| Much has now been written on the future role of the Royal
Pharmaceutical Society, once regulatory matters have been passed to a
new General Pharmaceutical
Council. There are widely diverging views on the way forward, and one
can only agree with the editor of The Pharmaceutical Journal in
asking “whether
the Government understands what it is doing”, since “it
has handed pharmacy a Pandora’s box” (PJ, 5
May, p512).
The Society’s
Council has been criticised both for failure to consult the membership,
and for failure to issue strong leadership on the subject. In view of
the contradictory nature of those obligations, and the timescale that
has been set by the Department of Health, I have some sympathy with the
Council’s dilemma. But a lay member, Bob Michell, has revealed
that the DoH actually tried
to prevent the dissemination of information (PJ,
14 April, p436). Those of a cynical nature might suspect a campaign of
subversion originating in the corridors of Whitehall.
Ten years ago, Bryan Hartley, the chief pharmacist at the DoH, praised
the Society and said that the DoH needed the support of the Society if
it were to be as effective as possible in health care policy development.
The Society devoted the intervening decade to providing that support,
and complied with every demand to change its governance, so that it could
continue to perform both its regulatory and representative functions.
In allowing the demands of the DoH to take priority over the needs of
its members, it alienated the many pharmacists on whose loyalty it will
now depend.
Now, at a stroke, the DoH has announced a change in policy, and expressed
a lack of confidence in the Society’s leadership. Lord Carter’s
working party was set up to review the implementation of the new arrangements
for regulation of the profession, but the DoH also wanted to set up another
working group to oversee the formation of a body akin to a royal college.
This demonstrates an insidious desire to restrain our professional freedom,
and perhaps explains the pressure that is now being placed on the Council
and on the profession.
The chief pharmaceutical officers for England and Scotland both set out
their views at a King’s Fund seminar on professional leadership
in pharmacy on 20 March. Keith Ridge tells us that the “profession
now admits there is a need for stronger leadership and has accepted that
splitting the functions of [the Society] is desirable”. Really?
I think we are simply accepting the reality of a decision that has been
imposed on us. He goes on: “This is not simply a matter of evolution
but of revolution. Only a minority of pharmacists would join [the Society]
now were it not mandatory. Whatever organisation eventually emerges must
be and must be seen to be a new organisation.”
It is an unusual and perhaps dangerous strategy for a government representative
to call for revolution. It may also be unnecessary. Relieved of the burden
of its regulatory responsibilities, the Society has greater potential
to give effective leadership and representation than any new body.
Although Dr Ridge appears to want stronger leadership, he does not mention
professional representation in his description of what a royal college
would do. He says “it would act as a central focus for the body
of pharmacy knowledge in order to drive forward patient care”.
He goes on to say that “there is not much time to get it reasonably
right and convince pharmacists of the value of a royal college”,
but he is setting the onerous timescale and, as Bob
Michell has observed
(PJ, 26 May, p607), the outcome of this Government’s hastily
conceived policies is grim, and certainly not in the public interest.
What Dr Ridge
describes as time-wasting, wiser men might refer to as meaningful
debate.
Bill Scott mentioned “scholarship, and a body of knowledge” as
characteristics and attributes of the profession in his presentation,
but insisted that “the royal college would provide professional
leadership and vision and it would be the authoritative voice and champion
for pharmacists and pharmaceutical scientists”. He expressed concern
about the 188 different organisations identified by the Society’s
scoping exercise and believed that the proposed model would provide an
opportunity to bring those groups, particularly those catering for specialists,
into a single “royal college”. A close look at this 188 groups
reveals that only a handful would be capable, or willing, to join together.
And those that represent specialists would hardly be representative of
the profession.
The discussion groups at the seminar pointed out that pharmacists would
ask “what’s in it for us?”, but Mr Scott believed that,
because of the rapid change in pharmacy practice, this was the wrong
question. He is wrong: it is the right question. And it should be asked
not just once, but at every juncture in this debate. What is in it for
us as a profession? What is in it for us as individuals? What are the
benefits? What are the risks? What are the alternatives? The issues are
linked, and they are the key to the success of any body that arises from
the ashes of our Royal Pharmaceutical Society.
Carwen Wynne Howells, chief pharmaceutical adviser for Wales, set great
store by the fact that we were being
given a blank sheet of paper (PJ,
24 February, p207), but what we actually appear to have received is the
back of a cigarette packet, covered with the hastily scribbled and ill-conceived
notes of a brainstorm by ministers and civil servants.
There seems to
be no consensus on the role of the new body: only a desire to destroy
the old. Of course, civil servants have become used to empires being
created and destroyed, of departmental boundaries being redrawn, all
on the whim of a minister. But just as attitudes and policies within
the DoH have changed drastically in the past 10 years, so they will again.
It
took the Pharmaceutical Society 147 years to earn its Royal patronage,
and we must not allow it to be sacrificed in the latest modernisation
purge. As Raymond
Dickinson, a former deputy secretary of the Society,
asks (PJ, 26th May, p607): does the DoH now have the authority
to destroy and create Royal chartered bodies?
We must hope that the political impatience perceived by Bob Michell is
now matched by the impatience of the profession at this unwarranted interference.
We have heard the views of the President Hemant Patel, of the “minority
interest groups” and of the usual movers and shakers, and now we
need to hear the views of every pharmacist (especially the generalists,
as we are patronisingly described). Let us prove that we are perfectly
capable of governing our profession without being bullied by Lord Hunt
and his henchmen.
So where do we go from here? The spectre of a body with “a role
akin to that of a royal college” has given rise to reactions ranging
from euphoria to panic, but the most common is confusion. What is its
purpose? Will it be inclusive or exclusive? Who will decide, and when?
What will it cost? Perhaps it is time to read the small print.
The phrase first appeared in the White Paper, “Trust
assurance and safety — the regulation of health professionals in the 21st
century”. Following from the announcement that the Society “needs
to separate its regulatory system from its system of professional and
clinical leadership, allowing each distinct function to focus on its
core role”, the White Paper continues that “the profession
will need a strong and clear voice to assume the critical responsibility
of a role akin to that of a royal college”.
So, it says nothing about actually becoming a royal college. It refers
to both professional and clinical leadership; it says it should be a
learned and authoritative organisation, supporting excellence, professionalism
and innovation; it refers to both the science and practice of pharmacy;
and it specifically gives the option of the Society redefining its leadership
role. Only in the frenzy since its publication have people sought to
move the goal posts, suggesting that we need a new organisation with
a new name, and I fear that this is more about power politics than about
excellence and professionalism.
Medical royal colleges are primarily concerned with improving clinical
and professional standards, and membership is by examination or assessment.
They manage to combine strong professional leadership and advocacy alongside
their role in promoting high standards in patient care. They restrict
membership to qualified medical practitioners and trainees, although
the Royal College of Paediatrics and Child Health has an affiliate status
for non-clinicians and the Royal College of Obstetricians and Gynaecologists “supports
other organisations having similar objectives to those of the college”.
(Perhaps this could be a non-controversial model for working with our
technicians.) No college has either a regulatory or trade union role
and fees are in the range of £100 to £400 per annum. There
are precedents for societies to become colleges: societies of psychiatrists
and ophthalmologists were transformed more than a century after their
initial
formation.
If the medical royal colleges are presented to us as a role model, we
must ask whether pharmacy has comparable influential organisations other
than the Society? The final report of the Society’s “Scoping
the profession project” identifies 188 unique support groups, but
this figure is misleading in my view. Many of them are local or regional
groups, such as pharmacy development groups, local pharmaceutical committees,
networks and forums.
Nationally, they included the National Pharmacy
Association, the Pharmaceutical Services Negotiating Committee, the Guild
of Healthcare Pharmacists, and primary care organisation support groups
that would not fit into a royal college-type framework. The signatories
to the Waterloo
agreement (PJ, 31 March, p357), which were vocal in opposing
a revamped Society, were mainly small specialist organisations, most
of which welcomed the chance to work together, but were wary of losing
their identity.
Of these signatories, the UK Clinical Pharmacy Association is the largest.
It was founded in 1981 with the aim of supporting and encouraging the
emergence of clinical pharmacy. It has around 2,000 members, who do not
have to be pharmacists.
Another, the College of Pharmacy Practice, was founded by the Society
in 1981 to promote excellence in pharmacy practice along with continuing
education and training. It became independent a few years later. Associates
submit a record of their continuing professional development each year,
and may move to full membership by undertaking a portfolio assessment.
The college has suffered a fall in membership in recent years, and now
has fewer than 1,000 pharmacists on its roll. It has independent faculties
of prescribing and medicines management, and of neonatal and paediatric
health, as well as a public health interest group.
Although both these bodies have achieved great success with small groups
of enthusiasts, they have not been able to recruit widely in the mainstream
of community pharmacy, or to become established as a respected body outside
the profession. Let me, therefore, submit a commonsense blueprint for
the future, one that at least offers a starting point for a debate.
If our new organisation is to hit the ground running and to be sustainable,
we must build on the strengths that we have. I hold no brief for the
Society, and I have frequently been vocal in my criticism of its leadership.
However, it has the infrastructure and a solid reputation we need to
form the umbrella organisation for professional leadership.
The Society
should be split immediately into two distinct departments, regulatory
and professional, each with its own separate budget. All the other national
pharmaceutical bodies should then join with the Society in a “confederation”,
which would review current activity, explore areas of common ground,
and put forward proposals for alternative structures, governance, policy
and remit for a future body.
The Society’s greatest fault in recent
years has been poor communication, both with the membership and with
the public. These discussions must be well publicised, with an opportunity
for members to comment, or submit their own ideas. A dedicated website
should be set up for this purpose, and written comments and journal articles
should be posted on the site.
The difficulty of this transformation process
should not be underestimated: working together as part of a team; trying
to integrate minority interests without upsetting the majority; splitting
off the regulatory function safely; and meeting a tight deadline. The
President must provide inspirational professional leadership at this
critical time and ensure that members are told the full facts, however
unpalatable, in plain English rather than in management jargon.
The College of Pharmacy Practice could form the ideal vehicle for driving
forward clinical leadership and excellence but it must once again become
part of the Society to maintain cohesion and financial viability. The
UKCPA and the small special interest groups could become faculties within
it. This would offer an interim solution to the inclusive/exclusive argument,
namely, membership of the Society for all pharmacists and pharmaceutical
scientists, with a voluntary route to higher qualifications via the college.
Pharmacy technicians should be eligible for affiliation to the college,
offering them access to higher qualification, but they would continue
to be represented by the Association of Pharmacy Technicians UK, avoiding
any potential conflict of interest.
The Society’s local branch network is currently dependent on the
enthusiasm of volunteers, and must be strengthened to provide a local
face for the college. Boundaries should correspond to primary care trust
areas, and local pharmacy development groups should become part of the
branch structure.
The Society’s information resources, including the library, are
probably underutilised, and should be marketed as part of the educational
package of the college. Consideration should be given to working closely
or even combining with the NPA’s information department.
I have tip-toed around the crucial problem of funding. Even using the
main Society infrastructure as a starting point, the new body will face
a several difficult years adjusting to its new role. Members will also
take a few years to decide whether it is fulfilling its purpose in terms
of professional leadership and clinical advancement. It will need a guaranteed
income to achieve stability, in addition to Government funding to finance
revalidation and to compensate for the work forced upon us. Membership
will have to remain mandatory for a transitional period of, say, five
years.
And one last plea: can we please boycott this wretched term, “body
akin to a royal college”, which has caused us so much grief? Let
us pull together to create our “body for professional and clinical
leadership”. If we can achieve this remarkable transformation,
then we can consider giving it a fancy name. |
The
Pharmaceutical Journal