Council members praise Society's integrated role but accept need to consider a clearer separation
The decision made at the December
Council meeting to commission a review of the Royal Pharmaceutical Society's dual role of representation and regulation (see p749) followed a long debate during which Council members expressed confidence in the Society's ability to manage its dual role but accepted that external pressures dictated a greater, if not complete, separation of the roles.
Opening the debate, Jonathan Buisson said that the Council was on the
verge of a momentous decision about the future of the Society. It was
probably the most important decision the current Council would have to
make and the second most important decision since the Society’s
founders met in the Crown and Anchor in 1841. There was a range of options.
At one end of the spectrum was keeping the Society exactly as it was;
at the far end was setting up two completely separate independent bodies
with no links between them.
Mr Buisson said that he welcomed the idea of an independent review before
the Council made its decision. The review would help it decide how far
along the spectrum it had to go to meet the recommendation of the Foster
Review that the Society should “clarify the separation of its roles”.
He added that the Council had a duty to the Society and all its members,
whether practising or non-practising, and whether or not their work was
related to the NHS. The Society was not a pharmacy delivery agency for
the NHS. That did not mean that it could not help members who worked
in, for or around the NHS, but there were also plenty of other members
who looked to it for support and who had nothing to do with the NHS.
A professional body run by pharmacists
Douglas Simpson pointed out that it was recorded in the minutes that
Council policy was “support for a regulatory board with a lay
majority”. The minutes also recorded that “the professional
body must be run by pharmacists” — and it had been agreed
earlier in the Council meeting that “run” meant “governed”.
Mr Simpson said: “A regulatory board with supremacy over a professional
board is unacceptable. The integrated role and professional self-regulation
are both dead ducks and there is no point in seeking to resurrect them.
It is clear that there must be blue water between the regulatory and
the professional; that is a given. I think that is the Government’s
position, no matter what structure we propose. That is the end of the
integrated role, it seems to me.
“Self-regulation post-Kennedy was a
move to professional regulation with public participation. Post-Foster
and Donaldson, it will be public regulation with professional participation.
So professional self-regulation is also gone.”
Mr Simpson added that the two-board model — as approved by the
special general meeting in 2002 — did not seem viable. It had made
no progress then because it had lacked support from the Council of the
day and the Department of Health. The chief pharmacist at the time (Jim
Smith) had said that the Council could not abrogate its responsibilities
for regulation (PJ, 3 August 2002, p158). The Government would only accept
a two-board model today if the regulatory side was dominant, which was
not acceptable to the Council.
“Pharmacists need a professional representative body that democratically
represents their views,” he continued. “They have had one
since 1841 and they continue to need one today. I believe that a body
developing educational standards in the same way as a royal college could
be part of the functions of the Society in the future. In the light of
the Council decisions already made on the composition of a regulatory
board and the supremacy of that board being unacceptable, and the official
line on supremacy that I have indicated already, it does seem to me to
require the existence of two bodies in the future.”
The Society should continue as a professional body, said Mr Simpson,
and a separate regulatory board should be set up. This would fit best
with Foster’s desire for a Northern Ireland-GB merger. The Pharmaceutical
Society of Northern Ireland could also continue as a representative body
with its regulatory side becoming part of a new UK regulatory board.
Because Foster had called for a further review in 2011, the Council needed
to make a decision that would stand the test of time. Any review that
was set up should be a “how to” review, not a “what
do we do now” review, because open-ended reviews could come up
with answers that were not acceptable to anybody.
Two legal entities with shared facilities
Perhaps the solution would be two legal entities, independently managed
but sharing some facilities and with staff continuing in the same pension
fund. But whatever was decided it would have to be confirmed by the
membership.
On the Society’s assets, Mr Simpson said that the Society had owned
valuable property since its foundation but it had only officially became
a statutory regulator in the 1930s. Other Society property was owned
by the Benevolent Fund, which did not have a regulatory role. Publications
such as The Pharmaceutical Journal and Martindale were extremely valuable
properties. Again, they could not possibly be regarded as regulatory
property. The Society’s valuable museum collections could not possibly
be said to have been assembled in any way as part of a regulatory function.
Those matters needed to be borne in mind when the Council came to consider
the assets of the Society.
David Carter said that he shared Mr Simpson’s views. There was
a clear steer from the Government to separate the regulatory and professional
functions. If he had to vote today, he would vote in favour of beginning
the separation process. However, the Charter required the membership,
not the Council, to take the decision. Therefore, to give the members
the chance to take an informed view and fully understand all the options
and pitfalls, an independent review had to be commissioned, but it should
be a quick review with a publicity campaign to go with it.
Danger of oversimplification
Stephen Denyer said that Council members were in danger of oversimplifying
what they read and the messages they believed they were receiving.
It was important to test what separation of function could mean. There
was strength in having a regulatory organisation informed by professional
understanding and leadership; there was strength in a professional
organisation being advised, supported and weighted by the presence
of regulation.
The President said that he would like to hear the views of all other
pharmacist members of Council first, followed by the pharmacy technicians
and lay members.
The Vice-President said that ministerial opinions and decisions made
it clear that a Society in which the regulatory authority was subservient
to a professional authority was unacceptable. It was also clear that
a model in which the two roles sat level or equal was unlikely to succeed.
The two roles had to be separated for the public benefit and for the
benefit of pharmacy — although that was not to say that they could
not exist alongside each other in separate bodies. His personal belief
was that there should be two organisations working closely together — one
a professional body in the form of the Society and one a regulatory pharmacy
council that could also cover Northern Ireland.
He added that the Council needed to make a decision on the way forward
and the review should follow that decision.
Brian Curwain said that much detail had to be sorted out. A review was
essential. It needed to be by someone independent and it needed to be
as quick but thorough, because the decision had to be right. The Council
also needed to reaffirm publicly its desire to continue to work with
the Government. To close any doors would be unhelpful. He was happy to
end with two separate organisations, but the Society needed to be clear
about how it was to be done before making a public statement about exactly
what would happen.
Review will point to medical model
Martin Astbury expressed the view that both the public and the profession
were best served by the integrated role. But it had become apparent
that the present model was no longer acceptable. He believed the review
would almost certainly point in the direction of the medical model.
Sid Dajani said that he endorsed the medical model. He did not need
a review to tell him what was needed. “The only people who want a
review,” he suggested, “are people who want to waste time,
procrastinate and hope things will change for the better. The truth is
that it won’t change. We have had so much direction, so much future
progression on the Government’s side. They want a ‘one size
fits all’ for all regulatory bodies. They do not want to see how
well
we have done in the past. They want us to
fit into a nice little pigeonhole, and unfortunately the Society has
never worked like that.”
Dorothy Drury said that, because the regulatory function had to be supreme,
there could not be true leadership for pharmacists in a dual-role body.
She saw no problem with pharmacists paying fees to two bodies.
Davan Eustace said that, like Mr Astbury, she had long been wedded to
the integrated role. It had taken a long time to reach a decision, but
she now believed that separation along the lines of the medical college
model was the best way to go. It was important to have a strong leadership
body as well as a strong regulatory body and the only way to achieve
this was along these lines.
John Gentle said that the Government wanted the Society to split but
it did not want to be responsible. It wanted the Society to make the
decision. Bearing that in mind, it seemed that it would allow the Society
some leeway. The conditions were now right for the Society to get the
best deal for the profession and the public. The decision should be taken
now and the review should be about how to do it, not whether to do it.
Mr Gentle added that he too had always believed that the integrated route
was the best way to go, but there was no longer any point. What the Council
now had to aim for was the best it could get away with, not the best.
Andrew Gush agreed that the Council needed to show leadership and make
an immediate decision about where it wanted to be, followed by a review
to show how to get there. He wanted the Society to be a separate, independent,
professional organisation with no regulatory function. Although having
a strong regulator with a lay majority was in
the public interest, it was also important for pharmacy to have a strong
representative body, independently governed to guide it through times
of great professional change, to challenge the regulator and to drive
the profession forward.
Graham Phillips said he concurred with the points made by others. The
simple truth was that the profession was over-regulated and under-represented.
That was not in its interest. More significantly, it was not in the public
interest.
He added that pharmacists were now petrified of their professional body
because the regulatory agenda had overwhelmed the professional agenda,
in terms of strategy and resources. To continue with an integrated fudge
would only make matters worse. A clear separation was inevitable, even
though the requirements of the profession and the Government were aligned
in many ways. The Council should show leadership and make a decision.
Continuing uncertainly was unfair for the profession and for the Society’s
staff.
If one looked at the responses to the consultation on the draft Section
60 order, every pharmacy body apart from the Society had argued for a
split. There was no feeling in the profession that the integrated role
should be maintained.
Mr Phillips added that he was in favour of a review. The Council needed
to decide not whether to have a review but what the review should be
about.
The good should not be thrown away
Colin Ranshaw said that the Society’s current integrated role was
not perfect but it had worked. There had been an independent Statutory
Committee not accountable to the Council for almost 60 years. There had
to be some good in that, and it should not be thrown away. He did not
want to be told what direction the review should take. He wanted all
the information in front of him to assess what direction to take, accepting
that the current situation was not acceptable to the Government.
One concern was whether the Government would regulate industrial pharmacists,
academic pharmacists and others not working directly with patients. Did
they need to be regulated? At the moment, the Society had power to regulate
them and take appropriate sanctions if they did not perform to a set
level of practice.
He also did not know where education sat. The regulatory body would only
be concerned with the NHS side of education. Where would that leave the
education of Qualified Persons, for example?
He did not know the answers, but hoped that the review would bring them
forward. A review was needed to give the debate to the membership. The
review should not be directed down one single tunnel.
Stephen Wells said that he still believed that the integrated role was
fit for purpose but now strongly believed that the way forward was
to form two separate bodies. He saw the Society becoming the professional
leadership body, but it also had a duty to ensure that a strong regulator
was formed to work alongside it. Working closely together would lead
to a healthy tension between the two, which would drive forward innovation.
An independent review was essential to show that this was the true way
forward and to consider the interests of all the parties involved — the
public, the members and the Society’s staff.
Council must show leadership
The Treasurer said that the most important factor was for the Council
to show leadership and reach a decision. Matters should not be delayed
any longer. The Society had had a clear direction from the chief pharmaceutical
officers and it would be negligent to disregard that view. He believed
that a review should only be undertaken after the Council had made
the principal strategic decision as to what direction the Society should
take. It did not have time on its side to delay the decision.
Rose Marie Parr and Peter Jones both believed it was important to give
members around Britain a chance to contribute to the debate.
The President replied that the Council would not make a final decision
until after consultation with all the members. He then asked the two
pharmacy technician members of Council for their views.
Corinne Hunt said that, while listening to the debate, her views had
swung between integration and separation. On the strength of that alone,
she believed there should be a completely independent review about which
way to go, with a follow-on from that to how it should be done.
Lesley Morgan said that the Council needed to know the implications of
different possible directions of travel. “Until we have got all
those facts, I do not think we can make our decision or guide our members,
because you can be sure that when we go out to consultation, members
will ask us the nitty-gritty. If we cannot answer those questions, that
is where we lack leadership.”
The President then asked lay members to give their views.
Michael Schofield said that some separation was clearly needed. The Government
wanted it and the profession now appeared to be taking that view. But
there was also a need for good linkage between regulation and representation
and pursuit of professional interests. If the Society could produce a
practical working model, the Government would take it seriously. In a
sense, it would have done the Government’s work for it. But if
it could not do so, and the question of regulation was left to the Government,
then one could not tell what the outcome might be. It might be a general
pharmaceutical council, but there were other ways of regulating the profession.
There was already the Health Professions Council which, to anyone taking
a simplistic view, would appear to be a possible option.
Professor Schofield added that the Society’s trump card was cost,
because any model that had close linkages (and maybe shared accommodation
and shared facilities) would be cheaper than any other. And that mattered
in Whitehall.
He warned that it would take time. It was a marathon, not a sprint, and
to cover the first 100 yards of a marathon in 10 seconds was not
a good idea. He added that the General Medical Council had asked Niall
Dixon from the King’s Fund to undertake a review. It had helped
the GMC get a better deal out of Donaldson than it thought possible.
That was one of the things a sensible review could achieve.
Concluding, Professor Schofield said: “I have tremendous sympathy
and support for those who want to see a separation. It is how to achieve
it and I think we should take it in a measured way, because I think that
will keep our options open until we are quite sure what it is we want
to go for.”
Independence of review is important
Marcia Saunders said that for her the independence of the review was
most important. It should be about how to clarify the two main areas
of function. The Council was in danger of pushing the Society into
crisis if it made a snap decision. There were huge risks — financial,
legal and human resources. The Council had to be seen to be acting
reasonably, and the way to act reasonably was to commission a genuinely
independent inquiry. She agreed with those who had spoken about keeping
the options open. Council members also had a fiduciary responsibility
for sound stewardship, and should get legal advice on their own personal
responsibilities. The Council should not destabilise the Society and
do things like float off a regulator if that had a profound effect
on its financial viability.
So, to show that the Council was acting reasonably, a properly independent
review should look at all the options. The big question was how to clarify
the separation
of functions between the professional and regulatory responsibilities.
Commenting on Ms Saunders’s reference to Council members’ fiduciary
responsibilities, Rob Darracott, director of corporate and strategic
development, said that the Society had already sought advice on the matter.
There could be implications in relation to Council members’ fiduciary
responsibility to the Council whichever route was taken.
Alan Kershaw said that that information spoke clearly to the need for
a properly independent review. He went on to say that it was unsubtle
to talk about just two roles. He saw three strands — regulation,
leadership and representation. It was also unsubtle to talk about a “royal
college model” as if there was only one such model, because the
royal colleges were not all the same. And he was also a little alarmed
about the apparent enthusiasm for the medical model: “Let us not
get all starry-eyed about it, because we are all quite happy to bash
it from time to time when it does things badly, as it does.”
Commenting on Mr Phillips’s reference to the views of other pharmacy
bodies, Mr Kershaw warned that some of them may have their own motives
for wishing to see the Society split in two.
Mr Kershaw added that he would not decide which model he favoured until
he had seen the arguments properly considered. There was nothing to lose
from a truly independent review and a great deal to gain.
Integrates model serves public well
Ray Jobling said that he was one of those who believed that the integrated
role model had served the public interest well in pharmacy. But the
external environment had changed, and in the shifting social climate
there had to be a separation.
Regulation had to continue as a partnership between professionals and
lay people, but it was now clear that in future it would be led by the
latter. He believed there would be a lay chairman and a clear lay majority,
with all the regulators appointed rather than elected. That was one thing
a review should discuss.
Professional leadership benefited from informed lay involvement, but
the professional leadership body, if it were a separate body, would be
chaired by a professional and have a predominating professional majority.
Furthermore, there was more to professional leadership than simply representing
the interests of the profession in a narrow sense. There was a public
interest here too, which pharmacy recognised but which needed to be written
more clearly.
It was the medical profession that had led pharmacy into this mess, which
it did not deserve, but now the medical profession had pointed the way.
The review should be thorough but not needlessly long. The membership
was waiting for it and the public, in so far as it was aware of it, was
waiting for it. Certainly the Government was waiting for it. But the
membership issue had to have priority, and the membership did not yet
have the issues and the options put properly before it.
Lorna Jacobs said that instigating a review would not delay a decision
for more than a few months but it would ensure that the decision was
well founded. Council members clearly had a number of ideas and their
experience and wisdom needed to be fed into the review. The review would
also allow an opportunity to clarify the legal and financial complexities
to find the most sustainable structure that was in line with the Society’s
vision and the constraints of the current political environment.
Sylvia Hikins recommended standing back, taking the heat out of the situation
and looking in a cool, rationale way at the future pathway for the Society.
A review was an important step. She hoped all Council members would keep
an open mind, even though they might have inclinations and leanings. “Let
us have an independent person whom we can all respect, who is respected
out there by the membership, to look at the different ways of separating
the roles, because that is the issue.”
John Hanlon said that the Government would make the final decision. The
Society could only help to influence it. But one immediate decision for
the Council was to seek independent advice on the human resources and
legal issues.
Another necessary decision was to set up a small review group to oversee
the review process, because a 30-strong Council would not be able to
manage it.
Phillida Entwistle said that it would not be abrogating leadership to
proceed with caution and to obtain as much evidence as possible via a
review before making recommendations to the membership. The review should
find out what the risks were and how they might be managed.
She added that, if separation was inevitable, she wanted to know why.
Her gut feeling was that it is inevitable, but the Council should proceed
with caution. The Society would not be able to go back if it makes the
wrong decision. Decision should be evidence-based
Seema Agha said that the words “split” and “separate” had
not helped the debate. She had sympathy for pharmacists because she,
too, was a regulated professional and knew how difficult the decision
was but, as a lay member, she wanted to act with caution. Her advice
as a lawyer was that the decision should be evidence-based and take account
of the risks and the conflicts. Whatever decision was to be delivered,
it had to be acceptable to the membership and the public and be robust.
She wanted an open-minded review that would clarify the issues. “What
are the risks? What are the options? How do we achieve the clarity of
the separation, if that is a recommendation of the models? What costs
are involved? What has not worked elsewhere? What lessons are to be learnt?
I want the review to be timely and evidence based.”
Closing the debate, the President agreed with the consensus that the
current model was not sustainable. Even if it were, the Government would
want a lay majority on the Council, which would not be acceptable to
the Council or the profession. So the Council had to consider either
an internal separation of roles or an external separation.
His personal feeling was that, subject to a review, by 2009 the main
role of the Society should be to provide professional leadership and
to support pharmacists in their education, practice and standards setting.
In addition, it had to ensure there was an excellent Benevolent Fund. |
The
Pharmaceutical Journal