The Pharmaceutical Journal
Vol 270 No 7236 p243-248
15 February 2003

February Council meeting

Future Council to have 29 members

The Council of the Royal Pharmaceutical Society has agreed that the future reformed Council should have a total membership of 29, comprising 17 pharmacists, two technicians (provided the Society proceeds to register technicians) and 10 lay members. The current Council consists of 21 pharmacists and three members appointed by the Privy Council.

The Council made its decision after considering a paper from the modernisation steering group, which had examined the 15 possible structures that would fulfil the Council's agreed criteria of 24–30 members in total, with an overall majority of pharmacists, two technicians and a lay membership of 30–40 per cent. The paper considered how well each structure would reflect the Council's remit and functions and how the different options would relate to the Council's supporting structures and workload, its effective functioning, its cost to the Society, the range of experience, views and expertise required and the views of stakeholders both inside and outside pharmacy.

On the basis of its deliberations, the steering group recommended a 26-strong Council, consisting of 15 pharmacists, two technicians and nine lay members. It also recommended that the Council should seek a mechanism to allow the reformed Council to request that its composition be changed if necessary while safeguarding the lay input required for a modern regulator.

When the paper came before the Council, the PRESIDENT said that the Council had discussed the topic on two reserve days. He felt that some background information should be given because some Council members might not believe that the recommendations were precisely in accord with what emerged from the previous discussions.

Effectively, the first recommendation was something of a compromise between the view of the modernisation group and the figure discussed by the Council at its "awayday". The group felt strongly that the Council should be as small as possible, recognising the demands on individual Council members. There were three reasons: first, a smaller Council was easier to manage in terms of effectiveness; secondly, the Council was a policy-making body and so the future might be different from what had been experienced in the past; thirdly, other individuals would be present at Council meetings (eg, the chief pharmacists of England, Scotland and Wales might be present, as might representatives of the Society in Wales and Scotland).

The second recommendation, which the President said should be considered in conjunction with the first, proposed a mechanism by which the new Council could change its composition if experience showed that the initial make-up was not acceptable.

The recommendations had taken account of Council members' comments and anxieties, noting the views of the steering group but seeking to produce a robust recommendation, which would stand the test of time whichever way circumstances moved in the future.

PETER CURPHEY said that he did not regard the recommendations as a compromise. He regarded them as an absolute classic fudge. They fitted in the middle of what was said to be a need for a small Council and what Council had decided would fit the requirements of the Government. The Council's decision that the number of pharmacists should be about 16 or 17 had taken into account the political reality within the profession of reducing the number of pharmacists on the Council. To reduce the number to 15 would be seen by some pharmacists as an unacceptable carving up of the Council.

Mr Curphey said he was even more concerned about the logic in the document. The suggestion that they wanted a small Council had never been the Council's view. They knew that they had to fit in with national requirements, but they had never argued for a small Council, but just a smaller Council.

The document acknowledged that, among the structures already agreed by the Government, the lowest number of lay members was 10, a proportion of 34.5 per cent. Presumably anything less was not a good idea, but the paper proposed nine. Why had the group decided on that when the proposal from the Council was 10? The paper had also reported the view of the National Consumer Council that 34 per cent lay membership was insufficient. But what was the paper's proposal? Was it 38 or 39 per cent? No, it was 34.5 per cent.

Mr Curphey said he was disappointed that the group had not been robust enough to look at a figure of 28 or 29 on the Council, with a good majority of pharmacists, not an overwhelming one, which took into account the membership's perception that they were carving up the profession and not leaving it to the professionals.

On the second recommendation, Mr Curphey suggested that implementing an "if" clause would not be the easy process implied but could be extremely difficult. If such a provision was to be put in place, then why not start with the Council's preferred constitution with the option of reducing the Council's size if it proved overwhelming and unwieldy.

The PRESIDENT said that the steering group had taken soundings from people from different backgrounds — from Council members and also from people who had knowledge and expertise in other areas who could add and introduce a different dimension. He was not saying whether it was a right dimension or a wrong dimension but it was a different dimension. But there was no question of a decision being foisted on the Council. Those who felt strongly that the figures should be changed should vote accordingly. The recommendation would be rejected. If the Council chose to reject the recommendations it could come forward with other proposals.

LINDA STONE said that she felt extremely uncomfortable with what was happening. The Council had had a constructive debate and most people had gone away thinking that they had arrived at a good consensus, a mature decision, after every Council member had had an opportunity for input.

David Lammy, Parliamentary Under-Secretary of State for Health, had told the Council that modernisation should strengthen the Society's professional leadership role (see p248). But reducing the number of professional members on the Council would not achieve that. It would undermine it and make it harder to carry the modernisation structure with the membership. She was also anxious about some of the assumptions about a small Council being more effective.

The PRESIDENT said that Mrs Stone had made the same points at the "awayday" meeting. He had heard nothing new.

Mrs STONE said that what was new was the paper before the Council, which totally disregarded those points.

The PRESIDENT said that the Council did not want to rehearse all points again.

Mr CURPHEY pointed out that the previous meeting had been held in private but the Council was now in open business, allowing Council members to express their views in public.

ASHWIN TANNA proposed that the motion be put to the vote.

Dr GORDON APPELBE seconded the proposal.

The PRESIDENT put the first motion, which was that the reformed Council should have 26 members, comprising 15 pharmacists, two technicians (provided that the Society proceeded to register technicians) and nine lay members.

The Council voted and the motion was lost.

The PRESIDENT asked for an alternative recommendation.

Mr TANNA suggested proportions of 18, two and 10.

Mrs STONE said that that at the Council's previous discussion the consensus had been 17, two and 10. That totalled 29. Mrs Stone proposed that accordingly.

Mr CURPHEY seconded Mrs Stone's proposal.

Mr TANNA said that having 17 pharmacists made Council elections difficult.

The PRESIDENT said that that had been debated at length, and it was not so. The Council should take a vote.

GERALD ALEXANDER said there should be an opportunity to discuss the matter.

The PRESIDENT said that the matter had already been discussed previously.

The Council then voted on the motion that the reformed Council should have 29 members, comprising 17 pharmacists, two technicians and 10 lay members. The motion was carried.

The second recommendation, on the proposed mechanism for changing the Council composition, was carried.

ANDREW BURR said that he was concerned about the whole modernisation process. He had been critical of the steering group from the start. He had opposed the inequity in the way some decisions were taken. He was left with a feeling of railroading manipulation of events. The group would have to give urgent consideration to the way it presented itself to the Council. Council therefore needed to think carefully how matters were presented. He felt uncomfortable about some of the decisions that had been taken.

The PRESIDENT repeated that the ultimate decision was that of the Council. There was no railroading. The best solution might not conform with the ideal solution of individual Council members. When Council members were not happy with anything, they made their views clear. They were not shrinking violets. The reality was that the ultimate arbiter was the Council.

Benevolent Fund steering group

The Council agreed to establish a steering group to improve the management arrangements of the Society's Benevolent Fund. The group will consist of three Council members, including a past president (as chairman), the Secretary and Registrar, the Director of Resources, the Benevolent Fund co-ordinator (as secretary) and the director of Birdsgrove House. The criteria used in selecting the Council members will be an overarching understanding of the Society's affairs, experience in managing funds, an ability to think strategically and diversity in the representation. The quorum will be three, of whom two must be Council members. The group will meet twice a year.

Duties of regulatory bodies

The Council approved four recommendations designed to ensure that the Society would in future comply with the common duties of health professional regulator to publish or provide certain information in the interest of transparency and accountability.

The Council had before it a paper produced by the modernisation steering group, which examined the professional regulators' duties to publish an annual report, to publish accounts, to publish or provide information and to co-operate with others. The paper noted that, although the Society already carried out these activities, the principles of transparency and accountability might require it to devote significant more resource in the future to collecting, analysing and providing information and to developing and implementing relevant policies.

Among other things, the paper noted that the Society's annual review currently did not include certain information that was likely to be required in future, such as statistical information relating to the Society's function to protect the public. On the publication of accounts, the paper said that it would be inappropriate for the Society's accounts to be submitted to the Comptroller and Auditor General, who certifies the accounts of public bodies. Although the Society performs functions of a public nature, it is not a public body.

On the publication of information, the paper suggested that the Society might in future increase its focus on providing information to the public about its work. On co-operation, the paper agreed that a duty to co-operate is reasonable but points out a number of potential difficulties.

The paper's recommendations were that, subject to various comments made, the Society should have a duty (1) to publish an annual report, (2) to publish accounts, (3) to publish or provide in such manner as the Council thinks fit, information about the Society and the exercise of its functions, and (4) to co-operate wherever appropriate and reasonably practicable with public authorities or other bodies or persons concerned with employment, education or regulation.

The PRESIDENT said that the Council had already debated the matter at considerable length. The recommendations were in accord with the discussion that had been agreed as a consensus elsewhere.

Dr GORDON APPELBE said he wondered why the fourth recommendation did not read "other bodies or persons concerned with health". Bodies concerned with health had been omitted.

CHRISTINE GRAY (project manager for the modernisation programme) said that it did not mean that the Society could not co-operate with other bodies as appropriate, but the Ministers specifically wished to see duty to co-operate with bodies concerned with employment, education or regulation included in the legislation for all health professional regulators.

The PRESIDENT said it was not restrictive but highlighted the fact that there may be obligation at some stage to co-operate, subject to caveats.

The Council approved the recommendations.

Electing technicians to Council

The Council agreed a procedure for the election of two pharmacy technicians to the reformed Council should the Society proceed to register pharmacy technicians. The procedure reflects that already agreed for the election of pharmacists to the reformed Council.

It was agreed that the two places would be filled by a closed ballot using the "first past the post" system, with the election run on similar lines to the election of pharmacists and administered by the Electoral Reform Society. Candidates would have to be registered as technicians with the Society and be nominated by five registered technicians. Only technicians registered with the Society would be able to vote.

As with pharmacist Council members, the period of office would be four years. For the first election only, a ballot would be held for both places. The technician who topped the poll would be appointed for four years and the technician in second place for two years. Subsequent elections would be held every two years for one of the two places.

The Council also approved a transitional arrangement. For the first term of the reformed Council, from 2005, a panel appointed by the Council would select two candidates, preferably from different sectors of practice, to serve for two years. Reappointment for two further years would be then possible if it was not by then practicable to move to election under the permanent procedure.

During the Council discussion, LINDA STONE pointed out that in establishing new health care regulatory bodies the Privy Council had initially appointed all the members, both lay and professional. It might be seen as the Privy Council's role to be make the initial appointments of technician members of the Council. Perhaps the modernisation group should take soundings in case the Society's procedure was out of kilter with that of the other bodies.

The SECRETARY AND REGISTRAR said that the matter could be raised during the Society's regular discussions with the Department of Health.

Primary care steering group

The Council agreed to change the way in which the Society supports primary care pharmacy because of problems arising from the rapidly shifting environment in primary care and in pharmacy.

The Council made its decision on the recommendation of Sally Greensmith and Clive Jackson (Council members with strong primary care links). In a paper circulated to Council members, they said that the Primary Care Steering Group had been set up in 2000 with financial support from the Society, Its aim was to provide a forum for sharing views, experience and best practice in primary care pharmacy and to identify how the Society could best work with and support primary care pharmacists.

Since the group's inaugural meeting, developments in the National Health Service had led to considerable change in the group's membership, and members had been unable to participate fully because of their own work pressures. As a result, despite the best efforts of all those involved, the group had failed to meet its core aims of producing an annual report and holding a seminar for primary care pharmacists. Furthermore, the NHS changes meant that the group's existing constitution and rules were no longer fit for purpose.

On the recommendation of Mrs Greensmith and Mr Jackson, the Council agreed that the PCSG's constitution and rules should be revised to concentrate on core deliverables. The group in its present form would have no further meetings and a primary care virtual consultative group would be formed. The Council would continue to support the group financially until the future of special interest groups was decided during the modernisation process. The group's funding would be managed by the Society's head of practice, Nigel Graham.

The Council also agreed that the Society would organise public seminars at five sites around Britain to provide a forum to share views, engage primary care pharmacists with the Society and improve the communication link. In addition, a formal one-day session was to be arranged at this year's British Pharmaceutical Conference.

OFT report

The Council adopted a statement expressing great concern at the findings of the Office of Fair Trading investigation into "The control of entry regulations and retail pharmacy services in the United Kingdom". The decision followed a long debate which the President said would inform the Society's detailed written response to the OFT report.

The PRESIDENT said that after the report's publication on 17 January he had written to David Lammy, the Health Minister, and he and the Secretary and Registrar had put similar points to the Minister at a face-to-face meeting on 28 January.

They had emphasised to the Minister that the Society's concern was the safety, effectiveness and quality of the pharmaceutical service and that it had no commercial interest. They had communicated their initial reaction after considering the OFT report from the perspective of the proper provision of NHS pharmaceutical services and the report's compatibility with the aims and objectives of an integrated health service as envisaged by the NHS and the Government.

Mr Lammy had invited the Society to submit a more detailed response, and the President hoped that the Council's discussion would provide the basis for preparing such a response.

The President said that the points he had highlighted had related to the availability of pharmacies and the fact that there is currently national distribution in broad terms and pharmacies where people live, shop and work. The OFT recommendation could damage the existing distribution and that might disadvantage the most vulnerable groups in society — the elderly, young mothers, the poor and disadvantaged, who were the heaviest users of community pharmacies. They were not the wealthiest groups in society and may not have the wherewithal to travel to one of the 500 new pharmacies forecast, which happened to be in supermarkets and in out-of-town areas.

He had asked the Minister whether a free, commercial, competitive approach would achieve the objects of the NHS and the Government, and he suspected that the answer would be no. There was a place for supermarkets, but he believed the commercial imperative and the health service requirements could in some instance be in conflict. There was anecdotal evidence that primary care trusts had in the past had difficulty in persuading the stores to open and provide a community pharmacy service where the commercial imperative within the store suggested that the stores might close. An example he had cited was Christmas Day.

He had also highlighted that under the Medicines Act the superintendent pharmacist of the company should be the final decision-maker but from time to time there was a potential conflict of interest between the commercial, professional and health imperatives. Typically pharmacy superintendents in some new larger organisations were not the ultimate decision-makers and were not on the main company board. He had also highlighted a recent report that a supermarket had withdrawn from a trial following shareholders' complaint at the company's annual general meeting.

The President had said that typically six pharmacists might be required to provide a service during a supermarket's extended hours. If there were to be 500 new pharmacies, then up to 3,000 pharmacists would be required, at a time when a national shortage of pharmacists was affecting community pharmacy and also pharmacy in primary and secondary care.

He had reminded the Minister that it was Government health policy that the nature and extent of health services should be determined locally, at least in England, by primary care trusts. Indeed 75 per cent of the funding would in future be spent by PCTs to meet local needs. It was difficult to see how that would be compatible with the purely commercial imperative, which seemed to be the basis of the OFT's report.

In summary, the President had said that as a Society they had considered the issue from the NHS perspective, seeking to fulfil the Minister's stated aims and the aims of the NHS of meeting local health needs, which were identified, determined and provided locally.

The Minister had asked the President whether he could comment or make any suggestions on the way that competition could be increased in the future. The President had replied that the Society would welcome competition that improved the quality of health provision but it was not the Society's role to identify how competition policy should be determined; its role was purely a professional and regulatory one and such policy was for others to decide.

GERALD ALEXANDER said that the Council had before it a proposal that it "views with great concern the findings of the Office of Fair Trading into the control of entry regulations and retail pharmacy services in the United Kingdom". He hoped the Council would support the proposal and give moral support to the 25,000 pharmacists working in this sector, who were gravely concerned, believing that ending the control of entry regulations for community pharmacy would be misguided.

Mr Alexander said that the public service that pharmacists contributed to the day-to-day lives and health care needs of the people of Britain was often understated within the context of health care and indeed the NHS. Community pharmacists and their support staff were a dedicated expert resource and workforce.

The OFT report acknowledged that the OFT had considered competition, but not health service planning considerations. OFT officials had openly admitted this in the stakeholder briefing on publication day.

Pharmacy supported competition. In fact, most patients currently had a choice of pharmacy, and people would choose by service and convenience.

Community pharmacists wanted to see the pharmacy network integrated into local health services far more than has been the case until now. The Government, too, appeared to be committed to this objective.

The OFT report unfairly and narrowly portrayed pharmacists only as retailers, thus failing to take proper account of pharmacy's health care role — including future developments that would be blocked by the uncertainty, instability and likely changes in pharmacy location that would result from the adoption of the OFT report.

If OFT's recommendations were implemented, the number of pharmacies would soon increase rapidly, perhaps by as much as 10 per cent. Early expansion in numbers would be followed by a contraction. Smaller pharmacies particularly would be at risk, leading to a loss of service in neighbourhood locations. Investment would decline, and service cuts could also be expected. For many community pharmacies, survival would be extremely difficult.

The OFT report identified the high levels of consumer satisfaction with the present network and found no consumer pressure for change. It identified the costs of administering the present system, but crucially, not the costs of removing controls.

The OFT was not the right body to undertake this work, because it could not balance the benefits and detriments, which required intimate understanding of primary care and where it was heading. In particular, it did not have the expertise to evaluate whether the free market was the most appropriate way of ensuring that the best use is made of pharmacists' skills in enhancing health care provision to patients.

The public interest was best served by developing the services that community pharmacy provided and meeting the policy objectives outlined in "Pharmacy in the future" (and the other UK pharmacy strategy documents). That required a stable environment, but the OFT recommendation would create enormous instability and uncertainty. Deregulation would frustrate the Government's plans for making better use of community pharmacy in health care planning and provision.

If the regulations were swept away, local communities generally would suffer, but there would be a particularly damaging effect on rural, isolated and socially disadvantaged areas. Planning guidance and the Social Exclusion Unit recognised community pharmacy as a valuable neighbourhood resource and its importance in supporting a community.

Implicit in the term "community pharmacy" was a close identity with, and a commitment to, the local community. Community pharmacies were at the heart of local health care, providing health care services and advice to patients where they lived.

The DoH needed to evaluate the extent to which unrestrained competition in providing pharmacy services would be detrimental to the improved services for NHS patients that could be offered by better use of community pharmacy. In addition, it had to assess whether adding to the existing competition would have any real benefits — and then decide whether they outweighed the detriments. The NHS interest had to predominate over non-NHS consumer interest. Indeed, it should not be forgotten that the NHS was pharmacy's principal "consumer".

Where competition could be introduced or controls relaxed with no detriment, then that should happen. A specific example was proposed in "Pharmacy in the future", namely, the relaxation of controls in major out-of-town shopping centres.

In summary, increased competition should support local health service planning, not frustrate it.

Professor BOB MICHELL said that, as a consumer and not a pharmacist, he unambiguously endorsed what had been said. It was horrific the degree to which the OFT regarded pharmaceutical products as if they were to be judged at the same level of competition as Nescafé.

LINDA STONE said that the OFT was clearly seeking to reduce costs to the Exchequer by increasing competition, but by its own acknowledgement £6.8bn of the £8.6bn that went into community pharmacies was actually for NHS dispensing and there was little room for manoeuvre to save money there. In fact, increasing the number of pharmacies would tend to force that up.

By undermining the stability of existing pharmacies, the OFT recommendation would not produce service quality improvements but would undermine existing professional developments. Being forced to cut costs, pharmacies would have to reduce their staff and services and therefore reduce the delivery of the enhanced roles envisaged in recent Department of Health papers. That reduction in staff could also lead to an increase in errors and a compromise of patient safety.

Control of entry had led to a stability that facilitated innovations in patient care, many of which had been adopted as mainstream. Many such innovations had come from private contractors.

ANDREW BURR said that the report did a grave disservice to the Office of Fair Trading. At the end of the day the public would decide who provided a good service or a bad service. The OFT's view was not in the interests of health care.

He wondered if the OFT had thought about the damage that its report would do in terms of the motivation of the profession, which for years had striven to offer a first class quality service. The OFT felt that he was just a retailer, but he had chosen to be a pharmacist because of patient care and quality and ensuring that the patient received the best type of care.

HASSAN ARGOMANDKHAH said that the Council needed to make a good case as to why applying the OFT report in its entirety would damage the future delivery of health care in the community. A submission based on that would be seen and heard in a better light.

He urged Council members to make sure their local MPs signed the early day motion that his own MP was putting forward. This would make sure that the right people in the right places were briefed appropriately so that they could win the battle by other means, because challenging the OFT report would not achieve that.

The Society should not base its argument on supermarkets versus the rest. It should make sure that all its arguments were based on the delivery of good quality pharmaceutical care. It should emphasise that changing the regulations would destabilise pharmacy and remove incentives for pharmacy proprietors as well as individual pharmacists.

Primary care trusts were concentrating on rationalising and modernising primary care services in a planned and phased manner. Removing control of entry would play havoc with what they were trying to do locally. The NHS had to continue with its long-term plans and this could only be done if pharmacy, as one of the cogs within primary care, was not constantly undermined. Only with the stability and maintenance of the network could the NHS planners deliver what they really wanted.

ANDREA ROBINSON pointed out that the OFT report had gone to the Department of Trade and Industry, and it was that Department that would collate responses from different Government departments. This meant that the Department of Health, the National Assembly for Wales and the Scottish Executive would all respond independently. From Wales she had sent a letter similar to the President's to the Minister for Health and Social Services outlining the key messages of access, manpower and health policy in general. The Health and Social Services Committee was meeting the following morning to debate the OFT report and all of the members of that committee had been briefed in anticipation of that debate.

DIGBY EMSON said that the OFT had started from the standpoint that everything should be a free market unless restrictions could be justified. It had built up its case by a series of well argued assumptions and economic theories. One had to go to the appendices to see that some of its assumptions were questionable. For example, it assumed that a surgery would not open its own pharmacy if there was one within 300m.

He said it would be wrong to give the impression that pharmacy was afraid of competition because competition did work in the public interest and in a sense community pharmacy had been competing for many years. It was also wrong to imply that the current regulations were inflexible: they were specifically designed to meet the changing needs of the population and labour forces.

The views of the medical profession would be important in terms of coming to an overall conclusion. He was not sure whether the Society intended to liaise with any elements of the medical profession in relation to sharing views on what action was to be taken. Would there be dialogue between the Society and the medical profession and the NHS Confederation?

The SECRETARY AND REGISTRAR said that a lack of time made it difficult. The Society had an outstanding arrangement to discuss a number of issues with the medical profession, but whether that meeting could take place before the closure of the consultation process she was not sure.

The PRESIDENT said that the OFT inquiry had been instigated by the NHS Confederation itself, via the Cabinet Office. He did not know whether the OFT had produced what the confederation had in mind, but it was important to recognise that the confederation, which negotiated on behalf of trusts, had actually felt that the matter should be examined.

SALLY GREENSMITH said that although competition improved services it should not be at the expense of the essential services that community pharmacists provided. From a PCT point of view she would support relaxing regulations to give flexibility in the delivery of service within the PCT area provided it did not undermine existing services in vulnerable areas. That was what she had hoped would come out of the report.

SULTAN DAJANI said that the OFT had accomplished what it had set out to do — to kick community pharmacy in the backside. He concurred with all that had been said. He asked whether the Society's response was to be put on its website and whether the Society would liaise with other bodies. He felt that it should examine every alternative route as well as the routes already discussed. It was a communication issue and one that the Society should turn to its advantage.

Dr NICOLA GRAY said that it was ironic that the OFT was trying to place the future of community pharmacy services in the hands of those consumers who could shop around for the best deals. But big groups of the population relied on the NHS to support their access to equitable health services. The OFT would not be standing up for these people — they were not even on their radar.

HELEN REMINGTON said that pharmacists would have an uphill struggle to persuade the Government that their significant interest in this area was not personal interest. The report should be examined with critical analysis and not opinion. The OFT had particular terms of reference but the Minister had a completely different responsibility for health care strategy. The Minister had a responsibility to look at the whole. In recommending the removal of regulations the report said that new remuneration was needed and a continuation of the essential small pharmacy scheme. The regulations should not be removed without the other half of this.

CHRISTINE GLOVER said that the response must talk about three health plans and not just one. Also it must not just talk about trusts because the Scottish and the Welsh health plans were also predicated on networks of existing pharmacies. The Scottish plan particularly aimed at using the network to deal with minor ailments in a more focused way than in England.

The response should also talk about the support that community pharmacy gave to public health, largely unsung, because issues such as that were vulnerable if the OFT had its way.

The VICE-PRESIDENT said that the Society had a great resource in its practice research division to provide evidence to underpin what it said in response to the document. Many of the points made were based on belief, but there was actually much supporting evidence. Everything the Society said should be backed by evidence.

CLIVE JACKSON said that the Department had to respond to the OFT report and the Society should help that process positively. It needed to consider the impression given in the report to those who are less directly aware of pharmacy's importance to the NHS, and that was particularly relevant to some of the arguments that the report used.

He wondered whether the likely outcomes could be predicted as confidently as the report suggested. Being able to predict the outcome would be difficult in the present state of flux. Therefore if the Society was going to help the Government respond effectively, it needed to think more widely. It seemed that local pharmaceutical services (LPS) already had potential effects on entry and configuration and would have more effect as time went on. He wondered whether LPS could be one of the arguments that might be used to help deliver some of the more beneficial elements of the OFT report in a more planned way, which would be a benefit to patients and pharmacy.

WALLY DOVE felt that Council members had to take a reality check because he was a bit worried about what he had heard around the table. First, he was absolutely against digging through the evidence at the back of the report because that was not what it was about. It really was a question of whether they could influence, in particular, Alan Milburn (Secretary of State for Health) to come off the fence in their favour. It might be hard, but it was something pharmacy had to try to do.

More importantly, David Lammy was to be a guest at that evening's Council dinner, and Mr Dove implored Council members not to moan at him because that would not work. They had to take a positive approach but at the same time remember that Alan Milburn was behind Mr Lammy. Pharmacy could get through this difficulty but they had to work at it and be positive and not whinge.

Dr GORDON APPELBE said that he believed the deregulation would take place and when it did the Society should not just leave it there but should say that if the Department of Health wanted the benefit of a good distribution in pharmacy then it should look again at the controlled distribution of the opening of pharmacies rather than a restriction of the contract. There should be geographical distribution of pharmacies without discrimination between pharmacies. All pharmacies should be able to supply a full pharmaceutical service in a competitive field. In some European models that worked well, it was only the pharmacy that was controlled. Pharmacists were not told that they could only supply some pharmaceutical services because a government would not give then a contract for providing other services.

PETER CURPHEY said that the Society should try to persuade the Department that things had to be done in the right order. To disintegrate the system and then try to find a new way of paying people was absurd.

When talking to the Government the first thing to do was to offer to solve its problem and not complain about something that was bothering you. The Government did not need convincing that it could not deliver the pharmacy plan in a market place that was in turmoil. Pharmacy needed to make it clear that the profession wanted to change and that it was not protectionist and not simply trying to preserve the status quo. However, it should not be done by commercial attrition but by health needs in local communities.

The Society should make use of its comprehensive survey on patient demand for pharmacy, which highlighted that patients wanted their pharmacies near where they worked, shopped and lived. It should use that to show that there had a good distribution of pharmacies for the current situation. Its offer should be that pharmacy wanted to change but they wanted to do it in co-operation and not under the threat of attrition.

The PRESIDENT thanked all who had contributed to the debate. He said that the Society's response should be positive and constructive and looking for an effective way forward for the profession. Every effort would be made to produce a response speedily on the basis of what had been said in the discussion, and taking into account Mr Alexander's proposal. Although time was short, he hoped that a draft could be circulated to Council members.