The Pharmaceutical Journal
Vol 269 No 7215 p375-376
14 September 2002

Society summary

No clear consensus on how to get right balance of pharmacists on the Council

Respondents to the second discussion paper (PDF 165K) issued by the Royal Pharmaceutical Society's modernisation steering group (PJ, 22 June, p883) have mixed views on how to get the right balance of members on the Society's Council. A document analysing the response from individual pharmacists and groups within pharmacy shows a slight majority favouring reserved places for pharmacists from England, Scotland and Wales and also reserved places for pharmacists from specific fields of practice. But stakeholder groups outside pharmacy responded differently, being strongly in favour of reserved places to reflect devolution but opposed to reserved places for fields of practice.

On the Council election voting system, respondents from within pharmacy tended to favour the "X" system, but bodies outside pharmacy preferred the single transferable vote (STV) system.

The steering group received a total of 59 responses, one of which was the feedback from the 1,760 completed questionnaires received by The Journal and analysed in last week's PJ (p341). Most of the 58 direct responses were from individual pharmacists; others were from groups within the Society, other bodies within pharmacy and a number of bodies outside pharmacy. The lower response rate than for the previous discussion papers is "perhaps inevitable as the modernisation programme moves on to cover more detailed issues", says the report.

Individual pharmacists

The analysis shows that 30 direct responses were received from individual pharmacists in addition to the questionnaire forms returned to The Journal.

Asked whether all pharmacist members of the Council should be elected or some appointed, 15 of the direct respondents thought that all should be elected and 14 favoured a mix of election and appointment. (In the response to the PJ questionnaire. 67 per cent thought that all should be elected. 25 per cent thought that over 50 per cent should be elected and 1 per cent thought that under 50 per cent should be elected.)

Those favouring election only said that this was an as an impartial, democratic method. Those favouring a mix of election and appointment believed that election alone could not ensure the consistent availability of the skills and knowledge needed on the Council to make it fit for purpose. It was proposed that pharmacists from the academic, industrial, hospital, pharmaceutical science or community sectors might be appointed.

Views were also fairly evenly split on whether there should be reserved places to reflect devolution. Fifteen thought that there should; 14 disagreed. Several opponents of reserved places said that they were not needed because the Society already had its Scottish and Welsh Executives, whose chairmen could attend Council meetings and ensure that the Council was aware of differences between the home countries. This could be reinforced by inviting the government chief pharmacists to attend Council meetings.

(Feedback from the PJ survey showed a similar split, with 49 per cent in favour of reserved places and 42 per cent against.)

In answer to a question about how reserved places might be filled, just over half the pharmacists who responded directly thought that members should be elected to the reserved places by the pharmacists in the country concerned. Reasons put forward were that this would provide local accountability and would be closer to the spirit of devolution. The remainder thought that pharmacists should be elected to those places by all members of the Society.

A small majority also thought that, if Scotland and Wales were to form constituencies for election purposes, England should remain one constituency. The remainder thought that England should be divided, perhaps along local government boundaries, to provide local accountability and to reflect the possible future regionalisation of England.

The concept of reserved places for specific fields of practice was also supported by just over half of those who responded directly. One response suggested that quality representation from all sectors would enhance the Council's strength. Fields suggested for reserved places included industry, hospital, academia, veterinary, community, primary care and pharmaceutical science, with academia and industry most often mentioned.

Some respondents among those who opposed reserved places suggested that they were unrealistic in view of the continually changing scope of practice and the impossibility of representing all sectors. Others reasoned that reserved places would undermine collective responsibility by suggesting that Council members were accountable to a sector: "Council members should always be looking to the broad picture and making impartial decisions on behalf of pharmacy as a whole, not pursuing a lone furrow ... for their specialist area". It was pointed out that alternative mechanisms were available to feed specialist expertise in to the Council.

(Feedback from the PJ questionnaire showed 55 per cent in favour of reserved places for specific fields of practice, with 36.5 per cent against. Suggested fields included community, hospital, industry and academia, with hospital and industry mentioned most frequently.)

Of those pharmacists responding directly who expressed a view on the election voting system, about half favoured STV, while a third favoured the X system and the rest had no preference. (In the PJ survey, 60.5 per cent supported the X system and 32.5 per cent preferred STV).

Society groups

Eight responses were received from committees or groups within the Society. Each took the view that all pharmacist members of Council should be elected. This was seen as democratic and avoiding any suggestion of "cronyism".

Views were split 50:50 on whether there should be reserved places for England, Scotland and Wales. Those not in favour of reserved places again suggested that the Executives were already in place and this was sufficient. Another view was that reserved places went against the principle of electing the best person for the job. Those who favoured reserved places said that this would inform the Council's decisions, reflect the different legislatures and represent the perspectives (not the pharmacists) of the home countries.

Three groups thought that, if reserved places were adopted, pharmacists should be elected to those places by the members in each country. Two groups favoured Britain-wide elections, feeling that the advantages of this arrangement outweighed the disadvantages because it reflected the Council's collective responsibilities and allowed for the election of the best people, as perceived by the electorate as a whole.

Four groups thought that if Scotland and Wales were to form constituencies for election purposes England should remain one constituency; two groups thought that England should be divided.

Four groups also favoured some reserved places for fields of practice. Fields suggested included academia, community, industry, hospital, veterinary and primary care, with academia and industry most often mentioned. Three groups opposed reserved places. Again, it was suggested that this was unrealistic and would undermine collective responsibility.

On the voting system, although there were more Society groups favouring the X system than favouring STV, most of those proposing the X system included caveats, such as ensuring that the concerns of minority groups were met or using STV if the Society were to have any single-member constituencies in the future.

Other bodies within pharmacy

Fourteen responses were from other bodies within pharmacy. Within this group, a small majority supported the election of all pharmacist members of Council. It was thought that this was the best way to ensure that members could command support and that they were representative of, and accountable to, the profession. One response suggested that, even though places should be filled by election, candidates should have to demonstrate relevant competencies within a formal assessment.

Groups that favoured a mix of elected and appointed members suggested that pharmacists from the academic, pharmaceutical science, industrial or prison sectors might be appointed. Suggested appointing bodies included the Heads of Schools of Pharmacy, the College of Pharmacy Practice and the Academy of Pharmaceutical Sciences.

A small majority of these pharmacy bodies did not favour reserved places for England, Scotland and Wales. It was again suggested that the existing executives were sufficient, that the government chief pharmacists could be invited to provide information on the home countries, and that it was more important to elect the best person for the job. Those who supported reserved places believed that the Council needed to reflect the geographical areas it covered if it was to perform its functions well.

Asked how pharmacists should be elected to reserved places, if these were adopted, only one respondent in this group favoured election only by members within the relevant home country. The other groups that responded to this question thought that pharmacist should be elected to the reserved places by all members of the Society. It was believed that this was the simpler system, allowing for the election of the best person for the job, in the eyes of the whole electorate, and maximising voter choice. Some respondents commented that, if constituencies were to be formed, it should be on the basis of proportional representation.

There was no support from these respondents for dividing England into smaller constituencies. It was believed that this would be overly complex and might not deliver the right candidates, because more than one excellent candidate might reside in one locality whereas another might not produce any competent candidates.

About two-thirds of respondents in this group favoured some reserved places for fields of practice. Fields suggested included academia, community, industry, hospital, veterinary, primary care, pharmaceutical science and advisory pharmacists, with academia and industry being the most often mentioned. Some of the responses recognised that achieving this could be complex. Respondents who opposed reserved places suggested that this proposal was unrealistic. One said that it "would completely undermine the concept of collective responsibility", and suggested that other methods of obtaining specialist input could be used. One response stated that Council members should be the most able to represent the profession in its totality.

On the choice of voting system, six respondents in this group favoured the X system, three favoured STV and two said that they had no preference.

Bodies outside pharmacy

Six stakeholder groups outside pharmacy responded to this discussion paper, compared to the 11 that responded to the first discussion paper.

Those that commented on whether all pharmacist members of Council should be elected suggested a mix of election and appointment. One regulatory body stated that an electoral process was essential to securing the profession's confidence but that it had found little support for a fully elected professional membership because the contribution made by appointed members in the fields of education and standards was widely recognised.

One consumer body stated that the system for recruiting pharmacist members should be as robust, transparent and fair as the system for recruiting lay members. Hence, it believed that a significant proportion of pharmacist members should be appointed by an independent panel, according to clearly defined criteria and following an open recruitment process. This, it felt, would help to secure specific expertise as well as ensuring competency of a proportion of the membership in a way that election could not guarantee.

This response also warned that election would imply that elected pharmacists were in some way delegates of the profession and there to represent their interests. The overriding purpose of professional regulation was protection of the public and the public interest and this was something all Council members should seek to uphold. The response noted that there might be pressure to have elected members of Council but that the emphasis should be on candidates demonstrating that they met the criteria for appointed members and were committed to the principles of protecting the public through professional regulation and open and transparent governance.

The six bodies from outside pharmacy showed overall support for, and no opposition to, reserved places on the Council for the home countries. It was suggested that this would ensure an active link to, and strengthen the relationship with, the devolved administrations. However, one response, while stating that the Council should adequately reflect the population it covered, suggested that administrative arrangements that took into account differences between the countries might be more appropriate than reserved places. It was emphasised that, whatever systems were introduced, flexibility to accommodate any changes would be important.

Four respondents in this group thought that, if reserved places were to be adopted, pharmacists should be elected to those places by members in each of the home countries. The other two respondents favoured election by all members of the Society. It was suggested that if candidates were unknown to voters, this could be seen as a positive factor as this would provide them with an opportunity to demonstrate their worth on competencies alone and communication should not be unduly affected, given advances in e-mail.

There were no strong views on whether England should be divided into smaller constituencies but the overall view was that England should not be split.

All these respondents were opposed to having reserved places for fields of practice. One professional body commented: "To attempt to have all areas of practice and expertise reflected in Council would be impossible through an electoral system without having a disproportionately large Council." A regulatory body stated that it had found insufficient support for reserved places for specialities. Arguments against reserved places included the difficulty of defining which specialities should have reserved places. There was also a view that the Council regulates the profession generically, hence an elected member's role was as a member of the profession first and a specialist second. Another point was that the Council should have confidence in the democratic process and not restrict voters' freedom of choice.

One consumer body thought that, while all fields of practice should contribute to the work of the Society and its Council, this could be achieved more effectively through specific forums (which might be virtual, physical, formal or informal) rather than by trying to ensure representation of each speciality on Council. Any system would need to be flexible to accommodate new fields of practice as they developed.

On the voting system, all respondents in this group who commented were in favour of STV, stating that it was a fair system that had been used successfully to date.