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There is a strong measure of agreement and enthusiasm for the development
of a professional body for pharmacy that, freed from the responsibilities
of regulation, can support members as they in turn seek to support patients
and the public, the Clarke Inquiry’s final report declares.
In
his report, Nigel Clarke discusses what possible functions this body
could incorporate and supports these ideas with a string
of recommendations (PJ, 12 April 2008, p432).
Although it stipulates that the Royal Pharmaceutical Society should form
a major part of the new body, the inquiry is clear that the Society should
not start making decisions alone.
So what does the report have to say
about the kinds of structures needed to underpin the new professional
body’s various duties?
Geography
National boards should form the basis of the new organisation within
a Great Britain structure and each board’s autonomy should increase
as far as cost-effectiveness will allow, the inquiry recommends.
The Clarke report says that the Society’s recent formation of national
boards for England, Scotland and Wales was greatly welcomed by those
giving evidence to the inquiry.
It says: “A constant theme in the
evidence put to us — and not just from pharmacists in Scotland
and Wales — was that the new professional body must be able to
work responsively and quickly with the devolved administrations.”
The inquiry says it was convinced by those who responded to the inquiry
that the operations of the NHS in each country were no longer the same
and that significant elements of pharmacy practice were diverging. Some
commentators in Scotland called for complete separation from any GB organisation
so that Scotland could have its own professional body, the inquiry reports.
However,
it says that most respondents wanted there to be greater powers and autonomy
for representatives of each home country, within a GB body.
“We do not see the relationship between the central GB body and the national
boards as being hierarchical,” the report explains. “The
boards are not simply agents, acting under instructions from the centre.
They would have specified roles and functions, which were essentially
devolved, not delegated. The task for the GB body would be
in part to enable and facilitate the work of
the national boards; to co-ordinate, not to manage.”
What is required is “smart subsidiarity”, the inquiry believes,
rather than “full application of the subsidiarity principle”.
The latter would mean taking decisions locally whenever possible and
only taking decisions at a GB level when unavoidable. Under such a scenario
most issues might need to be considered three times, with considerable
staff resources, to come to the same conclusions, the report warns.
Smart subsidiarity would involve identifying those issues best decided
locally and dealing with other matters that can readily be determined
at a GB level once only, for example, ethics, management, public health,
pharmaceutical science and clinical matters that have no obvious local
slant.
At the launch of the inquiry’s report, Mr Clarke told the press
that one of the biggest challenges arising from devolution is how the
professional body would deal with England. The report points out: “It
is important that members in England receive equality of service — no
better, no worse — than their colleagues in Scotland and Wales.
The need for the organisation to reflect devolved government should not
lead to a deterioration in its services to the bulk of its members.”
The report adds: “The evidence to us suggests that the English
experience of reserved places for sectors has worked well and has been
welcomed, especially by members of those sectors who feel disenfranchised
by the main Society Council. We heard, too, that the English and Welsh
boards felt they had been much assisted by having the technician voice.
If, as we envisage, the national boards are to play a prominent role
in the new body, it is appropriate for them to have arrangements in place
to ensure that their structure is broadly representative of the membership
in their home country.” Council
The existing Council’s structure is not a suitable vehicle for
making day-to-day operational decisions, the inquiry believes.
It says: “There was frequent comment that the size of Council,
the committee structures and the way they are operated in the current
Society is unwieldy — to the point almost of dysfunctionality,
some thought.”
The report also highlights the difficulties for people working in the
NHS becoming involved in the current Council: “We were told frequently
that the heavy burden of RPSGB Council membership, which could involve
meetings one or two days a week, was a real hurdle to membership from
the managed sector. Servicing the meetings is a substantial expenditure
item in the RPSGB’s accounts. From our experience, most professional
bodies are nothing like as demanding as this.”
The new council should meet no more than four times a year, with a further
day for an annual strategy meeting, and it should focus its attention
on broad strategy and policy, the report recommends.
The following 19 representatives — who, apart from the lay members,
should be elected — are suggested to form the slimmed-down council:
- The chairman and vice-chairman of the English Pharmacy Board
- The chairman
and vice-chairman of the Scottish Pharmacy Board
- The chairman and
vice-chairman of the Welsh Pharmacy Board
- Two hospital or primary
care organisation representatives
- Four community pharmacy representatives
- Two science and academia representatives
- A pharmacy technician representative
- Two lay members
- Two representatives from a committee of special interest
groups
The report also recommends the inclusion of one pharmacy student and
one preregistration trainee as observers.
The inquiry proposes that lay involvement in the council and main committees
of the new professional body should be kept to a minimum. It does, however,
say that the council and some committees could “benefit from the
wider experience of a few lay members acting in a ‘non-executive
director’ capacity”.
In another recommendation, the inquiry sets out the need for the council
to appoint an audit committee and a remuneration committee, both of which
should be chaired by lay council members.
In terms of corporate governance, the inquiry reports: “Some commentators,
especially those with experience of operating large and successful companies,
favoured there being, alongside a council that is broadly representative
of the membership, a smaller executive board charged with developing
strategic policy proposals for approval by the council and overseeing
the day-to-day management of the organisation, including implementing
that strategy.”
The Clarke Inquiry believes that “the profession should follow
what is now standard practice and ensure a proper separation of governance
and executive functions in the new professional body”.
Special interest groups
Last year’s Carter
Report — commissioned by the Department
of Health to look into the separation of regulation and professional
leadership for pharmacy (PJ, 19 May 2007, p573) — suggested that
specialist pharmacy groups should form an “academy of pharmacy
practice” within the new professional body.
The Clarke Inquiry believes that the term “academy” was one
that many people found off-putting and elitist, and that there is no
reason for retaining it. “There does however need to be a mechanism
for organising and encouraging [special interest groups],” it acknowledges.
The formation of a committee of special interest groups (CSIG) is the
inquiry’s proposal.
“The need for such a mechanism, operating at GB level, is one of the major
justifications for retaining a substantial GB element in the new body,” the
report states. “The work of the organisation under this committee
would be to take on much that the Carter Report spoke of as ‘faculties’ within
[Carter’s] ‘academy of pharmacy practice’.”
It goes on: “We see the CSIG as a GB-wide committee dealing with
those issues that are generic to pharmacy as a science-based profession,
rather than those that are territorial and relate to the place of pharmacy
within the devolved health services. These include matters relating to
the generation of scientific advice (including social scientific advice)
to the professional body and its partners; the definition and accreditation
of advanced and specialist practice; and the award of titles recognising
such practice, particularly that of Fellow.”
The existing Academy of Pharmaceutical Sciences — along with other
groups that have expressed a desire to be part of a future leadership
body — should be invited to become a special interest group, the
report also recommends.
Differences of opinion exist over whether traditional sector categories
(eg, community, hospital, primary care) should be represented within
the new organisation or avoided as much as possible.
The inquiry received two distinct messages: “First, that people
would wish to see the sector in which they worked represented in the
governance of the new organisation so that they could see a ‘home’ for
themselves; but second, that increasingly people had portfolio careers
working in several of the traditional sectors and that in any event the
boundaries between sectors were becoming blurred.”
Nevertheless, the report stipulates that the new organisation ought to
have a structure that allows members to “elect which sector they
wish to belong to”.
Involvement of the Society is the only pragmatic solution if a new professional
body is to be in place by 2010, the report states. Thus, the inquiry
places an onus on the Society to make sure that all the organisations
that wish to be part of the new professional body — and those that
do not but are interested in its success — are fully involved in
the transition process, and to offer the vast majority of pharmacists
the kinds of benefits and support that they cannot afford to be without.
The transition to a new professional
body
Time is short if both the new professional body and
regulator are to be ready for a start date at the beginning of
2010, the Clarke Inquiry declares. And it is “firmly of the
view that it cannot be a matter for the Society alone to decide
upon the remit and structure of the new body”.
The report
says: “[The Society] should not underestimate the number
of people who said to us that they would not want to join a body
that was simply a rebadged RPSGB without the regulatory function.”
The inquiry also believes that potential members are not likely
to accept the professional body’s new structure should it
emerge from an in-house exercise by the Society. It adds that the
arrangements for designing the new professional body must be transparent
and include an element that is clearly independent.
To oversee the preparation for a new professional body a transitional
committee should be set up by the Society, the report recommends.
It says that this committee should have representatives from all
the major organisations that have expressed an interest in joining
or working with the professional body — and it should be
independently chaired. The main aim of this group, the inquiry
says, should be to develop a prospectus for the new professional
body so that potential members can make an informed choice about
whether to join.
The report points out that several bodies suggested functions in
their evidence, for instance in the field of education, that did
not feature strongly or at all in the Society’s submissions. “These
are, nevertheless, legitimate functions for a professional body.
There are several organisations that, in the course of this consultation,
have declared they wish to be a part of the new body.”
The report continues: “Several significant organisations
and groupings of pharmacists stressed their sense of isolation
from the Society and the feeling that this would persist if they
were not invited back within the fold. Others have declared an
interest but, for understandable reasons, want to see more of what
the new body will be like before taking a decision on whether to
be a part [of] or simply to work closely with the new body.
“It
is vital that the new body is financially viable and it may be
that not all organisations that wish to have a prominent part in
it will be able to do so for reasons of cost. But we do not believe
that it is for the Society alone to take such decisions.”
The inquiry acknowledges that changing the name of the Society
might be a contentious issue. Nonetheless, it says: “We tend
to favour a change, perhaps to something like ‘The Royal
Society of Pharmacy’, on the grounds that this would give
a clear signal to potential members that this is, indeed, a new
organisation.”
This should be decided by the membership who
must have a sense of ownership of the title, the report says. How
the inquiry’s numerous proposals might be delivered with
changes to the Society’s existing Charter is discussed. Decisions
on changes needing Privy Council approval should be made early,
the report suggests. |
Fees The new professional body will have to
attract membership through the perceived value of what it offers,
which will
depend on the balance between fee levels and quality of services,
the report says.
“It will be essential to set fees, after
all other income streams are determined, at a level which, in combination
with the GPhC registration fee, is not seen by pharmacists as unaffordable.” |
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The
Pharmaceutical Journal