What should the RPS do to ensure the professional autonomy of its members isn’t adversely affected by the working conditions imposed by employers?
The results of the Royal Pharmaceutical Society (RPS) national pharmacy board elections are due to be announced at the end of May 2016. In order to get to know this years’ candidates and find out more about what they stand for, The Pharmaceutical Journal asked for responses to two questions.
In the second of the two questions, the candidates explain what they think the RPS should do to ensure the professional autonomy of its members isn’t adversely affected by the working conditions imposed by employers.
(Of the 21 candidates standing for election, 13 provided responses).
David Branford: Independent pharmacy adviser (mental health and learning disabilities)
In 2013, in his report of the Mid Staffordshire NHS Foundation Trust Public Inquiry, Robert Francis QC stated: “Above all, [the trust] failed to tackle an insidious negative culture involving a tolerance of poor standards and a disengagement from managerial and leadership responsibilities. This failure was in part the consequence of allowing a focus on reaching national access targets, achieving financial balance and seeking foundation trust status to be at the cost of delivering acceptable standards of care.”
In view of the recent revelations about medicines use reviews (MURs), the question we have to ask is: do we have a similar culture within some parts of pharmacy (hospital and community), and is this leading to unprofessional practices, poor scrutiny of prescriptions and unnecessary harm from medicines?
The RPS has provided leadership with the production of guidance for members and employers on workplace pressure, as well as creating an environment where whistleblowing about public interest issues becomes safe for individuals and is encouraged by employers. The RPS must continue its campaign for a just culture in pharmacy but it must go much further to make owners see that the clinical competency and performance of the pharmacy team is the basis for profitability.
Elizabeth Butterfield: Pharmacist consultant and chair of Primary Care Pharmacy Association
The RPS is the leadership and support organisation for all pharmacists and more needs to be done to incentivise membership — showing how RPS membership supports individual pharmacists and also how it influences improved clinical care for patients is essential. I think we need to be shouting louder about the good work that the RPS and pharmacists are doing and create demand for more impact.
We need to be realistic — employers in any sector of pharmacy will encourage their employees to maximise revenues from their activities. The RPS needs to lobby hard for the incentives to change, for pharmacists to be valued and rewarded as clinicians for the value they bring to patients and health and social care, not as a trade union but through raising professional standards and working closely with other bodies within and outside pharmacy to improve patient care.
Mike Hannay: Vice president and general manager at Fisher Clinical Services
We are a profession and our primary responsibility is to our patients. We need to oppose the imposition of unacceptable working conditions that prevent us from doing what we believe, as professionals, to be right for the patient. I believe the vast majority of employers, be they independents or large multiples, want to deliver a professional service that is of real value to patients. However, it is clear that some employers are putting corporate targets ahead of professional judgement and putting unacceptable pressure on pharmacists at the front line. As a professional body it is our duty to send a loud and clear message that every pharmacist should have the autonomy, resources and time to do the right thing for the patient even when that means missing corporate targets.
I believe that it is in the long-term interest of all employers and their shareholders to focus on the needs of our patients. If we do the right thing for patients, it will be the right thing for the profession, the right thing for the employer and will make the role of front line pharmacists truly rewarding.
Michael Holden: FRPharmS, principal associate, Pharmacy Complete and RPS Wessex lead
The RPS is not in a position to ensure professional autonomy. That is the function of the regulator (the General Pharmaceutical Council [GPhC]) and contractual arrangements between employer and employee. What the RPS should do is influence the GPhC, employers and their representative bodies to work towards an appropriate level of professional autonomy underpinned by legislation and regulation. The current rebalancing programme is an opportunity to get this right. The RPS should also offer support and advice to its individual members who may be adversely impacted by such situations while recognising that the RPS is a professional body, not a union.
Carol Roberts: Head of governance, medical directorate, NHS England Midlands and East (East)
Pharmacists should feel empowered to work in a professional manner and be clear when they are being asked to work in an inappropriate way. In a dispensing environment, pharmacists have to ensure that they work at a safe speed and in a safe manner and we need to support individuals to feel confident to say no to extra work pressure if it adversely affects patient safety.
I will make certain that pharmacists can understand how to raise concerns; in the first instance this should be to their own employer or superintendent pharmacist. Failing this it can be escalated to the GPhC and/or NHS England. There is a new NHS England policy, ‘Freedom to speak up’, which gives the complainant employment protection and this should help pharmacists feel confident to report concerns so that action and improvements can be made.
The RPS could develop a risk assessment tool to answer the following questions: how do I assess safe working practice? How do I address issues raised within my organisation? How do I escalate and get support outside my organisation?
Sally Omolara Rose: Locum pharmacist, author and radio presenter, RPS Leeds lead
I believe in working towards what I call a Pharmacist-led Win-win Service Cost Remuneration (PWSCR) model that benefits all parties. To put it bluntly, pharmacists are able to optimise medication use resulting in significant cost savings to healthcare. I believe pharmacists in turn should reap the benefit of this cost saving and be rewarded fairly, as opposed to cutting funding, which I feel will be detrimental to patients. This could potentially escalate healthcare costs in the long term in a landscape with fewer pharmacist interventions.
The RPS as we know it is a professional body and not a negotiator per se. We are however in a fantastic position to provide a unified pharmacy front and voice, act in an advisory role, and influence policy, contracts and fair working conditions. The RPS must continue to uphold and communicate the minimum to optimum standards under which pharmacists can continue to work and still ensure patient safety while minimising stressful working conditions and fair remuneration.
Tracey Thornley: Senior manager contract framework and outcomes at Boots UK and honorary professor in pharmacy practice at University of Nottingham
Confidence and competence are the keys to professional autonomy. I have great hopes for the RPS Foundation and Faculty programmes as a way of developing individual pharmacists’ skills, behaviours and confidence. Professional autonomy also has to be learnt and developed through daily practice – it means accepting responsibility for your own actions, wherever you work.
Keith Davies: Prescribing adviser
The GPhC already covers this point in their ‘Standards of conduct, ethics and performance’ as principle 2.2 states: “Make sure that your professional judgement is not affected by personal or organisational interests, incentives, targets or similar measures.”
However, to ensure that pharmacists can comply with this the RPS should be prepared to support any member who feels under pressure not to. This may involve communicating with employers but also with other organisations that may be better placed to defend the member. The RPS must be prepared to issue guidance for both employers and employees, including locums, to ensure autonomy and to stand by that guidance.
Sudhir Sehrawat: Superintendent and director, Clifton Pharmacy Ltd
The RPS plays an important role to make sure it is clear to members of the public and other healthcare professionals the high standards pharmacists work to and the positive impact pharmacists have in delivering high quality, safe services. The RPS provides resources to enable pharmacists to work to the highest professional standards. Employers have a responsibility to ensure working conditions support these professional standards and the RPS can provide guidance to both pharmacists and employers.
Kathleen Cowle: Relationships and revenue manager for Scotland, Boots UK
We are in a time of great change for pharmacists and pharmacy. I see it as the role of the RPS to give its members a professional confidence that empowers them to make the right decisions, whatever situation they are in. We want and need confident professionals to be working in a confident profession.
As with any healthcare professional, we need to be clear about what our individual professional standards are and consider the standard of care we want to give our patients. It is up to us as individuals to uphold these. The RPS can support by asking difficult questions, encouraging peer conversations so members don’t become isolated and sharing members’ experiences for everyone to gain from.
Johnathan Laird: Pharmacy manager and independent pharmacist prescriber
Professionally I have yet to take a backward step in the protection and defence of my personal and professional values. I expect the RPS to be there to support me in this endeavour as do other members. As a board member, I would shine the light on conversations around what it is to be a pharmacy professional. As I have done to date, I will continue to engage online and offline with members to allow them to tell their story, explain what it means to be a member of this great profession and fight for members’ rights to practise safely for patients. I firmly believe that casting light on these issues is the best remedy to negative stories that cast doubt on the integrity of the profession. If you have nothing to hide, then you have nothing to worry about.
Procedures and practices that have a direct impact on the Responsible Pharmacist need to be subject to further scrutiny and candour. Professional autonomy is absolutely central to the future survival of our profession. For this reason, I will vehemently protect the professional rights of pharmacists to make the correct decisions for patients without undue pressure to meet an outside agenda.
John McAnaw: Head of pharmacy, NHS 24
The RPS needs to have a strong position on why professional autonomy in the workplace must be protected, and should never be compromised. Without professional autonomy, for pharmacists working in the frontline, there is the potential for others to control the agenda with pharmacists potentially being tasked to non-patient-facing roles, and pharmacists not being seen as an equal to other healthcare professionals. This will not help drive the profession forward. Therefore, the RPS must ensure its code of ethics and standards of practice are clear in their support (and expectation) of professional autonomy.
The RPS also needs to challenge the GPhC to take a stronger line in dealing with situations where working conditions adversely affect the ability of pharmacists to practise autonomously. The message also needs to be taken to employers to make sure that pharmacists in the front line are enabled to do their job and provide the best pharmaceutical care they can for patients and the public. If working conditions are ‘unhealthy’, it not only poses a risk to the health and well-being of the individual pharmacist, it potentially leads to an increased risk to patient safety. Working conditions must enable rather than prevent professional autonomy.
Deborah Stafford: Principal pharmacist, education, training and development & ACT teaching lead for pharmacy, NHS Tayside
There has been much in the press recently regarding pressures that organisations bring to staff. This is especially likely as pharmacy services develop in the new health and social care arena. For example, where pharmacists are employed directly within GP practices.
The RPS can provide support at an individual level. The support helpline in my experience is a fantastic resource where calls are handled efficiently and effectively with sensitivity and practical support. At a local and national level, the RPS can provide support through professional networks, for example, Directors of Pharmacy, Community Pharmacy Scotland can raise awareness of concerns and challenge employers who demonstrate an unprofessional approach to pharmaceutical care delivery.
Unfortunately where the contract remuneration is based on numbers rather than quality of service or value added there will always be a risk of pressure in the workplace. As pharmacists take on further advanced patient facing roles, the RPS should consider the potential pressures that may befall practitioners in the future.
Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2016.20201171
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