The Pharmaceutical Journal
Vol 278 No 7451 p548
12 May 2007

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’Tis the set of the sails and not the gales, that decides the way to go

By Chijioke Agomo

I received a card last Christmas containing a quotation by Ella Wheeler Wilcox: “One ship drives east and another drives west, with the selfsame winds that blow. ’Tis the set of the sails and not the gales, that decides the way to go.”

While contemplating the wisdom behind the words, I began to appreciate that it was actually the setting of the sails by the captains of the various professions that determines the direction each profession is heading and not necessarily the pressures and expectations (gales) faced by them. In other words, it is the existence of, or lack of, flexibility and adaptation to change (the setting of the sails) that predicts the fate of any profession.

Changes

Over the years, there have been several changes affecting the ways health professionals perform their duties. The medical profession, due mainly to its number and impact on health care delivery, has dominated policies within the health care systems for a long time. However, this cannot completely explain the unfavourable situations that are sometimes seen in pharmacy. These unfavourable conditions range from poor remuneration and job satisfaction to lack of adequate representation and over-regulation, which stifles innovation within the profession.

Interestingly, both the Royal Pharmaceutical Society and the UK government are constantly developing new roles for pharmacists, resulting in the development of new services and initiatives within the profession. However, some critics of the profession are now questioning the quality and the relevance of some of these services provided by pharmacists to the general well-being of the patient (PJ, 3 February, p123). To further prepare pharmacists for these services, some relevant suggestions made so far include the general overhaul of profession, particularly in the area of pharmacy practice and education. The Society seems to be responding to this suggestion.

At the same time, one cannot fail to point out that the future of the profession lies mainly in the hands of the members of the profession. The future will be brighter if we pursue well-defined agendas and think strategically. The recently published government White Paper advocating the separation of the Society’s functions, although not completely accepted by all within the profession, if managed efficiently could actually help to propel the profession to heights never envisaged by many.

By splitting the Society, the Government may actually save the Society from an inevitable self-destruction, due to conflict of interests. Not many pharmacists seem to be bothered with the structure of the regulatory side of the split (General Pharmaceutical Council), but the structure of the emerging representative body (for now, a body akin to a royal college) is now generating much debate, thereby indicating its relevance to the well-being of the profession.

One point that seems to be coming out is that the representative body will take the form of a college, with the main objective of uniting the various groups within the profession (of which there are 188). Whether the representative body is going to be inclusive or exclusive, voluntary or compulsory is yet to be determined. However, as one of those pharmacists who foresaw what was coming and at many times suggested that, a split of the dual role was the only way forward for the Society, my suggestion will be that although the Government has enabled the splitting of the Society, to be fair to the membership and give them a sense of belonging, the format and future of any emerging representative body should be left for the membership to decide. The representative body can take whatever structure it likes, but to make it relevant to the profession it needs to be voluntary and, in my view, able to represent individual members and the profession. Moreover, its pronouncements need to be binding to all.

Many are suggesting that the new representative body for pharmacists should be inclusive in order to be relevant to all. Although, the British Medical Association is an inclusive organisation (inasmuch as it admits doctors and medical students), its main focus of protecting the interest of doctors is undeniable. The American Pharmacists Association is another inclusive organisation with a commitment to represent the interests of pharmacists in the US.

The way the profession is developing, it is important that pharmacists realise that they are now an endangered member of the profession. With issues such as personal control, remote supervision, responsible pharmacist, and the hypothesis of no difference between pharmacists and pharmacy technicians being widely discussed, pharmacists do stand the chance of becoming extinct professionals in the UK in the near future, particularly if they do nothing to save themselves first, before saving others.

The new strength and popularity of the nursing profession and the recognition of pharmacy technicians as professionals will exert pressures on the existence and relevance of pharmacists. The question now is, can UK pharmacists move from their comfort zones and maybe take on some of the roles already being handled by other health care professionals? These are the challenges which the new royal college-type body must overcome to make itself credible.

Taking on the extra load of inclusiveness to all professions related to pharmacy may be too much to carry, at least for now. This becomes important when one realises that these other professions which we want to include in our new representative body, are either not seeking inclusion or already have their own representative bodies, for example, the Association of Pharmacy Technicians UK.

Moreover, as more than 5,000 pharmacy technicians are now registered with the Society, one would not be surprised that in the next few years the number of pharmacy technicians might equal or even surpass that of pharmacists. It will be too late then, as the argument will then be on who owns the representative body. As registration of pharmacists and pharmacy technicians with the GPC will be compulsory, I do not think that registered technicians and others will have much to gain by being members of three organisations.

Issues

There are several issues, which will confront pharmacy and pharmacists in UK in the coming months and years. Many of them will involve not just their academic achievements which I am sure will be handled efficiently by the emerging royal college, but many of them will dwell on remuneration of pharmacists and their staff and also other issues relating the survival and relevance of pharmacists. Some of these issues will be beyond the scope of a college without a trade union activity as seen in the Royal College of Nursing or even the BMA. Experimentation with untested models will do no good to the profession, but will further divide the already divided profession and further alienate the members.

The representative body for pharmacists in the UK will function better if it is focused and willing to serve only one master at a time. These other numerous organisations, which are not pharmacists’ organisations, can affiliate themselves to the representative body for pharmacists in order to create good working relationship and also retain their independence.

The pharmacy profession in the UK should set its sails such that when the inevitable gale that blows on all professions blows on it, it will not be stranded at sea, but will sail safely to the promised land.