The Pharmaceutical Journal
Vol 278 No 7448 p461-462
21 April 2007

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What does it mean to be a member of a profession in 21st century Britain?

In this article Ian Caldwell describes the differences between a profession and a job, and points out that individual professionals have a collective responsibility for the competence and integrity of the whole profession

Ian Caldwell, FRPharmS, of Glasgow, is a past president of the Royal Pharmaceutical Society. He recently read for an MPhil degree at Strathclyde University on the characteristics of professionals

Definition? Where are we today? International interests? Commercial barriers Why join a profession? New generations

A person who has a calling is driven by the desire to make things, and people, better. So wrote Raymond Tallis in his book ‘Hippocratic oaths’ in 2004.¹ Professor Tallis chose the rather old-fashioned term “calling” when he sought to describe what set a profession apart from a job and his descriptor serves the purpose fairly well.

It is not condescending to say “fairly well” because trying to characterise both “profession” and “professional” has stumped lexicographers, politicians, philosophers and sociologists for around two centuries. There can be no doubt that professions are seen as strong social influences.

Both the French and the American revolutions saw fit to suppress the liberal professions on the basis of removing organisations which were capable of resisting revolutionary change. In the 20th century, in Russia and Germany, the Communist and Nazi parties winnowed the professions of “undesirables” and then sought control of the educated, organised professions by linking future progress of individuals to membership of the respective political parties. Paradoxically, the professions have long outlasted the political systems.

Professor Tallis also highlighted the longevity of his own profession of medicine by his choice of book title, which relates to Hippocrates — both a philosopher and a founder of the profession.

Definition?

Defining what a profession is has proved difficult. Both the historical and the semantic evidence show that the concept of a profession has changed radically with time and that occupational groups are increasingly seeking and attaining professional status. Early Victorians used “professional” to differentiate from amateur status. Fifty years later there was a language shift and a profession was defined as “the business which one professes to understand and to follow for subsistence”.²

Webster’s Dictionary and the Oxford English Dictionary now emphasise specialised knowledge, high standards of conduct and achievement and a dedication to the interests of the public together with an organisational structure to ensure these aims are met. If this seems to smack of idealism, it can be seen as a factor in distinguishing a profession from an employment. These broad definitions seem to ignore the great diversity of British professions but they actually illustrate that there is a homogeneity among them — they have much more in common than there are elements which might separate them.

It is for this reason that the largely unsung United Kingdom Inter Professional Group has proved so successful as a quiet lobbying unit in the spheres of education and legislation in general and as sources of information in specialised fields for all the participating professional bodies.

Where are we today?

That is the history and theory. Where are we today and what is a professional? Dictionaries have told us what a profession is and then defined the various practitioners as the professionals. Understandably, most people find this confusing and there have been many attempts to build an accurate picture of what is expected of this individual. The conclusions of the Monopolies Commission Report of 1970 (the Roskill Report) were used by Watkins et al in 1996³ to draw an outline of the distinguishing characteristics of a professional, most of which are concerned with “standards of competence, integrity and fair conduct” and include:

(i) detachment and integrity in exercising personal judgement

(ii) direct, personal client relations based on trust, faith and confidence

(iii) collective responsibility of professionals for the competence and integrity of the whole profession.

Writing some 25 years after the Roskill Report, Watkins et al had to accommodate the structural changes which had occurred in in professions such as law, pharmacy and optics during the intervening period. All of them had moved from being mainly practitioner-owned services to provision largely by limited companies or groups. If these companies become large enough it is possible, perhaps even probable, that the requirements and standards of these employers need not always match those of either government or profession. Such changes are not necessarily bad since, by presenting established professions with the challenge of considering the current needs of their client base, they ensure that modernisation takes place.

The Law Society of England & Wales review of Codes of Conduct in 1994⁴ summed this process neatly by concluding that, by frequent and evolutionary change of their codes, successful professions are those in a continuing state of flux. Such rapid changes can also have drawbacks: members of the profession can feel overwhelmed by the rate of shift away from that with which they were comfortable and members of the public may no longer recognise the profession they have previously depended upon. Both of these shortcomings require clever, well targeted communication with both members and clients, preferably with the aim of making them believe the idea of changes came from them in the first place. Or is that called spin?

Other aspects of existence of professions have been sought recently, not least in the Royal College of Physicians report “Doctors in Society” of 2006,⁵ one part of which gave the responses of members and fellows to a series of multiple choice questions. Perhaps the most striking reply was that 95 per cent of the respondents considered that the “purpose of medical professionalism” was to “maintain or improve patients’ care”. This is an indication that all the other elements of professionalism are subservient to and lead to improving the patient’s (client’s) circumstances.

The Royal Society (RSA) project “Exploring professional values for the 21st century”⁶ raised the question of whether the increasing use of targets and rule book approaches are damaging the relationship with clients and other professionals in the sense that professional judgement is being devalued. In an increasingly litigious society this is a change which must be expected and this is particularly so when it is noted that “accountability” is a professional requirement right across the spectrum of British professional bodies.

Rule books cannot envisage every circumstance of a client-professional relationship but if a practitioner feels compelled in a specific case to move outside the limitations imposed by his or her professional peers, he or she will be expected to justify that decision. This raises the question of to whom or to what does the practitioner answer? Is it employer protocol, professional regulator codes or criminal law — or some combination of these?

International interests?

We are also forced to look at the imperatives of globalisation. We already have the impact of EU directives on various aspects of pharmacy and it is not impossible that other international interests will be reflected in British professions in the future. The Royal Pharmaceutical Society — or a possible royal college successor — will have the job of ensuring that British interests, structures and traditions are responsibly represented in these broader organisations.

In spite of some commentators’ dislike of the use of lists of characteristics to define what is expected of a professional person, the great majority of investigations do depend heavily on such listings. It is striking that, over many decades, the values are repeated time and again no matter whether they are expressed by the public, academia, professional bodies or consumer organisations. If we assume that the RSA, as a learned society, is free from bias and we list their professional characteristics for the 21st century we find that they incorporate most of those identified by 20th century investigations, namely:⁶

• Trust

• Skill and competence

• Accessibility

• Innovation and invention

• Accountability

• Integrity

• Motivation

Commercial barriers

Pharmacists are often compared unfavourably to members of other professions because many of them are seen every day in a business context on the high street or in supermarkets. In reality the only difference between pharmacy and any other profession is that pharmacists often sell their professional expertise not in a laboratory or a closed office or in a well protected surgery but right in the public eye.

In addition, pharmacists are available more or less on demand. Every professional person, no matter in what sphere he or she participates, employs elements of business — deciding priorities, allocating resources, managing time, developing negotiating skills and developing strategies. They adopt this way of working in order to fulfil the most basic of needs — generating income to live on or to support a family. Only after these fundamentals are satisfied can any professional begin to address the aspirations and ambitions inherent in joining a profession. By that time they should have discovered that “it is all to do with standards”.⁵

Why join a profession?

If it is not a statutory requirement that a practitioner must join a professional body before trading his or her services to the public what is in it for the putative professional? It is likely that the use of a restricted title will be involved. In the near future pharmacy will have to help decide who “owns” the title “pharmacist”. Will it be the proposed General Pharmaceutical Council or will that restricted title reside with the proposed royal college? Leaving the title aside, the reputation of pharmacy and the status of pharmacist should reside with the professional body as should the assets to which the members contribute and the benefits of which they alone may enjoy.

Professional bodies often hold conferences to showcase the achievements, researches and developments of their members. Planning long-term strategies, fostering long-term relationships with varied political and economic organisations and confirming the individual practitioner as the authority on matters relating to the practice of a profession are among the factors which make membership of a professional body rewarding.

The publication and ownership of a wide ranging, independent, clinical and practice-based weekly journal is essential to underpin the aims and objectives of any professional organisation and should make money to keep fees down. In addition, a vigorous local network can provide professional support and education for members and form the common ground for a faculty-based organisation.

New generations

The Royal Pharmaceutical Society currently underwrites part of the function of that wonderful group, the British Pharmaceutical Students Association. The existence of the BPSA and the sheer enthusiasm of our soon-to-be-pharmacists is reason enough for anyone either to remain or to become a member of the Society or any possible successors. For the young, they are inspiring and for the older? Well, older people are liable to be dependent on graduates’ ministrations and professional expertise for their welfare and comfort at some point.

The quality and altruism of today’s students can be extrapolated from the results of graduate surveys such as the NatWest survey,⁷ which indicated that 82 per cent of graduates rated job satisfaction as their primary goal while a Mori poll for The Guardian⁸ revealed that 88 per cent of graduates expect to enjoy their work. A proportion of these graduates will join professions, including pharmacy, and their professional body should provide the life-long sense of belonging and involvement which will sustain interest and ensure satisfaction.

The extent to which any practitioner embraces the mores of his art will vary with time and personal circumstances. The enthusiasm of the newly qualified can eventually become the ennui of the about-to-retire. The role of the professional body is to extend the time between these two events for as long as possible. It is unlikely that any two individuals will exhibit the same degree of commitment to their work over their working life. A host of factors, such as divorce, financial problems, fear of change or illness, can influence the relative importance that any given person places on his or her professional responsibilities at any moment in time, although often such effects are transient.

As well as providing challenges and opportunities professions can continue to provide their members with professional colleagues who can offer support and encouragement at local level and, if necessary, benevolence and care at a national level.

Professions — who can do without them?

References

1. Tallis R. Hippocratic oaths. London: Atlantic Books; 2004.
2. The Imperial Dictionary. London, 1883.
3. Walker J. The future of UK Professional associations. Cheltenham: Cheltenham Strategic Publications; 1996.
4. Allaker J, Shapland J. Research Study No.16. London: Law Society of England and Wales; 1994.
5. Royal College of Physicians. Doctors in society. Medical professionalism in a changing world. London: RCP; 2006.
6. Royal Society of Arts. Exploring professional values for the 21st century. London: RSA; 2003.
7. NatWest Bank Plc. Student money matters. London: Natwest; 2000.
8. Gradfacts 2000 survey. London: The Guardian/Mori Polls; 2000.