The Society has not met its Waterloo

For the President of the Royal Pharmaceutical Society the issue is clear cut: “We as a profession have demanded a role in clinical care,” he declares. The creation of a royal college type body and the General
Pharmaceutical Council is, for him, an opportunity for pharmacists to provide a wider range of clinical services in all settings — in the community and in primary and secondary care. He disputes the suggestion that the separation is of the Society’s own making: “I say it is not; it is a prelude for the development of services and for pharmacists to be accountable [for what they do] in a modern way. And that is good news for the profession.” Nevertheless he acknowledges that there have been difficulties. “At the moment we are trying to serve two masters: the public through the regulatory role and pharmacists through the professional association.”

Strong position

The President also acknowledges that in the recent past the Society has been obliged to deal with major regulatory issues but there have been significant developments on the professional side that would not have happened without the input from the Society. He says pharmacist prescribing is a prime example of a successful Society activity. “People knock [the Society] for the sake of knocking it. One of the things the Society has done less well is dealing with the here and now, instead maintaining commitment and focus on longterm issues. Once the two functions are separated it will be clear what the royal college body can achieve.” He adds: “The Society is in a strong position to form a single royal college, or a structure similar to that, for all three countries.” The President emphasises that the separation of the two functions of the Society will not result in a trade union: “I do not know anyone on Council who is supportive of that. And neither will the Society turn into the regulatory body,” he says.
There are rumours circulating in pharmacy circles that the Society might not form the foundation of the royal college and that other arguably more academic bodies might take on that role. In response, the President says: “We are not arrogant. We have always sought to work with other bodies to develop the pharmacy agenda. I have heard about the ‘Waterloo agreement’ [see p357].” He wishes, however, that these other bodies had made their views clear at the time of the Charter debate. “We might have had a slightly different Society to the one we have now,” he says. “I have been told by Lord Hunt [the health minister with responsibility for pharmacy] that the Society is in a very strong position to form the royal college but he was also keen that we work with other relevant bodies so that the future structure is robust and fit for purpose. And, for example, we have worked with the Academy of Pharmaceutical Sciences and the College of Pharmacy Practice over the past 18 months,” he explains.

Although the establishment of a royal college is primarily a professional pharmacy issue, the President can understand why the Government has an interest in it. “In the first place, removing the GPC side of things [from the Society] could destabilise the organisation — the Government has a moral duty to ensure that it survives. Secondly, the Government would want us to have a strong and robust royal college with good governance arrangements because it will have to work with the regulatory body
and develop the pharmacy practice agenda. They will have to work closely together on a number of issues.” So who would join the royal college?

Currently there are fewer than 5,000 pharmacists who are members of a special interest body. That number is not sufficient to sustain a royal college and, as the President says, the fees would be prohibitive. “The Society should not just restrict its deliberations to those involved or invited to sign the Waterloo agreement. We have to involve other bodies like the Academy of Pharmaceutical Sciences and the National Association of Women Pharmacists — there are so many women in pharmacy we must include them,” he adds. The President mentions the exercise undertaken in 2005 — to scope the profession and to determine what bodies existed outside the Society and what their needs were.
“Scoping the profession revealed that some wanted to be taken over, some wanted to work closer with the Society others wanted to remain autonomous. If the royal college only had 6,000 or so members it wouldn’t take the public protection agenda or the professional development agenda forward fast enough. It is important to work with many other groups — scientists, technicians and others — so that together they come up with a structure that meets not only the future needs of the profession, but also the NHS and the public.”

Although this is an exciting prospect for specialist pharmacists, what will the new structure offer community pharmacists? Far less than 10 per cent of them have clinical diplomas, for example. “I agree that there must be greater opportunities for them. We are being told constantly that pharmacy has so much to offer the NHS but this is not matched at local level. They are not given the opportunities to make a contribution despite the Government’s desire for joined up working,” he comments. And he gives a topical example: “The Government spends millions on no-smoking campaigns but does not make sure that pharmacy services are kept going or encouraged. So it is not only a question of being inspired to join the royal college, there must be a resourced strategy to ensure it is successful. Without new and additional resources I cannot see any of this happening. “

Great deal of work

However, the President admits that a great deal of work has still to be done before the costs of having two bodies are completed. “My guess is that we will need between £10m and £12m a year to run a royal college and a further £8m for the GPC. Pharmacists must be aware that all royal colleges and regulatory bodies have seen their fees rise over the past 10 years because of the demands of Government. Fees for pharmacists will increase but not, primarily, because of the split. They will increase because of the legislative burden on the Society and the new demands of a clinical profession — it will cost money to develop that agenda.”

The resources are clearly a significant issue: “I cannot believe that [the establishment of the GPC and royal college] is possible without a huge injection of cash to speed things up. If there is not any additional money I see the GPC will be formed — because that is mandatory — and a very weak royal college, as well, that would not serve adequately the public, the profession or the government. Neither specialists nor generalists would be happy. Without the generalists on board there will not be enough resources for the specialists to do anything.”

The President suggests one way of attracting the generalist to join the professional body — in addition to offering assistance for undertaking continuing professional development and, in time, revalidation — would be through the development of support services for clinical activities. Clinical standards could be developed that are used all over the UK — and the President gives the examples of smoking cessation and emergency hormonal contraception. “Standards for service development could be set centrally and then be tweaked locally instead of hundreds of different services being developed. A range of support services would be available for members and a reduced rate would be paid compared with non-members,” he adds. According to the President, membership of the Society is often taken for granted but it gives members a certificate to practise. In a similar way he believes that membership of the royal college would impact on pharmacists by enhancing their status and their income — over and above being registered with the GPC.

The President believes that there will be an international element to membership of the royal college. The opportunity to register members working abroad will give them status and credibility and will be an important area to develop. “We will need strong leadership with people working hard and honestly with each sector of the profession.”

Two sides of the same coin

The President is clear on one matter: “Voluntary membership is the way forward but with a strong support structure which would make a compelling case for pharmacists to join. I see regulation and a professional body as being two sides of the same coin and the Department of Health morally compelled to help create the new bodies. The Society’s strong infrastructure and high calibre staff are great assets. There is an opportunity for us to develop two separate structures which are effective and cost-effective. I would argue for co-location because business continuity is critical but with areas such as human resources and IT shared.”

He explains that the whole Council is committed to moving forward to form a GPC and a body akin to a royal college. “We are committed to working with other bodies, with other health care professionals and others who are keen to see pharmacy succeed. We also need to start working at a comfortable speed — we cannot continue to work at the speed we have done for the past six weeks because it would burn people out.”

Meanwhile, the Society is advertising for a replacement for the Secretary and Registrar, Ann Lewis, who is retiring in the autumn (see pA19). Whoever is appointed must have a strong personality, the President believes: “Also strong change management and culture management experience. Most definitely it
does not mean that it is exclusive to a pharmacist. It would help if there were a pharmacist but the main requirement is that the individual will make changes for the profession and the Society. The Society needs to be more member-focused. ”

It is hard to believe that the White Paper announcing the separation was published as recently as 21 February and the momentous decision is likely to be put in train shortly and the two bodies up and running by 2010 or 2011. The President’s greatest anxiety is that the resources to carry out these changes will be insufficient and staff morale in the Society and within the profession in all sectors will drop even further: “If this is not handled carefully by the Government it will make cooperation of pharmacists even more difficult, and morale will sink lower. I intend to share with them as much information as possible, to consult them and engage them in discussion. But I still have concerns that, like the Section 60 Order, there may be delays and these delays cost us money.”