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Letters to the Editor
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The profession
Issues central to ethical practice
From Dr C. E. Heading, MRPharmS
Looking at the revised Code of Ethics, currently in the last stages
of consultation, the National Association of Women Pharmacists has some
concerns. There seem to be inconsistencies in the code that we hope do
not represent a change in the terms of reference of the profession.
In our experience, all pharmacists see their role as that of striving
to ensure that patients can access appropriate drugs in an appropriate
manner. Some members of the profession focus on development, registration
and production of medicines that are effective and safe, while a larger
number focus on ensuring that those medicines can be used in an effective
and safe way by those who need them.
The revised code of ethics partly reflects these views in some of the
early clauses of the code included in principles 1 and 2. However, one
of these two key themes has been dropped in principle 7 (Taking responsibility
for your working practices). Under principle 7, the code comments on
safety, risk, regulations and fitness to practise, with “safety” mentioned
in three separate clauses. Clause 7.9 imposes an obligation to “raise
concerns if policies, systems, working conditions or actions professional
performance or health of others may compromise patient or public safety”,
but there is no hint of a duty to consider whether care or effective
treatment of patients might be compromised by these factors. This seems
extraordinary. If pharmacists do not have a duty to try and ensure that
patients receive effective medicines at the right time, is there any
role for us at all?
Reverting to Principle 2, even here there are signs of attempts to stifle
pharmacists’ legitimate concerns. Clause 2.3 specifies a duty to “challenge
the judgement of colleagues and other health professionals if you have
reason to believe that their decisions could compromise the safety and
care of others” but there is no duty to challenge policies and
decisions taken by public bodies or employers. Twice Clause 2.4 specifically
warns against letting commercial gain influence decision- making but
seems unconcerned by any financial gain that might be made by denying
an expensive product to a needy patient.
The availability of medicinal products within the NHS, product licensing,
withdrawal of products, availability of emergency hormonal contraception,
development of stem cell products, opening hours and prescription charges
are just a few of the issues central to the ethical practice of pharmacy.
Are pharmacists being quietly stripped of their responsibility to question
policies and systems relating to such issues?
Christine Heading
President, National Association of Women Pharmacists
Professional representation of pharmacy
From Mrs H. St C. Howe, MRPharmS
Leadership is the most important quality for any body that represents
our profession. Leaders have a vision of goals, of change and of what
is sustainable, deliverable and better. Without leadership we regress.
The Royal Pharmaceutical Society’s Council is a complex mix of
pharmacist politicians (whose allegiances vary), technicians and appointed
lay members. Government interest in our body is particularly focused
on regulation whereas pharmacists and technicians are interested in the
professional leadership that develops and presents our profession as
a key health care provider — because we are.
The Society can provide such a modern regulatory framework that welds
professional leadership with continuously developing practice by able
practitioners. It has set its stall out to do this over the past five
years. At the same time the Society has had the respect of government.
Whatever may take its place, the current debate must secure a future
that offers more than the current arrangements, not less.
A Royal college perhaps? An excellent leadership body. Regulation would
run in parallel delivered by the Society as a separate body. The Society
could require membership of the relevant college as a prerequisite for
registration. Several Royal colleges could develop that met the needs
of different sections of the profession. Doubtless to meet Royal college
status they would need to be selfless, professional bodies that worked
for patient rather than member benefit. It could work well. It could
allow for devolution and for sector needs. The mandatory link to registration
to support the wider concept of regulation, as defined by Kennedy, would
be key. This model is used by chartered engineers in the UK.
The kernel of the specialist groups is already in place. They have leaders
who develop and share best practice in their area of expertise. They
set standards and educational programmes. Under the managed care sector
arrangements for grading and payment, they can set the Knowledge and
Skills Framework for their practice, and support the development and
accreditation of consultants.
So perhaps the future looks like this: regulation by the Society, ie,
managing performance, education and competence, with a mandatory requirement
for membership of a Royal college, ie, sustaining and developing practice
and research. Recommendation from the college, based on continuing professional
development and accreditation, would form the basis for a recommendation
for continued registration.
Helen Howe
Chief Pharmacist,
Cambridge University Hospitals Foundation NHS Trust
Can we have a proper, wide-ranging debate?
From Mr D. R. Knowles, FRPharmS
When the Royal Pharmaceutical Society was considering its response to
the Shipman Report in February 2005 I suggested (PJ, 5 February 2005, p146): “It
is self-evident to any diligent reader of the six reports of the Shipman
Inquiry that the General Medical Council is set for major review and that
there are implications for other health care professions. As Mr Ferguson
notes, the GMC strongly asserts that its role is ‘to protect patients’ and
claims not to protect doctors. Even so it will probably lose its long-prized
disciplinary function for medical practitioners. [This is already under
way.]
“Given the regulatory and representational roles of the Royal Pharmaceutical
Society, it is obvious that, in the public and professional interest, this
dual function cannot continue. Inevitably the new Charter will rapidly
become irrelevant. Unless pharmacy is prepared to put its own house in
order in line with current thinking, the Government will do it for us.
Against this background, debates about membership categories will pale
into insignificance.
“The time for a wide-ranging debate about the future of pharmaceutical
organisations is now. This is the real issue for the Society’s Council,
which must take the lead.”
I wrote this before Andrew Foster reported, but the contortions of the
then Council were almost irrelevant to the emerging situation. I am, therefore,
delighted to see the comments of John
Gentle and Graham Phillips (PJ, 25
November, p634) and Andrew
Gush (ibid, p635) and their recognition that
major change is now required if the profession is to progress.
In 2002 I suggested (PJ, 23 March 2002, p401) that “our Society is,
and has been for decades, a confused amalgam of statutory and representational
functions with irresolvable internal conflicts of interest which are made
worse by the enforcement powers under the Medicines Act and other acts.
(What other professional body is charged with initiating prosecution of
its members?)
“Furthermore, sectional, non-professional issues for pharmacists are
equally confused due to the existence of a plethora of narrowly focused organisations
concerned with NHS contract remuneration, a trade union, bodies representing
employers etc.
“The narrow range of options currently being explored by the Society
will lead nowhere useful. The Society is only one player but it must endeavour
to widen the debate to include all of pharmacy.”
Now that Council members are beginning to deal with reality, but only on
the limited vision of how change affects the Society, please can we now
have a proper wide-ranging debate with all concerned?
David Knowles
Exeter, Devon |
The
Pharmaceutical Journal