who have voiced concern
that the timetable for change is too tight to allow for proper reflection
or debate. Under different circumstances, it might have been possible
to adopt a more leisurely approach to the process, although I question
what ultimate advantage this would bring. But the fact is that all the
United Kingdom health professions are subject to the same tight timetable
for bringing forward proposals for modernisation.
The key driver for this timetable is the fact that the overarching Council
for the Regulation of Health Care Professionals, already recruiting its
lay membership, will be operational by the beginning of next year. If
our proposals for change are not well shaped by the end of the year, we
risk missing the opportunity for Parliamentary time to improve our legislative
framework. I am therefore pleased to note a significant shift among those
commentators who may have once questioned the need for the Society to
modernise at all and who now appear to recognise the need to meet the
many new expectations placed upon modern health professional regulatory
bodies.
Some have felt that pharmacy's excellent track record as a regulatory
body could somehow exempt the profession from the need to modernise its
framework. Put bluntly, the Government is not concerned simply with the
performance of individual regulators but has set out clear criteria for
how all regulators need to operate in future. The new overarching regulator
has power to ensure that health professions meet those criteria. In discussions
at meetings around Britain, I have gained the impression that, as health
professionals, pharmacists understand that the public should not be expected
take professionalism on trust. Health professionals need to be accountable
to the public they serve. Who would want it any other way?
Modern regulation
"Regulation" is the framework that allows the public to be assured
that their safety has been properly taken into account. It is in the interests
of society as a whole as well as the professions that regulation operates
to best effect. In the modern context, regulation has come to mean far
more than disciplinary activity, although of course, it must continue
to deal with the relatively small number of professionals whose conduct
or fitness to practise become a problem. But discipline is just part of
the regulatory role: the Government's new definition of regulation involves
all the processes that contribute to the registration of new health professionals
and then supporting them in achieving excellence throughout their careers.
For the Society, this new scope of activity should hold no fear. Since
it gained regulatory powers in 1933, the Society has discharged them in
synergy with its work to support pharmacists in their professional lives.
Commentators within the profession who have voiced concerns that the Society
might lose its professional leadership roles and become a "pure" regulator
should be reassured. The Council's decision to pursue the Society's future
as a regulatory and professional body recognises the complex, interrelated
nature of professional governance.
The value of the integrated approach may be thus summed up: you can
legislate to set standards but you cannot legislate to ensure professionalism,
which always goes one step beyond. That is why laws and rules cannot alone
deliver professional quality and why professional leadership and professional
development are now seen as a necessary part of health professional regulation.
It is true that the differences are diminishing between the Society
and the other health professional regulators. But this is not because
the Society is moving away from its professional functions: it is because
other regulatory bodies have recognised the benefits of a broader approach
and are taking on some of the strategic and supporting functions that
the Society already undertakes.
Representing pharmacists' interests
Nowhere in this new broader definition of regulation is there
the option to represent pharmacists' individual or sectoral commercial
interests. Some commentators persist in claiming such a role for the Society
but this is simply wrong. Such a role would immediately bring the Society
into conflict with the public interest. Pharmacy's historians may like
to remind us that the Society was originally established to support the
interests of pharmacy owners of the day but, as the Society's public interest
role developed, its objectives shifted towards the promotion of pharmacists'
professional interests and not their commercial gain.
As pharmacists know, the Society does not operate on their behalf as
a trade union and has no role in arguing for their contractual benefits
with employers. Yet some commentators persist in comparing the Society
with the British Medical Association and the Royal College of Nursing,
which, as trade unions, do legitimately negotiate pay and benefits for
their members. This confusion of roles arises perhaps from the fact that
these and other trade unions naturally seek to become influential in professional,
non-commercial areas of activity to widen their sphere of influence and
improve their standing with the public and other stakeholders.
Pharmacists employed within the NHS have a trade union organisation
to support their individual and sectoral interests. Other pharmacists
do not, but may wish to explore with relevant organisations how their
needs can be met in the future.
Representing the profession
Another issue about which commentators have voiced concern is
that, in the new organisation, the Society's role in "representing" the
profession will be lost. My colleagues and I involved in this work programme
have been able to reassure pharmacists that this is simply not the case.
In the context of my remarks above, I understand "represent" to mean
to act as an advocate for the profession and to bring influence to bear
on key policy decisions. The Society has invested heavily in building
influence with Government, Parliament and devolved administrations, the
NHS and other stakeholders. We regularly — and successfully — make representations
on behalf of the profession wherever there is an issue that affects the
ability of the profession to deliver a safe, high quality service. We
intend to continue to lobby and campaign as we do now to ensure that the
profession's voice is heard where policy is made and implemented.
Lay involvement in the Council
The need for greater lay involvement in the Society's Council
has given rise to concerns that the profession's influence over its business
will be diminished if the proportion of non-pharmacists on the Council
is increased. Other commentators have expressed the view that an external
perspective can often provide beneficial insight and therefore regard
an increase in lay involvement as an opportunity not a threat.
The reality is that the Government has given a clear signal that significant
lay membership on health professional governing bodies is a non-negotiable
requirement. Any health profession that fails to comply with this requirement
will most certainly find its influence over its own regulation diminished.
The new overarching regulator would no doubt exert its powers to direct
a regulator to increase lay membership. Non-compliance would not be tolerated
and a recalcitrant body could potentially be wound up and its regulatory
role subsumed into the Health Professions Council, which currently regulates
12 professions.
YPG model
The Young Pharmacists Group has proposed a thoughtful model
for the Society's future as a body that continues to undertake the regulatory
and professional functions. The model is a welcome contribution to the
debate but is none the less based on flawed assumptions that make it unacceptable
in terms of what the Government needs to achieve.
First, the model artificially separates the regulatory and professional
leadership roles into two distinct functions managed through separate
structures, whereas, in the context of the extended roles of a modern
regulator, most of the "professional" and "regulatory" roles undertaken
by the Society will be inextricably integrated. Law and ethics and education,
for example, are surely core elements of the extended regulatory function,
something that the YPG model appears not to recognise. The model also
separates such functions as practice, the branches and public affairs
from the extended regulatory roles of the Society, which would weaken
those functions as they would no longer be aligned with a major element
of the core roles of the Society.
Secondly, the model positions the Council, unaltered in its composition,
as the governing body of the whole organisation, including a committee
to oversee regulation, conduct and discipline. This will not be acceptable
to the Government. If the Council is to sit in authority over regulatory
functions, even at arm's length, it will need to comply with the new lay
membership requirements.
The fact is that an unaltered Council could not play a role in most
of the significant business of the Society, which raises the question:
what would it then do? I do not see how disengaging the Council in this
way would serve anyone's interests: on the contrary, it would disenfranchise
pharmacists, who would no longer be able to elect pharmacists to their
governing body.
Great opportunities
In taking this process forward, the Council wants to see the
profession fully involved in the processes that regulate the practice
of pharmacy. But we also recognise that the public has a legitimate interest
in health professional regulation and requires a significant place at
the table: the other health regulators have proposed lay membership of
40 to 49 per cent. The detailed proposals for the size and composition
of the Society's Council will be worked up once we have considered the
responses to our current consultation.
There are currently great opportunities for the Society to build on
its success and create a dynamic organisation that is second to none.
We will continue to work to help pharmacists understand the issues in
hand and to ensure that the debate proceeds in terms of realistic, workable
options that will give the profession a viable way forward. |
