The Pharmaceutical Journal
Vol 271 No 7270 p521-526
11 October 2003

Society summary

October Council meeting

Views sought on revised draft Charter

The Royal Pharmaceutical Society’s Council has approved a completely revised draft Royal Charter for the Society, with major changes made to reflect the views expressed by members and others in the consultation during the summer (PJ, 13 September, p349). It also agreed that the revised draft should be issued for further consultation.

The consultation will take the form of a further eight-page centre pull-out in The Pharmaceutical Journal. The pull-out will appear next week, accompanied by a feedback form. The consultation document and feedback form are to be placed on the “Making the Society fit for the future page in the “About the Society” section of the Society’s website by Friday 10 October.

The revised draft seeks to address all the major issues raised in the summer consultation, including the omission of the third Object found in the current Charter, ie, “to maintain the honour and safeguard and promote the interests of the members in their exercise of the profession of pharmacy.” Many people argued that, without such an Object, the Society might have difficulty carrying out the professional leadership and development role. In response to these views, the Council has approved an additional Object: “to safeguard, maintain the honour and promote the effectiveness and interests of the profession of pharmacy”.

The words “the profession of pharmacy” have been substituted for “members in their exercise of the profession of pharmacy” to make clear that the Society cannot represent or champion the interests of individual members but must concern itself with the effectiveness and interests of the profession as a whole, in all its diversity.

Another concern addressed by the revised draft Charter is the firm belief of many respondents that the earlier draft did not properly address the implications of the devolution of health policy to Scotland and Wales. In response, a new Article 6(1) places an obligation on the Council to ensure that appropriate structures are created to reflect the full implications of devolution. Article 7(4) provides the framework for proper devolution of powers within the Society to ensure that the new structures work.

Other major concerns that have been addressed in the revised draft are the balance between the Society’s regulatory and professional roles, the need to represent all sections of the profession (including non-dispensing pharmacists), the position of technicians within the Society and the checks and balances on the power of future Councils, including the balance between what should be specified in the Charter and what should be left for future Regulations or Byelaws.

The Council made its decision at its meeting on 30 September. The Council had before it a revised draft Charter that had had a number of changes made to it following discussion at an informal meeting of Council members earlier that day.

Presenting the revised draft Charter to the meeting, MARSHALL DAVIES said that the Charter was a high level document intended to sustain the profession for 20 to 30 years. It would facilitate developments that would take place during that period, some of which would be beyond members’ comprehension today. It was a permissive and enabling document. It sought to identify the Objects, but also highlight the Powers that would facilitate the Society developing and changing over the years.

Armed with that background, he sought to take members through the document to seek their views or comments. He asked that the detailed comments that had been made during an informal discussion in the morning should not be repeated. Members should concentrate on matters of principle, so they could take a decision on the Charter in part and in whole.

Asking the Council to accept the proposed Charter Objects, Mr Davies said that there were four Objects, which had been amended as a consequence of members’ discussions that morning.

DOUGLAS SIMPSON said that the third Object, “to safeguard, maintain the honour and promote the effectiveness and interests of the profession of pharmacy”, was a continuation of a provision that had been in the Charter since 1843. In the current Charter it read: “to maintain the honour and safeguard and promote the interests of the members in the exercise of the profession of pharmacy”. There was a personal element to it, reflecting the origins of the Society. It had been formed as a professional association, and in many respects he still saw it as such. Many people talked of a leadership body, but he saw it as a professional association — the voice of pharmacy. With the new wording it was not a personal thing any more, but more amorphous.

He also found no definition of what the profession of pharmacy was within the document. At various stages it spoke of membership being extended to include other people. So there was no guarantee that the profession in the future would just comprise pharmacists. He was concerned that they were losing the personal element on this particular part of the objects.

ASHWIN TANNA said that the proposed third Object might sound essentially the same as the current Object, but it was not. If it interpreted the new Charter as being the same as the old one, then the Council was fooling itself and the membership. The Council had to carry the can and show strong leadership, but to display strong leadership it had to take the membership with it. If not, the members would still think the Council was living in an ivory tower.

LINDA STONE said that the Council was not elected to represent the profession or individuals within it but to lead the profession and represent the profession as a whole. Sometimes leadership meant taking decisions that were not popular with everybody. The Council should have the courage to lead where it believed it should go. The proposed third Object, as written, strengthened the ability of the Council to lead and represent the profession in a way that the old wording would not do.

NICHOLAS WOOD, supporting Mr Simpson, said that the changes were leading the Society into an unknown area, because it could be diminishing the Society’s freedom of action by distancing it from the concept of a membership organisation. For that reason, he was unable to vote for the proposed wording. There had been clear consultation with the membership, which preferred the wording of the 1953 Charter with which they were familiar. That wording was not incompatible with what the Council was trying to do, nor was it incompatible with the wording “public benefit”, which was now to be included.

CHRISTINE GLOVER said that she could think of nothing better than putting the interest of the profession back into the draft Charter as an Object. To “safeguard, maintain the honour and promote the effectiveness and interest of the profession of pharmacy” was what the Society was about every day.

HELEN HOWE, agreeing with Mrs Glover, said that reworking the words was essential, because the previous words were utterly misrepresented by those who sought to use the Charter to suggest that there was an individuality in that representation, because that was not the case.

ANDREW BURR said that going back to the current wording would be a catastrophic step backwards.

GERALD ALEXANDER proposed an amendment to the wording by adding after “interests” the words “of pharmacists in the exercise of”. This would not change the Object much but he hoped it would satisfy those who were concerned about removing the word “members”.

MARTIN ASTBURY supported the proposal.

HELEN HOWE said that the amendment would reinstate the confusion that had always been there.

DOUGLAS SIMPSON said that the amendment was much the same as the current Charter Objective and did not change things. Members should vote either for the original Charter Objective, or for the one already proposed.

PAT HOARE said that she had wished to see the original Object reinstated. However, she accepted some of the arguments that were being put forward and she supported the amendment. If it were lost, she would vote for the new wording that had been put forward.

Mr Alexander’s amendment was put to the vote and was lost by 16 votes to three. The wording “To safeguard and maintain the honour and promote the effectiveness and interests of the profession of pharmacy” was agreed by 15 votes to four.

The Council also agreed a fourth Object, “to maintain and develop the science and practice of pharmacy in its contribution to society”.

After the Council had adopted a list of 21 proposed powers of the Society, Mr SIMPSON pointed out that publishing was not in the list.

The SECRETARY AND REGISTRAR said that publishing had always been in pursuance of the first Object, “to advance knowledge of, and education in, pharmacy ...”.

Mr SIMPSON said that he was surprised that that was the only reference to publishing because it was a large aspect of the Society’s operation.

Mr DAVIES said that the matter would be pursued.

Professor MICHAEL SCHOFIELD said that Mr Simpson’s comment was a sensible one. Publishing was not contentious subject. Could the Officers be empowered to take Mr Simpson’s suggestion, appropriately word it with the lawyers and put it in instead of leaving the matter hanging?

The SECRETARY AND REGISTRAR agreed that it would be helpful if the Officers could be empowered to approve such an addition.

[The words “to publish or promote the publication of information or other material in any form” were subsequently added to one of the Powers.]

Moving on, Mr DAVIES pointed out that the annual general meeting had been restored to the draft Charter, with the wording: “There shall be an annual general meeting of the Society at intervals of not more than 15 months and such other general meetings as may be required or permitted by this, our supplemental Charter or regulations made by the Council.”

Mr TANNA asked where the draft Charter mentioned a reduction in the power of the Privy Council to approve the Byelaws.

The SECRETARY AND REGISTRAR said it was not the case that there would be a reduction in the powers of the Privy Council. The Privy Council oversaw charter bodies. There was generally an agreement, normally through regulations, as to which of those particular changes needed to be taken to the Privy Council. In most cases, it did not include housekeeping activities, but would include major changes. That was catered for here.

Mr DAVIES said it had not been agreed at the meeting. It had been debated, but not agreed.

When the Council reached Article 5, “The membership of the Society shall consist of the persons who are for the time being registered pharmacists [within the meaning of [Section 60 Order] and such other categories as may, on application by the Council, be approved from time to time by order of Our Privy Council,” Mr SIMPSON said that if membership of the Society included persons other than pharmacists and the third Object was concerned only with the interests of “the profession of pharmacy”, then the Society had been taken away from its members. It was not an organisation for pharmacists any more. That would not be acceptable to the members, and he predicted a lot of opposition. He certainly opposed it. The Society had been set up as an organisation for pharmacists and had been maintained in that position ever since. Now it looked as if it was going to be given over to other people as well.

Mr WOOD, agreeing, suggested by way of amendment that “on application by the Council” should be replaced by “following Byelaw promoted by the Council”. This would provide a mechanism by which the membership would have input into what the Council decided in relation to people who may join the Society.

Mrs STONE stated that she had every sympathy with the concerns being expressed, but the Charter needed to enable for the future. The more restrictive detail that was put in the Charter, the more they would be tying the hands of the profession in the future.

Mr SIMPSON, supporting Mr Wood, said that it was important to check the views of members before big changes were made.

WALLY DOVE said that he was absolutely dead against membership of the Society being extended to technicians in the future. If something could be done to stop it ever happening, he would vote for it.

Mr ASTBURY said that the only change needed was to add the words: “following consultation with the members”.

Mr BURR pointed out that the sentence concluded with the words, “approved from time to time by order of Our Privy Council”. But the Council of the day could not go to the Privy Council without taking cognisance of the issue. The Privy Council would look at whether the Society had consulted the membership and, for example, conducted surveys.

Professor MICHELL opposed the amendment for two reasons. The first was the need to maximise flexibility, to provide room for manoeuvre. The second was that if the Council had to go to the membership on every major decision, it implied a huge distrust of the Council, which would be unfortunate, and (b) it would be expecting much tighter control over the Council than any of them had over those who they elected to national government.

Professor SCHOFIELD said that Council members could not go through the document putting in trip wires all over the place for their successors. They had to work on the basis that the Council of 2023 would consist of 30 people doing their best for the profession. They had to work on that basis to empower them to do what they perceived to be in the best interests of the profession at that time. He personally believed that what was written was a very decent piece of drafting that he would support as it stood.

The PRESIDENT then put Mr Wood’s amendment to the vote. It was lost by 15 votes to six.

Article 5, as worded, was put to the vote and agreed by 14 votes to three, with one abstention.

On Article 7, which concerns the Council’s structure and powers, there was a lengthy debate on the proposed structure of the Council, even though the draft Article simply reflected existing Council policy that the future Council should consist of 17 pharmacists, two technicians and 10 lay members, with the possibility of alteration from time to time subject to a maximum membership of 35.

After debate the Council endorsed the existing policy and the associated wording in the wording of the Article by 16 votes to two, with three abstentions.

Mr SIMPSON said that he had been very much taken with Clive Jackson’s idea for a senate structure, which was not even mentioned in the draft Charter.

Mr WOOD said that, like, Mr Simpson, he was concerned that following the debate they had been having regarding a model which included a senate, there was no provision sufficiently robust in the Charter.

Mrs GLOVER pointed out that Article 7(3) enabled the Council to do whatever was needed in the way of boards, committees or other bodies. The present Council might want a senate but in 10 years’ time the future Council might want an entirely different structure.

Having approved the revised draft Charter article by article, the Council went on to consider whether it should be issued for further consultation. Mr DAVIES proposed that it should be issued for comment despite the problem of time scale because of the need to run the Charter in parallel with the Section 60 Order so that nothing would fall down in the middle and the Charter would be recognised for the breadth and depth of its accountability. The intention, subject to the Council’s agreement, was to put the revised draft on to the Society’s website by Friday 10 October and produce an article for The Journal of 18 October. The period of consultation would be short — not because anyone wished to stifle or inhibit responses, but merely to comply with the timetable. The final response for the consultation would need to be in time for further consideration by the Council at the December meeting.

Professor MICHELL said that somehow one had to encourage people, if they were in broad agreement, to say so. Otherwise inevitably 95 percent of the response would still be disapproval of particular aspects. It was the old problem of the silent majority.

Mr BURR pointed out that members at the special general meeting had asked for a referendum. He felt it would be proper for the Council to explain why it had ruled out a referendum. The reasons he saw they were not going to go down that road were time scale and the complexity of the issue. To simplify and say, “Do you agree with this, yes or no?” was a non-starter.

The PRESIDENT said communication was a point they had to take seriously and that would be addressed. She asked that the vote be taken on whether to issue the revised draft Charter for further consultation as proposed (agreed).

Support for competent regulation

The Council agreed that the forthcoming Section 60 Order should recognise the need for the Council to put in place arrangements to ensure, as it sees fit, that it receives appropriate expert advice to inform the effective discharge of its functions.

Proposing a motion to that effect, Marshall Davies (chairman, Modernisation Steering Group) said that the proposals for a new Charter recognised the importance of expert advice to support the Council in its functions of leading, developing and regulating the profession of pharmacy. It was appropriate that the Section 60 Order should also recognise the importance of expert advice.

Investigation into complaint

The President reported that an investigation had been carried out into a serious complaint concerning the publication of the Council responses to the resolutions of the 2003 branch representatives’ meeting.

The complaint, made by a member of the Society at the British Pharmaceutical Conference, alleged that the published response to one resolution was not as agreed by the Council. The implication was that one or more members of staff were guilty of misconduct in publishing as Council policy a document that had not been approved by the Council. The investigation had found no evidence to substantiate the complaint of any deliberate wrongdoing.

The Council approved the publication of a statement about the investigation and also agreed to republish the response to the branch resolution concerned with extra wording added to remove any possible ambiguity that could lead to the response being misinterpreted (see p527).

British Pharmaceutical Conference

The President said that the British Pharmaceutical Conference had been most successful this year. She thanked all who had contributed to the programme and the organisation.

WALLY DOVE (chairman of the Conference Committee) said that substantial progress had been made with the conference. Some previous difficulties had been solved, but one problem that remained was the clashes between session starting times, so that important speakers had felt offended because people were walking out before they started to speak. That would not happen again.

On the social side, “deformalising” the dinner had been a great success, with something like 70 per cent more people attending the function. That meant that the event should break even rather than lose money as in the past. The dance had seen a 40 per cent increase in attendance.

Sponsorship had not been easy this year, but the exhibition had been an unqualified success, with many more stands than at previous conferences.

Pharmacy Practice Research Trust

The Council agreed proposals to integrate aspects of the Society’s research strategy with the work programme of the Pharmacy Practice Research Trust.

The Council made its decision after a presentation given by Sir GRAHAM HART, chairman of the Pharmacy Practice Research Trust. Sir Graham reminded the Council that at its April meeting it had accepted in principle a proposal that the trust take over the management of the Society’s extensive practice research programme. The proposal was that, to help develop the pharmacy practice researchers of tomorrow, the trust would take over the Society’s commissioned research programme (workforce, education and ethics) and its practice research awards, bursaries and so on. Drawing the Society’s and the trust’s programmes into a single operation would release some modest savings that could be ploughed back into productive work. There was no additional cost to the Society from any of these proposals. The composition of the trust board would change, initially by the addition of two former presidents of the Society.

The Council confirmed its April decision to continue to support the trust and provide core funding at the current level. It also approved the trust’s proposed arrangement for integrating more closely the work of the two bodies.

Reciprocal registration agreements

The Council agreed to end the Society’s reciprocal registration agreements with Australia and New Zealand. All applications from overseas pharmacists, other than those from Northern Ireland or from other countries in the European Economic Area, will in future be considered via the adjudicating process. The Council also asked the Secretary and Registrar to seek a meeting with relevant bodies in Australia and New Zealand to discuss how to facilitate timely registration of pharmacists from these countries through the adjudicating process.

The Council made its decision after considering a document reviewing the existing arrangements for reciprocal registration. Currently the Society has arrangements in place for pharmacists from Northern Ireland, Australia and New Zealand. It also honours a former agreement with South Africa, but only for pharmacists who registered before 31 March 1968, when that agreement ended.

The document suggests that the Society’s current reciprocal arrangements could be challenged in the courts, alleging prejudice against overseas pharmacists who, unlike those from Australia and New Zealand, must pass the registration examination as part of their registration process. In addition, the Department of Health is not keen on reciprocal arrangements.

No problem is seen with the reciprocal arrangement for pharmacists from Northern Ireland. The Belfast pharmacy degree course is accredited jointly by the Society and the Pharmaceutical Society of Northern Ireland, the PSNI’s registration requirements and registration examination are essentially the same as in Britain, medicines legislation is the same and the PSNI’s code of ethics and professional standards are much the same as the Society’s. In addition, pharmacists from Northern Ireland are unable to register under the free movement provisions of the European Economic Area because Northern Ireland is not a separate member state of the EEA.

Technician regulation

The Council approved several measures relating to the regulation of pharmacy technicians. The measures set out the criteria for entry to a register of technicians, the process for processing applications for admission to that register under a “grandparent” clause and the timetable for implementing mandatory continuing professional development for pharmacy technicians.

The decisions were all based on work carried out by the steering group on the regulation of support staff in partnership with the pharmacy sector committee of the Science, Technology and Mathematics National Training Organisation, which is responsible for the training requirements and accreditation arrangements of those staff. The recommendations were presented to the Council by HELEN HOWE, who is chairman of the steering group and a member of the pharmacy sector committee.

The document on the criteria for entry to the technicians’ register was largely based on existing Council policy. Primary qualifications acceptable for registration were the level 3 Scottish/National Vocational Qualification in pharmacy services, registration as a pharmacist with a current or recent licence to practise or any new qualification that the Council may approve. Those with a qualification that was not acceptable for direct entry to the register would be required to top up their qualification to the standard of level 3 S/NVQ. Those with an approved qualification who had not worked for four years or more would be required to demonstrate competence to return to practice.

The document went on to set out the criteria for entry to the register under the grandparent clause. The paper listed 13 specific qualifications that were acceptable for entry to the register under the grandparent clause during a two-year transition period from 1 January 2005. It also acknowledged that there might be other courses that the Council would find acceptable. The paper also listed other qualifications that were unacceptable in their own right but could be accepted if supported by other specified training or work experience. Finally, the paper allowed for a process to be developed to allow register entry for technicians with overseas qualifications plus relevant work experience in Britain.

The paper on the processing of applications for admission to the register under the “grandparent” clause set out two routes to the register. The main route involved providing evidence of completion of an approved qualification plus proof of an acceptable amount of recent work experience as a pharmacy technician, plus a brief employment or career history. The alternative route involved providing evidence of completion of an approved qualification plus demonstrating to professional assessors an ability to practise to standards of proficiency and competence set for pharmacy technicians.

The paper on the CPD for technicians recommended that CPD for technicians should be mandatory from the point at which they register with the Society, even if this is during the two-year voluntary registration period.

Commenting on the papers dealing with admission to the register, Mrs Howe said that one key point was the grandparent clause as it related to a large number of support staff who worked for Boots. Some of these staff had done only a one-year dispensing course but they were only allowed to do that course if they had completed all sorts of other run-in pieces of training. So to call it a one-year course was an understatement of its content. It had been agreed with the Boots training staff that there would be a top-up module that the pharmacy sector committee had approved and agreed.

Pharmacy support staff

The Council made several decisions designed to clarify of the scope of the Society’s competence requirements for pharmacy support staff, ie, that they should be trained to a minimum standard equivalent to the level 2 Scottish/National Vocational Qualification in pharmacy services or undertaking such training.

The Council agreed that the scope of the requirement should apply to anyone involved in the following activities: sale of over-the-counter medicines and the provision of information to customers on symptoms and products; prescription receipt and collection; assembly of prescribed items (including the generation of labels); ordering, receiving and storing pharmaceutical stock; supply of pharmaceutical stock; preparation for the manufacture of pharmaceutical products (including aseptic products); manufacture and assembly of medicinal products (including aseptic products).

On the receipt and handing out of prescriptions by medicines counter assistants (MCAs), the Council also agreed that the Society’s requirement for MCA courses should be extended to cover the knowledge and understanding associated with Unit 2.05 (taking in prescriptions and issuing prescribed items) of the level 2 S/NVQ in pharmacy services.

It was further agreed that assistants who have successfully completed an accredited MCA course or have previously been considered to have met the Society’s requirements for MCAs will be exempt from a requirement for a declaration of competence by a pharmacist or further training in certain units of competence.

On time limits for starting and completing courses for dispensary/pharmacy assistants and MCAs, the Council agreed that those for whom training and competence requirements apply should be enrolled on a training programme within three months of starting their role (or as soon as practical if no local training programme began within three months) and that training should be completed within three years.

The Council’s decisions were based on recommendations made by the steering group on the regulation of support staff and the pharmacy sector committee. Presenting the recommendations, HELEN HOWE (chairman of the steering group and a member of the pharmacy sector committee) said that Council policy related very much to the dispensing arena, and the major feedback from consultation was from the hospital sector saying, “What about our pharmacy assistants who are not in the dispensary but are involved in stores and the distribution of stock, drugs, not for individual patients but topping up the cupboards? What about those who assist with the running, the paperwork, the logistics and the reception of prescriptions in an inpatient dispensary, an outpatient dispensary or even in an aseptic dispensary?”

It was true that the hospital sector had staff of a lower skill level than a technician working in other arenas. Having looked at the matter, the pharmacy sector committee had adjusted the NVQ2 content and changed it to pharmacy services rather than dispensing to broaden its scope as much as possible.

The pharmacy sector committee was now content, but clarification was needed on the proposed scope. In strictly legal terms dispensing was not included in the terminology. Preparation and manufacture would not include individual patient dispensing but would cover only batch production. The group that looked at the matter talked in terms of supporting the dispensing process as well. Therefore it would be helpful if the titles of the modules actually included the word “dispensing” for clarification purposes. Mrs Howe had spoken to the main author, who had said that the words in the module were all about assisting in the process, because the people were assistants. The proposal had had the most rigorous involvement of experts all the way through and had been supported by the steering group.

NICHOLAS WOOD said that he had been reassured by some of the things that Mrs Howe had said. He had been concerned that the proposal might lead to a measure of deskilling in the community sector because of the options available for an assistant level course, NVQ2, rather than a technician level NVQ 3. Employers might increasingly choose to put their assistants only through NVQ 2.

So far as the hospital and NHS service was concerned, dispensing assistants were also on an NVQ2 level course within the hospital service. Mr Wood said that he was interested in the mapping across between the community and the hospital service. He was concerned about people who had been trained to NVQ level 2 in the hospital service being taken into the community service at the same level with the same level of training.

Mrs HOWE said it would be entirely possible. An NVQ2 was a portable qualification. A person would be able to work in the community sector or the hospital sector.

DIGBY EMSON said that many staff across various sectors of community pharmacy worked on medicines counters. He understood that they would not be subject to the NVQ2 mandatory element but would be subject to the relevant parts of it appropriate to their roles.

Mrs HOWE said that Council policy was that anybody involved in the dispensing process had to be trained to a minimum standard. Somebody who received a prescription was involved in the dispensing process. A medicine counter assistant’s training would have to match the relevant NVQ2 module. People would not be expected to do all of the NVQ2 if it did not match their responsibilities.

“A vision for pharmacy”

The Council approved the Society’s detailed response to the Department of Health document “A vision for pharmacy in the new NHS”.

The response welcomes the chief pharmaceutical officer’s “10 key roles for pharmacy” and said that the Society looked forward to their development and implementation. However, it questions whether “access to medicines” should be first on the list and expresses surprise at the omission of any reference to pharmacists’ role in promoting self-care and health and well being.

The response expresses pleasure at progress towards a new contractual framework for community pharmacy based on quality. But it points out that progress and development must be sustainable and stresses that pharmacists cannot provide the enhanced services outlined in the document without the resources to do so.

Welcoming the announcement of a £12m investment to build on pharmacists’ involvement in antimicrobial prescribing and usage in hospitals, the response hopes that this will begin to reverse years of under-investment in this area.

The response goes on to say that the Society is encouraged by the document’s recognition of the importance of information technology and technology in pharmacy. It adds that the sharing of patient information will offer important benefits to patients.

The response acknowledges the document’s recognition of the importance of pharmaceutical advisers and pharmacists on primary care trust professional executive committees (PECs), but it expresses concern that pharmaceutical advisers do not always receive the support and training that they need for such a key strategic role. It asks for national development programmes for both pharmaceutical advisers and PEC pharmacists. It also suggests that a pharmacist should be appointed to every PEC in England.

The response goes on to answer in detail the specific questions raised in the consultation.

Once some amendments suggested by Council members have been taken in, the response will be published in full on the policy section of the Society’s website.