The Pharmaceutical Journal
Vol 270 No 7249 p699
17 May 2003

Society summary

Special Council meeting

Council proposes that inactive members can call themselves pharmacists

The Royal Pharmaceutical Society’s Council has agreed a proposal that members of the Society on the inactive register can be allowed to describe themselves as pharmacists. However, they must always ensure that they qualify that with the proviso that they are non-practising pharmacists.

Main points Continuing professional development The Council has agreed a number of proposals relating to mandatory continuing professional development for pharmacists (this page). Among these are proposals that the register be reconstructed into “active” and “inactive” parts and that inactive members can call themselves pharmacists, so long as they make it known that they are non-practising. Interim suspension of Council members The Council has agreed that it may suspend a member of Council from any Council office, including Council membership, as an interim action while investigations by regulatory or public bodies or criminal proceedings are under way, and for as long as such investigations or proceedings may take (p701).

This was one a range of proposals agreed by the Council on the subject of mandatory continuing professional development and the structure of the Register. Others were that:

• CPD should be mandatory for those undertaking a job that legally requires them to be a pharmacist or one that is usually undertaken by a pharmacist, as well as those undertaking a pharmacy or health care job for which they do not have to be a pharmacist
• CPD should not be mandatory for those who have retired, who are on an extended career break or who are otherwise not active in pharmacy (inactive/
  non-practising pharmacists)
• Pharmacists who are inactive/non-practising should be required periodically to read a statement and sign an undertaking that they are not and will not engage in pharmacy practice — in its broadest sense, not just patient care — or proffer pharmaceutical or health care advice
• CPD records must, as a minimum, relate to pharmacy in general and as a matter of promoting good practice they should also relate to the pharmacist’s sector of employment and to his or her specific job; also, within the CPD record of every pharmacist wishing to be in the “active” or practising register, there must be evidence of reflection on pharmacy science or practice, or the application of learning and development to pharmacy science or practice
• The Register should be restructured to have “active” and “inactive” categories of pharmacist, with the latter not subject to a CPD requirement

The Council came to its conclusions at the end of discussions following a presentation on mandatory continuing professional development for pharmacists by Dr Robert Dewdney, head of the Society’s education division.

   Dr Dewdney told the Council that mandatory CPD should apply to anyone holding themselves out to be a pharmacist if employed, self-employed or in any kind of voluntary work. The Council did not have to go along with that, but its proposals for a Section 60 Order had to go to the Department of Health and be agreed by them. He said that CPD would be related to supplementary and independent prescribing and possibly other defined roles would emerge. Qualified Persons might come into this but there would have to be consultation with the Royal Society of Chemistry and the Institute of Biology. CPD might also apply to technicians.

n presenting the outcomes of the Society’s CPD consultation, Dr Dewdney said that the proposals of the Continuing Professional Development Implementation Committee were strongly supported. He wanted to focus Council members on the proposed Group 2 (those people who did not have to be a pharmacist, such as academics and industrial pharmacists) because that was where the implementation committee was holding to its guns. A small majority of respondents to the consultation had agreed that mandatory CPD should apply to such pharmacists. There would be some people in Group 2 who would regard this as an imposition but most members believed that that was the right thing to do.

Dr Dewdney said that the model the implementation committee had in mind was that there should be a register where some pharmacists were in the “active” or “practising” category and some pharmacists would be in the “inactive” category. He explained that the three options for pharmacists faced with the implementation of the mandatory system was that (i) when asked, they could make a CPD return and they would be an “active” pharmacist on the register, (ii) when asked they could make a statement that they would not hold themselves out to be an active or practising pharmacist and they could undertake to make that clear to anybody they were dealing with. If neither of these was what the person wanted to do then the remaining option (iii) was for them to leave the register.

Dr Dewdney referred to a question in the consultation that had asked whether the Society should restructure to create active and inactive practising pharmacists. That proposal had strong support. The implementation committee had newly proposed that, in the statement that pharmacists would have to sign, they should undertake that if they describe themselves as a pharmacist they should always make a personal qualification in words of their own choosing that they were non-practising. The Society was not proposing to change who could use the restrictive title “pharmacist” because people clearly felt very strongly about this, but they were saying that people who were in the inactive category on the register should state that they would not hold themselves out to be active or practising and that they would make clear to people that that was the situation.

Dr Nicola Gray said that anybody who made a CPD return would be active. The industrial pharmacists were worried because they would not be active pharmacists, but if they completed a CPD return they would remain as active pharmacists.

Dr Gordon Appelbe said that if somebody used MRPharmS how could they say that they were not practising.

Dr Dewdney explained that if somebody had put on their letterhead “MRPharmS” and nowhere in the letter was there any indication, they would have to cover that in guidance. If people used their title in that way on business headings or other notepaper then it would be incumbent upon them to make clear that they were not a practising pharmacist.

Helen Remington believed that there was still an element of self-regulation, because a person could quite easily submit a CPD return as a hospital pharmacist and then try to work in the community on a Saturday as a locum for which they were not competent.

Dr Dewdney stated that the feeling of the implementation committee was that they would make it an ethical obligation on the individual, rather than seek something in an Order to remove the restrictive title of “pharmacist” for those who were not on the active part of the register.

Digby Emson agreed that the individual should act reasonably but he welcomed the more liberal interpretation and use of the restrictive title, particularly in relation to retired people. He understood that such people could still be on the register if they agreed not to be practising pharmacists.

Dr Dewdney replied that they would be on the register and they would be inactive.

Peter Curphey believed that the Society’s position should be made quite clear to those pharmacists who were very concerned about the issue. In relation to letterheads, he could not imagine that underneath the heading there would be a bracket saying “I am still a member but I cannot practise because they will not allow me to”. It had to be something that people understood quickly and there should not be any suggestion that anyone was taking away anything from people. There was an onus on people to understand how to behave and that had to be made explicit. Retired pharmacists needed to understand that they were not taking away from them the title of “pharmacist”, but they would need to qualify their position when talking to other people. The Society was not trying to get them to remove titles, qualifications, and so on, in their everyday life.

Dr Dewdney stated that if a pharmacist was writing to someone else in a personal capacity which had nothing to do with the Society or pharmacy then it would not matter, but if a person was in some kind of consultancy and had used MRPharmS on the letterhead the recipient or recipients could reasonably infer that they were a practising pharmacist and that would have to be qualified in the letter or whatever they were sending. That would be the spirit of what the implementation committee intended.

Linda Stone pointed out that there was nothing which explicitly gave the Society the power to seek certain requirements if somebody wished to switch from the non-practising to the practising part of the register. If somebody decided after a long break that they wished to return to practice, there was nothing which covered that.

Dr Dewdney replied that the implementation committee had discussed people returning to the practising register from the non-practising register and the agreement was that the pharmacist concerned would have to show evidence that they had prepared themselves for that transition. That would take the form of satisfactory evidence of their CPD.

Mrs Stone requested that that be made very explicit so that people understood very clearly that there was a route back.

Hemant Patel said that at the present time every pharmacist, if they wanted to own a pharmacy, could do so but if they had to be practising or non-practising on the register what would happen in relation to their ability to own a pharmacy, he asked. Would it be restricted to those who were practising pharmacists or could a non-practising pharmacist own a pharmacy?

The President replied that the ownership of a pharmacy was not restricted to pharmacists.

Gerald Alexander said that, in relation to the issues surrounding the inactive part of the register and pharmacists declaring themselves through a personal statement or undertaking, he believed that the regulatory powers of the Society should be applied to the ethical obligation. Once a pharmacist had decided to put himself or herself on the inactive part of the register, that was where the powers of the Society would hinge. They needed to have a clear understanding of what would be included in the statement.

The Secretary and Registrar said that she understood that what was being recommended was that the Code of Ethics would apply whichever part of the register a person was on and whatever time of day it was.

Mr Alexander said that once someone had put themselves into that part of the register there were certain obligations that would apply and that person would not be able to practise as a pharmacist in their previous sphere of practice.

Dr Dewdney said that there was not going to be a perfect definition but if someone on the inactive register was found working in a community pharmacy by one of the inspectors there would be a problem. However, he suspected that the difficulties were going to be in other areas, such as consultancy and so forth.

Clive Jackson said that they needed to be clear about the impact of this active and inactive split in relation to existing legislation particularly where legislation referred to pharmacists in a formal sense, for example, in the Misuse of Drugs Act, and the ability of a pharmacist to possess Controlled Drugs. Would that be affected, he asked, by the active or inactive part of the register.

The Secretary and Registrar said that the Department of Health would take that into account in the drafting.

The President said the important point was that there was no intention to remove the restricted title from those who had registered as pharmacists and who were MRPharmS. Active pharmacists or practising pharmacists were those who submitted CPD and if they submitted CPD for the relevant activity then they were practising. Where they were not practising then the ethical obligations would kick in. They could address themselves as pharmacists but the ethical obligations that they were not practising would have to be emphasised inasmuch as others might believe that they were practising.

Mrs Remington asked if there was a definition available of “practising” or was somebody going to judge her CPD return and say “That doesn’t count and neither does that”.

Mr H. Patel said that nobody wished to be associated with negative terms. Perhaps the question should be turned round to say, “What should a practising pharmacist be allowed to call himself?”

Dr Dewdney replied that this point had been discussed with the other regulators and the Department of Health. Members of the public would understand the term “pharmacist” to mean a practising pharmacist: they would not understand it the other way round and it would be misleading.

The next point related to how those people were affected. The people who wished to remain on the practising part of the register must give evidence related to pharmacy in general or a particular job. For the non-pharmaceutically active people who wished to remain on the active register, in other words, the accountant or the retired person, they would make a CPD return and the proposal was that some of it must relate to pharmacy.

But what would be the minimum that would be accepted? They were heading towards a situation where they would accept from an accountant that they had just been on courses or undertaken distance learning. This was where the implementation committee had slightly modified its proposal in the light of what the members had said to them. Consequently, the proposal was that within every pharmacist’s CPD record there must be evidence of reflection on pharmacy science or practice, or the application of learning and development to pharmacy science or practice. When making a CPD return it must have the features of evidence in reflection on pharmacy science or practice, or the application of learning and development to pharmacy science or practice.

Andrew Burr said his difficulty was in relation to the definition of “pharmacy” because many people would interpret that very differently. He would assume it would be much more in keeping with something like medicine usage, medicine supply and that sort of thing.

Dr Dewdney said that they would take it very broadly. He did not believe that they had to define it because many of the evaluators would be pharmacists and they would talk it through and reach a consensus with a view to accepting things and not excluding them.

Kirit Patel said it was important that no hard demarcations were put in and it should be as generic as possible.

Mr Emson said that they should take a sensible, commonsense approach. The CPD cycle itself would direct people appropriately and it should not be made too specific and prescriptive.

Dr Gray said that there would be a relatively small number of people looking at a lot of records and they would be able to see the size of any problem very quickly and where the extremes were.

Dr Dewdney further explained that they had had a specific question about supplementary prescribers. It had been answered by an overwhelming 92 per cent agreeing with the proposal that if a person were a supplementary prescriber they should look for and find in their CPD evidence that they had addressed themselves to their prescribing role, and, obviously, relevant therapeutics would be important in this.

He went on to say that they needed clarity as to how far this system would extend because the planned roll-out covered the whole of Great Britain. But the implementation committee’s view was that exactly the same requirements should apply to all pharmacists throughout the world. There were 4,000-odd overseas pharmacists and to send them the CPD packs would cost in the order of £40,000 to £50,000 plus postage. They had an option either to give them exactly the same resources at a cost between £50,000 and £100,000 or just make it available to people overseas online.

Christine Glover did not think it was appropriate to disadvantage anybody by being prescriptive about the way they could do their CPD. If it required that they had to have it in manual form then so be it; if they could go online that would be a bonus. It would not be appropriate to say to anybody that they could not be registered on the register because they could not access computers in the middle of the jungle. Whatever it costs, then that was what they had to do.

Mrs Remington said that they should do everything possible to encourage an electronic system overall. The processing was an important issue because trying to process overseas pharmacists’ returns would be much more expensive and one would have to take into account an administration fee. She believed that the default should be electronic and if paper was required there would have to be an administrative cost.

Mr Emson supported what Mrs Remington had said but pointed out that the Society had asked for a substantial increase in membership fees over the past few years and one of the reasons for that was to fund CPD.

The Secretary and Registrar suggested that if overseas pharmacists were going to participate then the fee should reflect that because at the present time the Society was not recovering the costs.

Mr Burr saw the costs as being part of registration and all costs should be covered as part of that. He did not think they should have to pay out more money.

Mrs Stone said that it had to be borne in mind that overseas pharmacists did not benefit from other services in the same way and so they had to be very careful about picking out one thing. They did not have the branch network and some of them received the PJ by surface mail. They also had to remember that some overseas pharmacists were registered with the Society purely for economic reasons so that they could come here to work and go back again. Some overseas pharmacists had to be registered with the Society because there was no alternative. There was no proper regulatory process in some of their countries and some of these countries were extremely poor. So charging them what was an economic rate in this country was not necessarily equitable. She said she hoped that these points would be considered in due course.

Interim suspension of Council members

The Council has agreed that it may suspend a member of Council, from any Council office, including Council membership, as an interim action while an investigation or proceedings are under way.

Such investigations or proceedings could be by any UK or overseas regulatory authority or public body, or could be criminal proceedings. A member of Council in this position must inform the President promptly and in writing. The President, in accordance with guidance agreed by the Council, may decide not to inform the Council on the grounds that interim suspension would not be appropriate. In all other cases, the President must inform the Council. The Council will then decide whether the member of Council should be suspended from any Council office, including Council membership.

The Council further agreed that:

• The term of an interim suspension should be for the duration of the relevant investigation, allegations or proceedings
• If the Council or some section thereof is given discretionary powers to impose interim suspension on a Council member under specified circumstance, a two thirds majority of those present and voting be required, this two thirds being an absolute majority of all members of Council
• Should a procedure be chosen that includes a specific role for the President, provision be made for that role to be assumed by the Immediate Past President, should the President be the subject of an investigation or proceedings by a regulatory body or be charged with a criminal offence.
  The Council came to these conclusions after considering a paper from the modernisation steering group.

Christine Gray, project manager, modernisation steering group, reminded the Council that it had already dealt with and agreed the question of convictions and proven misconduct and had agreed that the Council should have power to make regulations for the removal of members of Council in specified circumstances. Following on from that was the question of whether it was proper for somebody accused of a serious crime or serious professional misconduct to continue under the governance of the Society during the period of investigation or proceedings. It was intended that suspension would be seen as a neutral act.

Dr Appelbe said it was a fundamental principle that in Britain one was innocent until proven guilty, which ruled out automatic interim suspension. What was being expressed was contrary to human rights. Until someone was found guilty the Council should do nothing.

The Secretary and Registrar said that they were not talking about guilt or innocence: they were talking about transparency. If a health care professional, particularly in the National Health Service, was the subject of an inquiry then they were normally suspended for a period without any implication as to guilt or otherwise.

Mr Curphey said that the Society was a regulatory body and that the Council was in a position of making policy that affected the lives of other people. In the interests of transparency anyone who was in the middle of that process should not be seen taking part in their proceedings until everything had been sorted out. He did not believe their members would support them if they found out that policy matters being made about their livelihoods could have been made by people who should not have been making those decisions. Therefore when fitness to practise matters were raised those people should be asked to stand aside. Other major regulators had an automatic interim suspension process.

Mrs Glover said that, in relation to safeguarding the function of the Society, it was about the greater good. It may be that they impinged on the individual’s potential rights, and so on, when they were absenting themselves but she felt that the greater good had to prevail. That was why a person absenting themselves on the advice of the President was the right way forward.

The President said that the points recently made could be incorporated in the guidance agreed by the Council adding that the difficulty was where it was left to the individual and the individual chose not to absent himself or herself. If people acted honourably there was no difficulty but it was where people chose not to act honourably where the problem arose.

Hemant Patel asked if suspension meant that the person was not allowed to enter the building or the Council Chamber, because a person could attend the meetings but not speak or vote.

The President emphasised that suspension was a neutral act. The difficulty was that suspension in the minds of many people sitting round the table was not a neutral act and the approach was slightly alien. The reality was that they were not talking about a trial but a neutral act to enable matters to be investigated further without any prejudice to the individual concerned.

The Secretary and Registrar believed that they needed to get the issue into proportion because she could only recall one incident when this had happened in the whole of her time at the Society. It was a pretty rare event.

The President said that full account would be taken of the points raised within the guidance which would be determined by the Council.

Change of Register title

The Council agreed that the title of the “Annual Register of Pharmaceutical Chemists, would in future be the “Annual Register of Pharmacists”.

The President emphasised that this was not removing the restricted title of “pharmaceutical chemist”. That restricted title would continue.

The Secretary and Registrar added that the register also included the list of bodies corporate and their superintendents in the register of premises. There would be no change in this.