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Peter Jones and Howard
McNulty are independent pharmacy consultants with Peter Jones Associates
and The McNulty Partnership,
respectively
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The Royal Pharmaceutical Society’s devolution review group, under
the chairmanship of Lord Fraser of Carmyllie, has had its first
meeting (PJ, 7 August, p203). We contribute a few thoughts for Lord
Fraser’s
consideration, particularly on the position in relation to Scotland.
Scotland is in a unique position in Great Britain, notwithstanding devolution,
having always received its NHS funding from the allocation to the Scottish
Office, and not from the Department of Health, thereby allowing it to
fund its service differently. Forty per cent of the Scottish budget is
devoted to health and social care, leading to a high parliamentary and
media profile.
There has been a separate Health Service in Scotland since 1947, with
different legislation, a different NHS Act, structure and philosophy
and with separate policy documents, guidelines and NHS circulars. Practice
is rapidly diverging to meet the needs of different populations, with
Scotland having many deprived and remote rural areas. NHS policy in Scotland,
embodied in “Our national health: a plan for action, a plan for
change”, is patient-focused rather than organisation-focused. The
strategy for pharmaceutical care for Scotland, “The right medicine”,
published in February 2002, has large political support and created a
climate for rapid change in practice.
The Pharmaceutical Journal of 12 June (p751) reported a meeting held
in Edinburgh, where pharmacists present indicated they required an enhanced
infrastructure to support professional decision making powers on Scottish
issues. At a time when power in the NHS is increasingly being put at
the lowest possible level, we must move away from centrally dictated,
GP-wide policy on national matters.
It is peculiar that the Society’s Scottish Executive is not part
of its committee infrastructure and has been by-passed in many consultations
and decisions, even some affecting Scotland.
The Scottish Department has been run by a secretary (who until 2003 had
a deputy), and three administrative staff. A director has now been appointed,
but how this post sits with Lambeth directors is not yet clear to us.
Another peculiarity, created by the executive itself, is that in elections
for the current Scottish Executive, candidates are not allowed to state
any policy or view; they may only provide a short curriculum vitae, so
they are elected on their past record, not future plans.
What is needed for the future?
The latest draft of the proposed Royal Charter provides for devolution
under articles 7(1) 9(3) and 9(4) better than the previous versions,
and this paves the way for a devolved professional leadership role
within a GB framework. This is fundamental for the future of the
profession in Scotland.
Most important are:
· How Scottish professional matters are integrated into the Society,
working to avoid the frequent occurrences of the past where advice and
decisions were often only for England and Wales. We suggest that each
country has its own professional committee co-ordinated into a Great
Britain-wide overarching body. Perhaps even a UK wide approach is possible
professionally.
· How much authority is delegated by Council to pharmacists in Scotland
to operate independently within an overall agreed framework. With responsibility
will come accountability, empowerment and a stronger profession.
The Council, and the Society’s committees and directors must be
alerted to matters that affect Scottish practice through the following:
· An elected body for Scotland, with electoral procedures replicating
those for Council, allowing candidates to make policy statements
· Scottish input to Council, ideally from this elected body and to any
Council committees that might affect Scottish professional practice
· Input to the professional directorates from Scotland through the Scottish
Department’s director (some directorates could even be located
in Scotland to maximise benefits of our practice development experience
for Britain as a whole)
· Clear lines of communication between the director for Scotland and
other directors with the Secretary and Registrar
The Society will regulate GB-wide but there may be some Scottish regulatory
differences. Applications for premises registration from Scottish addresses
are currently processed initially in Scotland. Scottish law and ethics
matters may also differ.
Pharmacists practising in Scotland need professional leadership that
is able to influence health policy and strategy making in Parliament,
NHS Scotland and the Scottish Executive.
We must relate to and work with other learned and professional bodies
in Scotland, such as the Glasgow and Edinburgh Royal Colleges of Medicine
and Surgery. The profession must work with Scottish organisations in
pharmacy and health, including
patient groups, and with relevant non-pharmaceutical organisations such
as local authorities, the Scottish Prison Service, Scottish Qualifications
Authority etc.
The Society branch and the professional networks are strong in Scotland
but they could achieve much more if they worked together. Council proposals
on branch size and functions are awaited following a review two years
ago, apparently still held up by the Charter. Some branches have vast
areas to cover (Glasgow and West of Scotland has over 1,400 members and
stretches from Campbeltown to Oban and the islands in the west and Glasgow
in the east).
A new Scottish identity
New names are required for the headquarters building, the staff and
the elected body that allow effective promotion of the profession in
Scotland.
The terms “the Executive” and the “Scottish Department” can
be confused with the executive of the Scottish Executive Health Department.
We suggest the terms “Scottish headquarters”, “Scottish
directorate” and “Scottish committee”.
The “Scottish committee” should include Society Council members
who are resident in Scotland and possibly be attended by
the Chief Pharmaceutical Officer in Scotland. It should establish a forum
with pharmacy groups and representatives of relevant bodies to debate
and develop professional ideas.
Arrangements for the registration and inspection of premises, the sampling
of Scottish NHS dispensing (still practised here), the inspectorate and
links with the Scottish committee need clarification.
The Scottish arm of the Society needs to have adequate resources and
manpower, in particular greater supporting staff and expertise specifically
relating to Scots law, ethics, clinical governance, and Scottish health
policy and public relations.
These tasks are beyond the capacity of one pharmacist, and adequate financial
and staff support, resources and facilities for pharmacists and other
workers are needed. Ten per cent of the money invested in professional
services elements in Lambeth would be about right. The building at 36
York Place, Edinburgh, is limited and cannot meet disability access requirements
without significant modification. Income could be generated from a modern
conference and resource facility.
Finally, a shorter name is needed for professional marketing purposes: “Scottish
Headquarters of the Royal Pharmaceutical Society of Great Britain” could
be reduced. “The Royal Pharmaceutical Society in Scotland” was
a good try, and could be a model for others to follow. |
The
Pharmaceutical Journal