| On Thursday, 14 September, the Council of the Royal Pharmaceutical
Society and senior members of staff met to make a preliminary stab at
what points
they might wish to make in their response to the “Foster” review
of the regulation of non-medical health care professions. I was also
invited to take part and, more significantly, to write a report of the
deliberations.
I took up this invitation for a number of reasons. First, notwithstanding
the difficulties of reporting such meetings, it seemed a real opportunity
for readers of The Journal to have some insight into how the Council
goes about its business, particularly when it is a long way from formulating
policy and at the stage of getting to grips with the issues (final decisions
on policy are always made in the Council chamber). Secondly, there has
been much gnashing of teeth in recent years over how the Council has
been perceived to formulate strategy behind closed doors.
Inevitably, since parts of the discussions took place in small groups,
this cannot be a verbatim report; it is my personal view of the day’s
exchanges. It would be invidious, too, to quote individual speakers by
name so what is reported are general themes.
So, what was on the agenda? To recap: early in July the Government published
two reports into the regulation of the medical and non-medical health
care professions: the Donaldson” review (“Good doctors, safer
patients”) and the Foster review (“The regulation of non-medical
healthcare professions).” I am not going to go into the background
of these reports or summarise their recommendations; there is plenty
of material on that to be found in recent issues of The Journal.
The aim of Thursday’s gathering of staff and Council members was
to map out the areas of concern to the profession with a view to formulating
the Society’s response to the consultations on the reviews, which
close on 10 November. (Readers who want to add their views to the Council’s
deliberations should follow
the timetable given on p376.)
Three pressing issues
The Council and staff met to consider the following:
1. The need to clarify the the separation
of the Society’s
regulatory and professional lead functions
2. Proposed changes to the composition of the regulators’ councils
(replacing some or all of the elected professional members with
appointees) and possible changes to the future balance of professional
and lay council members
3. Proposals for the Society to share functions with Pharmaceutical
Society of Northern Ireland, followed by a formal merger into
a single UK body |
Back to 14 September.
The three most pressing issues that had been raised by Foster and which
the meeting was asked to consider are shown in the
Panel (right). I have witnessed many Council meetings (formal and informal)
over the past five years that have become acrimonious but, here, not
a cross
word was to be heard and there was a large measure of agreement among
professional members of Council and lay members. There was acknowledgement
that whatever the outcome of the deliberations and whatever route is
followed, either voluntarily by the Council or after a nudge from the
Government, there would be members of the Society who will be disappointed
and angry, and think that opportunities have been lost or thrown away.
Concern was also expressed — and this is something the Society
will ask the Department of Health to clarify — that the Foster
review, in particular, seemed driven by an unspoken political agenda.
Foster is asking the Society to implement changes that would not necessarily
improve the quality of care patients receive, or change the way pharmacists
are regulated, but would satisfy some perceived need to tidy up the Society’s
appearance. More of that later.
The discussions were further clouded — or informed, depending on
your point of view — by the opinions expressed at the British Pharmaceutical
Conference by the chief medical officers for Scotland, Bill Scott, and
for England, Keith Ridge, who seemed to be advocating the splitting of
the Society in order for there to be clear sky between regulation and
professional leadership (PJ, 9 September, p313). In the event only the
first two issues outlined in the Panel were discussed in any detail and,
more importantly, it seemed at this stage, no decisions were made. Opinions
were teased out through questioning the context of Foster and its implications.
Is it really broke?
One of the main questions asked was what is the problem that the Government
is trying to fix. The regulation of doctors is widely acknowledged
to be in a mess. Has the Society merely been caught up in the medical
slipstream or are their fundamental problems that need to be addressed?
So, notwithstanding the chief pharmaceutical officers’ views (and
questions were asked about under what authority they had been speaking),
one of the strongest messages that came from the meeting was that the
dual role of the Society (being both regulator and professional leadership
body) should be maintained. In fact, the term “dual role” was
thought to be misleading and should not be used. The terms “unified” or “integrated” far
better describe the Society’s activities, most believed.
Similar discussions of appropriate words centred around the description
of the Society as the representative body for pharmacists. Not surprisingly,
discussions were more divided but I would guess a majority of Council
members thought that the use of the words “representative” and “representation” caused
confusion — among members, in Government and more than likely in
the outside world. “Representation” implies individual membership,
with its overtones of trade unionism and negotiation, rather than signifying
the whole membership and its collective activity. Describing the Society
as the “champion” for pharmacy or the “professional
leadership” body is a better reflection of what the Society does
under its Royal Charter.
Questions were also raised about the Government’s motivation. Although
the meeting accepted that the Donaldson review was based on strong evidence,
it believed the Foster review was less secure. There were suspicions
that the Government wanted some changes to be made to make all regulators
look the same rather than because the Society’s integrated roles
do not work effectively. The question was raised about whether the Government
was aiming at the creation of separate bodies, not a simple separation
of functions, although this had not been spelt out by Foster. The Society
needed to demonstrate that its integrated functions fulfilled the Government’s
aims for a modern regulator far better than splitting into two organisations.
What evidence is there that a different model would meet the Government’s
agenda? A split Society would have huge implications for other pharmacy
organisations, would involve lengthy primary legislation and would be
costly. Would that fit in with the Government’s timetable and might
it damage the delivery of the wider NHS agenda including the wish to
grant pharmacists greater autonomy? Would this really benefit patients?
And would a small profession such as pharmacy be able to sustain two
bodies — unless membership of both was compulsory?
Nevertheless, it was acknowledged that greater clarity of the activities
that underpin an integrated role was required, as well as those that
were purely regulatory and those more biased towards professional leadership.
There was time, it was acknowledged, to develop evidence-based options,
and to calculate the relative costs of professional leadership and regulation,
for example.
Another point raised was that the Foster review was carried out before
the Society’s national boards were up and running and it was thought
that their existence would clarify the Society’s internal structures
that underlined the different functions. National boards will provide
the structure for professional leadership. What should be fixed?
Although there was an acceptance that the Council has an obligation
to create the best level of expertise in Council, there was less consensus
in the discussions on how that might be achieved.
Discussions focused on the interpretation of one paragraph in the Foster
review: “Although the roles of professional leadership and promoting
the profession, which have been exercised for the public benefit, do
indeed benefit the public, there is a tension between their focus inward
on the professions’ interests and the need for the regulator to
be seen to be free from such influences.”
A number of people — pharmacists and lay members alike — wondered
whether by addressing the composition of Council the perception of the
difficulties of the integrated role would be reduced. Was it because
all pharmacy members of Council are elected (with the exception of the
academic representative) that Foster thought the Society, as the profession’s
regulator, was not — by definition — able to be free from
influence by the membership?
So what could the alternative be? Certainly there was some consensus
that the Council, with 30 members, is currently too big. There was also
consensus that any regulator should have a professional majority. Would
a Council with a three-way split be acceptable? A third would be elected
professional members, a third would be professional appointed members
(and this group might include non-pharmacist academics involved in the
teaching of pharmacy students) and a third would be appointed lay members.
Another model could be to develop electoral colleges. This could be an
extension of the way the academic member is currently appointed: the
heads of the schools of pharmacy nominate and vote to support one of
their number. Similarly, different sectors of the profession could nominate
candidates from among their ranks and then put their names to the vote.
This would ensure that there could always be a hospital pharmacist and
industrial pharmacist on Council (plus any other sectors represented
by an electoral college). This system might be further refined to exclude
individuals who were members of the governing committees of other pharmacy
organisations.
There were a number of pharmacist members of Council who rejected any
changes along these lines. One strong argument against it was that without
a transparent and full democratic election, the credibility of the Society
as the leadership body, championing the profession, might not be sustained
within the membership.
There was also some anxiety that the Society was being pushed down the
road of “one size fits all”. No model is perfect but is there
any evidence that other models serve their professions better than pharmacy’s?
So, in summary, the meeting agreed that the Society has come a long way
in the past five years and it is continuing to evolve. The Society must
determine what more the Government wants. And while the Government might
have an ideal position for the Society to reach, taking other political
considerations into mind, how far would it be prepared to come to meet
the Society? |
The
Pharmaceutical Journal