The Pharmaceutical Journal
Vol 270 No 7244 p527-529
12 April 2003

Society summary

Branch Representatives' meeting

Several motions submitted for the Royal Pharmaceutical Society's 2003 branch representatives' meeting reflect concerns about Council decisions relating to the future of the Society. One motion says that in restructuring for the future the Society should observe the modernisation principles drawn up by the Young Pharmacists Group. Another asks the Society not to seek charitable status without full consultation and a referendum.

One motion asks the Council to drop its proposal to "hive off" its publications activities and another seeks a reduced retention fee for those not employed solely in non-pharmacy jobs. Other motions makes suggestions relating to the possible election of technicians to serve on the future Council and the introduction of mandatory continuing professional development. Two further motions bemoan the Council's recent decision on branch funding, two others are concerned with medicines packaging and one asks for the Society's registration examination pass list to be published in at least one newspaper.

There are 11 motions this year, compared with 17 in both 2001 and 2002.

The branch representatives' meeting takes place at the Society's London headquarters on Thursday 15 May. The 11 motions will be debated during the morning session. All motions carried by the meeting will be referred to the Council for its consideration. In the afternoon session there will be presentations by the President, Marshall Davies, on the Society's petition for a new Charter and an update on continuing professional development by the Society's CPD consultant, Dr Peter Wilson, with an opportunity for branch representatives to raise questions.

Set out below is the text of the motions for debate. Each is followed by an explanatory paragraph from the branch or branches concerned and background information provided by the Society's Council.

1. British Pharmaceutical Students Association That there should be an extensive review of the packaging of medicinal products currently available including generic products, with regard to the marked similarities between different packaging, in an attempt to reduce dispensing errors and patient confusion.

The association says: In the current state of affairs, there is a huge opportunity for dispensing errors and patient confusion to occur due to similar packaging of medicines. Although the fact of similar product packaging has been recognised in many dispensaries and safeguards introduced, errors still occur, and different packaging would avoid such safeguards being necessary.

Many hospital admissions a year are related to patients taking the wrong drug or wrong dose due to confusion. Any effort that can be made to reduce this should be encouraged.

Pressure should be put on the pharmaceutical companies to act more responsibly when packaging their products.

The Council says: The Council recognises the potential for confusion and medication error that can result from similarities in product packaging and shares the concerns expressed in this motion.

Contributing to meeting the Department of Health's target of reducing the number of medication errors by 40 per cent by 2005, the Medicines Control Agency has recently published a working document, implemented from 1 March 2003, entitled "Best practice guidance on the labelling and packaging of medicines.

The Society is to meet representatives from the Medicines and Healthcare Products Regulatory Agency, the Association of the British Pharmaceutical Industry, the British Generic Manufacturers Association, the National Patient Safety Agency and other key stakeholders in order to express the concerns of the profession. The Society is to seek to establish a process for identifying products where similarities in packaging and labelling have been a factor in medication error, and the actions that need be taken to ensure that these products will comply with the new best practice guidance.

2. Brighton That patient information leaflets are made less frightening and more user friendly for the general public.

The branch says: Patient information leaflets often frighten the general public with their long lists of side-effects, such that they do not take their medicines, resulting in potentially greater harm to the patient and waste of valuable NHS resources.

The Council says: The Council recognises the potential for patient harm that can result from the misinterpretation of patient information leaflets and shares the concerns expressed in this motion.

The Council of the European Communities directive 92/27/EEC Article 8, requires that package leaflets must be written in clear and understandable terms for the patient and be clearly legible. Subsequent guidelines were also produced on the readability of package leaflets in 1998 and on the user testing of package leaflets in 1999, for marketing authorisation applicants.

The Society is to meet representatives of the Medicines and Healthcare Products Regulatory Agency, the Association of the British Pharmaceutical Industry, the British Generic Manufacturers Association and other key stakeholders to express the concerns of the profession and to review how the directive and guidelines are being complied with in practice.

3. West Metropolitan That this meeting deplores the fact that the branch funding has been reduced and the means of allocating funds changed without consultation or notice.

The branch says: Branch committees were first informed of the changes (which took effect in January 2003) in October 2002. Branch secretaries were only given the opportunity to comment on minor details of the new system.

Extra funding will only be available for activities supported by the Society — meaning a decrease in autonomy of the branches.

Extra expense of modernisation was given as the reason for the reduction in sums available to branches. This belies the assertion that modernisation will not affect the Society's commitment to membership issues.

Council comment: See Motion 4 below.

4. Shropshire; Northumbrian That the recent decisions to reduce branch funding and to change the way in which branch grants are allocated should be condemned and reconsidered.

The branches say: In October 2002 the Society's Council decided to reduce the budget for branch grants by more than 13 per cent. In addition, a new system of funding was imposed in an apparent attempt to give less money to branches that are not spending it on a branch programme, and to give more to "active" branches. The system they have come up with to do this is a blunt instrument which will result in the amount that branches are guaranteed to receive being reduced by an average of 43 per cent.

Although branches will be able to apply for additional money from a pot of some £56,000, many will find the new procedure difficult to comply with. The restrictions put on branches that apply for the "extra" money are unrealistic and unfair, and although a few branches may gain, the overwhelming majority of branches are likely to be penalised.

In implementing the new system branch officers will be faced with considerably more work for less return and most branches will see an overall cut in their grant, active or not, as the total spend on branches is being reduced by about £26,000.

Branch committees feel ignored, as the final proposals were put forward as a fait accompli with little or no chance of amending the proposals, not even to make them more workable.

The new system of branch funding should be scrapped as soon as possible and the Society should work with its branches to replace it with a much fairer and realistic one.

The Council says: The membership team was asked to reduce the total spend on grants by £25,000 as part of the budgeting process. However, the main impetus for introducing the new system for 2003 was the Council's wish to address the situation whereby some branches feel deprived of adequate funding for their programmes while others struggle to use up their allocation and accrue considerable unspent bank balances. Rather than claw back unspent grant allocations, the Council wanted to encourage branches to use the funding for the benefit of their members and to help take the profession forward locally.

The Council's decisions on these matters were made shortly before the branch and regional secretaries' meeting in October 2002; a workshop session was put into the meeting to gather views and useful ideas so that the system could be put in place in time for 2003. In line with the views of that meeting, the method for allocating grants for 2003 has been made as simple and fair as possible. All branches will receive core funding and those branches that need extra funding for their programmes can apply for it. The system will be reviewed at year end. The membership team has invited any branch secretary who has a difficulty as a result of the changes to contact them in order to discuss their problem and seek to solve it.

5. West Metropolitan That the Society should observe the modernisation principles agreed by the YPG [Young Pharmacists Group], NPA [National Pharmaceutical Association] and PSNC [Pharmaceutical Services Negotiating Committee] in any changes it recommends to the structure of the Society.

The branch says: The agreed principles are that:

(a) The Society's professional representative roles must be properly accommodated in a reformed structure and be distinguished from and given equal prominence to the functions of a modern regulator. Moreover, the structure of the Society's governing body must be such to allow for independent consideration of Government policies that may impact adversely upon the profession. The Society must be sufficiently independent of Government to be able, if necessary, to oppose Government policies affecting non-regulatory issues;

(b) Lay members of Council must not become involved in determining policy in respect of representation on professional issues;

(c) The number of pharmacists on the governing body should be similar to the number on the current Council to adequately represent the broad spectrum of interests across the profession;

(d) The Society must be accountable to its pharmacist members for promoting the profession, and for the development of professional roles and opportunities. At the same time it must be accountable to pharmacists, Government and the public for the regulation of the profession;

(e) The Society has a duty to safeguard and promote the interests of its members.

The Council says: The Council has already made a number of decisions to prepare for its responsibilities as a modern regulator and professional body. These include specifying, within its proposals to government, the Society's functions of: protecting the public by keeping up to date registers and setting and enforcing standards of education, practice and conduct; considering allegations of misconduct or of unfitness to practise owing to poor performance or ill health; supporting and fostering good practice and science in pharmacy; promoting the profession of pharmacy so that its contribution to health and health care is understood; and developing the profession of pharmacy.

The proposed responsibilities of the reformed Council include: leading strategic development and policy in the profession, science and practice of pharmacy; contributing to wider policy debate in the public interest; advising the public, other professions, the Government and pharmacists on pharmaceutical matters, including the use of medicines in society; representing the Society's policies and views to others and promoting the profession of pharmacy in the public interest; making rules governing the Society's regulatory functions, including setting standards for education, practice and conduct; and ensuring the proper exercise of regulatory and law enforcement duties.

Another key decision is the preferred structure for the reformed Council: 17 pharmacists, two technicians (provided that the Society registers technicians) and 10 lay members. Assuming that this structure is accepted by government, the new Council would have a substantial pharmacist majority. It would be supported by other structures which would include pharmacists. The motion suggests that a lower number of pharmacists on Council would result in fewer areas of expertise being included. However, a larger Council would not guarantee a better balance of experience and views and could never include all the expertise needed. This could be brought in by other means. It is also worth noting that Council members need to take a holistic approach in their decision-making: they do not represent any particular interests within pharmacy.

The Society will need an identifiable governing body. That body will be the new Council. It will have to meet government's requirements for modern regulators, including increased lay membership. It would not be practical or desirable to exclude lay members from part of the Council's agenda. The Council, as governing body of the Society, is responsible for the discharge of all the Society's functions. It would, in any case, be particularly difficult to separate "regulatory" and "professional' discussions at Council level, where the focus is on setting strategy and over-arching policy within the broad context of pharmacy and health management. However, it would be feasible and appropriate for work on some issues within that policy framework to be taken forward by groups comprised mostly or entirely of pharmacists.

The motion refers to the Society's "professional representative roles". The Society's professional role and its representational work are sometimes referred to interchangeably but they are not the same.

The Society's representational role spans its entire remit. It acts as an advocate for the profession, bringing influence to bear on any issue — regulatory or professional — that affects the profession's ability to deliver a safe, high quality service. This includes, when necessary, opposing government policy. The Society is independent of government and will remain so. The Society cannot represent pharmacists' individual or commercial interests, and it cannot act in conflict with the public interest. However, the Society's view of the public interest need not always coincide with that of the government of the day. This is the situation now — modernisation will not change this.

The Society serves both public and profession and its arrangements for accountability reflect this. The public is represented by Parliament, and the Society will be accountable to Parliament for the exercise of its regulatory functions. Accountability to pharmacists is expressed primarily through the election of pharmacists to the Council.

6. Oxfordshire That Council ensure that technician representation on the future reformed Council will be confined to those working in pharmacy practice, in community pharmacy or hospital sectors.

The branch says: We wish the Society to avoid technician representation on the Council being extended to those working outside the direction of a pharmacist. This would therefore exclude those working for dispensing doctors.

The Council says: In December 2002 the Council agreed a regulatory framework for pharmacy technicians, including registration with the Society. This decision was made with the knowledge that, if the Society had not decided to take on this role, it is likely that technicians would be registered by another body, perhaps the Health Professions Council (formerly the Council for Professions Supplementary to Medicine). This could lead to different, perhaps incompatible standards operating within pharmacy to the detriment of patient care. On the other hand, extending professional regulation to technicians should help take pharmacy forward on a broader front than ever before. Assuming that the Government accepts the Society's proposals and the Society does indeed regulate technicians, pharmacy technicians will be included on the reformed Council.

It would not seem appropriate to exclude registered technicians in some practice settings (or those not currently working) from being able to stand for Council. This would be analogous to excluding pharmacists who were working outside mainstream pharmacy practice from standing for the Council.

It is intended that technicians would be elected to the Council by and from technicians registered by the Society (except for the first term when technicians join the Council, when they would be appointed). Again, this is analogous to the way in which pharmacists are elected to serve on the Council.

It should also be noted that dispensary assistants working for dispensing doctors may not be able to fulfil the requirements for registration as pharmacy technicians with the Society since they may not be able to meet the entry requirements proposed for registration.

7. Oxfordshire; Hull That in relation to the Society seeking charitable status, (a) there must be full consultation with the membership using all available information, (b) the membership should be satisfied that charitable status does not contravene the Society's Charter, (c) the membership must be reassured that the Society will not give away "the family silver" and (d) a referendum of all members must be held before Council's proposal for charitable status is taken further.

The branches say: It is recognised that charitable status may bring tax benefits to the Society. But we believe that the advantages and disadvantages of charitable status have not been fully explained and members should have all information before such a change to the Charter is proposed.

Furthermore, in view of the likely changes in charity law for which many charitable organisations are currently lobbying, this may not be the right time to be considering such a move.

Considerable assets have been accrued, largely through revenue raised from commercial activities, like publications. The membership, through the Society, must retain ownership of key assets like the headquarters building and publications. Any changes to the publication arm must ensure that the Society continues to benefit from future profits.

The Society should allow members' professional interests to be protected and maintain its right to take part in "political" activities.

The Council says: The Council, in considering the proposal that the Society should seek charitable status, debated all of the issues on three occasions and made its decision based upon the following key considerations:

1. In examining the public good component of the Society's work, expert opinion indicated that the organisation already operates to many of the standards expected of a registered charity. Levels of governance are high; members of the Council have an appreciation of the role of trustees and are, indeed, already working to appropriate standards in their role as trustees of the registered charities that the Society has.

2. Following on from the above, expert opinion also indicated that, given the Society's public good role, there may already be an implied duty to register as a charity.

3. Charitable status would mean that the Society would not bear certain costs borne in the commercial sector.

4. The Council has been considering the Society's publishing operation for some time with a view to developing its full potential while retaining all the traditional standards of quality and excellence. Regardless of the issue of charitable status, there is a compelling argument for separating publishing activities to provide a more suitable environment and management framework. All commercial activities carry a risk element and the Society's publishing activities are no exception.

5. The Council has stressed that the Society must have full ownership of the planned publishing company. Thus, the Society would own 100 per cent of the share capital of the new company. If the Society were a charity the publishing company profits would be capable of being transferred, free of tax, to the Society by means of gift aid.

6. Potential changes in charity law have no real bearing on the case to register as a charity.

8. Cheltenham and Gloucester That the Council should not proceed with its proposal to hive off its publications activities to a separate company.

The branch says: The profession was informed by the editor in The Pharmaceutical Journal of 14 December 2002 that, as a consequence of the Society seeking charitable status, the publications arm would have to be disposed of because business activity would be incompatible with its aspirations.

This may have a short-term attraction but if this profitable side of the Society's activities, which supports its role in looking after the profession, is put under the control of a separate company, it would be possible for some future Council, consisting of more lay members and technicians, to dispose of it. This and its proposed charitable status could lead to a professional organisation with a greater role in looking after the public rather than the profession's interest, a larger and more costly Council and ultimately without the assets to support it.

The Council says: There are several reasons why the Society is considering a proposal to place its publications activities in a separate, wholly owned company. The report in the PJ of 14 December 2002 reflects these accurately: in sum, better governance and sustained growth. As a result publications will create more financial and intellectual resources for the Society. However, the Council will consider the matter again later in the year, when it will review a fully costed business plan as well as the detailed arrangements for incorporation. Only if it is satisfied that these are in the best long-term interests of the Society will it proceed with incorporation.

Whether publications are managed within the context of a wholly owned company or remain within a directorate as now, they will continue to preserve the current balance between professional interest and financial advantage. For those publications which are central to the Society's interests, including The Pharmaceutical Journal and its associated publications, and the British National Formulary, special safeguards will be required to ensure their continuing integrity and independence.

It should also be noted that there are powerful commercial arguments for retaining an intimate link with the Society. Although the relationship may curtail the company in the exploitation of some commercial opportunities, it nevertheless gives the publications a considerable authority and standing in the market-place, and this has been in large measure responsible for their present success. To sever it would have direct and adverse commercial consequences.

Finally the act of placing publications in a separate company does not in itself increase the likelihood of their disposal. At present the Council has the power to close or dispose of any of its current portfolio of publications, and has occasionally done so in the past. Intrinsically there seems no reason why a reformed Council with a larger lay component should take any different view. Nevertheless the establishment of a separate company will of necessity require clarification of the remit of publications within the Society, and will put better governance arrangements in place. As a result it is quite possible that any divestment of publishing interests would become harder rather than easier to do in the context of a separate company.

9. Harrow and Hillingdon That when pharmacists are required to submit regular CPD records to remain an "active" practitioner, then these pharmacists should be issued annually with a form of identification that is easily recognisable to employers, other health care professionals and pharmacy colleagues.

The branch says: Once the Register differentiates between "active" practitioners and other pharmacists, it will be necessary to issue them with a form of identification that enables employers and colleagues to check the currency of their "active" status. One cost-effective method might be to issue a card with integral photograph downloaded from a digital image retained on the Society central database. Such cards are now commonly used in universities and hospitals. This identification should be issued annually upon receipt of registration fees and appropriate declarations of fitness to practise.

This will help employers and colleagues to check that a pharmacist whom they have not worked with before is on the "active" part of the register. The format of such identification should therefore be publicised appropriately prior to implementation. Moreover, the inclusion of a data chip may provide further technological opportunities to identify individual practitioners for the purposes of access to patient records etc. The cost of issuing such identification should be met from the annual retention fee for "active" members.

The Council says: The policy, processes and methods by which the "active" practitioner is recorded must be carefully considered. The issue of some form of identification needs to be addressed under the policy, and, if accepted, procedures and processes devised to ensure that the issue of the identification is robust. If this is to be issued annually, an expiry date will need to be included on the identification document or card.

10. Harrow and Hillingdon That the current option for full-time membership fees with the Society should relate only to "active" pharmacists, and that members who are employed solely in other trades should be entitled to claim Society membership as "non-active" members and hence be required to only pay "part-time" or otherwise reduced membership fees."

The branch says: A significant number of Society members no longer practise pharmacy but still wish to retain their professional membership. With the expected introduction of mandatory CPD, there is an opportunity to show a distinction between "active" and "inactive" pharmacists, and to accept that the burden of membership of "inactive" (ie, non-practising) pharmacists should be lower than those who are practising.

The Council says: The issue of membership fees and status of pharmacists on the register is currently being considered.

11. British Pharmaceutical Students Association That the names of successful candidates who sit the Society's registration examination should be published in at least one national broadsheet newspaper.

The association says: An increased public awareness of our professional profile would benefit the profession, and this is one way to achieve this. It would also create a feeling of being valued in those who are newly qualified, something which is often missing.

It is important for the pharmacy profession that pharmacists are recognised as professionals and valued as much as other professions. For other professions, the governing body is responsible for publishing their names, and some universities also show their pride in their graduates, using this method.

The cost of such a move could be offset by the clever sponsorship opportunity that this would provide.

The Council says: The membership unit has recently made enquiries with regard to such a list appearing in either The Times or The Independent newspaper. The quoted costs for this were £20,000 and £7,500, respectively.