Sultan 'Sid' Dajani raised eyebrows during the Avicenna Conference in April when he claimed pharmacy is regulated by individuals with little knowledge of the profession. The vice-chairman of the Royal Pharmaceutical Society English Board reveals his fears over the regulatory standards of the General Pharmaceutical Council...
When I was in Turkey for the Avicenna Conference I was asked to speak about the splitting of the Royal Pharmaceutical Society of Great Britain and how joining the new professional leadership body would make all the difference to us as pharmacists. One of the important roles I envisaged for our new strong, vibrant and dynamic Pharmaceutical Society (RPS) was around tempering the excesses of the regulator. This sparked so much controversy.
Representation and regulation in pharmacy has spent nearly eight decades dancing a very well choreographed routine and with good organisational ‘ambidexterity,’ the RPSGB would have been the place where the Science of Regulation met the Art of Representation. Alas we all knew merry-dance was one where representation was always lead by regulation and we were merely members by name and registrants by nature. It was not an equal relationship at all and therefore the RPSGB was significantly not member-centric; it was more of a Dr Jekyll and Mr Hyde organisation and for those who inadvertently made errors, just when you needed the RPSGB the most, it became more Mr Hyde!
Pressures
Some argued being regulated by your peers was a good thing because they would understand your work pressures and could separate between honest mistakes and those more crooked. It also meant a cheaper registration fee because it was subsidised by membership services such as publishing and being a joint regulator guaranteed sustainability.
Others argued it meant we had a poor representative professional body and because it was risk averse, the RPSGB could not be more outspoken and proactive. The government decided all regulators had to be more transparent and so they appointed Lay members onto the Council and we were forced to accept.
Suddenly the three privy councillor appointees on the Council swelled up to 11 paid career committee-ists. This added significant extra cost to meetings, wholly funded by the profession, and sadly we never saw a return in terms of support; in fact the opposite happened - the vast majority undermined your elected representatives on matters they never understood.
If any Lay members sided with us, they were considered to be ‘closet professionals’ and on many occasions it was ‘us’ against ‘them.’At times it felt like the RPSGB was being hijacked on serious professional issues which they could never understand and, being non-pharmacists, they had a poor handle on the profession.
We have a strong foundation in pharmacodynamics, pharmacology, pharmacokinetics, pharmacotherapy and toxicity of medicines and how they may be used to prevent and treat illness, relieve symptoms or assist in the diagnosis of disease. This is underpinned by knowledge of the law relating to pharmacy and medicines and its application with ethics and supervised experience with patients.
It takes experience to know what makes pharmacy work. The Lay members were not interested, so much so that at times it felt the vast majority of them were ‘anti-pharmacist,’ playing political games, doing the bidding of the Department of Health (eg, on remote supervision, the Responsible Pharmacist regs, etc) rather than only overseeing regulation.
Professionalism cannot be imposed by governments or by a regulatory culture - it must emerge from and be sustained by ourselves as practicing pharmacists. So when the split happened, I was glad the new RPS was free from the shackles of its regulatory role.
However the demerger is not the end, it’s just the beginning! My genuine concern, post-split, is not the politics, it is the cohesion of regulation and practice. Are we going to be left with something that works or one that is good at punishment?
What makes matters worse is that we are the only profession that can still be criminally prosecuted once gross negligence has been ruled out and that honest people who make genuine mistakes are treated as if they were criminals - a lifetime of good practice destroyed and blackened by one error.
Therefore my gut instinct is that we need intelligent regulation as opposed to simply a plethora of processes that give the public a sense that the matter is covered. The argument for cross fertilisation between education and disciplinary roles so that regulation can be preventative and educational rather than punitive is the right one.
Understandably the GPhC must safeguard the public interest but I believe it also has to be alive to the professional spirit of those who seek to diversify and extend their services to patients and to advance professional practices and boundaries. Its decisions cannot solely be based around risk. We need our regulator to work with the profession to offer solutions to problems rather than merely pointing to problems with a big stick. It must be concerned with working environments and consistent delivery. Regulation has to be proportionate, light touch, efficient and seen to do proportionate justice.
Realistic
We would all support regulation that maintains appropriate standards that are realistic and practical in their application and which are enablers of safe innovation. We would all support the GPhC in these endeavours and look to it to support us in preventing our profession being turned into a cut-price horror profession and more errors arising from a mixture of human error, lack of funds and bad luck.
Without joint working we could all be governed on the principle of collective irresponsibility as we will make more mistakes when the systems, tasks and processes work in are poorly designed - the GPhC must surely realise that.
However the GPhC, with a wholly appointed Council and a token minority of appointed pharmacists, will regulate us. I cannot imagine those appointed will be outspoken, defend the profession or have a good understanding of it, much less be well-informed. Even if they did, they will be over-ruled.
We are in real danger of being educated as pharmacists but turned into performance management monkeys if past experience of Lay members is anything to go by. Hence without a good, strong leadership body we will be regulated almost to a standstill. A climate of fear will mean our priorities will centre around defensive practices rather than patient care, while our clinical focus becomes buried under the sheer weight of bureaucracy through regulation.
"The GPhC, with a wholly appointed Council and a token minority of appointed pharmacists, will regulate us. I cannot imagine those appointed will defend the profession or have a good understanding of it."
I have repeatedly asked if the GPhC will partake in error prevention and support professional practice around workload pressures, empowering the Responsible Pharmacist, pushing for the decriminalisation of errors, the regulation of dispensing doctors, updating the prescribing standards amongst other things. However, I am continually told it is not in their remit.
This is a huge disappointment because we need to support pharmacists in their interests of their patients before errors happen and the valuable unions get involved. The lack of interest and solidarity the GPhC has shown to our problems, giving themselves pay rises and increasing our registration fees despite the current economic climate are bad signs. They say their pay rises are in line with other regulators but that is sad. They could be setting an example rather than finding an excuse to get a bigger trough!
The GPhC is putting its house in order but even with the best intentions, it can't do it alone. The RPS knows what makes our members sad, mad and glad and we need to work with the GPhC because regulation cannot just be about a risk-based approach, otherwise why should anyone innovate, take a risk, try something new, make an effort, push the boundaries, experiment, endeavor and go the extra mile if their work is traduced by the regulator with a lap-top and files of risk averse files.
In the absence of positive regulation, tempering the excesses of the regulator is about a comprehensive, effective and fair RPS challenging and supporting the GPhC to deliver the best possible codes, rules, frameworks and processes to ensure regulation that is effective and informed. Being pro-pharmacy does not mean I am anti-tech, anti-doctor, anti-regulation or xenophobic. I believe it is about having the best regulation and considering not only the crimes but also the causes and then helping to address them so others improve. Only then will the GPhC enjoy the confidence of the profession, our patients and the public.
The article is Sultan 'Sid' Dajani's personal view and not Royal Pharmaceutical Society policy. The GPhC refused to respond when contacted by Pharmacy Business.
The GPhC has a 14-strong Council as well as statutory committees overseeing registrants' fitness to practice. So who sits on the regulatory body's Council?
Bob Nicholls CBE; Chairman of the GPhC. Has 40 years' experience in the NHS as a senior manager and chief executive at hospital, district and regional levels.
Cathryn Brown; A pharmacy manager with the Co-operative Pharmacy in Longridge. Previously worked for Boots for 10 years as a consultant pharmacist.
Sarah Brown; A non-executive director with experience in the public and not-for-profit sectors.
Professor Celia Davies; Professor Emerita at The Open University. Retired from her post as Professor of Health Care in 2005.
Professor Soraya Dhillon MBE; Foundation Professor and Head of the School of Pharmacy at the University of Hertfordshire.
John Flook; Self-employed and director of John Flook Coaching and Consultancy Ltd since 2003.
Christina Funnell; Part-time consultant as Patient Engagement Officer with Patient Opinion.
Kirstie Hepburn; Career in pharmacy spans over 13 years. Currently a Regional Director for Lloyds Pharmacy and accountable for leadership of around 325 community pharmacies.
Ray Jobling; Fellow and college lecturer in sociology at St John's College, Cambridge. Also Trustee of the Pharmacy Practice Research Trust and Chair of Pharmacy Health Link.
Professor Elizabeth Kay; Clinical director, medicines management and pharmacy services at Leeds Teaching Hospitals NHS Trust. Responsible for 440 staff and a medicine expenditure budget of £70m.
Lesley Morgan MBE; A registered pharmacy technician. Worked for the Welsh Centre for Pharmacy Professional Education for 15 years.
Professor Keith Wilson; Deputy Dean of the School of Life and Health Sciences at Aston University.
Dr Peter Wilson; Retired as head of the Education Development Division at the Royal Pharmaceutical Society in October 2009. Was also an external examiner at the University of Leeds.
Judith Worthington; Left her position as a Magistrate and Court Chair of the Melton and Rutland Bench where she had been since 1991. Background is in education and training.
