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Sydney Holloway, of Leicester, has written extensively
on the history of the Royal Pharmaceutical Society
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Museum of the Royal Pharmaceutical Society
Sir William Glyn-Jones: his 1926 memorandum about the Society’s
dual role was rejected by the Privy Council |
The future of the Royal Pharmaceutical Society is the most important
issue facing British pharmacy today. The chief pharmaceutical officers
for England and Scotland have both recently discussed the option of the
Society’s regulatory role being separated from its core representative
functions. Bill Scott (Scotland) proposed that the Society, as the profession’s
leadership body, should continue to be answerable to the membership but
with a degree of independence from the profession’s regulator.
Keith Ridge (England) suggested that the Society could collaborate with
the Guild of Healthcare Pharmacists, a trade union, to provide a strong
leadership body. Both agreed that the profession’s regulator did
not have to be part of the same organisation as the profession’s
representative and leadership body. In any consideration of this matter,
two separate but related issues arise. The first is whether the Society
should split because it performs incompatible roles; the second is the
clarification of what those roles are.
Rational case for separation
There is no difficulty in making a rational case for the separation
of the regulatory or disciplinary role from the representative or professional
leadership role. The case has already been made on several occasions
in the past. In 1926 Sir William Glyn-Jones in a memorandum submitted
to the Privy Council pointed out that “the Society has had to
act as both the General Medical Council and the British Medical Association
of Pharmacy”. “In my opinion,” he continued, “the
establishment of a Board of Pharmacy with, generally speaking, somewhat
similar powers and duties to those possessed by the GMC and the Dental
Board, is required. … If these changes were made, the Pharmaceutical
Society would be free to protect and enhance the interests of its members,
without the limitations at present imposed upon it as a body possessing
statutory powers to be exercised primarily in the interests of the
public as a whole.”
The Government ignored his advice and instead passed the Pharmacy and
Poisons Act of 1933. This transferred the Society’s powers in connection
with the control of poisons to a newly created Poisons Board under the
Home Office. By the same Act, however, the Society’s powers to
represent and regulate the profession of pharmacy were enhanced. The
Statutory Committee was set up as “the disciplinary tribunal of
pharmacy” and the representative character of the Society was strengthened
by the provision that all registered persons would ipso facto become
members. “By the operation of that Act,” wrote Sir Hugh Linstead, “every
person registered as a pharmacist became, by virtue of his registration,
a member of the Pharmaceutical Society, and as a result the Society has
become the corporate representative of all those who practise pharmacy
in Great Britain, and its influence as a representative body has correspondingly
increased.”
Even before membership became obligatory, the Society had been remarkably
successful in attracting and retaining members by representing their
interests; in 1930 there were 15,053 members comprising 68 per cent of
those eligible.
When the Society celebrated its centenary, Sir Hugh Linstead returned
to the theme which had agitated Sir William Glyn-Jones: the tension between
the Society’s Charter and statutory duties. This tension might
be resolved, Linstead thought, by putting the statutory duties into a
new Act of Parliament and the constitution of the Society into a new
Charter. The Pharmacy Acts of 1953 and 1954 and the 1953 Charter were
intended to do precisely that. Linstead deliberately aligned the objects
of the Society in its new Charter with those of the British Medical Association.
The 1953 Charter did not contain a single reference to the Society’s
regulatory role, whether as a purpose, function, power or object. On
the other hand, protection of the members’ interests could scarcely
have been made more explicit. “The healthy way of promoting the
interests … of a profession, and at the same time serving the public
properly,” Linstead said, “was to have a body looking after
the interests of its members.” He characterised the Pharmaceutical
Society as “a professional society of individual practitioners”.
There is, he continued, “a great deal to be said for keeping a
professional body restricted to its professional members.”
Although the arrangements arrived at in 1953/54 seemed to work well in
practice and appear to have been acceptable to most pharmacists, the
Pharmaceutical Society came under attack from two standpoints: it was
said to be sluggish in guiding the profession towards new practice roles,
and it was urged
to be more assertive in promoting the
profession.
Within this context, the Nuffield Report in 1986 revived the debate about
the Society’s dual role. In its appraisal of the Society’s
work it observed: “It is most unusual, if not unique, for one organisation
to be responsible for both promoting the interests of the profession
and for enforcing the provisions of a series of Acts of Parliament, particularly
as these bring under the jurisdiction of the Society people and bodies
who are not themselves members of the profession. For many pharmacists,
particularly in community pharmacy, the most visible aspects of the Society’s
work are the Inspectorate and the Statutory Committee. The Society may
thus seem to act heavy-handedly and repressively towards pharmacists,
rather than defending their interests and reputation.
“From time to time, therefore, the question is raised of whether
there should be a second body to whom the statutory responsibilities should
be entrusted, thus leaving the Society free to concentrate on its professional
role.” A political issue
The Nuffield Report refrained from pronouncing on this subject, and
it remained dormant until the self-regulation of professions became a
political issue during the premiership of Margaret Thatcher. The recently
published Foster review of the regulation of non-medical health care
professions succinctly restates the case made by Glyn-Jones in 1926: “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.”
Throughout history organisations and people have successfully performed
combinations of roles which, from certain perspectives, appear incompatible.
At a personal level, working mothers are an obvious example. European
governments since the Middle Ages have prohibited physicians from dispensing
and apothecaries from prescribing. Combining the two roles is said to
make the patient vulnerable to overdosing. In education there is a tension
between teaching and assessment.
In the early years of the Pharmaceutical Society, the Council was persuaded
that it was “inconsistent with the principles of modern legislation
that the same corporate body should be an educating and an examining
body, with the power of granting degrees or diplomas”. Since the
Society’s Charter already defined it as an educational body, it
was proposed to create a College of Pharmacy, entirely independent of
the Society, to take over the functions of examining and registration.
Fortunately nothing came of this idea. When London University in Gower
Street was founded, it was intended to be, like the universities in Scotland,
both an educational establishment and a degree-awarding body. However,
when application was made for a Royal Charter, it was held that combining
these two roles was against the public interest. The result was that
the institution in Gower Street became University College and the University
of London was founded specifically to conduct examinations and award
degrees. In more recent times, the separation of teaching and examining
in institutions of higher education has been seen as an impediment to
the diffusion of cutting-edge knowledge. Incompatible roles have become
integrated.
Organisations are adept at finding ways of performing apparently contradictory
roles. The British Medical Association is a prime example. It is both
a professional association and a trade union. Its principal purposes
are to maintain professional standards and promote medical science and
education, but it has also become involved in negotiating terms and conditions
of service for all doctors. Before 1970 it was a professional association
registered as a company limited by guarantee. It was forbidden, by its
own Articles, to take any action which would make it a trade union. The
controversial Industrial Relations Act of 1971 forced it to become a
trade union. However, BMA resistance during the passage of that Act led
the Government to accept a compromise, whereby the BMA, along with the
Royal College of Nursing and 13 other professional bodies, were placed
on a special register, a mechanism which allowed them to continue as
corporate bodies but with the additional legal privileges of trade unions.
The BMA has maintained its status as a “special register body” even
though the register was closed in 1974 and industrial relations legislation
has since undergone a sea change. The BMA continues as both a professional
association registered under the Companies Act 1985 and a trade union
within the meaning of the current law. Multifaceted, multipurpose
The Royal Pharmaceutical Society has never been a trade union and has
never sought to become one. Its membership has always comprised employers,
the self-employed and employees. It is and always has been the professional
association of pharmacists. Its founder Jacob Bell saw it as a multifaceted,
multipurpose society.
As I wrote in my book ‘Royal Pharmaceutical Society of Great Britain
1841–1991: a political and social history” (London: The Pharmaceutical
Press; 1991): “The Pharmaceutical Society that he envisaged would
unite under its auspices all the chemists and druggists in Britain; it
would be active in promoting the solidarity and professional consciousness
of its members; it would represent its members to the public, to other
occupations, and to the government. It would protect the interests of
the profession and guard it against interference and encroachment. It
would ensure that the profession was self-governing and self-regulating;
it would secure its members’ professional autonomy. The ignorant,
incompetent, and unscrupulous would be excluded by a system of education,
examination, qualification and registration. Educated practitioners would
be protected against unfair and unethical competition and their status
and remuneration would be enhanced. The progress of chemistry and pharmacy
would be promoted. The victims of circumstance would be relieved by an
occupational welfare scheme.” Institutionalisation
With little or no assistance from the state, and often in the teeth
of opposition from the medical profession and elements within the field
of pharmacy, the Pharmaceutical Society constructed both the science
and profession of pharmacy in Great Britain. That construction involved
the institutionalisation of an occupation based on specialised knowledge
and skills, whereby the competence and integrity of its members were
guaranteed to the public by the professional association. Regulation
and representation have necessarily been inextricably intertwined in
that process. Regulation is best seen as a contract between public
and profession and, like all freely made contracts, it has mutual advantage
at its core. Since 1868 the Pharmaceutical Society has exercised the
general duty of protecting the public by compiling and publishing the
registers of duly qualified practitioners and by ensuring that the
educational standard of entry to the registers is continually upgraded
in line with advances in knowledge. The benefit conferred on the public
by the maintenance of these registers is clear. The advantage to the
profession is equally obvious. The registers confer public recognition
on the qualified and protect their economic and social status. By transforming
the practice of pharmacy from a trade to a profession, the Pharmaceutical
Society furthered the economic and social interests of its members
but, at the same time and in the same process, it served the interests
of the public.
How does this discussion relate to current concerns about the future
of the Royal Pharmaceutical Society? What conclusions may be drawn? It
has been suggested that no two roles are intrinsically contradictory
or incompatible. At certain times, to certain people, certain roles may
appear to be so, but this is a passing phase. In practice, the most antipathetic
roles can be accommodated within one person or one organisation. Regulation
and representation are not incompatible functions; they have been inextricably
interwoven in the historic fabric of the Royal Pharmaceutical Society.
It is, of course, open to anyone to produce evidence that roles are not
being performed satisfactorily and to argue that they would be performed
better if separated. No one has yet produced evidence that the Royal
Pharmaceutical Society has failed in its duty to regulate the profession
in the public interest. The a priori case for role separation is unconvincing.
The idea that the Society should split into two bodies, one to be concerned
with promoting and leading the profession, the other to be regulating
it, is not new.
The Foster review is reviving a well rehearsed position. But let us make
clear what that position is. It is that the Society should cease to be
the disciplinary tribunal for pharmacy but retain its established role
as a professional association. Foster is not suggesting that the Society
should become a purely regulatory body, nor was that ever suggested in
the past. The assumption is and always has been that the Society would
give up its regulatory or statutory functions in order to concentrate
on its representative or leadership role. This is not surprising, since
the statutory or regulatory functions were grafted onto an existing professional
body.
The Royal Pharmaceutical Society has never been a trade union, but it
has always been a professional association. The Royal Pharmaceutical
Society was founded by its own members; it was not created as an organ
of the state. Anyone familiar with the history of the Society recoils
in disbelief on learning that the Society’s Council has seriously
discussed ways of changing its composition to free it from the influence
of the members. Instead, the Council should be considering ways of freeing
itself from the baleful influence of the Department of Health. “Any
organisation that is complacent enough to believe it can rely on a comfortable
working relationship with the Department of Health needs its head examined.” The
head in question is the Society’s Council; the wise words are those
of Sandra Gidley,
MP (PJ, 30 September, p390).
The profession of pharmacy in Great Britain has reached a critical stage
in its development. Pharmacists face an insecure and uncertain future
and work in conditions of increasing pressure and stress. The need for
an organisation to promote and support them in their professional practice
has never been greater. Defence and support
The Royal Pharmaceutical Society created the profession of pharmacy
in this country. It must now defend and support it against those who
believe
that social problems can be solved either by market forces or by wrapping
them up in bundles of regulations. Eliot Freidson, in his collection
of essays, ‘Professionalism reborn’ (Cambridge: Polity
Press; 1994) has argued that “professionalism is both necessary
and desirable for a decent society”.
By professionalism he means the occupational control of work, which
he sees as the best way of providing expert, discretionary services
to the
public. He maintains that market-based or bureaucratic methods diminish
the quality of service to the client by eroding the communal or collegiate
principle that is distinctive of the professional mode of organising
work. His perspective is relevant to our present discussion. If pharmacists
are to become mere passive workers, without a strong organised voice
in the political and administrative arena of the NHS, they will find
it difficult to retain personal commitment to their profession.
If they are to play the role of merely providing whatever is demanded
by patients and authorised by the Department of Health, they will find
it difficult to preserve a sense of the value of their education and
training. If they are to be merely loyal servants of the state or of
large private companies, they will have difficulty sustaining any independent
commitment to serving the needs of individual patients and the public.
As Bill Scott, chief pharmaceutical officer for Scotland, has
recently said: “Pharmacists must be valued and allowed to make
independent clinical judgements.”
An urgent task facing the Royal Pharmaceutical Society is to ensure that
structures are in place which will make it probable that ordinary, or
just a bit more than ordinary, young people will undertake a long and
demanding period of professional education and will not be discouraged
from performing their work in the spirit that their profession has promised.
The Royal Pharmaceutical Society can achieve this objective only if it
remains a professional association with its Council fully answerable
to its members. |
The
Pharmaceutical Journal