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Noel Baumber is a member of the Independent Pharmacy
Federation
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The Broad spectrum feature is
open to any reader. Contributions of around 1,100 words commenting
on topical issues
may be posted to Graeme Smith, managing editor, or
e-mailed to graeme.smith@pharmj.org.uk for consideration
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There was bound to be controversy over the foundation of a royal college of pharmacy (or pharmacists) since there are so many specialist organisations already pursuing the cutting edge of pharmacy practice. It is all the more difficult when an eminent body such as the Royal Pharmaceutical Society is called upon to self-destruct, and rise in a new guise like a phoenix from the ashes.
It is the consequence of the Society splitting its functions in two — to
form a regulatory General Pharmaceutical Council and a royal college — that
it loses both the power to perform its regulatory function and the income
from retention fees and what it does on the educational fronts. If membership
of the reformed Society or college is voluntary rather than mandatory
it will have to look for other sources of income.
In rebuilding its life on a reduced income, the Society will look at
the example of other colleges such as the medical Royal College of General
Practitioners, founded in 1952. The RCGP set a precedent with its concentration
upon the routine workings of general practice medicine. Its syllabus
covers consultation, prevention, screening, clinical dilemmas, social
medicine and diseases, legal and ethical matters, and epidemiology.
The RCGP attempts to be practical and rigorous rather than elitist or
specialist, but forms the essential gateway to practice that drives conformity
and raises standards by a process of assessment and training. Milestones
in its history include the establishment of vocational training in general
practice, the setting up of clinical guidelines for doctors, the expansion
of research into general medical practice and the promotion of primary
care. It is also a charity deriving income from subscriptions, grants
and examination fees.
There is much goodwill for an all-embracing royal college from some 20
training organisations, which have met and produced what they describe
as the Waterloo
agreement (PJ, 31
March, p357).
However, the main support for a royal college has to come from retaining
the interest of those involved in community pharmacy, some 70 per cent
of the existing membership of the Society. The royal college needs to
become attractive, and possibly indispensable, to this sector to become
financially self-sustaining and, if it follows the RCGP model, it will
need to concentrate on pharmacy practice.
Financial survival would then mean having to attract income for the products
and services that the new royal college produces in the education market
(although, in time membership of the college may become mandatory for
the purposes of validation and revalidation to practise).
The scale of such an educational exercise, the co-ordination of its direction,
the need for a multidisciplinary entanglement, and the extent of its
agenda (encompassing the essence of a medical education) dictate that
validation for existing members of the Royal Pharmaceutical Society would
need to come with initial registration, while revalidation would be reached
over a transition period in progressive stages with a meaningful endpoint
in mind.
To my mind, it is not enough to form boards and committees to oversee
the work being done by others in the educational field. For my money,
the royal college will have to co-ordinate and facilitate the total educational
effort in pharmacy for the simple reason that we have no other agency
to embed diagnostics and therapeutics into our lives and effect the changes
in practice that are needed. It is not education for education’s
sake; it is for the benefit of patients and for the guidance of pharmacists
who already work solidly for 10 hours and more a day.
All this could be easily underpinned by the Government if it put its
money where its mouth is and financed the new community pharmacy contract
properly. To date, the development of cognitive services — such
as anti-coagulation services, emergency hormonal contraception services — have
been, in some senses grudgingly, funded by community pharmacists out
of purchase profits, rather than by a direct and separate income stream.
Our weakness has been, as usual, to expect the Department of Health to
pass the hat around for ad hoc donations from primary care organisations
rather than bother the Chancellor of the Exchequer for positive funding,
even though the overall benefits and outcomes should produce a handsome
return for the Government.
In the current exercise of splitting the Society into a GPC and a royal
college there is no hint, yet, of any facilitative funding for what will
be a worthwhile investment.
Let me emphasise that I am not suggesting here any diversion of funding
from dispensing, but the present output of community pharmacy is around
95 per cent dispensing and 5 per cent cognitive service. Medicines use
reviews are not the be all and end all of our contribution to patient
health. They are just a beginning and a trite measurable device. They
have to be surpassed, by an appreciation of the true scope of medicines
management and pharmacists’ deeper involvement with community services,
and elevated to new levels in which there is realistic growth in the
funding of cognitive services rather than diversion from the dispensing
budget.
The Independent Pharmacy Federation has already suggested to Anne Galbraith,
who is leading a review of contractual matters, that there should be
a separate
cognitive service contract that may or may not be associated
with a dispensing contract (PJ, 24 March, p332). Ring-fenced pharmacy
funding would mean that the format of practice can diversify and cognitive
services be recognised at financially sustainable levels, rather than
subsidised at unprofitable levels from dispensing income.
The synergy in all this is that money for a full cognitive service contract
flows into those pharmacies providing the services, and then on to the
pharmacists whose needs to be sufficiently competent to take on these
new roles in turn depend upon the royal college. Looked at as a market,
the royal college will be able to make a major contribution to the future
development of the profession by developing essential products and services
to sell which will focus on the changes in pharmacy practice.
But the royal college will not only concentrate on the needs of community
pharmacists. By making use of those organisations that are already at
the cutting edge, the various specialisations that are needed to support
leading-edge hospital and industrial practice can themselves be supported
and expanded. (They may not need to be incorporated into the royal college
to serve their constituents; whether they do or not will depend on the
type of relationship they choose to have with the royal college.)
Universities, too, will want to play a major part in the role of this
new agency for change, perhaps forging closer bonds with schools of medicine
and adapting their syllabuses. The scale of the change goes beyond the
Society’s reincarnation. The political influence or representative
role of the royal college will be difficult to construct and to manage,
but the transformation could be infinitely rewarding for the public and
the profession alike and arguably the Government and should, therefore,
not be cost neutral to the departments of health.
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The
Pharmaceutical Journal