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Alan Nathan, lecturer in pharmacy practice at King's
College London and a former member of the Royal Pharmaceutical
Society's Council
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Recent developments in pharmacy politics could, in my opinion, effectively
lead to the death of pharmacy as a profession within a few years. As
I see it, the cause is a combination of apathy and the misguided desire
of a small minority of the profession to turn back the clock to a time
when it was considered legitimate for the principal role of the Royal
Pharmaceutical Society to be professional self-interest.
I was a member of the Council for 15 years until I retired from it two
years ago. In my last couple of years on the Council it became apparent
that the Government intended to address its concerns over poor practice
and malpractice in the health professions, revealed through a series
of scandals, mainly in the medical profession, by considerably tightening
up on regulation. Pharmacy, although it had a good record of discipline
and regulation, was not to be excluded. Accordingly, and reluctantly
facing the fact that the Society would no longer be entirely master in
its own house, the Council set about trying to find the best way of meeting
the Government’s requirements while retaining the Society’s
unique combined role as a professional regulatory and representative
body, which the Council believed would best serve members’ interests.
It seemed to be on the road to achieving this by the time I retired from
the Council. The work on a new Charter had not begun by the time I left,
but what has been drafted and submitted to the Privy Council seems to
me very much in line with the Government’s requirements that the
interests of the public be put before those of the profession.
At around the time the new regulatory arrangements were being formulated
an article appeared in The Pharmaceutical Journal which advocated divesting
the Society of its regulatory role and leaving it as a purely professional
representative body (PJ, 19 August 2000, p263). After that, a movement
seemed to grow to oppose the changes that the Council was proposing,
evolving eventually into the SOS campaign. It seemed to see itself as
representing the views of the membership as a whole although only a small
proportion has taken any interest in it. Last year it mobilised its support
to call a special general meeting on the new Charter and win a vote calling
on the Council to rescind its proposals and, at this year’s annual
general meeting of the Society, it narrowly won another similar motion.
In the recent Council election SOS fielded seven candidates all standing
on the same manifesto and they were all elected. There can be no complaint
about this since SOS did no more than use the democratic process and
persuade sufficient members of the Society who bothered to vote to vote
for its candidates. I believe, however, that SOS’s success may
have had less to do with the Charter issue than with many of those voting
registering a general protest, and expressing their dissatisfaction with
the profession’s leadership in general and its perceived failure
to deliver on pharmacists’ professional and financial aspirations.
The Council now has 10 SOS candidates, as three were elected last year,
and, with two or three other Council members more or less sympathetic
to its cause, it has a majority. At the first Council meeting after the
election the existing president, vice-president and treasurer of the
Society were deposed and replaced by SOS members or those sympathetic
to its cause. One of the three Privy Council nominee members, who represent
the public interest, resigned in protest, and the other two have put
the Council “on notice”.
Catastrophic consequences?
For the three-quarters of the membership who did not vote in the Council
election, if they thought about it at all, the events of the past two
years would seem of little importance. And they would be right insofar
as they will have no direct effect on their jobs or how their professional
activities are controlled, at least for the time being. For whatever
may happen at the rarefied heights of the profession they will still
have to be subject to professional control by some body, and they are
not particularly concerned what that body is. But the recent events
centred on Lambeth could have catastrophic consequences for pharmacists
in the longer term.
Whatever the opponents and detractors of the Council and senior management
at Lambeth might say or think, the Society has, up until now at least,
been regarded by the Government as maintaining good governance of the
profession and it has consequently been allowed to run its own affairs
without interference. The Society is also a respected and credible professional
leadership body and, although it may not have achieved as much as pharmacists
might have liked, it does have the ear of the Government and over the
years has influenced it in the profession’s favour. The fear of
the Council when the “modernisation” issue first arose was
the danger that if pharmacy did not fall in with the Government’s
agenda for the regulation of all the health professions, it could lose
its independence and autonomy and be absorbed into the umbrella health
regulatory body, the Health Professions Council, along with groups such
as paramedics, physiotherapists, chiropodists etc. The Council therefore
carefully designed its new regulatory and disciplinary machinery to fit
in with the Government’s regulatory requirements while retaining
its membership representative function, and the proposals seemed to find
favour with the Government.
Following recent events, the danger as I see it is that the Society will
be seen to be torn by internal dissension and unable to govern the profession.
If the new Council also tries to renegotiate the regulatory set-up around
a revised Charter that gives primacy to the profession’s over the
public interest, the Government may decide to take pharmacy regulation
away from the Society and put it under the control of the HPC. As I see
it, the consequences for the profession of that decision would be disastrous.
The Society would be left as a purely professional representative body,
membership of which would be voluntary. Since three-quarters of the current
members appear to take no interest in the Society, I envisage that all
of them and probably more would not remain in membership, leaving the
Society fatally weakened as a representative and lobbying body. Furthermore,
pharmacy is really an association of several professions — community,
hospital, veterinary, industrial etc, plus many smaller special interest
groups within these. With no cohesive leadership these could split off
to form their own organisations leaving the Society with little to represent.
The consequences for the occupation of pharmacists of a loss of confidence
in the Society by the Government could be even more dire. It is clear
from the Government’s NHS plan launched in 2000 that it is intending
to deregulate the supply of medicines, both on and off prescription.
Without a strong body like the Society to defend the profession’s
interests there would be nothing to stop this taking place on an even
bigger scale and at even faster pace than the Government originally envisaged.
Dispensing could be done cheaply by technicians from within primary care
practices with GPs taking ultimate responsibility. All over-the-counter
medicines could become “general sale list”, a system that
already operates successfully in the US. Community pharmacies, and community
pharmacists, would become redundant and cease to exist. The only role
left to registered pharmacists would be as pharmacotherapists, doing
essentially what clinical pharmacists in hospitals and practice pharmacists
in primary care now do. Perhaps some seven or eight thousand of these
would be required to service requirements in primary and secondary care
combined, little more than 15 per cent of the number of pharmacists on
the register. What will become of the rest?
Is the death of pharmacy an impossible doomsday scenario? I think not,
if events within the Society continue along the suicidal path upon which
they appear to be travelling. |
The
Pharmaceutical Journal