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Pharmacy in Scotland is different from pharmacy in England and Wales.
This is hardly news: since health policy is devolved to the Scottish
Government, differences in approach are inevitable. The reason these
differences matter now, however, is because they might influence the
structure of pharmacy’s future professional body.
The Clarke Inquiry is currently examining options for a professional
body for pharmacy. Some pharmacists in Scotland say that they get a poor
deal from the current professional body, the Royal Pharmaceutical Society,
because most of its functions are based in London. When the Clarke Inquiry
started so, too, did rumours that pharmacists in Scotland wanted to break
away and set up their own professional body.
Is there any truth in the rumour? Well, yes, some do want a separate
body in Scotland. But the vast majority who spoke to The Journal for
this article support a federal model, in which power is devolved to a
Scottish board but which would remain part of a larger organisation covering
the whole of the UK.
Importance of devolution
Rose Marie Parr, chairman, and Frank Owens, vice chairman, of the Scottish
Pharmacy Board, spoke to The Journal together. The board proposes a
structure in which a UK-wide professional body is formed but power
is devolved to national boards.
“The professional body should
operate GB-wide, or preferably UK-wide, but must be able to understand
and reflect the differences in policies, practice, demography and geography
of each country,” explains Dr Parr. “Each national board
should have sufficient authority to manage its own affairs and should
be able to decide the matters on which co-operation is mutually beneficial.”
Speaking in a personal capacity, Bill Scott, Scotland’s chief pharmaceutical
officer, also proposes a federal model. He says this would involve separate
professional bodies in England, Scotland, Wales and Northern Ireland,
each with its own president, that come together in a UK-wide organisation
that provides head office-type functions.
“I believe there is support
in Scotland for autonomy and an independent voice for pharmacists in
Scotland without going as far as complete separation,” he explains. “The
federal model would allow a professional body in Scotland to have the
autonomy to speak for and to represent pharmacists in Scotland. The individual
professional bodies would then decide when a collective approach should
be taken.”
David Thomson, Royal Pharmaceutical Society Council member for Scotland,
says: “At this stage, I favour retention of the national boards,
albeit with more authority and autonomy than present, linked to a federal
structure with a much smaller national council in place to support this
network.”
Perhaps Graeme Millar, a former chairman of the Society’s Scottish
Executive, sums it up when he says the answer lies not in independence
but in a stronger sense of devolution. “A federal structure would
give autonomy in each country but it would retain the benefit of a collective
when the countries came together,” he comments.
Without devolution, this debate would probably never have happened. Devolution
has resulted in different NHS structures, different approaches to planning
services and different community pharmacy contracts. Devolution is certainly
the reason behind the Scottish Pharmacy Board’s desire for greater
autonomy in Scotland.
Rose Marie Parr: needs of members in Scotland can only be met by
a body that has a physical presence in Scotland |
“A successful professional body must be able to understand the
aspirations of its members and be able to positively influence the environment
within
which they practise.
“It must have a full understanding of the political
and cultural environment, and be close to both its members and to those
who develop policy and plan services. This clearly means that the needs
of members in Scotland can only be met by a body that has a physical
presence in Scotland,” explains Dr Parr.
Mr Scott also quotes the significance of devolution. “Health services
have separated: people have different views on devolution but it is a
reality and we have to work with it. When people seek to work with or
get advice from a professional body, they should get advice that is pertinent
to Scotland, not advice cleared by a body based elsewhere,” he
comments.
Mr Millar spells this out when he says: “The Scottish Parliament
has no time for people who say they have to consult with colleagues in
London before responding to questions. The federal structure would
allow the organisation in Scotland to be
influential.”
James Semple, managing director, TLC Pharmacy Group,
comments: “There
is now a cross-party consensus in Scotland that devolution is a process,
not an event. Health policy in the devolved nations continues to diverge.
“NHS
Confederation boss Gill Morgan recently stated that there are now four
different NHS systems operating in the UK and there is corresponding
need for a professional body which truly represents its members, and
can speak with authority and autonomy on any subject which affects those
members.”
Lyndon Braddick, director for Scotland, Royal Pharmaceutical
Society, says: “Pharmacists want a single, clear and strong voice
for the pharmacy profession. A strong professional body has to be effective
at
influencing at four levels. These levels are:
• at a local level which,
in Scotland, means health boards, community health partnerships and members
of the Scottish Parliament
• at a national level with the Scottish Government
and Parliament
• at a UK level with the Westminster Government (because
of the legislative framework within which the profession practises)
• at a European level
To have a strong and influential voice at those
four levels, I think the most effective approach is a single organisation
for Great Britain, preferably for the UK, with a devolvement of power
and responsibilities to three or four national bodies.” Time to separate
Arguing for a separate professional pharmacy body in Scotland is Harry
McQuillan, chief executive officer, Community Pharmacy Scotland. “I
think there is an opportunity that should be fully explored to establish
a separate body for Scotland. I believe there are other models in the
world where it works, involving similar numbers of pharmacists as there
are in Scotland. And I believe we have the people in Scotland to make
it happen,” he says.
Community Pharmacy Scotland is currently collecting evidence for its
submission to the Clarke Inquiry by surveying its pharmacy contractor
members. It is asking them: “Should there be a new professional
body specifically for Scotland?” Mr McQuillan says that the results
will not be known for another week but he comments: “So far, significantly
more people have said ‘yes’ than ‘no’. But more
people have said ‘no’ than I was
expecting.”
One pharmacy contractor answering with a resounding “yes” is
Campbell Shimmins, a community pharmacist in Doune. “Of course
it is time for Scotland to have a separate, autonomous professional body.
It is increasingly looking like it is necessary: things are coming out
of Lambeth that are either not relevant or the ramifications haven’t
been thought through in terms of the devolved administrations,” he
says.
Mr McQuillan cites similar concerns. “Over the years, I have lost
confidence in the ability of an organisation based in London to fully
represent us in Scotland,” he explains. The crux of his complaint
is that the Society sometimes gives the impression it is acting at an
English, rather than a British, level.
For example, Mr McQuillan points out that many Society documents and
statements refer only to a single pharmacy contract (the one that applies
in England and Wales), apparently forgetting that Scotland has a different
pharmacy contract.
Another example is a recent e-mail from the Society about how this year’s
registration fees will be spent. “It talks about spending money
on accreditation of pharmacy services at a ‘national’ level
rather than in individual primary care trusts [which is only relevant
in England]. I don’t want a penny spent on that,” he says. Against
separation
Creating a separate organisation in Scotland — and, therefore,
also in England, Wales and Northern Ireland — would certainly be
a challenge. Can pharmacy afford to have a professional body in each
country? Is there any point in such replication?
Mr Scott says the argument against total separation is economic. “Any
one of the professional bodies could provide supporting functions, such
as human resources services, on behalf of the others. Having everything
in Lambeth has demonstrated that it can work in one place but it has
also demonstrated that you have to have excellent communication and trust,” he
says.
Ian Caldwell, a former president of the Society, points out that the
number of members a future version of the Society will attract must be
considered. “The new body — and I hope it will still be the
Royal Pharmaceutical Society — will be very much smaller than the
current Society. Therefore, I believe it should be UK-wide,” he
says.
Two other factors Mr Caldwell highlights are: the need to establish the
functions of the future body, such as initiating and organising science
research, and the practical considerations of creating a separate organisation
in Scotland.
“Should it come to a split, there would need to be
a detailed consideration of what would happen to the assets of the Society,
such as its reserve funds, the Pharmaceutical Press, The Pharmaceutical
Journal, and the Society’s buildings,” he
comments.
Although those advocating a completely separate body are in a minority — among
those interviewed for this article in any case — there is almost
universal agreement that the current organisation of the Society does
not work for pharmacists in Scotland.
The most frequent complaint is
that the Scottish Pharmacy Board, set up in light of devolution, has
its hands tied by the Society’s Council. Pharmacists in Scotland
want their professional body to be able to act without checking with
London first.
“The boards haven’t progressed much further than the previous executives.
Influence needs to be devolved, rather than pulling back to London,” Mr
Millar says.
Mr Semple adds: “While the national boards can inform Society policy,
they have been constituted in a way which binds them to the diktats of
Council. This strikes me as being fundamentally undemocratic: as an elector,
I expect my national board members to have an influence on policy beyond
that of a ‘focus group’.”
Indeed, it is this lack of progress that makes Mr McQuillan doubt the
proposed federal model. “My reservation with a federal structure
is I am not convinced it would happen,” he says. “We need
an autonomous voice, divorced from any other body. I am not criticising
the people on the Scottish Pharmacy Board but the board has not made
a difference yet because it can only implement Council policy. So, based
on current evidence, I want complete separation.”
Speaking in a personal capacity, Alison Strath, Scotland’s principal
pharmaceutical officer, says: “As a past chairman of the Society’s
Scottish Executive, I believe that we need a professional body that is
autonomous in Scotland. The decision as to whether this is through a
federal or independent approach should be for the members in Scotland
to decide.
“In addition, we need a Scottish council (or equivalent) that
is accountable to pharmacists resident in Scotland and a chief executive
(or equivalent) who is directly accountable to the Scottish council.
The fact that the current Scottish board, director and department are
all still accountable to the Council of the Society despite a review
on the impact of devolution is unfortunate but [this is], in many ways,
inevitable given the current role of the Society in terms of both regulatory
and professional body.”
What about the future? “We believe that the governing body of the
UK/GB professional body should consist of officers of the national boards.
These officers should be elected annually by board members, and board
members should be elected by members in their constituencies,” Dr
Parr says.
Mr Thomson suggests a similar structure. “Membership of the Council
is for future debate but should include at least the chairs of the respective
boards. This would ensure that pharmacy in Scotland would continue as
a world-wide driving force in future developments, the interests of Scottish
pharmacists are respected and maintained, and allows for the debate on
the prospect of a Scottish professional body to take place at an appropriate
juncture in the future.”
Mr Scott adds: “The pharmacy profession in Scotland needs leadership
from a professional body that is part of Scotland. It is not just about
understanding the environment in Scotland in a theoretical way: the professional
body has to be based in Scotland. The location of the Society in Scotland
is crucial, it must be based on ‘health alley’ [Queen Street/York
Place area of Edinburgh]. And it must have a president who is at the
forefront of practice in Scotland.”
Mr Semple goes further: “I propose four national royal colleges
(for England, Scotland, Wales and Northern Ireland) that would be self-funding
and autonomous. The scope of membership would be decided at a national
level, as would the functions of each royal college. Seed funding would
be obtained by the fair division of the assets of the existing Society.
“In
addition, a UK-wide federal body with responsibility for cross border
issues, with a board comprising of the chairs and vice-chairs of the
national royal colleges, would be funded by an equal contribution from
each national board. This federal body would also provide a secretariat
for those groups of pharmacists who best interact
at a UK-wide level, such as industrial
pharmacists.” Work together
Jim Bannerman, a former president of the Society, believes the future
professional organisation should take a UK approach. But he stresses
that it will only work if all the different parts of pharmacy are brought
together. “The new body must get the constituent bodies in,” he
explains.
“If the organisation does not include the opinion makers
from the pharmacy boards then people will not join. If the boards are
represented, then members will come.”
Perhaps this underlines what pharmacists in Scotland really want: for
their voices to be truly represented within pharmacy’s future professional
organisation, along with the autonomy to speak for themselves in Scotland. |
The
Pharmaceutical Journal