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Letters to the Editor
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White Paper
A professional issue
From Professor A. R. Michell
Lord Hunt (PJ,
19 May, p583) asserts that the reorganisation of health care regulation
stems from public expectation. I prefer to believe the
White Paper which tells us (paragraph 18) that “public opinion
research continues to show a high degree of trust in health professionals”.
Would similar research show the same for the degree of public trust in
politicians and the regulation of their activities? Why not reform that?
The
research I commissioned for the report Good Doctors, Safer Patients (PDF 2.1MB)
suggested that the public said that they were satisfied with the regulatory
system. They did not say fairly satisfied,
mostly satisfied,
or satisfied in some respects, but satisfied. This reorganisation is
politically driven, as amply confirmed by the fact that the principles
underlying the Kennedy Report, embraced by the Government as the blueprint
for the future of health care regulation in the NHS only six years ago,
when we were all well aware of the crimes of Harold Shipman, have simply
been brushed aside. Despite the fact that it contained some 200 pages
specifically on the principles of regulation for health care, its shortcomings,
if they exist, are not even considered or debated.
We should not be surprised. The dealings on the future of pharmacy have
been out of the same “rush to misjudgement” stable that gave
us the out-of-hours care debacle, let alone the junior doctor training
placement disaster. This intemperate haste is not in the public interest,
let alone the tax payers’ interest; it is generated by political
impatience.
Nor is it confined to the Department of Health: the Prime
Minister took personal charge of the 2001 foot and mouth epidemic and
presided over the most harrowing, expensive and unnecessary slaughter
of animals in our history — at a cost still 65 per cent higher
than the combined costs of the wars in Iraq and Afghanistan to date.
That sort of money could have financed the Medical Research Council’s
research for five years.
The Government has already vested the future public interest in pharmacy
in the proposed General Pharmaceutical Council. Whether the heir to the
remaining activities covered by the Society’s charter is a royal
college or something else is not really the Government’s business;
the new body will surely act in a way consistent with the public interest
but not necessarily in the public interest.
Indeed it should be primarily
concerned with the future role of pharmacy, including the potential benefits
for public health and the interests of pharmacy professionals — a
matter for the pharmacy community and those whom it serves. The public
interest is not synonymous with the short-term interests of any Government,
especially an administration in its dying days, with an expiring electoral
mandate.
The saddest aspect of these events has been the way members of the Society’s
Council have been treated, by Government, like irritating prefects obstructing
the headmaster’s orders. Obsessive secrecy has been imposed, preventing
the Council from properly consulting the profession in an era of “openness
and transparency”, as if we were discussing the design of our next
generation of weapons of mass destruction.
As the noble Lord says, leadership
of the pharmacy profession is primarily a matter for the profession
itself. It is not a matter on which Government ministers should be seeking
to
advise pharmacists. The doubts which ministers may harbour in their
minds, or what they may want to see, are irrelevant to what is primarily
a professional
issue with a public interest context. Bob Michell
Member of Council
Royal Pharmaceutical Society
Free from other influences and controls
From Mr R. Dickinson, FRPharmS
I have been trying to follow the debate on the professional organisation
that will emerge from the regrettable and unnecessary decision to form
a General Pharmaceutical Council. Many are advocating a body that would
be entirely different to what would be left of the Royal Pharmaceutical
Society, in terms of membership, objectives and activities.
Initially
a body “akin” to a royal college was suggested but more recently
we see references to a royal college without any qualification (Lord
Hunt’s letter in the PJ of 19 May, p583, and others).
I am presuming that what is meant is a body with a Royal Charter and
with permission
to use “Royal” within its title.
For some decades now, for a body to be granted a Royal Charter it needed
to demonstrate, over a period of years, that its activities, and the
way in which they were carried out, warranted such an honour. Subsequent
permission to use “Royal” in that organisation’s title
was only given after substantial further experience of its performance
as a chartered body. Does this mean that the Government, through the
Department of Health, has devised a means of establishing an “instant” chartered
body using “Royal” in its title?
Furthermore, during my time at the Society as deputy secretary and before,
the responsibility for the establishment and supervision of such a body
lay with the Privy Council Office, through the Lord President of the
Council and the Clerk to the Privy Council. When the Society wished to
seek changes, for example, the introduction of the registration examination,
the approach would be to the Clerk, who would seek comments from relevant
government departments.
In this case the main departments would have
been health and education. On important issues there would then be a
meeting, involving representatives of the Society, to resolve any differences
of approach and eventually a decision would be made. It seems strange
that only the DoH and its spokespersons have taken the lead in recent
discussions about the fate of the chartered Society. Has there been a
significant increase in the DoH’s influence over chartered bodies
in the health arena?
My thoughts were first drawn to the above when I noted that government
pharmacists shared the platform with the President of the Society at
a meeting discussing the future arrangements for pharmacy’s professional
activities. There has also been support from at least one of them for
the formation of a royal college with no reference to the normal procedure
for doing so. Now we have the minister with responsibility for pharmacy
joining the fray.
All of this begs the question of whether such a body,
rising from the ashes and assets of the Society and with the DoH so
involved in its evolution, would fulfil the aspirations of those who
see the proposed
removal of self-regulation from pharmacy as an opportunity to establish
some form of completely independent professional organisation, free
from other influences and controls, run by the profession for the benefit
of its members. Raymond Dickinson
Former Deputy Secretary
Royal Pharmaceutical Society
Forget political correctness — let us get to the point
From Mr A. Matalia, MRPharmS
Hemant Patel stated the Royal Pharmaceutical Society is working
to create a royal body for the pharmacy profession (PJ,
31 March, p369-370). Would he care to state, for the record, whether
he expects or wants membership
to be voluntary or compulsory?
Furthermore, why is the Society considering technicians be part of the
proposed royal college of pharmacists? I do not subscribe to this political
correctness nonsense. Ask any member of the public and they will tell
you the pecking order is doctors, pharmacists and then technicians. The
general view is that pharmacists are inferior to doctors, but superior
to technicians.
I would go so far as to suggest most people do not view technicians as
a profession. Most are not educated to degree level. They may have delusions
of grandeur, but like it or not, that is the reality. So why on earth
do pharmacists want to “marry” below their rank? Surely,
they should seek allegiances above their rank. Not that doctors would
ever accept them.
Instead of aspiring to greater things, why does the Society seek an alliance
with the technicians? Technicians should never have been provided discounted “membership” and
should now be told to fend for themselves, as only then can both camps
promote their own interests.
Maybe the Society realises it does not have a future without conscription
and is desperate to attract members, wherever they come from. I just
wonder if they will next try to regulate counter assistants and pharmacy
cleaners.
A. Matalia
Coventry
| |
HEMANT PATEL, president of the Royal Pharmaceutical Society, responds:
The
Government White Paper on the regulation of health professionals
published in February proposed the creation of a General Pharmaceutical
Council to carry out regulatory functions currently undertaken
by the Royal Pharmaceutical Society. It also called for a body
akin
to a royal college to provide professional leadership.
A short-term working party, led by Lord Carter of Coles and including
the Society, was established to work on the proposals to form
two separate bodies to oversee pharmacy. Last week Lord Carter
published
his recommendations which have been reported in the PJ. The recommendations
call for consideration of technicians and pharmaceutical scientists
as associate members of the proposed professional body. The Society
believes that its members must determine the future of its professional
body and that the following are necessary to underpin the formation
of the GPC and body akin to a 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 body akin to 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
At this stage it would not be helpful to start ruling any group
in or out of a future professional body since that will be decided
by the members. Much informed discussion and debate has to take
place first in order to canvas the profession’s opinion
on the White Paper proposals.
The Society has started the process of engagement and has already
hosted two major stakeholder meetings on this issue. A report
from the latest which took place on 30 April is available on
the Society’s
website.
I expect membership of a professional body to be voluntary but
compellingly desirable from the member’s point of view. |
Butt out Lord Hunt
From Mr M. A. Walker, MRPharmS
Lord Hunt appears to be against the Royal Pharmaceutical Society being
transformed into a royal college (PJ, 19 May, p583). If pharmacists,
through our professional body, the Society, do not petition for a Charter,
then I cannot foresee any other body fulfilling the requirements for
petitioning for a new Royal Charter. The small groups invited to the
King’s Fund meeting (PJ, 31 March, p357) seem to have
given the Government the answers it wanted. However, when the vast majority
of
members (unrepresented at this meeting) realise that our professional
representation is at risk, a different response will be generated.
The Department of Health will probably have a new Secretary of State
in July, who I hope will end any political interference in our professional
deliberations. In the meantime, I join with Alan Rogers’s annual
general meeting phrase to say, “butt out, Lord Hunt” (see
p626). Leadership of our profession is entirely a matter for our profession.
The Society is far from perfect but it is the professional body for pharmacists.
I have criticised the Society many times in the past. However, I hope
that the Society is transformed into a professional body which, at a
minimum, represents pharmacists as professionals and is a world-class
publisher (my personal vision for a pharmacist’s professional body
has a much greater scope than this).
The Institute of Pharmacy Management International advised that “a
review of other options to a college is imperative”. An institute
or society seem likely to be better options, since forming a royal college
could well be a poisoned chalice.
Our professional deliberations, which started in March 2007, are really
just beginning.
Mark Walker
Oxford
Pharmacists should have own body
From Mr G. S. Phillips, MRPharmS
I refer to Steve
Acres’s response (PJ, 19 May, p584) to my letter.
The Association of Pharmacy Technicians UK claims it is an organisation
run “by technicians for technicians” as a fundamental principle,
yet Mr Acres would deny pharmacists their own professional body run “by
pharmacists for pharmacists”. I am not sure why this is. Membership
of a new royal college will be voluntary. If it is not solely for pharmacists
it is doubtful that many of us will join.
Mr Acres is evasive as to his association’s makeup but admits that
it has less than 10 per cent of technicians in membership and only one
community technician (in a position reserved for community technicians)
on its executive. It, therefore, cannot legitimately claim
to be representative. This is significant because if technicians
are offered the opportunity to become members of an over-arching professional
body akin to a royal college it is highly unlikely they will be prepared
to pay for membership of APTUK as well. Since this body will inevitably
be dominated by pharmacists, technicians will have lost a voice of their
own.
As Mr Acres admits, there are obvious conflicts of interest around how
far technicians can further extend their roles without endangering public
safety. I agree. This is especially the case with issues like remote
supervision and the role of the responsible pharmacist. Where I part
company from Mr Acres is that conflicts like this can best be resolved
within a single organisation. The principal criticism leveled at
the Royal Pharmaceutical Society is that it has been too conflicted,
while being the regulator, to act as an effective champion for pharmacists’ professional
aspirations. The last thing we need is to swap one conflicted organisation
for another — none of the medical royal colleges include support
staff within their membership.
Does all of this mean I am “anti-technician?” Absolutely
not. Technicians are invaluable members of the pharmacy team, as
are dispensary and medicines counter assistants. An effective solution
is not difficult to conceive: in my view the body akin to a royal college
should be for pharmacists only. It should develop strong and effective
links with organisations like APTUK and others, such as the Academy of
Pharmaceutical Scientists. APTUK, meanwhile, should concentrate on putting
its house in order and becoming a legitimate, democratic voice for pharmacy
technicians and other pharmacy support staff.
Graham Phillips
Member of Council
Royal Pharmaceutical Society
A royal college and an association is needed
From Mr. J. B. Paige, MRPharmS
The Royal Pharmaceutical Society is poised to take a leap into the unknown,
as is the practice of pharmacy itself. Contributors to the debate all
agree that the right structure is vital, if the profession is to thrive
or even survive, but they differ on the form it should take. Now that
the Government is taking over the responsibility for registration and
discipline, some want an organisation that will represent pharmacists
as a sort of trade union, while others want a royal college that will
take responsibility for professional development, training and producing
publications. Why do we have to have one or the other? Why not both?
As the electronic prescribing service takes effect and the Government
continues to squeeze costs, the bulk of dispensing will move to large,
automated facilities. Pharmacy chains, wholesalers, etc, will set up
centralised dispensing “factories”, distributing completed
prescriptions through local pharmacies or by direct-to-user mailing.
As this change advances, the number of pharmacists directly involved
in dispensing will fall dramatically.
The real future for most community pharmacists will probably be as “pharmacists
with a special interest”. This is work that patients need and can
easily understand, and which can been carried out through the existing
network of community pharmacies. It is also a role for pharmacists that
would integrate smoothly with other health care professionals and earn
their respect.
The Government has defined this new direction for community pharmacists
but the profession will need to put in place the necessary education
and training and make sure that health authorities make full use of pharmacists’ potential
in this area. A royal college of pharmacy will be needed to take over
the educational functions of the Society and put in place suitable programmes
to prepare pharmacists to become practitioners with special interests
in all the different areas of therapeutics.
At the same time, a British
pharmacy association will be needed to promote pharmacy and ensure
that pharmacists are not exploited by those organisations that see the
profession
solely as a way to make an easy profit. To gain the confidence and
support of pharmacists, the Government and the public, the two bodies
will need
to have different constitutions and personnel but there would be an
obvious advantage if they were able to work closely together. For this
reason,
I would like to see the royal college of pharmacy and the British pharmacy
association share the premises soon to be vacated by the Society. Barrie Paige
Vale,
Guernsey
Let us form a body equivalent to the BMA
From Mr G. L. Stafford, MRPharmS
All the talk is of a royal college. For my part I do not care one
way or another. My guess is that neither do most of my colleagues.
If there was a vote on it now, what percentage of the electorate would
even bother to vote?
My opinion is that the silent majority need a strong representative body. Let
us get on with forming the pharmaceutical equivalent to the British Medical
Association. That would get my vote and the politicians can tinker
about with societies and colleges until the cows come home.
What I want is someone to represent me.
Graeme Stafford
Morecambe,
Lancashire |
The
Pharmaceutical Journal