The Pharmaceutical Journal
Vol 272 No 7284 p135-137
31 January 2004

Society summary

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Fit for the future: Summary of the Society's recent consultation on structures to support the Council

Marcus Longley summarises the key issues raised in the recent consultation on how the Royal Pharmaceutical Society's professional leadership and development responsibilities and its regulatory work can both be properly informed and effectively discharged in the future

This is a summary of the key themes to emerge from the consultation on structures to support the future Council of the Royal Pharmaceutical Society, focusing particularly on structures to support professional leadership and development (PLD). The consultation was launched in The Pharmaceutical Journal of 27 September 2003 (centre pull-out and p431), with a closing date of 1 December 2003. Other relevant articles appeared in The Journal of 12 July 2003 (p66 PDF (90K)), 8 November 2003 (p657) and 15 November 2003 (p692 PDF (120K)).

This report summarises the responses received up to the closing date on 1 December 2003. A total of 28 responses was received by the closing date, of which 20 were from individuals, two from Society groups, and six from other groups in pharmacy. As always in such analyses, it is not appropriate precisely to quantify the opinions expressed, and neither is it possible to generalise from the responses to the whole of the profession.

Ten questions

Ten questions were posed in the September article, and the answers given to these questions are reported here. Other significant points which respondents chose to raise are summarised in the next section.

Question 1: How should democratic accountability be achieved in each of the three stages of the policy cycle — agenda setting, policy development, policy implementation? The importance of the direct election of pharmacists to Council was emphasised, together with the need for Council to oversee the expert input to detailed work. The need to communicate effectively with both the experts on ad hoc groups and the profession as a whole was also highlighted — to ensure that both understood that their views were important, and could see how they influenced the outputs from the Society.

The Boots Pharmacists Association summarised the views of many:

“Stage 1: Setting the agenda. Consultation and communication with the membership is essential to produce an overarching strategy that is flexible enough to meet the changing demands of professional leadership and development. Strong focused leadership, with electorate buy-in, is required.

“Stage 2: Developing policy. Informed and expert sub committees should work WITH Society staff to develop policies.

“Stage 3: Implementing policy. Policy should be implemented through Society staff in an open and transparent way. Total communication with the membership using the branch network would enhance the members’ feeling of ‘belonging’.”

Question 2: How can we overcome “silo working” and ensure that regulation and PLD are properly “joined up”? The responsibility for ensuring effective “lateral” working was seen to rest with the Council (and other standing bodies). It was suggested that this could be facilitated by ensuring that the processes adopted were transparent — to ensure that as many pharmacists as possible were aware of the processes being followed and their outcomes — and by having an element of shared membership between Council and standing groups. Such transparency, however, could be costly. It was also argued that those who were involved in particular areas must be made aware of the bigger picture, and must also see that their work influences subsequent decision-making.

Question 3: What sorts of arrangements are most likely to get the necessary input from leading experts? Respondents emphasised the need to ensure that the input of experts is valued, and has a clear impact on outputs. The Academy of Pharmaceutical Sciences made this point strongly:

“It is essential that the outputs from whichever structures are put in place demonstrate that Council has listened to its advisory bodies. The clear impression at present is that it does not”

Some argued that ad hoc groups — with definite terms of reference, fixed reporting dates, use of video-conferencing and an assurance that participation in one group does not mean that they will be approached regularly for other topics — would encourage people to give their time. It was also important to involve people who were widely recognised as genuinely being “the experts” — having the appropriate expertise. In some instances, it may be necessary to pay experts to take part. Supporters of Model Two (which would include a Pharmaceutical Senate and a range of specialist faculties) argued that the existence of the faculties would provide a ready-made source of expertise for the Society, which would be representative of the profession as a whole.

Question 4: How should the impact of devolution be reflected in the structures? It was recognised that there was a need for continuous input from Scotland and Wales (as well as England) on any standing bodies, to ensure that they were aware of the realities of health care provision throughout Britain. This might argue for the boards of each of the standing structures (Academies, etc) to have places reserved for each of the three countries. The membership of ad hoc groups might also need such representation, but could be determined on a case-by-case basis.

Question 5: To what extent are standing groups required, and where are ad hoc arrangements better? The need for both types was recognised, with ad hoc groups being charged with much of the detailed work. Standing structures were nevertheless considered important to ensure that all sections of the profession felt part of the overall structure, to provide visible and credible democratic accountability, to determine priorities and agree policy, and to provide co-ordination and direction to the various ad hoc arrangements and internal departments of the Society. Some argued that ad hoc groups should not remain the sole preserve of the Council: other groups within the profession should be able to establish (or at least initiate) ad hoc groups to address issues of particular importance to them.

Question 6: How should technicians fit into the PLD structures? Several issues were raised in connection with the position of technicians. It was generally recognised that their position was somewhat anomalous. On the one hand their position was similar to that of pharmacists in that they were recognised as being an important part of the future of pharmacy, and as such would be regulated by the Society. On the other hand, the Society’s PLD remit appeared to be oriented much more towards pharmacists, with the needs of technicians potentially receiving little attention. Given the strong argument that regulation and PLD should be integrated, it appeared somewhat odd that technicians’ regulation and PLD might be the responsibility of separate organisations.

There was some difference of opinion among the respondents on how — or, indeed, whether — this anomaly should be resolved. Some argued that the Society was a regulator for the whole of pharmacy and. therefore, technician representation in the regulatory role was appropriate. But as the body responsible for the leadership and development of pharmacists, it was argued that technician participation in its PLD functions should be minimal. It was therefore appropriate that pharmacists and technicians be regarded differently.

Others, however, argued that the two roles were indivisible, and that since pharmacy technicians were playing an ever more important role in pharmacy as a whole, they should be fully represented in all areas of work, including PLD. This representation could be internal to the Society — in the same way as different groups of pharmacists would be represented, for example, through membership of the “Academies” in Model 1 (including Clinical and Practice Senates for the three home countries plus Academies for science and technology and for education and learning) — or it could be “semi-detached”, through formalised links with a body or bodies representing technicians.

On the latter point, the Association of Pharmacy Technicians stated:

“The association is keen to clarify the future role of the Society in relation to pharmacy technicians. If the Society is to be the professional body for ‘pharmacy’, then mechanisms need to be put in place to support this, eg, it has been suggested that formal links to the association, as the professional body for pharmacy technicians, are established with the Society acting as regulator. We would welcome the Society’s view on this.”

The detailed structural and procedural solutions required considerable further thought and discussion. The Association of Pharmacy Technicians argued:

• for technician representation (however provided) on the Senates and Academies (Model 1)
• for a technicians’ “royal college” in Model 2, and
• for technician representation in branches and most of the other structures in Model 3 (combining standing advisory boards and ad hoc groups with planned but less formal networking).

Question 7: What role should the lay members of Council play in PLD for pharmacy, beyond their role as members of the governing body accountable for all the Society’s functions? Respondents did not object to the participation of lay members in PLD activity, but most thought their role should be limited to testing ideas for acceptability to government and the wider public.

One specific exception was seen to be the invaluable role played by non-pharmacist (and therefore in that sense “lay”) academics in the work of the Academic Pharmacy Group, which the latter felt must be maintained in the future.

Question 8: How should the PLD and regulatory activities be funded? There was general agreement that regulation should be funded as at present, with technicians bearing the costs of their regulation. Opinion was divided as to whether PLD should be funded solely from within current funding streams, or whether the government should be asked to contribute as well. The latter could be argued on the basis that the NHS benefits from a well-led and developed profession, the counter-argument being that the acceptance of government support might compromise independence. There was some limited interest in the possibility of pharmacists being asked to contribute an additional sum (ie, more than the retention fee) to belong to a “membership” body (within the Society), with specific additional services being provided to those who pay but this possibility was not further developed.

Question 9: What are the advantages and disadvantages of having shared membership between the Council and its subordinate bodies? Opinion was also divided on the merits of this. Some argued for shared membership, on the basis that it ensured greater democratic accountability for the full range of the Society’s activities, by ensuring the presence of elected members in a wide variety of forums. Others, however, argued that having a limited number of members in common could delay decision-making processes, with the danger that many issues would have to be discussed twice (by both bodies). It could also place some of the members in an invidious position, where their colleagues had already had the opportunity to consider issues (and reach a decision) in the subordinate body, before discussing it again in the full Council. It could also inappropriately restrict lay involvement in the work of the subordinate bodies (eg, the Senate in Model 2), and might unnecessarily exclude “expert” input — and the nuances of the debate — from the deliberations of the Council.

Question 10: How can we ensure that the needs of all sections of the profession are properly addressed? The importance of the issue was acknowledged. Some were particularly concerned that the scientific and academic perspectives within pharmacy, and the views of non-dispensing pharmacists, might not be properly represented, given the absence of reserved places on Council and their small numbers.

Some respondents argued in favour of structural solutions to this problem, through the establishment of standing bodies which, between them, would ensure a voice for all parts of the profession. One approach in this context would be to allow the existing “affinity” groups (primary care trust pharmacists, academics, industrialists) to nominate representatives to the standing bodies. This, it was suggested, might help to address the problems of communication which have been apparent hitherto.

Others, however, argued for procedural solutions, with particular effort being given to regular “listening” exercises outside the formal structures. It was thought that these should involve a broad cross-section of the membership, and provide subsequent feedback on what influence their views had had on policy.

In either case, it would be important that the “sectoral” voices were heard on all topics, and not just on those in which they were deemed to have an interest. Managing to achieve such inclusivity would require effective leadership. Provision should also perhaps be made for the Society to act as an honest broker, bringing together the sometimes disparate views of the many organisations within pharmacy, and developing where possible a consensus position to which all could subscribe.

Other issues

A number of other issues were raised in the response.

1. Equally effective in regulation and PLD The reduction in the proportion of pharmacists on the Council from the current 88 per cent to the proposed 59 per cent was seen to establish a prima facie case for the need to enhance the machinery to support PLD. Most respondents accepted that within the reformed Society, the three core principles set out in the September PJ article (see Panel 1 above) were appropriate — that regulation and PLD should be “joined up”, that the Society should be equally effective at both, and that there should be one over-arching governing body.

Some respondents were uneasy, however, at the assumption that regulation and PLD would be happy bedfellows. A few went so far as to argue that regulation and PLD were fundamentally incompatible, embodying two different (and sometimes contradictory) sets of interests. They believed that the Society should therefore not attempt to straddle both, and there should be separate bodies for regulation and for representation of the profession.

Others could envisage a satisfactory modus vivendi within one Society, provided that the potential difficulties were recognised and managed. The Academic Pharmacy Group drew an analogy with car maintenance and the MoT test, where one garage can carry out both functions, with appropriate safeguards. Some argued that to achieve this degree of internal separation of functions, the third principle — one governing body — should be amended to allow for two, inter-locking bodies: one (the Council) would have responsibility for regulation; the other (the Senate in Model 2) would have lead responsibility for PLD. Such responsibility — and the relationship between the two bodies — was not precisely defined, beyond a statement that the Council should essentially allow the Senate considerable delegated power within PLD. This was seen as a way of achieving the advantages of integration of roles, while avoiding the danger that regulation would become the cuckoo in the nest, forcing PLD into a minor and ill-resourced role:

“There is no question that there will be a regulatory body for pharmacy and pharmacists will have a place on its governing body. The big question is will pharmacists have a professional association devoted to their interests.”

2. College of Pharmacy Practice Several respondents pointed out that little specific consideration had been given to the position of the College of Pharmacy Practice in the various PJ articles. The college itself highlighted this issue:

“ ... the college would like to support Model Two in the Society’s paper, but believes that much of the role of the Senate as described in the Model is already being carried out by the College, or could be done with further development. ... The college, therefore, proposes that the Royal Pharmaceutical Society and the College of Pharmacy Practice work together to achieve a structure based on Model Two, but with the college undertaking much of the Senate function ... Our proposal is that on registration, all pharmacists would be members of the Royal Pharmaceutical Society and associates of a faculty of the College of Pharmacy Practice. They would then work towards full membership of the college by keeping a continuing professional development portfolio, and making a submission for membership based on this.”

3. Missing elements Some important issues were raised which had not been specifically addressed by any of the models.

Branches One of these issues concerned the position of branches. Although they featured in each model, little indication had been given of their potential role, how this might be realised, and what other changes might be required to their ways of working, including their links to the rest of the Society’s structure.

Weighting Another concerned the need to weight the contribution of different parts of the profession. In Model 2, for example, it was suggested that some faculties should clearly have greater resources and impact than others; in Model 1 (Clinical and Practice Senates, plus Academies), the same issue applied to the internal workings of the Senates.

Education The Academic Pharmacy Group argued that “education” should be listed as a separate item in Panel 1 — the list of PLD functions — to emphasise its importance.

Ways of working Although the consultation was focused on structures, some respondents emphasised the need to look also at ways of working. The Guild of Healthcare Pharmacists, for example, pointed out:

“whatever structure is adopted, it has got to be made to work. This means setting out clear objectives on process and implementing them, for example, designating one person as the ‘lead’ for each topic of work, eg, development of consultant pharmacist posts, and ensuring that everyone else feeds into this and does not carry out work on this topic without the knowledge of the lead person.”

Which model?

The consultation was specifically not designed as a beauty contest between the three models, which were presented only as a way of highlighting different approaches to structural reform. Several respondents pointed out the absence of any costings — an important issue given that Models 1 and 2, at least, appeared potentially to be more expensive than the current structures. Nevertheless, about half of the respondents did express a preference, with Model 2 (Council and Senate) being the most popular. However, the numbers involved were small.

Several respondents commented on specific aspects of the three models. The key comments are set out in Panel 2 above.

Conclusion

The issues summarised above will speak for themselves. Overall, there have been relatively few responses. Nevertheless, the issues identified in the 10 questions have generally been confirmed as the key ones.

The greatest concern centres on the need to provide constitutional mechanisms to ensure that PLD is “substantial, credible and well-resourced” in comparison with regulation.

Many respondents acknowledged the need for further, detailed discussion on most of these issues, and significant criticisms were made of all three prototype models.