Healthcare Professional Regulation: Public Consultation on proposals for change

Hereunder please find the views of the Council of University Heads of Pharmacy (CUHOP) on themes and proposals emergent from the review report by the Chief Medical Officer on the arrangements for medical regulation, Good doctors, safer patients and the departmental review, The regulation of the non-medical healthcare professions.

Before proceeding to our views, I would describe that the membership of CUHOP comprises heads of UK schools of pharmacy which enrol students to read for a Master of Pharmacy (MPharm) degree with the expectation of registering with the Royal Pharmaceutical Society of Great Britain (RPSGB) or the Pharmaceutical Society of Northern Ireland (PSNI) and registering as a pharmacist in this country. The objectives of CUHOP are, to

1. represent the collective interests and views of the Schools of Pharmacy

2. develop and articulate a vision for pharmacy education in the UK

3. liaise with professional, national and local bodies on matters relating to pharmacy education and research

4. establish CUHOP as a body to be consulted on matters of higher education policy

5. engage with international bodies and at international forums on matters pertaining to pharmacy education

6. work with other healthcare professions to develop educational policy and practice

7. promote UK pharmacy education and research

CUHOP has evolved from and replaces the former UK Committee of Heads of Schools of Pharmacy.

With respect to the two review reports, Good doctors, safer patients and The regulation of the non-medical healthcare professions , and the public consultation on proposals for change that they have prompted, all CUHOP members were provided with the relevant documents. There was a preliminary discussion of the documents at a full meeting of CUHOP on 7 th September and then all CUHOP members were invited to submit written views to a drafting sub-group of the main committee. When the drafting sub-group met on 20 th October it was in possession of views from the great majority of CUHOP members, that is the great majority of Heads of UK Schools of Pharmacy.

This submission from CUHOP is organised primarily by the common themes as identified in Healthcare Professional Regulation: Public Consultation on proposals for change. In fact we respond in a major way in respect of just three of the 11 themes, immediately below here. However, at some points in our response we map to the conclusions “Ministers have come to… subject to consultation”, as numbered and set out in The regulation of the non-medical healthcare professions (the departmental review). We also have many comments from our members in respect of other conclusions from the departmental review. These more minor comments are set out in an appendix to this letter.

Theme 1. Changes to the governance and accountability of regulators.

The conclusions (taken to be a provisional decision) from the departmental review of most relevance to the objects of CUHOP in terms of potential impact are

17. All regulators have the same role of protecting the public. Where existing legislation adds other roles of professional leadership and promoting the profession, as for example in pharmacy, these should be explicitly and exclusively exercised for the public benefit. The implementation of changes following this review will provide opportunities to bring the regulation of these professions into line with the majority.

and the related, latter part of

24. The Pharmaceutical Society of Northern Ireland (PSNI) should remain as an independent body for the time being but with shared functions with the Royal Pharmaceutical Society of Great Britain (RPSGB). In the longer term, however, the two societies should amalgamate into a single UK body, following the passage of the necessary primary legislation. At the same time any necessary changes can be made to clarify the separation of the RPSGB’s regulatory and professional lead functions. However there should be no other changes to the number of regulators at present.

The prospect of the separation of regulation from membership and representation of the pharmacy profession has attracted a range of views and comments from CUHOP members. The majority are those (Aston, Bath, Bradford, DeMontfort, East Anglia, Hertfordshire, King’s College London, Manchester, Portsmouth, Queen’s Belfast, Reading, Robert Gordon Aberdeen and Strathclyde) who are for or who accept separation of the roles of regulator and representation for the pharmacy profession. Against them are those (Brighton, Cardiff, Kingston, School of Pharmacy London and Sunderland) who while they might wish to see reform of the present arrangements ( Sunderland suggests a clear split within the RPSGB) wish for both the regulatory and representational roles to remain with the RPSGB (or a combined RPSGB/PSNI). There are other members (Liverpool and Nottingham) who are more neutral, possibly leaning more to no separation of roles. Nottingham would be reluctant to abandon present arrangements without knowing what will or is likely to take their place. Liverpool cannot discern the relative benefits and risks of the two approaches and therefore reserves its position for the present.

The view that the two roles should be separated, with one removed from the RPSGB (or a combined RPSGB/PSNI), is perhaps best elaborated by the Aston Head of School (he gives various reasons but the one that resonates most strongly with those of like mind is):-

“Where a professional body has multiple functions it is inevitable that one function will become dominant. It is likely that the most dominant function would be that supported in a statutory fashion, i.e. regulation in the case of the RPSGB. Under such circumstances the membership/professional function would be secondary, eroded or lost.”

* * *

“In order for the profession to be able to discourse freely on matters professional… membership issues must be separated from regulatory function.”

Within CUHOP there is a feeling that over the past several years the RPSGB has favoured its regulatory over its membership and representational roles. There is also a worry that, having encountered the Donaldson/departmental review proposals, the RPSGB will see its main role as that of regulator rather than as a champion for the profession; its legitimate interests, its members and its imaginative and challenging development.

Those members who wish for a reform of present arrangements but still to have the regulatory and representational roles remain with the RPSGB believe in the position adopted by the RPSGB itself. There is no concise quote to be made here but the position can be summarised as follows, it comes in two parts:-

First, that the RPSGB has over many decades been effective as a regulator and in representing the interests of its members in their exercise of the profession of pharmacy or put more pithily, “if it ain’t broke, don’t fix it”; and

second, that the best interests of patients and the public are in fact best served when regulation and representation for a profession are integrated, with all aspects of the ‘quality assurance’ and professional development of members ‘brought under one roof’. A point that is strongly advanced in support of this argument is that the Kennedy report of not many years ago mapped out the desirably holistic role of a modern health regulator and that the RPSGB is a good fit, indeed in the UK probably the best fit, with this model.

One must however emphasise that CUHOP members are approximately 2:1 for or accepting of a split of regulation from membership/representational functions for the Royal Pharmaceutical Society of Great Britain.

Theme 6. The number of regulators for the non-medical professions.

In the case of pharmacy, there is a specific consequence, from the departmental review provisional decision that

24. The Pharmaceutical Society of Northern Ireland (PSNI) should remain as an independent body for the time being but with shared functions with the Royal Pharmaceutical Society of Great Britain (RPSGB). In the longer term, however, the two societies should amalgamate into a single UK body, following the passage of the necessary primary legislation. At the same time any necessary changes can be made to clarify the separation of the RPSGB’s regulatory and professional lead functions. However there should be no other changes to the number of regulators at present.

CUHOP is conscious of the achievements and strong ownership by pharmacists in Northern Ireland of the PSNI. It is reluctant to support a proposal which will possibly see the PSNI disappear altogether. There have always been strong links between PSNI and RPSGB and these should remain. However, if within the pharmacy profession regulation is to be separated from membership and representation, it is likely that PSNI as purely a regulator would be too small to take on the role. This suggests a merger of the pharmacy regulatory functions for Northern Ireland with those of the rest of the UK. PSNI should continue in its exemplary activities in support of the membership.

Theme 8. The role of regulation for student healthcare professionals.

We take it that this theme comes mainly from Good doctors, safer patients , wherein there is the recommendation for “processes to bring medical students within the scope of medical regulation”. We do not agree that such a move should extend to pharmacy students. Pharmacy students are undertaking a general university education (albeit with a vocational orientation) funded by the relevant higher education funding council and standard tuition fee income. Pharmacy students and pharmacy schools do not enjoy NHS-facilitated access to patients and SIFT funding as applies in medical education – with parallels for students of other healthcare professions – and should not have imposed the burden of costs and bureaucracy of provisional registration and policing ‘professional’ discipline. However, if pharmacy schools become more involved with the pharmacy pre-registration year then perhaps for that year group there will be no alternative but to register and regulate the students involved. It should be noted that pharmacy schools have for many years explained and impressed upon pharmacy students that they are future health professionals and that they should behave accordingly. In cases of student misbehaviour which could be so serious as to be equivalent to professional misconduct, pharmacy schools contact the regulator (presently RPSGB or PSNI) for advice. It should be further noted that the European Charter on Human Rights has relevant content which is something of a check on the regulation of students in a manner akin to the regulation of health professionals.

If any of the above is unclear or you or colleagues would welcome expansion on one or more points, please do not hesitate to contact me or the CUHOP secretary, Dr Robert Dewdney, at the Welsh School of Pharmacy, Cardiff University.

Appendix

November 8th 2006