White Paper

Your readers will by now either have read or heard about the recent Government White Paper on the regulation of health professionals. The paper proposes the creation of a General Pharmaceutical Council (GPC) to carry out regulatory functions currently undertaken by the Royal Pharmaceutical Society. It also calls for a royal college role to provide professional leadership.

This is a historic event in our 166-year history and the Society is an active member of a Government working party, chaired by Lord Carter of Coles, working on how these changes should be implemented.

Working with the Carter Working Party we believe that the following are necessary to underpin the formation of the GPC and proposed royal college:

• The new arrangements ought to improve on current structures, leading to both improved public and patient safety and stronger professional leadership for pharmacists.

• The transition to a GPC and the possible establishment of a royal college needs to be properly managed and resourced.

• Structures for both regulation and professional leadership need long term financial sustainability.

• Strong and transparent governance arrangements will be needed for both the regulation and professional leadership of the pharmacy profession.

• The pharmacy profession and other stakeholders ought to be fully considered and consulted during the process of change.

The Society is uniquely placed to evolve into the royal college role and work has already begun to inform and consult the profession and other stakeholders about the White Paper. I have written to all the Society’s branches and regions inviting members to take part in a meeting in London on Friday 9 March. This will be the first in a series of planned consultation activity.

In the meantime the Society is continuing to fulfil its functions. The Council, national board members and the staff will still be working hard to help support, promote and develop the profession. The newly established pharmacy boards for England, Scotland and Wales are just one example of the work we are doing to maximise the profession’s ability to influence political thinking and raise awareness of the new face of pharmacy.

I would urge all your readers to engage in the forthcoming debate and help the Society to build on its strengths, expertise and experience to bring about stronger leadership for the pharmacy profession and ensure greater patient safety.

Hemant Patel
President
Royal Pharmaceutical Society

An opportunity to create a strong professional voice

From Mr A. R. Cox, MRPharmS

The leaders of our profession have reacted to the decision to create a General Pharmaceutical Council and the proposal to create a “Royal College of Pharmacy” with great optimism.

It is to be hoped that all in the profession will embrace this opportunity to create a strong professional voice.

However, in order to set the record straight, I must respond to Andrew Burr’s letter (PJ, 3 March, p245) in which he alleged that the Save Our Society campaign has been directly responsible for this outcome and, in doing, so has demonstrated a political naivety that is unlikely to be surpassed in his lifetime.

As someone who was, at one time, involved with the Save Our Society campaign, my own recollection is that I was in a minority with my opinion that the Royal Pharmaceutical Society should be split into its representative and regulatory parts, which Howard Fox and I had set out some years previously (PJ, 19 August 2000, p263).

Only recently have many in the SOS campaign come to accept that such a split was inevitable. There was no such general view at the time of the debate over the Charter. Even with a Council heavily loaded with SOS supporters, the Society’s response to the Foster Review in August 2006 was arguing for a continuation of the dual role.

Of course, Mr Burr could argue that by drawing attention to the role of the Society as a representative body, the campaign created the environment for such a split. Yet, even Mr Burr notes the inherent conflict in the two roles of the Society. He describes the split as an iceberg that was visible from far away, which presumably could have been avoided.

Mr Burr fails to note that a wider political and social climate has driven regulatory changes. The Society could not resist such changes by the use of special pleading or citing its past performance. In the face of an unavoidable threat, the correct decision is to adapt and survive. One option was to concentrate on regulation, in order to placate government concerns, at the expense of representation. However, such a process risked destroying the very organisation it was meant to protect. There was no realistic way, in the current regulatory environment, to sneak under the government radar a professional body disguised as regulator. Those who argued that such a body would have continued to exert useful professional influence after such a process were either naive or unconcerned about the Society’s representative role.

The other option was to have spotted the potential threat, and taken action to protect the Society, and its assets, if such a change were likely. It was primarily for this reason that I supported the SOS campaign, even though I disagreed with many involved about the future direction of the Society. Far from destroying one of the profession’s most valuable assets, the change in direction given to the Society by the SOS campaign has led to a chance to create a stronger professional body.

Now that the broad direction is set, there are crucial decisions to be made about the future of the Society. It is vital that important leaders of the profession, like Mr Burr, focus on saving the Society for future generations of pharmacists.

Anthony Cox
Sutton Coldfield, West Midlands

An opportunity for the Society to move in a new direction

From Mr G. S. Phillips, MRPharmS

Cover, Pharmaceutical Journal, 24 February 2007 Your front cover and editorial (PJ, 24 February, p206) gave the misleading impression that the Royal Pharmaceutical Society of Great Britain is being torn apart as a result of the recommendations of the Government’s White Paper on the regulation of health care professionals. In fact the Society has been invited to play a full part in the working party chaired by Lord Carter to work on agreed proposals for implementation.

The changes proposed by the Government provide an opportunity for the Society to move in a new direction and evolve into a royal college-type organisation. Although the split in roles will see responsibility for regulation move to a new General Pharmaceutical Council, the Society itself will continue to build on its strong foundations, built over 160 years, of supporting and representing the pharmacy profession and protecting the public.

Graham Phillips
Member of Council
Royal Pharmaceutical Society

Misdirected criticism

From Mr D. I. Simpson, FRPharmS

Andrew Burr implies that, but for Save Our Society campaign, the Royal Pharmaceutical Society would be all set to enjoy a secure future as a strong, robust professional body performing the dual role of representation and regulation (PJ, March 3, p245). He is living in cloud-cuckoo-land.

As anyone who has read the Foster and Donaldson reports on health profession regulation and the subsequent White Paper will know, it is the intention of government to separate regulation from representation. And this separation now means that the two functions cannot be performed by the same body.

This applies across all the health professions. To suggest that the SoS campaign had anything to do with this is absurd. The revolution in health profession regulation stems from medical scandals of great magnitude, not a campaign by concerned pharmacists to preserve the Society’s role as a professional association supporting and championing the cause of its members.

What the SoS campaign was about was safeguarding the Society’s representative role while its regulatory role was being transformed at the behest of government. Representation was being compromised while the regulatory agenda was being taken forward. The SoS stance enjoyed the support of the membership, as the Council election results in recent years have shown.

The problem that the Society has been facing is that the price of keeping regulation has been getting ever higher. Following the Kennedy report on child surgery deaths at Bristol Royal Infirmary, the number of lay people on the Council was more than trebled, while the number of elected pharmacists was cut. Now the White Paper — which has its roots in the Shipman murders and other acts of gross medical misconduct — seeks parity between lay and professional members on regulatory councils. With technicians counting as professional members, pharmacists will be in a minority. That is the kind of make-up that the Society’s governing body would be facing if the government had not decided to pre-empt matters and take regulation from the Society and set up a General Pharmaceutical Council. A governing body constituted in such a fashion might be acceptable for regulation but it could by no stretch of the imagination be said to represent pharmacists.

The emphasis must now be on building a secure future for the Society and not on pointless recrimination.

Douglas Simpson
Member of Council
Royal Pharmaceutical Society

Loss of political influence is a high price to pay

From Mr A. J. Burr, MRPharmS

It was with some incredulity that I read the contribution from Nicholas Wood, former president of the Royal Pharmaceutical Society (PJ, 3 March, p244). He appears to want to rewrite his own legacy as the champion of the “member-friendly” Charter and perpetuate the myth that the changes he sought were somehow good for the profession and membership.

As he well knows, the Society was held up as a model for all the modern health regulators. While other regulators were criticised in the wake of the Bristol and Shipman inquiries, the standing of our Society grew. Our dual role gave the Society unprecedented access to Government and was enormously beneficial to the promotion of the profession. The then president, Gillian Hawksworth, had tremendous influence with Government and was able to ensure that professional aspirations, such as prescribing status, became a reality. Simply to allow the regulatory role to be discarded will merely reduce our access and influence to Government and ultimately not serve our members well.

The reason the Society is in the mess it now finds itself in is because the Save Our Society campaigners sought to push the membership and professional association aspect in an overt manner. The 2004 Charter process should be seen in its true context as a battle between pharmacists with opposing views on how best to serve the long-term interests of the membership. The then Council was fully aware of the Government’s intention and sought to preserve the dual role and hence the ability to influence. Others showed little or no understanding of the importance of that dual role or appreciation of how our role as a modern regulator fundamentally underpinned our professional membership activities. Shouting from the roof tops may impress some members but key political influence at the heart of Government is a high price to pay.

History will eventually show that the splitting of the Society cost the members dearly, both financially and professionally.

Andrew Burr
Sutton Coldfield, West Midlands

Heralding the primacy of pharmacy, not its Armageddon

From Mr M. Beaman, FRPharmS

I write in support of the recently published White Paper on the regulation of health professions and to endorse the points made by the the Royal Pharmaceutical Society’s Vice-President, Gerald Alexander and past president, Nicholas Wood (PJ, 3 March, p244).

The recommendations in the White Paper should have come as no surprise to those of us working in the managed sector of health care and were long overdue.

As an associate of the Healthcare Commission and a former Commission for Health Improvement reviewer in primary care I was always acutely aware of the fact that pharmacy was out of step with the other major health care professions in terms of its clinical governance arrangements. Some may question the need for change: after all, complaints and service delivery failures are rare in pharmacy and public satisfaction levels are relatively high. However this could all change as pharmacy becomes more clinically focused, as a result of developments such as the new pharmacy contract and pharmacist prescribing starting to impact on the service.

On the professional front the proposal for a royal college would do much to enhance the leadership of pharmacy, promote closer working relationships with other professions and resolve the problems around the fragmentation of the profession; problems that have existed in pharmacy for far too long.

The recommendation contained in the White Paper should herald the primacy of pharmacy, not its Armageddon.

Mike Beaman
Rustington, West Sussex

What is it going to cost me?

From Mr P. J. Tidy, MRPharmS

Like many of my colleagues I suspect the key question at the back of our minds over the Government’s proposal (PJ, 24 February, p207) is a simple one: what is it going to cost me?

From different angles, both A. Matalia (PJ, 3 March, p245) and Mark Walker (ibid, p246) appear to make the same point. If the Government believes the public need protection then, frankly, the Government (and public) should by and large pay for it, and the assets built up by members over the years must not be stripped to fund some Government quango. However, it would appear that it is not just the Government that is after our money — a plethora of pharmacy special interest groups seem to be emerging, all with claims to a place in some new Society, and all apparently suggesting it is only feasible if membership is compulsory and their particular vision embraced. That makes me fear we are going to end up paying twice over.

I suspect the Royal Pharmaceutical Society will not actually cut its fees when it loses the regulatory aspect; instead it will choose to keep the money to fund “new and exciting developments”, chiefly those proposed by the aforementioned special interest groups. Meanwhile our pockets will be hit again by the General Pharmaceutical Council for the costs of that “new and exciting development”.

I wait with interest for somebody in the Society or Government to guarantee this exercise will be cost-neutral for the membership, but I will not be holding my breath.

P. Tidy
Lancaster

Well, is that it?

From Mr A. R. White, MRPharmS

I really do not know where to begin. When I read the the Royal Pharmaceutical Society is to be split (PJ, 24 February, p207) I could not believe that, after all our efforts to satisfy the politicians that they would be so vindictive. So I waited for the next edition to see what others would say about it.

Frankly, I am extremely disappointed. The only letter making any sense to me was that from Raymond Dickinson (PJ, 3 March, p244) and, as far as I am concerned, he has more knowledge of how to regulate pharmacists than all the others put together. Should he decide to form an appropriate organisation to carry forward his proposals I will back it in every way possible.

So, what else? Let me start with “I hate bureaucrats”. Who do these self-important civil servants think they are? I accept their positions of chief pharmaceutical officers and advisers have given the holders the power to direct government thinking on how the NHS could be run. But from where have they got the (in my opinion, misplaced) confidence that they know how to manage pharmacists?

Furthermore, having proposed the removal from the Society of the power to “regulate” pharmacists (and presumably also pharmacies) it is pure arrogance to tell us what we should do with what is left of our Society.

As is the case in many situations in life, the choice is often between two less-than-ideal options and the compromise reached by recent Councils appeared to me to be sensible and workable.

Why is the word “split” being used? Surely, if a General Pharmaceutical Council is to be created, it cannot be part of what we call our Society. The operation is amputation, if that word can be used for the loss of approximately half of its body.

Is there, I wonder, some unwritten understanding that, as the only expertise in running the regulation (and registration) of pharmacists lies with those who are currently employed by the Society, that the new GPC will be staffed by transferring these same people en bloc? That would be a split of the staff of the Society, but not of the Society itself.

Alan White
Gravesend, Kent

Civil servants and black holes

From Mr J. R. Fowler, FRPharmS

A. Matalia’s letter (PJ, 3 March, p245) clearly reveals what Raymond Dickinson (ibid, p244) and others have been at pains to underline.

It can be deduced from its content that Mr Matalia could not care a fig about professionalism, so why did he go to the bother of taking a professional qualification in the first place?

One might also ask why he thinks that if the Government takes over the registration task it will cost pharmacists only £20? The setting up and running of the General Pharmaceutical Council will presumably be organised by civil servants, who are well acquainted with creating black holes.

At least up until now, the monies have been spent by pharmacists on the profession of pharmacy, if not always to everyone’s satisfaction.

If Mr Matalia has chosen not to participate in the Society and what it has achieved over the years, that is his loss.

John Fowler
Egham, Surrey

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