The Pharmaceutical Journal
Vol 270 No 7253 p839-841
14 June 2003

Society summary

June Council meeting

New fitness-to-practise machinery agreed

The Council agreed that the Society's existing disciplinary procedures and committees, including the Statutory Committee, should be abolished and replaced by new fitness-to-practise machinery.

New procedures would be introduced for dealing with complaints or evidence that a person's fitness to practise as a pharmacist or to conduct a retail pharmacy business was impaired by a conviction or caution for a criminal offence, misconduct, impaired competence, deficient professional performance, a physical or mental health condition, or a decision of another health or social care regulatory body that the person's fitness to practise that profession is impaired.

The procedures would also cover persons seeking to join or be restored to the register of pharmacists. The Society would seek enabling powers to allow these procedures to be applied also to pharmacy technicians.

Introducing the proposed procedures to the Council, the outgoing PRESIDENT (Marshall Davies) said that the chairman of the Statutory Committee had been consulted during their development and was anxious to see new arrangements in place as quickly as possible. The current arrangements needed to be made more robust.

Asked whether the proposals bound the Council to its current model for reforming the Society, the President said that the proposals related to the future governing body that was accountable to the Government for discharging the Society's regulatory function. That might or might not be the future Council. What he was asking the Council to agree was the framework and principles. The details of who precisely at that level would be accountable to Parliament would be debated further. He hoped everyone was content with that point.

Answering a question, CHRISTINE GRAY (project manager for the modernisation programme) said that transitional arrangements would allow the Society to deal with cases that were still in progress when the reformed Council, or other governing body accountable to Parliament, took office.

Asked about the position of pharmacy companies, the PRESIDENT said that corporate bodies and their superintendent pharmacists would be dealt with in another paper.

Answering a further question, Ms GRAY said the proposals would give the fitness-to-practise machinery the power to look into overseas convictions and regulatory decisions, but this would not necessarily lead to action being taken. Such matters would be considered on a case-by-case basis.

In response to a question about pharmacy technicians, Ms Gray pointed out that disciplinary committees and health committees to hear individual cases would be drawn from a panel that would include lay members, pharmacists and technicians. A disciplinary committee would not have a fixed membership and could include technicians if appropriate. It would be for the committee chairman to select a suitable panel to hear a particular case.

DOUGLAS SIMPSON asked whether technicians would have the same code of ethics as pharmacists. He was told that they would have their own code. How it related to the pharmacists' code had yet to be decided, but the Society might follow the example of the General Dental Council, which had produced a parallel code for dental hygienists and therapists that mirrored the main dentists' code.

The Council then went on to endorse a large number of recommendations concerned with the detail of the proposed fitness-to-practise mechanism. The first recommendation was that the reformed Council (or other body), while retaining overall accountability for the Society's regulatory functions, should delegate functions related to investigation of and adjudication on fitness-to-practise cases to an Investigating Committee (replacing the Infringements Committee), a Disciplinary Committee (replacing the Statutory Committee) and a Health Committee.

These recommendations were followed by a further 26 recommendations concerned with the structure, composition and appointment of committees, 12 recommendations concerned with the preliminary processes handled by the Investigating Committee, 26 recommendations concerned with the procedural aspects of the Disciplinary Committee and 19 recommendations concerned with the procedures for health cases.

The Appointments Committee would be appointed by the Council but would not include Council members. It would be responsible for appointing a panel of adjudicators from which members could be drawn to serve on a Disciplinary Committee or Health Committee to hear specific cases. The panel would include pharmacists, technicians, medical practitioners and lay people. It would not include any Council members, members of the Investigating Committee or Appointments Committee, members of other Society committees or Society staff.

The Investigating Committee would consider any information that had come to the Council's attention that a person's fitness to practise or to lawfully conduct a retail pharmacy business might be impaired or that an entry in the Register was called into question. If the committee considered there was a case to answer, it would have the power to issue a written warning, refer the case to one of the fitness-to-practise committees or, where the Society had the power to do so, determine whether the Society should prosecute.

The Disciplinary Committee would have much wider powers than the Statutory Committee. It would be able to direct a caution, conditional registration, suspension, removal from the Register, referral to the Health Committee, restriction of a person's right to act as a superintendent pharmacist, disqualification from running a pharmacy, financial penalties, removal of premises from the register and award of costs. It would also be able to impose interim suspension orders or interim conditional registration orders.

The powers of the Health Committee would include referral of cases to the Disciplinary Committee, imposing conditions with which the person concerned would have to comply for a specified period of up to three years, or directing the Registrar to suspend the person's registration for a period of up to a year. Such interim conditional registration or suspension orders could take immediate effect if deemed necessary for the protection of the public or the person concerned or otherwise in the public interest.

[Details of all the decisions on reform made at the Council's June meeting can be found in an updated version of the document "Reforming the Society: summary of Council decisions", which can be accessed from the "About the Society" section of the Society's website.]

During consideration of the recommendations, LINDA STONE asked why the term "disciplinary" had been chosen, when other professions had used the words "professional conduct" for the same function.

Ms GRAY said it was broader than merely conduct because it also related to competence and performance.

Professor MICHAEL SCHOFIELD questioned the extent to which it was appropriate for the current Council to decide processes for the new one. Members of the new body would expect to frame those kinds of things. The preparatory work would be helpful, but in principle the structures and processes should be established by the new Council.

PHILIP GREEN (deputy secretary) said that many of the structures would need to be defined in legislation and the basic framework had to be compatible with other regulators. The current aim was to form a basic framework with separation of investigation from decision making and of discipline from health. The new Council might well have decisions to make about the detail.

Dr PHILLIDA ENTWISTLE and Mrs STONE expressed concern at a recommendation that the Council should seek power to appoint people to screen out complaints that the Investigating Committee did not need to see. They asked why an additional layer was needed.

The SECRETARY AND REGISTRAR said that the proposal was for a power that did not have to be exercised. However, it was sensible to provide for the power in case the committee's workload became too heavy, bearing in mind that [with registration of technicians] it could have 80,000 rather than 40,000 people to deal with.

Professor SCHOFIELD said that the General Medical Council found it helpful to have that power.

HELEN REMINGTON said that she was concerned about inappropriate screening by someone who did not have the right set of skills.

The PRESIDENT said that note would be taken of the anxiety expressed.

ALISON EWING questioned the Disciplinary Committee's proposed power of interim suspension from the Register. Her understanding of the Human Rights Act was that if someone were suspended but then proven not guilty, the suspension should have been done without any prejudice. Was that correct?

Ms GRAY confirmed that interim suspension would be a neutral act.

ASHWIN TANNA questioned a recommendation that removal from the Register should normally be for a minimum of five years.

Ms GRAY said that that was on advice from the Department of Health. Ministers wished to see it in all health professional regulators' legislation. One had to bear in mind that the committee would also have other options including the power to suspend from the Register or impose conditions of practice.

The PRESIDENT said that striking off would be for extreme cases only.

Registration appeals

The Council approved a future procedure to be followed in considering appeals against certain registration decisions. These would include refusal of a fourth attempt at the registration examination, refusal of initial registration on grounds related to health or character, refusal of registration of overseas applicants and refusal of continuing registration or restoration where education or training requirements had not been satisfied.

Appeals would be considered by a Registration Appeals Tribunal under authority delegated from the Council. As well as having power to dismiss an appeal or to allow an appeal and quash the decision appealed against, the tribunal would be able to substitute a decision with any other decision that the Registrar could have made or to remit the case to the Registrar to dispose of in accordance with its directions.

The tribunal, appointed by the Appointments Committee, would have an operating norm of five, with professional members in a majority of no more than one over lay members. Council members could serve on the tribunal.

Dual registration as pharmacist and technician

The Council agreed that, should the Society proceed to the registration of technicians, such registration would be open to any pharmacist on the "practising" section of the British or Northern Ireland pharmacy register and to anyone who had been so registered within the previous four years provided their names had not been removed for misconduct.

The Council decided that anyone with dual registration who was removed from one register because of misconduct would automatically be removed from the other register. Where a person was removed from either register because of deficient performance or competence, the Disciplinary Committee would have power to determine their status in relation to the other register.

Special general meeting

During preliminary consideration of the views expressed by the Society's special general meeting on 1 June (PJ, 7 June, p802), the Council agreed a set of principles on which there was common ground between those members who approved the Council's existing policy on reform and those who sought an alternative way forward.

Opening discussion on the SGM, the outgoing PRESIDENT (Marshall Davies) said it was important for the Council to discuss two of the SGM motions because they were of immediate relevance. They were the operation of the Society by two separate boards and the motion regarding membership of Council. In relation to the motion regarding the Charter, the Council was part way through a consultation process and should wait for that process to finish. Charitable status was not an issue because it was being put on the back burner.

He then called on Dr SUE AMBLER and DAVID PRUCE (senior members of staff who have been part of the wider discussion on reform over the past two or three years) to make a presentation reminding the Council of the key points and principles that had informed the decisions taken to date.

The presentation included a draft statement of common ground, which said that:

• The Society would be the integrated professional and regulatory body for pharmacy

• The Society would be equally effective in both aspects of this role

• The Society had not taken on and could not take on a trade union role

• The Council would retain overall accountability for the discharge of the professional and regulatory functions

After the presentation, SULTAN DAJANI said that no one was against anything that Dr Ambler and Mr Pruce had said. The point of contention was that only one model had been put forward, when there could have been others.

Linda STONE said a vote should be taken on each of the four points.

Votes were then taken on the first two points, which were agreed.

On the third point, Mr DAJANI said that the reference to a trade union role did not prevent the Society from representing its members.

WALLY DOVE said at the SGM there had been reference to the British Medical Association model, but the BMA was a trade union.

DOUGLAS SIMPSON said the BMA was a federal body with different parts doing different things. The Government recognised part of the BMA for a particular purpose, and it could do the same with the Society.

ANDREW BURR said that people talking about the BMA did not actually mean the trade union part. A better analogy might be with the medical royal colleges.

HEMANT PATEL said that, without being a trade union, the Society could still talk about money because of the need for funding to deliver high quality pharmaceutical services in the interest of the public.

HELEN REMINGTON said that the Society needed to say that it would not take on the role of a trade union, but would continue to represent members in the practice of their profession. That would make clear that it was not intending to dump its political representation role.

GERALD ALEXANDER agreed, saying that the Society could represent the professional interests of the members generally but not the individual interests of members, which would be a trade union activity.

NOEL WICKS suggested that the Society should be able to represent an individual pharmacist if he or she were being threatened professionally.

Mrs REMINGTON said that the Council should agree to support the point so long as the wording acknowledged that this was not in any shape or sense changing the Society's representational role on a policy level, rather than on an individual level.

That was agreed unanimously.

On the final point, that the Council would retain overall accountability for the discharge of the professional and regulatory functions, Mrs REMINGTON asked for clarification on whether the Council would have to have lay representation in the way the Government had determined even if the regulatory function was carried out within just one part of the Society.

The PRESIDENT said that it would.

NICHOLAS WOOD said that the sentence could be read in two different ways. With a two-board model in which the two boards came together in a single Council, then indeed the responsibility lay with the Council.

Mrs REMINGTON said that the Council would need to have lay members.

Mr WOOD said the two-board model took that fully into account, because lay board members wold automatically became members of the overall Council. The broad plan had a regulatory board and a professional representative board. For argument's sake he had suggested that each board had 20 members. The regulatory board would include a lay membership of eight, perhaps nine. The professional representative board could have 20 pharmacists or include some lay members. The point was that it was the boards, not the Council, that were elected.

The regulatory board would have its powers underpinned by legislation and would have accountability. The professional board would be largely controlled under the Charter, and would deal with things at the other end of the spectrum. The Council would bring all members of both boards together. That would bring the lay members into the Council, although they would be in a smaller proportion than on the regulatory board. The Council would meet to deal with matters that went across both areas.

The President, whom he thought should be a pharmacist, would chair the Council. Two Vice-Presidents would chair the boards. A Treasurer would be elected by the Council and might be from either board. The Secretary and Registrar could perhaps be Secretary of the professional board and Registrar of the regulatory board, or the two roles could be split, as had been done historically.

The boards would appoint committees, some of which would be joint committees where the work of the boards overlapped.

The Council would have authority over the Society's assets. The incomes would be directed appropriately towards the boards.

Mr PRUCE said that the debate had moved on from principles to specific models. As a number of people still wished to speak, he suggested that a more in-depth discussion should take place at the Council's strategy day on 2 July. (Agreed)

Dr NICOLA GRAY thought that Mr Wood's model was unworkable because of the difficulty of figuring out which items went on which agendas.

Professor Michael SCHOFIELD said that he did not see how one could distinguish the professional and regulatory roles. The bottom line was that, if the Society took this model to the Department of Health, the Department would stick it in a drawer and take no notice of it. It did not meet the Government's requirements for a modern regulatory body.

Mr PATEL said that it would be useful for the Council to hold discussions with the people who had called the SGM.

The PRESIDENT said there were no plans for that at the moment because the Society had yet to see the SGM transcript.

Mrs STONE said that Mr Patel had made an important point, and she looked to Mr Davies, in his continuing role as chairman of the Modernisation Steering Group, to take it forward. Other information that would help the Council have a constructive debate during its strategy day would include a résumé of the various models that had been discussed and the reasons why they had been considered unacceptable.

The Council then went on to formulate a statement for immediate publication (PJ, 7 June, p801), acknowledging the concerns expressed within the profession, undertaking to take them fully into account when deciding on the content of the new Charter after completion of the current consultation and encouraging members to attend roadshows or branch meetings on the Charter and submit their comments.