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Howard McNulty is a visiting professor at the University
of Strathclyde, Glasgow
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The Royal Pharmaceutical Society is not in control of the professional
regulatory agenda. The Council for the Regulation of Healthcare Professions
already reviews Statutory Committee decisions not to strike off and has
indicated what are striking off offences for all professions (PJ,
20 September 2003, p357).
The new Scottish contract arrangements will lead to the NHS listing all
pharmacists working in community pharmacies in
the Pharmaceutical List, in line with other professions providing NHS
services and no one who is not on the list will be able to practise (PJ,
13 March, p306).
The Shipman inquiry will probably lead to even more controls.
Therefore, the professional elements of the Society’s work are
increasingly important to our future. The Society’s professional
leadership consultation exercise initiated on 27 September 2003 generated
only 28 responses (PJ, 31 January, p135) and where we now go is not yet
clear. The original paper proposed three models with mixtures of senates,
academies, standing and ad hoc groups, but these were difficult to grasp.
There were no explanatory meetings to help us.
In many other professional bodies, fellows provide leadership to their
profession. In pharmacy they are a largely untapped resource and the
award of a fellowship means little more than an additional certificate,
a nice presentation and the designation “FRPharmS”. This
group has been ignored in all three proposed structures, yet it offers
considerable potential for contributing to the delivery of the professional
agenda.
Before seeing how things might work in future, we need to know how things
work now. The Council is to be expanded and has both professional and
regulatory responsibility, but it has delegated much authority to a complex
committee structure, with committees — mentioned in the Society’s
Corporate Governance Handbook (PJ, 3 April, p430) — for resource
management, education, infringements, law and ethics, practice, science,
audit, remuneration, adjudicating, animal medicines, conference and publications.
The Scottish and Welsh Executives do not have any delegated Council authority,
yet a review of the 10 items listed for professional leadership in the
consultation paper shows that at least five of these will require different
approaches in the various devolved NHS and Government structures.
Headquarters staff have recently been reorganised into seven directorates
(PDF 60K), though not all are new (PJ, 3/10 January, p36). It
is not clear which director posts and committees are regulatory and which
are
for professional
support; many seem to have both roles. How the new directorates relate
to the current Council committee structure is unclear, with some directors
having several committees relevant to their work and others having no
such support. This is a recipe for future difficulty and, for effective
future governance, a realignment of the committee structure and the new
directorate substructures is required providing maximum clarity of regulatory
and professional roles. Where a directorate must have both roles, then
clear separation is required at deputy level to ensure both elements
have equal status.
Regulation is mostly a Great Britain-wide Council function, but professional
leadership activities and contractual matters must in future be related
to the policy and health care funding agendas of individual parliamentary/
assembly policies and legislative processes. No models proposed in the
leadership debate offered separate professional organisations at national
rather than GB level.
There is presently no requirement even for Scottish or Welsh input to
the Council or to any Council committee (although the position is under
review). So how, currently, can any committee or Council take the many
different political agendas on board? The President recently spoke well
of many pharmacy developments, but these efforts all related to England
and referred to “the contract” when there are several different
national contracts (PJ, 28 February, p260).
The Secretaries for Scotland and Wales report to the Secretary and Registrar
and are shown as quite separate from the new directors and unsupported
by them in the new structure (PJ, 3/10 January, p36, PDF (60K)).
The department secretaries are shown only as working to realise Council
strategy in
England — is there any such thing for Scotland or Wales? Scotland
and Wales and other unnamed devolved organisations are to get a review
from Lord Fraser that may conclude by the end of the year (PJ, 14 February,
p197). Failing to use the well-respected professionals on their national
executives for this purpose is a big mistake and undermines any advisory
role they may have. Incurring additional expense on this unnecessary
review and creating more delay in progress is unjustified.
National professional organisations would provide considerable freedom
to work within an overall GB professional framework and could be co-ordinated
by a GB supreme body (senate, academy or whatever). A number of separately
elected fellows should form a significant part of the professional leadership
arrangements in each country and on the GB body in the future.
National pharmacy organisations must be adequately resourced to meet
the professional leadership needs of their home pharmacists and technicians
in the rapidly diverging national infrastructures and legal systems.
We require a professional strategy that is updated annually, not one
that is produced ad hoc. For this we need professional policy and strategic
planning committees at national level. Professional directors require
national advisers to develop policies and plans that meet the needs of
all members of the Society at the outset.
Our professional leaders must also have a strong network that makes more
use of the expertise on the register. They must also be closely allied
to local politicians, government agendas, professional infrastructures,
and varying NHS organisations and legislation.
Branches could be the local influencers of politicians, provide opportunities
for debate and help influence Council thinking through a strong network.
At the moment branches are rarely asked for advice and still await a
new set of objects after a review produced some two years ago while the
structure slowly disintegrates.
Let us look at all possible options and reignite the leadership debate.
There must however be a clearer briefing showing what elements (committee
and directors) are regulatory and where branches, fellows and empowered
national professional organisations fit in the professional structure
with explanations of the risks and benefits of each of the options.
A better prepared and a longer and more informed professional leadership
consultation is necessary, with plenty of local debate to make sure we
get this most important element right for the future. |
The
Pharmaceutical Journal