The Pharmaceutical Journal
Vol 277 No 7417 p313
9 September 2006

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British Pharmaceutical Conference 2006

Profession should push boundaries defined by its regulator, say UK chiefs

Pharmacists will have to listen to patients and the public and deliver what they want in terms of professionalism and regulation, Bill Scott, chief pharmaceutical officer for Scotland, told conference participants at BPC 2006 in a presentation made on behalf of the chief pharmaceutical officers and advisers of England, Scotland, Wales and Northern Ireland.

The drivers for change had been high-profile cases, such as Shipman, which had affected the trust that the public placed in health professions. He warned that regulation of pharmacists must be taken seriously and said that it was a job for specialists to take on. And in terms of public perception the regulatory body should not be seen to represent the interests of the profession.

Mr Scott said it was important that the regulator defined boundaries while its professional leadership body pushed those boundaries. “Pushing the boundaries develops our profession and allows us to give better and more comprehensive services to patients.”

He stressed that a regulator must be focused, and suggested that such a regulator could be a board with appointed members rather than the current Council model.

He also argued that the profession’s leadership body should have a degree of independence from the profession’s regulator and be answerable to the membership. And he suggested that a leadership body needed as its chairman a skilled practitioner with the gravitas and track record to champion the profession.

He proposed just two future models: either one body with a dual function of regulation and professional leadership like the current Society model or two separate bodies. These two organisations would consist of a regulatory body that the public could see as its champion and that would be focused on protecting the public as practice moved on, and a professional body to support the profession in the development of its practice.

“This is key to whether w e grow and succeed or whether as a profession we are stifled,” he said.

Mr Scott pointed out that most pharmacists are now in an employee-employer relationship and that this puts accountability on the employer to ensure that their working environment supports pharmacists’ skills. “This relationship is going to be key. Pharmacists must be valued and allowed to make independent clinical judgements.”

In the debate that followed Mr Scott’s presentation, Eileen Neilson, head of policy development at the Society, raised the issue of standard setting. She suggested that it was dangerous for the profession’s regulator not to be closely engaged with what leading practitioners were doing. “The way standards are expressed needs to be dynamic so they are capable of reinterpretation,” she said.

But Keith Ridge, chief pharmaceutical officer for England, argued that although there needed to be a close understanding between those setting the standards and those regulating the profession, the professional leadership body and the profession’s regulator did not need to be part of the same organisation.

He added that there were a range of pharmacy organisations that provided leadership — such as the United Kingdom Clinical Pharmacy Association and the Guild of Healthcare Pharmacists. He suggested that the Society could work with these groups collaboratively to provide a strong leadership body.

Speaking in a personal capacity, Mark Koziol, chairman of the Pharmacists’ Defence Association, argued that the Society’s role as leader was being undermined by its strong regulatory functions. “If the Society relinquishes its regulatory role, all its efforts could go into leading the profession,” he said.

Mr Koziol added that for this to happen the Society would need to be offered a deal. He suggested that a meaningful role for the Society as a professional body could be within education and particularly in the revalidation of pharmacists and that this would allow it to push the leadership agenda.

Karen Acott, pharmacist and partner in a GP practice in Devon, said what she wanted from her professional body was the reassurance that it supported the innovative services she provided without any watering down of professional leadership through regulation. “Without this certainty, pushing the profession forward with new services will come to a halt.” And, as a patient, she said she expected the regulator of pharmacists to work 100 per cent on her behalf.

Carwen Wynne Howells, chief pharmaceutical adviser for Wales, said it was clear that there needed to be a separation of the regulatory and professional leadership roles but suggested that any changes would need to be carefully managed.

Mr Scott pointed out that the Foster review of the regulation of health professions was due to be revisited in 2011. “We need to have something well under way and working long before that. It has got to be carefully choreographed but we have to have vision,” he said.

Alan Kershaw, a lay member of the Council, said that there were more models than the two put forward in Mr Scott’s presentation. “Having a split is no guarantee you will get a good result,” he said. “You get better results through collaboration not confrontation.” He argued: “Creative tensions within a single body are one thing; confrontation between two bodies with separate aims is quite another.”

He added that education and revalidation must remain as functions of a strong regulator. “Regulation is not about discipline. It’s about helping practitioners to stay good and to become better.”

Mr Scott suggested that the royal medical colleges, rather than the British Medical Association, which is a trade union, should be considered as an appropriate model for pharmacy’s leadership body. Dr Ridge agreed, saying that he would like to see such an organisation come forward and be authoritative about professional leadership.

Ms Wynne Howells said she was not convinced that the royal college model was the only option for pharmacy. “There are other means to strengthen the profession,” she said, and suggested that there was an opportunity for the Society’s proposed national boards to provide a strong professional presence in the home countries.

Norman Morrow, chief pharmaceutical officer for Northern Ireland, raised the option of a single regulator for all the health professions but warned that the professions would have to think about how they would be represented at an individual level.

Ian Mullen, chairman of Forth Valley NHS Board, warned his fellow pharmacists not to become too introspective. “As an NHS chairman, virtually everything I do is determined by what the public and patients want.” Dr Ridge and Mr Scott agreed that the public would drive the agenda.