The Pharmaceutical Journal
Vol 277 No 7427 p619-620
18 November 2006

Society summary

How the Society intends to secure sustainable outcome post Foster

The President of the Royal Pharmaceutical Society, Hemant Patel, outlines the Society's responses to the Foster and Donaldson reviews of the regulation of the health care professions

The Royal Pharmaceutical Society has now submitted its response on the two reports on the future of health professional regulation — “Good doctors, safer patients (Donaldson review) and “The regulation of non-medical professionals” (“Foster review”). These two reports will have far-reaching implications for how health professionals, including pharmacists and pharmacy technicians, are regulated in the future, and the Council has devoted a great deal of time to formulating its response. We discussed the key messages at our August and October meetings, scheduled a special thinking day in September and devoted much of our planned review time in November to the specific professional leadership challenge thrown down to the Society around Foster by the governments’ chief pharmaceutical officers at the British Pharmaceutical Conference.

In formulating its response the Society wanted to involve the membership as fully as possible. The Society invited stakeholders’ and members’ views directly through The Journal, via the website and approached more than 80 pharmacy groups and organisations. Comments were received from members of the Society’s special interest groups, individual members, Council members and branch representatives, which all served to inform the development of the response.

The Society, through Ann Lewis, the Secretary and Registrar, was an active member of the group that advised Andrew Foster, NHS England’s former director of workforce. Ms Lewis shared much of the work we have done to modernise the Society’s regulatory role in line with best practice, and detailed the unique nature of some of the Society’s activities, including the role of the inspectorate. We were, therefore, pleased to note that the direction of travel for health care regulation identified in both reports would, in many respects, bring other regulators into line with the Society. I include in this progress on making the adjudication processes more independent — the Society’s Statutory Committee has, of course, been independent of the Council since 1954 — while the Society moved to the civil standard of proof (operated to a sliding scale) some time ago. Elsewhere, our submission reflects the evidence-based arguments on the wide range of issues considered in the Foster report that we provided throughout its development.

We have, however, issued one note of caution against any further “medical exceptionalism” and have argued that a consistent approach between the medical and non-medical professions should be pursued in moving forward.

Readers will not be surprised to learn, however, that much of the Council’s time and energy in considering the reports have been devoted to two key questions, one of which was posed to the Society specifically. In considering how we might “clarify” the separation (to use the words in the Foster review) of the Society’s regulatory and professional functions, the position we have reached is that clearly there is a perception that our current configuration contains within it the potential for conflict of interest. In the Fifth Report of the Shipman Inquiry, Dame Janet Smith laid firmly at the door of the General Medical Council the charge that its proposals for the periodic revalidation of doctors had been watered down by medical interests. This charge led specifically to the establishment of the Donaldson review (with Foster immediately following), so it is how we got here.

However, we are acutely aware as a Council of how complex an organisation the Society is. In particular, our current internal structure, which gives effect to the integrated professional and regulatory roles, was implemented along the lines of the “modern regulator” as defined in the Kennedy Report of the inquiry into the Bristol paediatric cardiac surgery unit. The Council has, therefore, agreed that while the profession’s development needs to be supported by robust regulation in the interests of public protection, the Society also has to be equally clear about how the profession’s development needs are met as we fulfil our remit. That remit was recently renewed with the granting at the end of 2004 of the new Supplemental Charter, to lead, develop and promote (as well as regulate) the profession.

This specific challenge — that of developing real professional leadership — was the one issued to us in Manchester, and I intend to ensure that we respond effectively to create an organisation of which we can all be proud, one that captures the best of our profession in developing its vision for the future, and one that truly supports every member of the profession in delivering health care for the public.

So, in presenting our response to the two reviews, we have explicitly recognised the need to clarify these two roles, but given the complexity of the organisation, the Council has also recognised that this might not be a simple task, and we will, therefore, be going back to government after our December meeting with a proposal for how we make progress on this over the next couple of months.

What we are clear on for now, however, in terms of the second key question, is that regulation does require oversight by a structure that commands the confidence of the profession, but which also has embedded within it a lay majority in order for the public interest to be seen to be served, and for the public to have confidence in the outcome. That this structure would be the Council is something I am uncomfortable with so, in our response, we have accepted the notion of a lay majority for a regulatory oversight body, but in so doing have reserved our position on the Council itself.

The Council has also spent some time looking at other bodies, in health and outside it, that have faced similar challenges and which have developed a range of responses, including new organisational structures and establishing new bodies, as examples of how we might respond to this particular challenge. Again, we will make definitive decisions about how we take this forward next month.

Any solution must be able to command the demonstrable confidence of the profession as a whole — the Society was created by members for members. The Council’s priority now is to secure a workable and sustainable outcome for the future for the profession. And members can rest assured that we will involve them in that process, and seek their endorsement of the outcome.