White Paper

The recently published White Paper on the regulation of health professionals will put pharmacy into a position it has earned and deserves. The chief pharmaceutical officer for England, Keith Ridge, was right when he said that it is about ambition, consolidation and leadership.

The proposed separation of the Royal Pharmaceutical Society’s regulatory and professional leadership functions are all part of the Government’s plan to harmonise regulation for all health professionals. So all health care regulators will be affected by the White Paper and all will undergo fundamental change. It also comes at a time when the safe and effective prescribing of medicines is becoming more complex and greater clinical responsibilities are placed with the pharmacy profession.

The creation of a General Pharmaceutical Council will move the regulation of the profession forward; the creation of a body akin to a royal college will promote excellence in clinical practice, as well as innovation and leadership within the profession. Times are changing and we must all move with them. The Government has chosen to change how regulation is to be carried out and it is our responsibility to make sure that this works as well as possible for the public and the profession alike.

For the Society, evolving into a royal college-type structure represents a means of taking the pharmacy profession from the championship into the premier league. It is a coming of age for the profession. The profession is taking on new clinical roles, such as prescribing, and for this there must be new structures. And the Society has a significant role to play — as part of the working group headed by Lord Carter — in shaping these new arrangements because it has a well established, proven track record as a professional and regulatory body. It also has a strong history of protecting the public and supporting and representing pharmacists.

In the process of change, the Society will impress upon the Government to build on its existing strengths, expertise and experience in order to bring greater patient safety and stronger professional leadership for pharmacists.

The picture outlined in the White Paper of the real opportunities presented to the profession contrasts sharply with your cover, the associated news story and the editorial in last week’s issue (PJ, 24 February, p206 and p207).

Gerald Alexander
Vice-President
Royal Pharmaceutical Society

A disastrous proposal

From Mr R. Dickinson, FRPharmS

I must record my utter dismay at the Government’s proposal that the Royal Pharmaceutical Society should split (PJ, 24 February, p207). This is particularly surprising so soon after the Privy Council and, therefore, the Department of Health agreed to the granting of a new Royal Charter that embraced the regulatory and representational roles within its Objects. If there had been any justifiable concerns, surely they should have been raised at that time.

If the Shipman case was at the root of the proposed changes I cannot understand the logic. This anomalous occurrence was, after all, within a profession that already had a separate regulatory authority. Such separation did not, in itself, prevent the horrific crime from happening.

So why should such a dramatic change be forced upon a professional body which has performed both of its major roles in an exemplary fashion? What can possibly justify the tremendous cost and such a major distraction from the normal business of a respected professional body?

I worked closely with Society Councils for 30 years and can testify that, throughout that period, professional and regulatory policies were only promoted and decisions made when they were clearly in the public interest. Successive Councils and staff were well aware that, not only was this criterion necessary for acceptability by other stakeholders and government, but otherwise it would have led to calls for a separation of the dual roles. Such a call did not come, until now, even though there has been no valid assertion that the Society has abused its responsibilities.

I would also draw attention to the way that pharmaceutical education, practice and science have developed together within the orbit of the one body, in step with and more often in advance of the needs of current health care. Why is the dual role no longer conducive to the continuing development of the pharmacist’s “increasingly clinically important and professionally demanding role in the treatment of patients”?

All that is needed to meet the calls for a clear separation of roles, is to develop further the current autonomous disciplinary procedures within the Society to include other aspects of regulation and other appointed personnel, including the chief pharmacists if they or the DoH feel the need to be involved.

I ask myself, what would a past Council have done if faced with such a disastrous White Paper proposal? I am confident that it would have mounted a massive campaign, while the Bill is being prepared and then presented, to persuade members of both Houses of Parliament and other influential parties to support an appropriate amendment. The aim of that change to the draft legislation should be to maintain the dual role of the Society and promote internal developments that would strengthen the independence of its regulatory procedures. The Society’s track record makes the case for such a campaign.

Raymond Dickinson
Farnham, Surrey

Reclaim the Society as a professional membership body

From Mr N. L. Wood, FRPharmS

The White Paper announcement of the Government’s intention to create a General Pharmaceutical Council (PJ, 24 February, p207) is undoubtedly a historic one, as the White Paper itself acknowledges. It is not a statement, as you contend in your editorial (ibid, p206), that the Royal Pharmaceutical Society is not fit for purpose; rather it is a recognition that the Society has been caught up in the wide-ranging reforms of health and particularly medical regulation.

It is true that the Society “was not really broke”, and the Society can be proud of its enviable reputation, developed since the 1930s, of effective self-regulation of the profession. However, we have to recognise that the political climate is such that the case for the separation of regulation from professional leadership has become overwhelming and the consequential split in the Society, inevitable. Paradoxically, the need to reform is also a recognition of the success that the Society has had in the recent past in making the pharmacy profession a much more important player within health care than has previously been the case.

The recognition that such a split was possible lay behind much of the thinking among those of us who fought, amid huge controversy, for the final version of the 2004 Royal Charter. That the Charter finally obtained during 2004 was much more “member friendly” than might have been the case, is a vindication for those of us who were vilified (although finally triumphant) in standing up for the Society’s role as a membership and professional association.

Your alarmist report (ibid, p207) that the 2004 Charter might be forcibly revoked leaving the Society powerless and with its assets claimed by the Crown is outrageous and cannot go unchallenged. Rather, the White Paper provides the Society with a golden opportunity, if carefully managed, to metamorphose into a royal college model to take on the professional leadership of the profession. Although few of us involved in recent years may have wished to see this split, the President and Council must now grasp the opportunity enthusiastically. When pharmacy has been criticised for its fragmentation, the reinvention of the Society with the functions of a royal college could do much to bring diverse groups together. The opportunity to create faculties to encompass say, the College of Pharmacy Practice, UK Clinical Pharmacy Association and the Institute of Pharmacy Management under a single Society umbrella must not be missed.

It now falls to the current leadership to embrace the new political reality and to make the most of the opportunities presented to the Society in the White Paper. As President in 2004–05, supported by the current President (then the Vice-President) and many members of the current Council, we obtained a Charter designed to make the Society fit for its dual role, but also fit to be reclaimed by its membership as a professional membership association. Although further changes may be needed to the Charter, the time to make such reclamation is upon us. Today’s leaders of the profession must grasp this eventuality with both hands.

Nicholas L. Wood
Past President
Royal Pharmaceutical Society

A catastrophe

From Mr A. J. Burr, MRPharmS

There will be many pharmacists across the land who will simply not appreciate the catastrophe that has befallen their profession, yet there are a few who recognised the disastrous path along which the Save Our Society group would lead.

Sixteen Council members who fought to save the profession through the new Charter were pilloried by a membership who failed to understand what the Government wanted. Contrary to popular belief, the 16 knew what the then Government wanted and sought to steer a course that would ensure the dual role and a strong, robust professional body. If the Society was to succeed in professional representation, it would only ever have been by listening to what the Government wanted and evolving our model accordingly. Members of the SOS group thought they knew best and rallied the membership to support a campaign based solely on representation and the Charter. They failed to listen to what the Government was saying and appeared to ignore the obvious mismatch between overt professional dogma and serving the public interest. We will now have to wait and see if the Government takes the unprecedented step of revoking our Royal Charter.

Over two years ago (PJ, 23 April 2005, p487) I wrote: “My greatest regret is that so many fellow members and colleagues, including many of the newly elected Council members, will believe they [SOS] have secured a great victory when the reality is that they charged up the wrong hill and have completely misunderstood the Government’s agenda. When the inevitable split comes — and, mark my words, it will — we should all remember that it was pharmacists themselves who decided to steer the profession into an iceberg that was clearly visible from afar.”

The President tells us (PJ, 24 February, p207) that the Royal Pharmaceutical Society “is a well established, proven professional and regulatory body, with a strong track record for protecting the public and supporting and leading pharmacists”. He must surely have been reminiscing about where we stood before his presidency, because under his stewardship and leadership, we have appeared more and more as a group of self-interested professionals who believe they can tell the Government what to do. I believe our political influence has gradually been eroded, due mainly to the direction in which the SOS-led Council has sought to go. We should never forget that the President was on the original modernisation steering group, and so he knew what could happen and he was fully aware of the Government’s intent from the outset. Despite all this, he sought to embroil the profession on a kamikaze mission which has left our Society in tatters.

Last week the profession finally discovered it had charged up the wrong hill and we are set to see our beloved Society split. The profession has lost at a stroke one of its greatest assets, and it is unlikely to recover. I believe the Save Our Society group has demonstrated a political naivety that is unlikely to be surpassed in my lifetime.

Andrew J. Burr
Sutton Coldfield, West Midlands

Let freedom of choice and liberty prevail

From Mr A. Matalia, MRPharmS

The decision by the Government to split the Royal Pharmaceutical Society into two organisations is a breath of fresh air. Let us hope the cost of registration is no more than £20 a year. If other organisations can maintain their databases of members for this sum, it should not be beyond the realms of the General Pharmaceutical Council to do the same. This council must be headquartered in a low-cost region, with functions of compilation outsourced to a low cost economy.

The cost of “protecting the public” should be paid by the public and not pharmacists. Alternatively, those pharmacists found guilty of breaking the law should be fined and pay the cost of the investigations. The code of ethics should be scrapped, and pharmacists and all health care workers should be subject to the same disciplinary procedures and be expected to abide by the law alone and not some half-baked code of ethics which a pharmacist may not believe in. Let freedom of choice and freedom of liberty prevail within the boundaries of legislation alone.

Pharmacists must campaign for membership of the “new” Society to be voluntary and it must prove its worth to its members.

A. Matalia
Coventry

Our common purpose should guide our thinking

From Professor J. A. Cromarty, MRPharmS

Challenging though it is, the decision to separate the functions of professional regulation and leadership should prove helpful in establishing a new and effective professional framework which is fit for purpose in the 21st century. NHS Scotland Directors of Pharmacy welcomes this Government decision, which we believe has the potential to secure a leading role for the profession in the delivery of pharmaceutical care and medicines governance.

The public requires an assurance that we work within a transparent regulatory structure in which patients’ interests and safety are paramount. As a consequence of the pace of change in health care provision and professional practice, further assurance is required that we have in place a robust modern professional structure, capable of developing the profession’s clinical and scientific credibility within rapidly emerging, new and more clinical roles. There is a need both to develop the clinical competence and confidence of the profession and to maintain the trust of the public.

The Royal Pharmaceutical Society has served the profession and the public well in traditional areas of pharmacy practice. Keeping pace with, or leading, cutting edge developments has proved more challenging.

There is a need now to build upon the profession’s considerable strengths and diversity in a way that delivers consistently high quality pharmaceutical care for patients irrespective of their location. We require new mechanisms to support and share innovative and successful methods of pharmaceutical care delivery across our various areas of professional practice. We need effective leadership to create an integrated health care system, one which better safeguards the public interest and one which better meets the needs of individual patients. It is against these objectives that we should propose and evaluate the potential options for the future of our profession.

What would not serve us well as a profession would be to enter into a defensive response; nor would any useful purpose be served by dividing our opinions based on sectional or possibly vested interests. Our common purpose of improving patient care should guide our thinking on this important issue.

We trust that there will be effective engagement and communication with all members of the profession in determining the route ahead. The model selected will require ownership and the support of the profession as a whole if it is to succeed in driving up professional standards and innovation to improve patient care.

John A. Cromarty
Chairman
NHS Scotland Directors of Pharmacy

Time for reflection and expression of views

From Mr S. J. Churton, MRPharmS

So the Government has at last spoken, and has proposed that the Royal Pharmaceutical Society separate its regulatory responsibilities from its professional leadership role (PJ, 24 February, p207).

The current joint accountability of the Society is unique among health care professional bodies and, some would say, has served the profession admirably for over a century and a half. So why change something which evidently works? After all, past evidence is surely the best predictor of future behaviour.

If the Society is to be judged on its record of regulatory control and professional advocacy, surely history will show it to have been successful in discharging these responsibilities in a fair, proportionate and well reasoned manner. It has always been aware of the need to balance the primary importance of patient safety with an understanding of the pressures that so many pharmacists experience in their daily concern to act in the best interests of their patients, and the need to ensure that pharmacists are supported to maintain the clinical competence which patients have rightly come to expect.

There are sometimes difficult issues and individual circumstances which need to be recognised and understood in forming a judgement about the professional competence of a pharmacist. Who better placed to do this than pharmacists who themselves are certainly well qualified to understand and make judgements on issues affecting professional competence. Surely a professional body which embraces all aspects of regulation and professional leadership should be ideally placed to take a holistic perspective on competence to practice.

I believe that the maxim “if it ain’t broke, don’t fix it” certainly has its place in so many situations we encounter. Changing something for the sake of change can often bring with it disruption, and result in complexity or confusion — and an undesirable outcome.

Conversely, we are often too busy, too involved or (it has to be said) too apathetic to recognise the benefit of changing something which on the surface appears to be working fine — and I think we may be in danger of walking down this particular road when it comes to considering the future composition and role of our professional body.

Surely we must all agree that patient safety and the confidence that patients should have in their pharmacists are of primary importance. We must do everything we can, both as individuals and as a profession, to ensure that every practising pharmacist is professionally competent, and acts with absolute integrity and in a manner which engenders the trust and respect of patients.

It is human nature for people to have concerns when they see a profession self regulating. Questions arise around self and conflicting interests, the possibility of cronyism and other practices that do not seek to undermine public confidence but often result in doing so.

Surely it must be in the best interests of our membership to be seen to be anxious to remove such concerns, and to demonstrate transparency, objectivity and integrity. Surely patients will have more confidence and trust in a profession which, when tasked with taking difficult decisions, acts with complete independence from both political and professional pressures, and surely we should acknowledge that, however successful we believe our current constitution to be, we should always be open to the possibility that change can be beneficial.

Now is the time for reflection, for listening to each other, for the expression of views and for the development of our future. We need to engage in constructive debate so that the emergence of positive landmark decisions will better serve our patients for the next century and a half, and beyond.

Steve Churton
Loughborough, Leicestershire

Society's assets must not be split

From Mr M. A. Walker, MRPharmS

Members of the Royal Pharmaceutical Society may have concerns after reading the PJ of 24 February. To be clear, when enacted the White Paper will simply take regulation away from the Society; it will not dissolve the Society or revoke the Royal Charter. The White Paper’s proposals restore the usual historical position of the Society: for more than half of its history the Society has not been a regulator. Even if the proposal becomes law and receives Royal Assent, the Society remains as the corporate body which owns all of the assets of the Society. The Council is under no legal or moral obligation to hand over any of the Society’s assets to the General Pharmaceutical Council. I do not envisage any of our elected members of Council voting to give the Society’s assets to an unelected regulatory body, so The Journal’s question on splitting assets is a red herring, best ignored by members.

In the highly unlikely scenario that the Society’s Royal Charter is revoked (PJ, 24 February, p207), a simple transfer of assets from the Society to a new corporate body with similar objects would preserve the assets for members. When a previous Council attempted to turn the Society into a body with a greater regulatory focus the members voted decisively against it. I expect that members will ensure that all current and future elected members of Council become active protectors of the Society’s assets for the members.

The Society’s Council is entitled to offer the GPC free or economical office space at Lambeth. However, this could be seen as an attempt to gain influence over the GPC, so I advise the Council to offer no financial benefits to the GPC and ensure that the regulatory body is visibly independent from the Society.

The Society has a bright future as the professional body for pharmacists. This revolution will need consultation between the Council and members. It could possibly entail a revision to the Royal Charter but only after the GPC is operational, not before. A key and trend-setting appointment will be made when the Council chooses the new Secretary of the Society. Someone from outside the Lambeth establishment is essential.

Mark Walker
Oxford

A real opportunity

From Mr E. S. S. Yuen, MRPharmS

The White Paper, “Trust, assurance and safety: the regulation of health professionals in the 21st century”, represents a real opportunity for pharmacists. I welcome the fact that my professional standards will be regulated by an independent body with clarity and transparency. I have no doubt that this will improve the public’s perception of our profession.

I would support the Royal Pharmaceutical Society’s transition to a model that is not dissimilar to the Royal College of Nursing, whose voluntary membership is dependent on the RCN council’s ability to “wow” nurses. This model will allow pharmacists to reclaim their Society, and make the Society work for the interests of pharmacists. I would go as far as to suggest the new Society adopt a similar mission statement as the RCN and, if I may paraphrase:

• Represent the interests of pharmacists and be their voice locally, nationally and internationally

• Influence and lobby governments and others to develop and implement policy that improves the quality of patient care, and build on the importance of pharmacists to health outcomes

• Support and protect (i) the value of pharmacists in all their diversity, (ii) their terms and conditions of employment in all employment sectors, and (iii) the interests of pharmacists professionally

• Develop (i) and educate pharmacists professionally and academically, building our resource of professional expertise and leadership, and (ii) the science and art of pharmacy and its professional practice

• Build (i) a sustainable, member-led organisation with the capacity to deliver our mission effectively, efficiently and in accordance with our values, and (ii) the systems, attitudes and resources to offer the best possible support and development to our staff

The monies freed from the demise of the regulatory functions of the Society should be diverted into membership benefits. The Council of any new royal college-style pharmacy body must be close to their membership and reflect their priorities, to lead and not govern. Hence, membership, by definition, must be voluntary to ensure success, or other associations and organisations will be formed to fulfil that role.

Eric Yuen
Walsall, West Midlands

Mr Yuen wants a pharmacy body along the lines of the RCN. However, the RCN is a trade union, something the Society is unlikely to become (see p241). It is also unlikely that there will be monies freed from the demise of regulatory functions. Regulation by a body other than the Society will still have to be paid for, probably by pharmacists through retention fees.
— EDITOR

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