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Howard McNulty and Peter
Jones are independent pharmacy
consultants in Scotland
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With the Royal Pharmaceutical Society’s devolution review (the
Fraser review) ongoing and its new Charter now in place, it is increasingly
evident that the devolution and professional leadership debates are closely
intertwined. To date mainly pharmacists in Scotland and Wales have taken
interest in this. Separate pharmacists’ bodies for England, Wales
and Scotland have been proposed by stakeholders in Scotland (PJ, 30 October
2004, p645). So is national devolution a possible way forward?
Many think that the Society has leant towards regulation in the past
and the new Council is unlikely to act differently, especially after
the Fifth Shipman Report’s deliberations (PJ, 18/25 December 2004,
p874). This says one of the General Medical Council’s fundamental
problems is a conflict between representative and regulatory roles, and
it should have more appointed medical members, people who are not beholden
to an electorate section. There are also Section 60 proposals for pharmacy
due out soon which will also impact on the regulatory role.
The new Council will comprise elected pharmacists, technicians, appointed
Privy Council members and public representatives. Its role is Britain-wide
and covers not just pharmacists, but professional practice and regulation
of all in the business of pharmacy, owners and workers. Can appointees
appropriately reflect pharmacist’s professional aspirations? If
we are to retain a body which has a dual role, the professional leadership
debate is of fundamental future importance.
Draft leadership models
How do the three draft professional leadership models published in
2003 (PJ, 8 November 2003, p657,
and 15 November 2003, p692 PDF (120K)) look now against
the principles of corporate governance, namely, clear lines of accountability
and responsibility, defined levels of authority, roles and remits
and Shipman most recent demands?
Model 1 proposed clinical and practice senates for Scotland, Wales
and England, and two academies, which fed into Council directly.
Could the
newly constituted and partly appointed Council adequately reflect the
needs and views of pharmacists at a GB level should, for example, technicians
wish a different path?
Model 2 had a senate with some 11 or more royal colleges relating to
it and ignored devolution. The costs of this model are difficult to
control and from a governance perspective it would be difficult to
know which
college dealt with what issues, creating confusion and multiple responses
to the same issues.
Model 3 proposed a number of standing and ad hoc groups with branches
and others feeding into Council, including Scotland and Wales. This
perhaps is a small modification to current arrangements, which do not
work well
and require a radical overhaul.
We believe that none of these models meets the needs of the present
or future adequately. One problem in the past has been that the Council,
as a Government regulator, did not wish to be associated with professional
criticism of its master. Pharmacists on the other hand need to be able
to initiate developments and have their views heard. Our professional
leaders must ensure that matters relevant to the profession are raised
publicly, however unpalatable they may be to the Government or our
regulatory
body. A professional structure must also develop where growing national
differences can be properly accommodated. Westminster focus
In the past Lambeth has focused attention on the Westminster Parliament
for both GB and English health policy, leaving those in Scotland and
Wales to their own devices. It is clear from the new Charter and responses
to the Fraser review that this must change.
There is a great potential opportunity to set the professional direction
in line with the diverging health care policies in all three home countries.
Some form of English devolution is needed, not to regions, but to a national
level so that health policy for the NHS is represented in all three countries.
The pharmacy profession needs to function effectively at all levels where
legislation and policy affecting practice is made and where it is possible
to influence funding and allocation of resources. For the future therefore
we agree with the need for three national organisations for pharmacists
in England, Scotland and Wales.
Each country should have its own elected professional body, which should
be composed differently from current executives and represent the spectrum
of pharmacists in each country. In other professions, fellows take a
strong role in professional direction. Perhaps they should in ours; at
the moment they are an under-utilised resource. Council committees at
Lambeth should also have appropriate national representation from members
of these bodies.
For effective Governance the three national bodies require clearly delegated
responsibilities for dealing with their own health policy and parliamentary
priorities, and for liaison with other national professional, government
and industry bodies.
There would also be merit in these being co-ordinated GB-wide by a group
of professional representatives from each national organisation. These
national organisations should present a united face for pharmacists and
pharmacy whenever possible under the GB professional umbrella that also
allows for differences to meet national priorities. The GB-wide approach
should allow for targeting the best parliamentary opportunity for schemes
that are capable of extension GB- or UK-wide.
One important matter will be to distance the professional body for pharmacists
from that of the Council in any dealings with the media. Appropriate
names will be needed and colleges and boards have been suggested. It
is important that the chosen title provides something meaningful to the
public, is distinctive and allows for a reasonable degree of free speech
for pharmacists at national and GB-wide levels. Titles that could be
confused, such as Scottish Executive, Scottish Department and College
should be avoided. Terms like “academy” and “senate” do
not mean much to the public or to most pharmacists. Simple names such
as the English, Scottish and Welsh Pharmacists Boards could suffice. Challenges
There will be challenges over devolution of staff and resources. Governance
regarding Council committees and Lambeth directors must be clearly
defined and those with both professional and regulatory roles will
need to split the two responsibilities. If we adopt the principles
applied in Good Manufacturing Practice where production and quality
assurance posts are of equal status and work together to a common good,
we should have these professional and regulatory roles teased out and
separated and of equal status. Neither should have the power to override
the other.
The new Council will meet less frequently and its work will be to oversee
clearly defined regulation and professional leadership and, like a good
manufacturer, ensure the product of our enterprise is produced quickly
and efficiently is of good quality and meets patient’s needs.
Pharmacists in England may wish seriously to consider the idea of an
English professional body and put their thoughts in to Lord Fraser to
ensure they are adequately professionally represented in future. |
The
Pharmaceutical Journal