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I have always tried to influence change by understanding the
need for it and I have tried to get colleagues to respond positively
by motivating
and inspiring them, and making our goals clearer. With the discussions
about the arrangements for a new regulatory body for pharmacy and a separate
professional body ongoing, I remembered what John Smale, in the Harvard
Business Review, wrote: “When you’re going to address
a problem, get the people who have something to contribute in the way
of creativity
if not direct responsibility. Get them together. Turn them loose.”
The Royal Pharmaceutical Society believes that the formation of a new
regulatory body and a professional leadership organisation will bring
lasting benefits to professionals, to government and to the public. In
fast-changing times the profession needs to be innovative, ambitious,
strong and confident. So it needs robust and appropriate support structures
at local and national level.
Working with others who have an interest in the success of pharmacy is
the way to be sure a new professional body — a royal college — is
a success. On Monday 30 April, the Society is starting the process of
engaging in discussion with the rest of the profession and other pharmacy
organisations. The Society believes, but does not take for granted, that
it is well placed, working in partnership with the Pharmaceutical Society
of Northern Ireland and others, to host a professional body. The Society
wants to collaborate with other organisations in pharmacy. But this is
not a new desire.
In my presidential policy statement of 2005 I said: “There is a
need to transform the profession by co-creating a compelling vision for
the future that respects our history and our increasing diversity (of
membership and work). We can do better: I believe that change must be
managed with a clear aim to bequeath to the next generation of pharmacists
a profession which is in a better state than we inherited. We must renew
our resolve to modernise the culture, education and practice of pharmacy,
but set within a new context of facilitated and purposeful change management
at individual and collective levels.”
In 2006 I said: “In the recent years debates have been about retaining
the profession’s unique values, protecting our assets and our sense
of identity. Now, the Council has to work with the branches to create
a culture of increased innovation, commitment, performance measurement
and good patient outcomes whilst at the same time adding meaning to people’s
lives by creating an environment where pharmacists can practise and be
fulfilled by their work. The Pharmacy 2020 project will do just that.”
Although I had radical change in mind nothing adequately prepared me
for the scale of change unveiled in the Government White Paper “Trust,
assurance and safety — the regulation of health professionals in
the 21st century” published on 21 February. Coming some three years
after the Government granted a new Royal Charter to the Society and following
a taxing, hectic period to develop the Section 60 Order, I am impressed
with the work rate, intellectual capital and sheer tenacity of the staff
and the Council. They have clearly accepted the public policy need to
separate the functions of the Society to reflect the Government’s
thinking. So has the profession. This presents the Society with a challenge
and an opportunity to start to develop a new focus for a professional
body for pharmacists (and others, if the members agree).
Pharmacy 2020, like Pharmacy in a New Age, is the Society’s project
to plan the profession’s future. By the time the White Paper was
published the Society had already been working on it for over a year,
but there is now a greater urgency and a greater commitment of time and
resources required. An external review of the Society’s communications
has already been commissioned. Its “Scoping the profession” project
aimed to discover what support groups and organisations exist in pharmacy
and what support they are providing to those working in pharmacy. The
Society has carried out a consultation on values and ethics followed
by the development of a new values-based code of ethics. It has also
carried out a consultation on education that will influence future education
and training. Crucially all this work has had valuable input from members
of the Society.
In terms of planning the future the Society has a good track record but
what it perhaps needs to improve on is its communications and dealing
with here-and-now issues affecting its members.
The pharmacy profession
Society is changing and the pharmacy profession has to reflect that
to remain relevant. The profession is going through a rapid change. In
addition to providing a supply function, it is being repositioned to
provide a medicines- and patient-centred health service that includes
public health and clinical services. In the wider health care world
we face a plurality of health provision and the breaking down of traditional
professional boundaries. Within the profession there are various specialists,
including an increasing number of generalists who are developing specialisms
along with opportunities to work outside dispensaries. These developments
must influence future practice, education and regulatory strategies.
So discussions about representation in a future democratic professional
body need careful thought in order to make that body relevant to the
future needs of pharmacists — and perhaps others. These new structures
should have an explicit duty to recognise and support specialisms and
diversity within the profession.
The Royal Pharmaceutical Society is facing a future with new demands
and new pressures — and possibly new competitors. Change is not
only coming more quickly but at a cost. In challenging times the Society
and all parts of the profession have to work together to maintain continuity
with the past. It also needs to evolve rapidly by being flexible and
fleet of foot. Objectives
The recent White Paper aims to ensure that regulatory bodies for health
professionals are competent and seen to be independent of their professions.
So a number of questions arise: • What is the ultimate goal of the Government?
• What problem is it trying to solve?
• What difference might the formation of a new pharmacy regulator and
a royal college make?
• Will their establishment lead to the creation of a valued, confident
and creative profession?
• What else, other than robust structures, is needed to make a demonstrable
difference to pharmacists and the public?
• What kind of leadership and followers are required to make a difference?
• How will the leadership role be organised?
In order to stimulate discussion I offer below some early personal thoughts,
which I hope are helpful.
I believe that the ultimate goal of the Government is to protect patients
and the public from any avoidable harm and to hold the health professions
and health organisations to account. The pharmacy profession’s
ultimate objective is no different and it is worth noting that motivating
and rewarding the professions is a means to an end.
My vision
My ambition is to make the UK the safest place in the world to take
medicines. The chief medical officer, the chief pharmacists for England
and Scotland
and others, including the chairmen of the Royal College of General Practitioners
and the Healthcare Commission, have all shown an interest in, and support
for, this ambition.
The vision is simple, but how will we, as an important and central part
of a multidisciplinary team, achieve the vision? It has to be through
the Society taking the lead and supporting its members and others.
I want an examination of all aspects of our work as pharmacists and to
ensure that we are seen to be demonstrably contributing to the social
good. This, as agreed by the Council recently, is about starting a critical
examination of a drug’s journey from raw material to manufacture,
from manufacture to supply, and from supply to administration. This examination
must be carried out with a view to defining areas where pharmacists,
working with others, can contribute to safety and efficacy. It should
also involve an examination of prescribing and patient experiences, in
order to improve safety. From this work we should be able to identify
what support should be provided to pharmacists who are working collaboratively
to ensure that no harm comes to patients.
What I am describing is the process of creating an empowered profession
working within appropriate structures, increasing confidence and commitment
by enhancing the value of the contribution of pharmacists in our communities,
with the Society leading and supporting the process.
Empowerment is the new buzzword, taken to be the fix-all in the workplace.
The Society is trying to meet the new challenges and is seeking to make
improvements in the way it supports members. But this needs the involvement
and commitment of members, too. Yet many members appear to resist and
withdraw from these well intentioned and much needed efforts. To develop
an empowered profession we need a new type of working relationship between
the Society and its membership.
It takes more than a few meetings or a crash programme to develop pharmacist
involvement and empowerment. It involves both pharmacists and the Society
rethinking old ways and learning new ones. It may even demand a big shift
in the way that the leadership operates.
Creating social capital and utilising it must be a new priority for the
profession as it repositions itself in a more clinical and health-related
role. Empowerment of pharmacists, too, is critical for the successful
development of health care.
Empowered work relationships share power, responsibility, communication,
expectations and rewards in ways that are different from relationships
in a traditional hierarchical organisation. The current competitive environment
and accompanying scarce resources in the profession require pharmacy
leaders to behave differently in order to be effective and to help the
profession to thrive.
We need to think about the three elements that make up what I call the
empowered workplace: • Attitudes, values, beliefs and behaviours
• Relationships, privileges and obligations
• Flatter (rather than hierarchical) structures, and learning
Each of these dimensions of the profession must adapt to create an empowered
workplace, or the effort to liberate the creativity of pharmacists will
be doomed to failure. The creation of a new professional body in itself
will not lead to better creativity.
Core mind shifts in strategy and operations of the profession are required.
The shift from getting the job done to attending to processes, taking
responsibility for the development of the whole workplace or the profession,
and solving problems using active learning, is at the core of the shift
to empowerment of the Society and the individual pharmacist. We need
to do three things: attend to processes, take responsibility, and seek
and promote learning.
The Society as a professional body, needs, for example, to do the following:
• Support pharmacists much better in dealing with here-and-now issues
as well as long-term planning and lobbying
• Create new opportunities for practice — prescribing and creation
of other new clinical and public health roles provide new areas of opportunity
• Make practice easier by developing and disseminating support tools
and guidance in a variety of areas
• Provide training and develop local and national leaders — the
National Association of Women Pharmacists has already demonstrated how
mentoring can work, so further development and rolling out of a mentoring
programme is crucial to maintaining momentum and the broad appeal of
this initiative
• Support local pharmacists through the branches and further develop
the concept of pharmacy team working, thus creating training and networking
opportunities for pharmacists and support staff
Where does clinical governance fit into all this? In addition to reaching
its goal of dispensing safely and appropriately, a pharmacy team must
look at how it gets there. It must be able to reach the goal again and
do things better next time. It must develop self-awareness of how it
does things, and this understanding must be shared within and outside
the team.
In the empowered pharmacy team, everyone has the responsibility that
was traditionally given to the pharmacist or leader. If anyone, including
support staff, sees a problem or has an idea, he or she is responsible
for bringing it to the team. The idea must be respected, and everyone
should be engaged in looking for ways to grow and develop pharmacy practice.
It is not enough for only the pharmacist or leader to do this.
In the past the Society has been reactive in some areas, either to Government
plans or to the general environment. In an empowered organisation, people
are willing to take action, to seek out and solve problems, to take risks,
to speak out and to work together. They do not wait to be told and they
are not paralysed by fear or caution.
There is much talk of leadership without anyone saying precisely what
they mean by it. In my view leadership generally involves helping people
do something differently from what would have done without your involvement — in
short, a departure from the status quo. We at the Society want to offer
the kind of leadership that those in the profession want to willingly
follow. So at this time we need to discuss the relationship between the
two and the following:
• Clarity of purpose of the exercise to form a professional body
• Morale — what will raise morale within the profession?
• Fairness — ensure all sectors and individuals feel that there
is fairness in the system
• Recognition of diversity, specialisms, and individuals who excel
• Team work — organising local branches, national boards and work
with the professional body
• Participation — if there is a duty to recognise excellence
and achievement, should there be a complementary duty to participate
in events
and programmes?
• Communication — a new communications strategy at the Society
is under preparation and this will, I hope, address the issues raised
In conclusion
The Royal Pharmaceutical Society has to deal with a vast range of issues
and does not get it right every time. It needs to take action through
better communication and strategies to ensure that the views of members
and others are welcomed and considered appropriately. The Society needs
to remember that there is no generic pharmacist and that he or she
is a human being with responsibilities outside work and needs broader
support as a member of a society.
And what about members’ responsibilities? Let me quote Walter Kiechel,
former editorial director of Harvard Business School Publications: “Hereinafter,
employees will assume full responsibility for their own careers — for
keeping their qualifications up to date, for getting themselves moved
to the next position at the right time, for salting away funds for retirement
and, most daunting of all, for achieving job satisfaction. The company,
while making no promises, will endeavour to provide a conducive environment,
economic exigencies permitting.” |
The
Pharmaceutical Journal