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Malcolm E. Brown is a pharmacist and sociologist
from Beccles, Suffolk
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Events are occurring within the pharmacy world that threaten to reshape
our landscape. The upheaval is that our Royal Pharmaceutical Society
seems likely to have to lose its regulatory or leadership functions.
Like most other members, I wanted our Society to continue to exercise
both functions as it has done for generations. To be part of the generation
that lost that dual role would feel like a disgrace. An analogy is the
aristocrat who, after decades of punitive taxation, finally forced to
relinquish the family seat.
But that is nostalgia — the comfortable memory of a past that sometimes
seems more golden that it actually was. Public distrust in the motives
of the professions is part of the reduced respect for authority that
has grown in western societies since the 1960s. High profile cases such
as Shipman have escalated the change. Today the public demand regulators
that are seen to be only concerned with the public interest; a regulator
that also represents the interests of the profession — such as
our Society — will probably no longer do.
Our Society strives to be a “people pleaser”, the people
being both patients and the members of the profession. This article examines
that dual role through particular sociological spectacles as a contribution
to the debate.
On the one hand, regulation of a profession by a completely impartial
organisation, that only possesses interests outside itself — specifically
the good of patients — can be seen to have just one reason. That
is altruism. Max Weber, founding father of sociology, said that altruism
was one of the main reasons for human behaviour. An example of an altruistic
institution is a charity; Society members recently rejected mooted charitable
status.
On the other hand, a membership body that is a professional leader, by
enhancing standards, should improve the status of its members. That is
often associated with enhanced material circumstances or class position.
It is likely to follow even if, like our Society, the institution is
forbidden to participate in any trade union activity. That reason is
instrumentality, egotism or self-interest. Weber identified instrumentality
as another reason for human behaviour.
Bisected so simplistically, the status quo of our Society’s dual
role probably seems unsustainable. I regret that.
In practice, its dual roles are entangled. Our Society has achieved both
altruistic and instrumental objectives, each increasing the other in
a “positively synergistic spiral” (or “feedback”,
like the resulting sound from a microphone and loudspeaker that are too
close together). For example, practitioners who kept patient details
confidential (altruism) were more highly regarded by patients. The patients
would trust those practitioners and so would tend to return for more
healing — and pay (instrumentality).
Somehow our Society has, over generations, fulfilled both purposes: a
dazzling performance. This cannot have been comfortable and our history
is littered with torment. Recent examples are the closure of Birdsgrove
House and the “Save Our Society” group that stimulated revision
of our Royal Charter. But generally our Society has appeared comparatively
calm while being torn by the tensions of dual altruistic and instrumental
motivations. The person who claims to feel at a comfortable average temperature
with one foot in freezing water and the other foot in boiling water comes
to mind.
Yet for me, an ordinary member, it has felt reasonably relaxed. It has
been “home”. I have felt proud to be a member, proud of our
long history of professional self-improvement, proud that the Society
bothered to percolate pharmacy into every cranny of my career. I have
enjoyed meeting like-minded people. The existence of a benevolent fund
has reassured me. Members receiving snotty disciplinary letters feel
bad but want to conform co-operatively because they believe that another
part of their Society cares about them. Indeed, there is the “Listening
Friend” scheme. Members suspect that, if a microphone were accidentally
left on deep within the secret bowels of the organisation, a luminary
would seldom be overheard to broadcast, “Yo, members!”
Perhaps during pharmacists’ professionalisation endeavour, our
Society was an essential intermediate step. By looking after patients
and members it allowed members to develop their sense of altruistic commitment
to patients so it became a passion. Altruism to patients may have been
a consequence of our Society that its founding fathers did not intend.
But each generation has stood upon the shoulders of the generation before
and the youngsters’ sincere belief in altruistic reasons for pharmacists’ existence
has grown.
Altruism is now so well accepted that members may countenance the creation
of a completely impartial regulatory body — a governmental “General
Pharmaceutical Council” or equivalent that has zero concern about
the interests of pharmacists.
If that were to be the case, our Society would have created its offspring
even if during the process of giving birth, our Society as we know it,
dies. But it would not be a death but a rebirth.
Let us look on the plus side. Presumably, pharmacists would pay less
or nothing for such regulation; the public should pay some of the overheads
out of taxes. Certainly registrants should pay less because the institution
would be doing less. There probably would be no need for information
services, a museum, district, regional or national branch structures
and, if a journal were required, it would have little to address.
Pharmacists could enjoy letters that were more succinct and, arguably,
more understandable to the public. Presently “MRPharmS” or “FRPharmS” defines
an individual as a pharmacist; a possible replacement is “RPh”,
an abbreviation for state-registered pharmacist.
There are opportunities for the professional leadership role and promoting
the aspiration towards excellence. Institutions may dissolve and reform.
The College of Pharmacy Practice (CPP) is one contender. Our Society
planted the CPP’s seeds a generation ago. Probably, if our present
Society injected funds, increased membership, intellectual capital and
achievement, the development of the CPP, a charity, would be brisk. For
example, the title “The Royal College of Pharmacy Practice” may
rapidly follow. Farewell M(F)RPharmS. Greetings M(F)RCPP.
Then there is the trade union-type function. Perhaps the National Pharmacy
Association and Guild of Healthcare Pharmacists would not receive funds
from our “dissolved” Society because it was forbidden trade
union activity. What is needed is an utterly instrumental union for employee
community pharmacists — union clout might enhance salaries towards
more professional levels.
On balance, exciting opportunities exist. |
The
Pharmaceutical Journal