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The Pharmaceutical Journal
From Mr G. A. Miller, MRPharmS, on behalf of the Young Pharmacists Group Executive
In your leading article (PJ, 13 July, p42) you stated that "the word on the street is that the Government would not accept models like that suggested by the Young Pharmacists Group". We understand that an official from the Department of Health stated his opinion that the YPG proposal was not an option, but this was not necessarily an official DoH view. If this is the case, then the Royal Pharmaceutical Society's Modernisation Steering Group should obtain an official statement from the DoH clarifying this position for members.
The YPG is pleased to see that the modernisation debate is starting to gain momentum. The YPG has so far received many positive responses, with our web poll (as of 15 July) showing that 100 per cent of pharmacists agree to the principles in the YPG model. This is illustrated further by opinions of members expressed at local meetings and in The Pharmaceutical Journal.
In order to widen the discussions, we have created a forum on our website. Anyone who has comments or would like their submissions regarding modernisation to be in the public domain, should send them to firstname.lastname@example.org where they will be made available for viewing at www.ypg.info.
The YPG requests the Department of Health and the Council to state publicly their views of the YPG proposal and how best to take the profession forward, bearing in mind the reaction by the membership to the options proposed by the Modernisation Steering Group.
From Mr A. R. Cox, MRPharmS
Comment has already been made about attempts to redefine the meaning of words in the debate about the Royal Pharmaceutical Society's future. Now, we see both Christine Glover (PJ, 13 July, p56) and the President, Marshall Davies (ibid, p79), resorting to the logical fallacy of the straw man. In arguing the case for the Society as a purely regulatory body, they construct the straw man of the Society as a trade union, in order to knock it down and stress the regulatory role. However, this has little to add to the debate that the Young Pharmacists Group proposal (PDF*, 50K) (PJ, 29 June, p906), which does not envisage such a role, has provoked.
The Society, at present, continues to be a democratically accountable body with elected representatives. These representatives must attempt to reflect the views of the membership to the Government, not argue and spin a position to the membership that they think the Government may want. Sadly, it would appear that some fundamentals for reform of the Society may already have been offered by some at the Society to the Government. Current consultation exercises start to look like campaigns to sell a fait accompli.
Mrs Glover threatens the profession with the risk of the regulation of pharmacy being taken over by the Health Professions Council. Yet, even she notes this would not be in the best interest of the public. Indeed, would the Government really want to cripple a regulatory and inspectorate system that is serving the public well?
If the leaders of our profession were able to present a coherent plan that would enable modern regulation to occur within a separate regulatory and standard setting arm of the Society, perhaps the Government might work with them. It would be crucial to make that regulatory arm clearly responsible and accountable for all aspects of regulation.
However, by already offering up our Society and its assets as a regulatory body, devoid of its representative role, they have prevented real debate by priming Government expectations. The most important decision that the Society has faced since its formation has effectively been taken from the hands of its membership.
Watching from the sidelines, the Government may be disturbed by the level of dissatisfaction, and solidarity, being expressed at the current plans on modernisation. It may wonder if the current leadership of the Society has the ability, and the support from the membership, to carry out any effective regulatory reform.
Perhaps the present President should listen to the 11 past presidents (PJ, 6 July, p15) and, furthermore, heed the words of another president, Franklin D. Roosevelt, who said: "It is a terrible thing to look over your shoulder when you are trying to lead and find no one there."
Sutton Coldfield, West Midlands
From Mr I. M. Caldwell, FRPharmS
In regard to "modernising" the Royal Pharmaceutical Society, much has been made of "signals" to indicate the Government's preferred structures for health professions. I make two points about this approach. First, signals have overtones of the long gone method of communication favoured by 19th century navies. If the Government has valid concerns about one group of professions it would be more appropriate to the 21st century to consult all the suspect groups, frame new legislation for debate in the House and then stand by its acceptance or rejection. Anything else is a mealy mouthed, politically correct fudge that invites individual professions to participate in their own emasculation.
Secondly, why have the health professions been singled out? Shipman and Bristol have indicted individual health professionals but, in both cases, there were administrative structures in place, none of which appears to have picked up the statistical anomalies which might have saved some lives. Have the administrative structures been realigned to prevent future disasters? Apart from some growls from the Lord Chancellor concerning the failures of the Law Society of England and Wales to deal timeously and adequately with a stunningly large backlog of complaints, have there been "signals" to modernise the legal profession and, if so, what are they? Indeed, what other professional groups, academia, teaching, finance, civil service, local administration, have been sent "signals"? Perhaps they are all perfectly structured and are not in need of reorganisation to represent the public interest.
This vague nudging towards an ill-defined political goal reminds me of the suggestion of the sociologist T. J. Johnson some 30 years ago that state recognition of competence of a profession may not be a delegation of authority by the state but a first step towards state accreditation of practice.1
If "signals" are the order of the day, let us send a signal back to the Government. Let them tell us exactly how we have failed to encompass the public interest and, if we have, then we will sort it. At the same time let us remind them that our disciplinary machinery has gender and racial representation under expert legal lay chairman and that our ruling body has high quality lay membership appointed by the Privy Council, which, in effect, means appointment by the Government itself. Let us not just roll over and play dead.
From Mr P. Jenkins, FRPharmS
The present discussion on the future direction for our Royal Pharmaceutical Society is both complicated and worrying. When talking to other pharmacists, I find that many consider it so complicated that they have lost what little interest they may have had in pharmacy politics. This is no surprise given the reported wrangles over the past few years, and those who are still concerned believe, like myself, that it is difficult to get a truly accurate picture despite Journal reports and meetings as the story is evolving.
However, it does seem that there is an overall consensus of opinion emerging. Many experienced Lambeth watchers, including some who held senior positions in our civil service, have expressed concern at the thrust of official policy. Other experienced figures have been specific; for example, 11 past presidents are also showing scepticism for the present official line and expressing a preference for the so-called Young Pharmacists Group option (PJ, 6 July, p15). This seemed to me from the early stages to make a deal of sense and to fit what I would feel comfortable with. It places pharmacists in the majority concerning professional matters while an increase in the number of lay people gives weight to the regulatory field by showing that we really wish to look after the public not just ourselves when problems arise.
Now in an editorial (PJ, 13 July, p42) we are told that the word on the street is against such a scheme. What on earth does that actually mean and what weight does it have? It seems too much like smoke and mirrors to me.
The word on other streets is pointing one way and before that word, which is shared by many experienced, and named, people who have the benefit of the profession at heart and no ulterior motives, is brushed aside they deserve a more detailed reason for its abandonment.
Meanwhile, until a possibly refined YPG idea is ruled out of court on solid evidence, it still seems the best option.
From Mr J. Ferguson, FRPharmS
In her letter (PJ, 13 July, p56), Christine Glover repeats the mantra used by the President of the Royal Pharmaceutical Society at this year's annual general meeting when she refers to "the wider definition of health professional regulation that has now been adopted by the Government".
The Council knows, from documents before it over the past 15 years, that the Society has been ahead of the Government for decades in applying that definition. Through its accreditation of relevant degrees at every school of pharmacy in the United Kingdom as satisfying the academic requirements for registration, in its setting of the framework for, and administration of, the competency based preregistration training programme which every aspirant for registration must complete successfully, and by its setting of the registration examination which everyone must pass to be registered, the Society has surely encompassed all the processes related to education and training of UK graduates up to the point of application for registration.
There are parallel controls covering overseas pharmacists through the Adjudicating Committee procedure, reciprocal agreements or European Union legislation.
Then every applicant must provide a medical certificate confirming good health in relation to the possibility of taking sole charge of a pharmacy, and must be of good character, before being registered. And there has, for some years, been an ethical requirement for every pharmacist to keep up to date with developments in the pharmaceutical sciences and in pharmacy practice, through participation in continuing professional development.
The Society has also acted effectively and efficiently in dealing with pharmacists "whose conduct or competence is unacceptable" through the inspectorate and, if necessary, the disciplinary machinery.
The only new responsibility seems to be revalidation and there appears to be no reason why that cannot be accomplished by a fine-tuning of, rather than a revolution in, the structure of the Society and the constitution of the Council.
The Royal Pharmaceutical Society has, indeed, "created an impressive track record" by "underpinning its regulatory work with its role as a leadership and professional development organisation". So why is there a need to destroy the structure that has achieved all this rather than adapting it to meet current requirements?
The professional leadership role is threatened by the proposal to change, beyond recognition, the constitution of the Council. There needs to be a genuine debate on how adequate lay input can be guaranteed in all the regulatory duties of the Society within an administrative structure that satisfies the Government, while ensuring, at the same time, that the leadership and development of the profession remains in the hands of a Council, the great majority of members of which are pharmacists elected by members of the Society.
Lay input in the regulatory function is to be welcomed, providing the majority of those appointed are users of pharmacy services and representatives of patient support groups rather than Government appointees delegated to pursue a specific agenda. There is, after all, already strong lay membership of the autonomous Statutory Committee, which bears responsibility for one aspect of regulation ? discipline.
But professional leadership should remain in the hands of those elected by the members to undertake that important task.
Members, old and young, appear to be unwilling to accept what you describe as "the word on the street" (PJ, 13 July, p42) without a proper debate during which alternatives to what is now proposed are given genuine consideration.
The current "consultation" is obviously perceived as the first type described by a former Government chief scientist in a letter to The Times ask for comments so that an already decided policy can be announced with the words "after wide consultation".
Haywards Heath, West Sussex
From Mr J. D. Khan, MRPharmS
After my previous letter on the modernisation of the Royal Pharmaceutical Society (PJ, 20 April, p537) and the subsequent debate, I am still concerned at the direction and manner in which the consultation is being implemented.
Lambeth and your editorial (PJ, 29 June, p894) seem to have a skewed interpretation of the modernisation debate, forcing it to go down one avenue at the expense of looking at other models. I do not agree with our President's perceived vision of the Society having a predominantly regulatory function at the expense of representing members. The membership has made it clear that it wants the Society to undertake both regulation and representation functions. Simply having more lay people on committees does not solve the problem of the Government's requirement for modern regulators to be publicly accountable. Also the Kennedy report does not stipulate that the Society should become a purely regulatory body; it has simply called for strict monitoring and resolution of poor performance and corporate governance structures to be in place. Ironically, its recommendations can still be fulfilled if the Society continues its dual roles of representation and regulation and to compare it with the General Medical Council and other bodies is invalid.
I believe the Young Pharmacists Group proposal (PDF*, 50K) (PJ, 29 June, p906) represents the best way forward both for the Society and the membership. Your concern about disputes between the proposed Pharmacy Regulation and Compliance Committee and the Society's Council is a hypothetical scenario that would not happen if the structures and roles were clearly defined.
I am happy that The Pharmaceutical Journal has published the YPG paper but unhappy with the consultation papers received thus far, eg, in one section it states that the ideal number of council members should be X then asks how many Council members there should be. I get the impression that the Modernisation Steering Group is either pushing the consultation in a specific direction or the consultation documents have been devised by an amateur. Pharmacists are sensible people who can make up their own minds without such patronising and leading questions. Let us have a proper debate instead of the repetitive statements of intent from Lambeth, which bias the whole debate. The Society is fast becoming like George Orwell's "Big Brother"; does it really mean "direction" papers, rather than "consultation" documents?
Is this exercise another example of a wasted opportunity by Lambeth in the same vein as Nuffield, Pharmacy in a New Age and others that waste a lot of time but yield nothing, eg, pharmacist prescribing, optimising skill mix, corporate governance? Modernisation starts by reforming the Society and if we cannot get this right then what hope is there for extended roles, technician registration, etc?
I would urge the Council and the Modernisation Steering Group to consider all options first then choose the model that best fits our regulation and representation requirements. As the YPG has challenged, they should provide vision, goals and robust structures so that we can have a strong professional body for the 21st century and, in turn, enable pharmacists to look forward to better professional roles.
Jahn Dad Khan
From Mr A. O. Bond, FRPharmS
In trying to be all things to all people and this populist Government in particular, the present Council and its apologists are in danger of losing sight of the Royal Pharmaceutical Society's Charter.
While they reread that, they might also like to check the dictionary distinction between "regulate" and "regularise".
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