The Pharmaceutical Journal
Vol 270 No 7210 p190-192
10 August 2002

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Letters to the Editor

The Society

A newly qualified pharmacist’s view of modernisation

From Miss K. Marsh, MRPharmS

As a newly qualified pharmacist, I have been interested in the debate surrounding the modernisation of the Royal Pharmaceutical Society and find that I can look at the issues with fairly fresh eyes. There have been many different opinions voiced on the matter, but one theme that seems fairly common is that the actual decision-making process is not being led by the membership.
There has been much talk about the bias shown in the consultation papers, and although some responses have been gained, there will also be those who have become disillusioned with the whole charade, as it becomes apparent that events are to follow a pre-determined path. Why should busy pharmacists waste time expressing their opinions when the future of our Society has already been decided for us?
This became especially clear with the publication of Dr Jim Smith’s letter (PJ, 3 August, p158). He is essentially speaking from the Government’s point of view and yet he urges us to support the Society’s decisions and brushes away any possible objections with the phrase “change is not always comfortable”, which I find patronising. One thing I am not comfortable with is the chief pharmacist at the Department of Health trying to influence our debate. If his letter is read in conjunction with John Ferguson’s letter (PJ, 3 August, p157), it seems clear that the Government’s plan to increase lay membership on the Council is actually a plan to increase the Government’s everyday control of our profession.
Why should we be expected to swallow a pill just because the Government wants us to, or because the patient information leaflet we are provided with is well-worded, and we are told that a team of so-called experts have decided that this pill will be acceptable to the powers that be? And, why should we be rushed into agreeing that this is the best medicine for us?
The Modernisation Steering Group seemed like a fantastic idea when it was first set up, but in reality it appears simply to rehash information given to it by the Department of Health and pass it on to us. If such a committee could be reformed with those who have the member’s interests at heart, we might start to make more positive progress.
I suggest that we, the members, be given a fairer, more timely chance to express our views, with no interference from the Government, and that the people who are pushing us in a direction according to their own agendas be stopped.

Kathryn Marsh
Leeds

A helpful letter from the chief pharmacist

From Mr D. I. Simpson, FRPharmS

The letter from the Department of Health’s Chief Pharmaceutical Officer, Dr Jim Smith (PJ, August 3, p158), is helpful in two ways.

First, it clearly sets out the background to the current debate on change in the regulatory processes of the health professions. Second, and more importantly, it makes clear that the Lambeth “modernisers” are toeing the Government line rather than seeking to arrive at a solution on the future of the Royal Pharmaceutical Society that is in the interests of the profession. I say this because there is clear concordance between the chief pharmacist’s views and statements in the Modernisation Steering Group’s discussion paper on the responsibilities and composition of the Council (included in the PJ of June 15).

The chief pharmacist says that the scope of professional regulation, as defined in the Kennedy report — education, registration, training, continuing professional development, revalidation and discipline — encompasses most of the current functions of the Society. In line with that, the consultation document suggests that the Kennedy list comprises “the majority of the Society’s activities”.

Another area of concordance relates to the powers of the Council. Dr Smith says that the Council cannot “abrogate” — surely he means “abdicate” — responsibility for regulatory matters. In like vein, the consultation paper makes clear the steering group’s opposition to regulatory functions being performed by a separate board within the Society.

One consequence of this concordance is that if one party is mistaken, then so is the other. This is the case in at least one important respect.

Both the chief pharmacist and the consultation document are wrong about the extent of regulatory activity within the Society. One only has to look at the Society’s annual review for 2001 to see that that is so. According to the review, half of the Society’s income is derived from publications and some 35 per cent of expenditure is devoted to it. When other Society activities — the library, the branches, the regions, the museum, conferences, the Scottish and Welsh departments, membership groups, benevolence, and representing the interests of the profession — are taken into account as well as publishing, it is plain that regulation is far from being the Society’s main activity. I would put its extent at around a quarter.

The chief pharmacist could also be wrong over “abrogation”.

“Discipline” is one of the regulatory matters on the Kennedy list and that is a function exercised independently by the Statutory Committee, which is not a committee of the Council. The Council cannot overturn its decisions and appeals against its decisions lie not to the Council but to the High Court or the Court of Session in Edinburgh.

The chief pharmacist offers no evidence to back his assertion on “abrogation”. It would be helpful to know why he holds the view that he does.

There is one thing that needs to be clearly borne in mind during this key chapter in the Society’s history. The Government’s writ only runs to regulation. The changes that are to be brought in under Section 60 of the Health Act 1999 can only modify the regulation of the profession.

The representational role must not be compromised by inappropriate changes made solely with regulation in mind.

The regulatory tail must not be allowed to wag the representational dog. The representational role came first. The statutory, regulatory role came later. The Council, if it is to perform its role properly, must not simply do the Government’s bidding. Any Council member who believes that that is the Council’s role has been elected on false pretences.

Douglas Simpson
Beckenham, Kent

Do we want the Department of Health at the Council table?

From Mr J. Ferguson, FRPharmS

It was a happy coincidence that your leading article in last week’s issue (PJ, 3 August, p146), based on a 4 per cent return to a survey of the membership, and the detailed analysis of those responses should appear in the same issue as a letter from the Chief Pharmaceutical Officer of the Department of Health (p158).

First, it would be immediately obvious to the majority of your readers that the “discussion papers” issued by the Royal Pharmaceutical Society’s Modernisation Steering Group, if not written by the Department of Health, have certainly been strongly influenced by the Department.

Secondly, most pharmacists would not need to be told by Dr Smith that “change is not always comfortable”. They would know that from their need to adjust to the changes that have been imposed by the Department over the past decade.

I was, however most interested in Dr Smith’s statement that there is no reason why the Society’s advocacy and professional leadership role should not continue under the proposed new structure of the Council. Your analysis of the returns to the questionnaire indicated that a great majority of respondents saw no difficulty over the chief pharmaceutical officers from England, Scotland and Wales sitting at the Council table and taking part in debates and, some even said, voting.

My mind turned to the many occasions over the years when a proposal from the Government would have had detrimental effects on one or other sector of the profession, might even have been controversial between sectors and therefore within the Council, which was seeking to agree a response and a strategy for gaining support to resist the implementation of the proposal. Would the members really want the pharmaceutical officers, whose job it is to advise ministers, to have knowledge of all the differences within the Council, the narrowness of a decision and all the strengths and weaknesses of the case to be put on behalf of the profession?

Honestly, you could not make it up!

John Ferguson
Haywards Heath,
West Sussex

The YPG and “arm’s length” leadership

From Mr N. J. Wicks, MRPharmS

The Executive of the Young Pharmacists’ Group welcomes the clarification from Dr Jim Smith, Chief Pharmaceutical Officer for England, concerning the “fundamental principles” that must shape proposals for modernisation of our profession (PJ, 3 August, p158). We are delighted that the important principles behind modernisation identified by Dr Smith are the same principles on which the YPG proposal for the modernisation of the Royal Pharmaceutical Society is based (PJ, 29 June, p906).

Dr Smith advocates a “reformed and restructured Society, independent and at arm’s length from Government” and he sees the professional leadership role “enshrined in the Society’s new framework”. To date, the YPG proposal is the only one that enshrines the Society’s professional leadership roles in a way that is independent and at arm’s length from Government.

The YPG would have a Council responsible for the professional leadership and representative roles comprised mainly of pharmacists. The Modernisation Steering Group’s proposal is flawed in that it would not have a large majority of pharmacists in charge of representative and professional leadership roles. Under the steering group’s plan, we would see a much greater influence of lay members who would be appointed specifically to deal with regulatory functions as defined by the Government and/or the United Kingdom Council for Health Regulators.

Under such circumstances it would be unthinkable that the Society could maintain a professional leadership role “independent and at arm’s length from the Government”. Others have already stated that a Council not comprised mainly of pharmacists could never hope to have a truly representative role.

We agree wholeheartedly with Dr Smith’s comments that a reformed Society would be
freshly empowered and would bring renewed authority to this important professional leadership role.

Dr Smith then states that the key challenge is to improve professional self-regulation and that “the NHS plan said that as a minimum regulatory bodies must be smaller, with greater patient and public representation”. These principles are fundamental to the YPG proposal, since we advocate that a Pharmacy Regulation and Compliance Committee (PRCC) would be set up within the structure of the Society to fulfil the regulatory role. The PRCC would be a small group, with greater patient and public representation, which avoids conflict between the “enshrined” professional leadership role and the regulatory role.

Dr Smith says that the scope of the professional regulation as defined in the Kennedy report encompasses most of the current functions of the Society. We disagree, since more than half the Society’s income derives from activities that are unrelated to the widest definition of regulation. The Society’s role in publications, branches, regions, the British Pharmaceutical Conference and many other non-regulatory activities already account for the greater part of the Society’s income. We believe that the YPG proposal would enable the Society to develop these and other professional activities substantially, which would enormously strengthen the Society’s representative and professional functions. It is clear now that the only plan that delivers “arm’s length” professional leadership, while remaining compatible with Government criteria for regulation, is that put forward by the YPG.

The YPG desires to work with the Department of Health to deliver a workable set of proposals for our Society’s future. As Dr Smith is already aware, the YPG has been in contact with the Health Minister regarding the modernisation issue.

Dr Smith reassures us that the Government aims to work with the professions to strengthen the existing systems of self-regulation. We understand that it is important to the Government that a proper and meaningful consultation process is undertaken and we ask that the Society takes note of this.

Noel Wicks
Chairman
Young Pharmacists Group

Time for a referendum on modernisation

From Mr M. Koziol, MRPharmS

There are few who would argue that there should be a greater lay involvement in the affairs of the Royal Pharmaceutical Society and so the results of your survey (PJ, 3 August, p175) come as no surprise. What is surprising, however, is your interpretation of the results and the claims that you make that they support the Modernisation Steering Group’s position (PJ, 3 August, p146).

You appear to miss the fact that the debate has long moved on; indeed, the debate has been largely held within the pages of The Pharmaceutical Journal. No one is arguing about the need for greater lay involvement in the regulatory affairs of the Society; the debate is focusing on whether we should have a regulatory body within the Society (with significant lay involvement) and a separate Council to deal with the representative/professional leadership affairs that has pharmacists in the large majority. Your survey does nothing to move the debate forward and just confuses the issues even further.

You appear to suggest that only a minority of pharmacists have not yet bought into the Modernisation Steering Group’s agenda. You have no evidence to substantiate this, but there is plenty of evidence to the contrary. In the past few weeks, not only the Young Pharmacists Group, but also the National Pharmaceutical Association, the Pharmaceutical Services Negotiating Committee, 11 past presidents, the branch representatives’ meeting and many Council members privately (and publicly in the case of the Treasurer — an Officer of the Society no less) have all indicated that they were unhappy with the current plan put by the steering group. Additionally many branches have notified the steering group that they are dissatisfied with its proposals. Furthermore, the YPG has run its own survey which has suggested that 100 per cent of respondents do not support the steering group’s view.

The fact that 28 per cent of respondents showed support for the YPG model in your survey, which did not even ask such a question, is astounding. Imagine what the results may have been if you had asked the question; what would your editorial have said then?

The only way that we will know what the membership will support is to ask the question. Do you support the model put by the Modernisation Steering Group, which is predominantly a regulatory led model with a huge increase in lay representation? Or do you support the alternative view, which enables significant lay input into the Society’s regulatory functions only, leaving its professional/representative functions mainly in the hands of elected pharmacists?

I would suggest that such is the importance of the end result to the whole profession that the time has come to hold a referendum on this issue.

Mark Koziol
Birmingham

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