The Pharmaceutical Journal
Vol 271 No 7266 p349-351
13 September 2003

Society summary

Views on the draft Royal Charter: a report on the consultation

By Marcus Longley, MA(Oxon), MSc Econ, PhD

This report summarises the key issues that have emerged from the consultation on the draft new Royal Charter for the Royal Pharmaceutical Society. The following responses have been analysed by the author: individuals, 359; branch meetings, 31; roadshows 11; Scottish and Welsh Executives, two; national meetings (special general meeting, annual general meeting, branch representatives' meeting), three; pharmacy organisations, 12; non-pharmacy organisations, five; others, seven. The total number of responses is 430.

Individual responses were a mix of completed consultation questionnaires, and other written communications (letters, e-mails). Most of the questionnaires were completed with answers to the specific questions asked; some contained more wide-ranging responses.

The various issues raised in all of these responses have been identified, and similar issues have been grouped together to simplify the presentation. The report gives an approximate indication of the frequency with which issues were raised — most frequent, less frequent, infrequent — but it is not possible to be precise about the numbers of respondents stating different views. This is because much of the feedback is from groups or meetings, where there was no consistent indication of how many people contributed to the response/meeting, nor how many individual participants supported each point raised. In addition, some people sent in more than one response and/or took part in more than one meeting during the consultation. However, all of the issues raised frequently have been included. Issues raised by only a few respondents have also been included where they appeared to identify a potentially significant issue.

It is important not to assume that the results of this consultation represent the views of the wider membership: there is no way of determining how representative is this self-selected sample.

Most frequent issues

The following issues were raised many times. The only topic that has been excluded from this section is the debate about future charitable status, which the Council has now decided not to progress in the near future.

1. Support for the concept of a Royal Charter There was little dissent from the notion that the Society should have a Royal Charter. For most respondents, it was seen as conferring helpful and appropriate status on the Society, and by extension on the profession itself. It was helpful to confirm the parity of esteem between pharmacists and doctors and others, and also served to highlight the independence of the Society from the government of the day. There was considerable concern, however, about two related issues:

(a) Was it necessary to have a "new" Charter, or would minor amendments to the 1953 Charter be sufficient? Most respondents appeared to accept that some changes might be required, but many confessed a lack of understanding of the detail — in what way, precisely, was the old Charter no longer adequate? Others were frankly suspicious that major change was being advocated for reasons other than those declared by Council — to reduce democratic control over Council, and to move the Society away from representing its members towards being a modern regulator (see below). This group were therefore highly sceptical of the argument that a major revision to the Charter was actually necessary.

(b) Was the draft Charter broadly acceptable? While acknowledging their lack of understanding of the detailed arguments, some respondents were prepared to accept that the Council could be trusted; it followed that if the Council was advocating change, then that was sufficient. Many more, however, argued that the draft was fatally flawed for the reasons set out in the remainder of this report, and should therefore be rejected. In response to the question, "Do you think that Chartered status adds value to the Society ... ?", one respondent replied: "If Chartered status means we get a better deal than legislation would give — Yes, but if Council simply sets up Charter so it goes even further than government would with legislation in hampering aims of pharmacy and pharmacists it is a bad thing."

2. Removal of the Object "to maintain the honour and safeguard and promote the interests of the members..." This was cited more than any other single issue. It was taken as evidence of the intent of the Council to turn the Society into a regulator, at the expense of its "representative" function. Of all the Objects and Powers, this particular Object was regarded as being the embodiment of the "representative" role. To relegate it to a Power appeared to give any future Council discretion over whether it wished to pursue membership representation as a role or not.

Many argued that such an Object would be entirely compatible with the public interest or with regulation and, therefore, there was incomprehension that there could be any legitimate reason for removing it: "It is important that the promotion of members' interests should be retained as an explicit Object of the Society. The addition of the phrase 'whenever doing so is not inconsistent with the public good' would give the necessary priority of regulation over representation. I expect the Society to regulate and police my professional activity in the public interest. I also expect it to speak up on my behalf whenever it is not prejudicial to the public interest to do so."

One group commented: "The proposed relegation of the object promoting members' interests to a power is a very radical change: powers can only be exercised in furtherance of the objects."

Some respondents showed considerable passion and pride for what they described as the fine English of the 1953 Object, and its reinstatement without significant modification was essential if these respondents were to be persuaded to support any future redraft.

3. Importance of public interest/regulation over professional representation Closely linked with 2, above, was the argument that the draft revised Charter placed too great an emphasis on the public interest, acting for the benefit of the public, and regulation generally, at the expense of professional representation. The latter term was seldom closely defined, beyond the words of the Object mentioned above.

Many argued that there was simply no need to state explicitly that the Society would act for the "public benefit": it was implicit in the concept of professionalism. Furthermore, to do so might make the effective representation of the profession more difficult in the future, particularly with more lay members on the Council — it could leave vigorous professional representation open to challenge as being ultra vires. The Charter was seen as the expression of the representative role, whereas the Section 60 Order would set out the regulatory role. In this context, the Charter should vigorously address the membership agenda, and leave explicit statement of "public benefit" to the Section 60 Order.

Some argued that the Charter should contain an explicit statement that its prime purpose was to act in the interests of its members. There was a suggestion that to do otherwise would in effect be to make the Society an agent of government. One individual respondent stated: "It is not a public body, it is not a government department, it is a member-funded Society for the members. It [the draft Charter] puts public interest first and therefore becomes a regulatory body and cannot be truly representative of pharmacy. ... The Charter should be giving us a stronger voice. It appears to fail in this aim miserably."

4. Checks on the power of the Council Many respondents identified various aspects of the draft Charter which, they believed, served to reduce the ability of the membership to control the actions of the Council. Specifically, these were:

• The removal of the Charter requirement to hold an annual general meeting

• The reduction in the majority required to support changes to the Charter from three quarters to two thirds

• The reduction in the power of the Privy Council to approve changes to Byelaws

Many were not convinced of the benefit of such changes, and at the same time could see important disadvantages: "The removal of referral to Privy Council and any obligation to hold an AGM/SGM abolishes the existing safeguards for members. The only recourse for members would be through the ballot box. To ensure proper governance the Charter must include explicit safeguards against inappropriate changes to the constitution and workings of Council."

Many responses did not trust future Councils to remain faithful to the wishes of the members — a charge also made against the current (and recent) Councils, and a problem that was considered to be exacerbated by the inclusion of a substantial number of lay members in any future Council. Given such lack of trust, the checks on the power of the Council which these provisions represented became even more significant.

A related issue was the frequent call for any proposed new Charter to be put to a vote of the entire membership.

5. Need to represent all sections of pharmacy There was a much-expressed concern that the Society already fails to represent the interests of all sections of the profession, and a concern that the draft Charter would do nothing to address this problem. The section most frequently cited as being under-represented was the "non-dispensing" pharmacist — most commonly the pharmacist working in industry. There was also some concern that hospital pharmacists were marginalised, as were those working in veterinary pharmacy. Some respondents argued that the commercial interests of certain sections of the membership — notably in community pharmacy — sometimes overrode the concerns of other pharmacists and of the public.

There were no detailed suggestions as to how the Charter should address this problem, beyond a statement of the requirement to be inclusive. For example: "There is a tremendous feeling of alienation among all but community, and perhaps hospital, pharmacists that the RPSGB is growing less and less representative of their interests — in fact, by its very actions over the past few years it is apparent that the Society would really rather be done with the nuisance of representing pharmacists outside the community and hospital sectors. Stating clearly that the Society is representative of more than just community pharmacists, which is certainly implied in the proposed Charter, is essential to draw the profession, in its entirety together."

6. Anxiety and uncertainty over inclusion of technicians Some respondents were concerned over the reference in the draft Charter (3(1)) to "other persons engaged in related activities". This was taken by many as a reference to pharmacy technicians. In their view, the fact that this phrase was in the Power that was seen as the replacement for the disputed Object merely added insult to injury.

The concerns focused on the dilution of the effectiveness of the Society as a representative body for pharmacists, which the involvement of technicians might provoke. Their interests were regarded as being significantly different from those of pharmacists. There was also some uncertainty about the precise position of technicians within the Society — how their role and contribution might differ from those of pharmacists, and what precisely the Society would do for them, in terms of representation.

Even the Association of Pharmacy Technicians UK, while welcoming much in the draft, was unclear on some points: "Draft new Charter refers to 'member', not 'registrant'. Technicians will become registrants, but not members of the Society when the register is opened in 2005/7 — unclear as to how pharmacy technicians will be regulated by or 'fit' within the new Charter. . . . Pharmacy technicians as registrants of the Society, rather than members, will still pay an annual registration fee. Will this entitle pharmacy technicians to some degree of influence on how this money is best spent?'

7. Reflection of Scottish and Welsh devolution There was little support for the way in which the draft Charter set out the position of Scotland and Wales. Among those who commented on the position of Scotland, there was almost unanimous concern that it failed to give adequate recognition to the differences between Scotland and England. In part, the concern focused on the perceived failure to safeguard an appropriate level of devolved power within the Society. It was argued that there should be specific mention of the Scottish Department, and that in some circumstances, and on some matters, the Scottish Executive might need to pursue a different policy approach from England.

More generally, there was a concern that the Society believed — despite its protestations to the contrary — that Scotland really did not merit sufficient separate consideration in a variety of matters: "I am increasingly reminded that one size does not fit all, and I think it is getting away from the translation and 'tartanisation' of documents to fit the Scottish perspective. The language is increasingly different. We have a different dimension up here."

The responses from Wales acknowledged similar issues to those in Scotland — although some argued that various points could be addressed satisfactorily in Byelaws or Regulations, rather than in the Charter itself. In general, there was a call to recognise that in some circumstances (and with appropriate safeguards), the Welsh and Scottish Executives should be able to develop policy for Wales and Scotland, and have the ability to promulgate such policy effectively.

8. Balance between Charter and Byelaws It was generally acknowledged that the Charter should be a "high level" document, focusing on the key principles rather than the detailed mechanisms and procedures by which they were delivered. However, there was a sharp difference over precisely what should be specified in the Charter and what could be left unsaid. Those who were most critical of the draft Charter felt that it should specify more than those who were broadly content with it. The former group were concerned that future Councils — under the influence of their lay members and the government of the day — might neglect the professional representation agenda unless the Charter effectively required them to give it due importance.

Less frequent issues

1. Future ownership and control of Society assets One particular element of concern for some of those unhappy about the draft was the future position of the Society's assets. It was argued that they had been built up by successive generations of pharmacists, primarily for the development and safeguarding of the profession and those who practise it. If such assets were now to be used by a body whose prime interest lay in regulation, this amounted to a betrayal of pharmacists' heritage. In addition, if the Society in the future should cease to exist, provision should be made to ensure that those assets were redirected to another organisation which also had the interests of the profession as its prime role. It was argued that the draft Charter was not sufficiently clear on this issue.

2. Separation of "membership" and "regulatory" functions For some respondents, the only satisfactory response to the dichotomy between regulation and professional representation was to create two separate bodies, one for each role, with the Society performing the latter. This would avoid conflicts of interest, and would ensure that the professional representation function was performed effectively. This argument was not developed extensively, and was not advocated by most of those concerned about the draft Charter.

3. Lay membership of Council There was some concern about the proposed increase in the number of lay members on Council. First, there was concern that lay members would have little understanding of, or interest in professional representation. Their presence on Council, therefore, allied to the other changes proposed in the Charter, might reduce this function to a neglected rump. Second, there was concern that the individual lay people appointed to Council may not have the ability or inclination to challenge the government of the day.

4. Definition of "science" There was some concern at the removal of the specific reference to chemistry (Article 4 of the existing Charter). It was argued by some that this remained a defining aspect of the knowledge base of the profession. While other sciences might now also be important, chemistry remained at the core.

5. Designatory title for pharmacists Closely linked to 4 above, some respondents argued either that chemistry should be specifically included in the Charter or, if not, then the opportunity should now be taken to change the designatory title from "pharmaceutical chemist" to a more appropriate title, such as "pharmacist". To exclude chemistry but retain "pharmaceutical chemist" appeared contradictory.

6. Position of retired pharmacists Some respondents argued that the position of retired pharmacists was not adequately addressed in the draft Charter. As one respondent expressed it: "To be struck off the Register is a disgraceful thing. There is no clause in the present Charter that allows a pharmacist to retire honourably; one has to be struck off the Register. I think a clause should be added to the Charter to allow for retirement."

Infrequent, but potentially significant issues

Need for more "outward looking" Charter It was suggested that the draft Charter placed too little emphasis on the need for pharmacists to work with other health care professionals, outside pharmacy. Such working was seen as vital in the delivery of modern health care.

Definition of medication Another point raised was that the Charter should define "medication" in such a way as to ensure that drugs were of correct quality at the point of use, not just at preparation (eg, correct containers). Also, there was no reference in the current Charter to products supplied on prescription by pharmacists such as surgical dressings, catheters and medical gases/ cylinders — a gap that the new Charter could fill.

Consultation process

There were a number of adverse comments about the consultation process itself. Two themes were common. First, several respondents thought that there had been insufficient information about the process generally, about the differences between the current and draft Charters, and on why the current Charter was inadequate. Second, some respondents argued that the questionnaire circulated for responses was biased — the specific questions would tend to elicit a positive response, and no mention was made in the questionnaire about the possible removal of the Object "to maintain the honour and safeguard and promote the interests of the members ...".

Final remarks

The specific issues identified in this paper should be self-explanatory, and require no further development here.

At a more general level, two features of the whole process are perhaps worthy of brief comment. First, there was an observable lack of trust in the Council among many respondents. This was closely related to criticisms about past performance as a body for professional representation, and a belief that the Council, and the Society's senior staff, might be pursuing hidden agendas. It was also manifest in a desire to "tie down" any future Council by making the Charter clearly a document for professional representation as well as regulation, and relatively specific in its provisions.

Second, there was a strong feeling among many that the Society currently "belongs" to its members — its current position owes everything to previous generations of pharmacists, and it exists above all to represent the interests of the profession, in what for many is a relatively hostile environment. This raison d'être was seen to be threatened — by the regulatory agenda, by encroaching government, by lay members, and by the inclusion of technicians. Many respondents therefore felt the need to defend their Society against others, and their attitudes towards the Charter were probably influenced by this belief.