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Long read: Time to bite the CPPE bullet – some facts, history and proposals

It is great to see the work on reform of professional leadership in pharmacy finally starting its delivery phase. The appointments to the UK Pharmacy Professional Leadership Advisory Board should get the show properly on the road, says Keith Ridge, former chief pharmaceutical officer for England.

One of the defining principles that underpins any professional is a commitment to lifelong learning. In other words, continuous personal and professional development so that as science and public expectations change and advance, professionals can keep up to date to ensure their practice is as modern and effective as possible.

Professional regulators, whose core function is to protect the public, have processes that aim to deliver this. For pharmacy, that’s centred on the General Pharmaceutical Council’s (GPhC) revalidation regimen, which ultimately demands the minimum required to ensure patient and public safety. Revalidation is underpinned by professional regulatory standards determined by the GPhC through a rigorous development and public consultation process, the principles of which are set out in legislation. 

Professional leadership bodies think about patient and public safety too, as well as high quality patient outcomes, and express this by driving the profession towards excellence. Professional leadership bodies also have standards, based on that aim of excellence in practice, although not grounded in legislation. Instead, the standards are a consensus of what the profession decides is best practice. Those standards should be developed through a robust process that draws on the latest research and evidence.

Through this, patients receive good care, the profession remains in good standing and driven forward – and that is good for everybody. The regulator draws on this professional ambition in developing its standards, albeit with a much wider input. 

In medicine, mainly because the risk to patients is considered much higher than in other professions, the regulator (the General Medical Council), alongside its responsibility for basic patient safety standards, also has very clear legal responsibilities for professional development, even though the delivery of this is delegated to professional leadership bodies (i.e. the medical Royal Colleges).  

In non-medical professions, the professional regulators’ responsibilities for patient safety don’t stop at the door of entry to the profession. They still have legal responsibility for patient safety throughout and across an entire professional lifespan of a registrant, but how those responsibilities are delivered is not so clearly set out as in medicine. In the context of rapid change in pharmacy practice, the GPhC is looking carefully at the future of how it regulates professional education and development, and rightly so. 

Of course, there are other bodies in the world of healthcare. Trade unions, who mainly worry about terms and conditions of their members; trade bodies, who mainly worry about income and profit for their members; universities, who want to deliver high quality graduates in a profitable way so as to drive other activities such as research; and employers, who should want the best for their staff but definitely want the best outcomes for their businesses – whether public or private sector. 

And all of the above comes together in a heady and complex mix of power, interests and influence. Joe Public is either caught in the middle or reaping the rewards, depending on how you look at it! 

Some proposals 

It is great to see the work on reform of professional leadership in pharmacy finally starting its delivery phase. The appointments to Sir Hugh Taylor’s UK Pharmacy Professional Leadership Advisory Board should get the show properly on the road. 

The opportunity to enhance and advance professional leadership is significant. There is a real opportunity to bring together in a collaborative way all the major professional leadership bodies in pharmacy just in time to support, not just the current pharmacy workforce who themselves are being asked to deliver more clinical care but, importantly, the new type of workforce that will emerge from 2026 when all newly qualified pharmacists will be prescribers. People talk about game-changers but this will change the whole league. 

However, the profession won’t be able to make the most of this if professional education and development is not eventually cemented into professional leadership and professional regulation. At the moment CPPE is beholden to its masters – NHS England’s Workforce, Training and Education Directorate. Similar arrangements are in place across the UK with the equivalents to England’s CPPE accountable to NHS or Government bodies. That’s good for policymakers because they can direct and draw on their expertise, and it was right for the era we have come through – but now we need to let the pharmacy profession fly.  

Fingers crossed within a year or so we will see the first solid proposals for a collaborative approach to professional leadership in pharmacy. Within three years (preferably fewer) we should see the formation of a new unified professional body, perhaps with faculties covering the various specialties emerging from existing bodies like CMHP and UKCPA, and perhaps within a further five years a Royal College for Pharmacy will be born.  

It is critical the heritage and expertise of each component body is protected throughout that process, but none of this will fly unless CPPE is a central part of the new body. That might be delivered gently at first, for example by creating CPPE as the standalone education department of any new body, but a clear road map of full integration is needed. This must include pump priming the transfer of CPPE funding to the new leadership body, alongside a solid proposal for how to sustain the new body’s new role in professional education and development without the need for public finding.  

Typically, that would include registrants paying fees for professional development just like medicine. Professional regulation also needs to reform to make postgraduate development much more central to its day-to-day business, not least because the risk to patients will increase from a more clinically orientated pharmacy profession. That may need some strengthening of the relevant legislation as well as additions to competence and capacity.  

Of course, in due course, the GPhC will also be able to draw on the new enhanced professional leadership body for advice on professional education and development. 

Some policymakers may think that integrating CPPE into professional leadership will throw the baby out with the bath water. Why do this when currently we have the ability to guarantee the right training for the services commissioned? But now is the time to bite the bullet and, with the right safeguards, trust the profession to deliver its own fate and take on full responsibility for delivering innovative, high quality, and excellent patient care. 

Some history

How CPPE came about – and what should happen next

Back in the 1980s, Government and professional ambitions to deliver more clinical care through the pharmacy profession came into alignment in the form of the Nuffield inquiry – a clinical prophecy that still has influence today. For those charged with delivering the recommendations it became apparent that, if pharmacy was to deliver excellence in clinical practice, the approach to lifelong learning had to be much more robust.  

The obvious candidate to deliver this was the then Royal Pharmaceutical Society of Great Britain but it was both a regulatory and professional leadership body, and the former was statutory so that was its focus (i.e. delivering the basic patient safety standards). Specialist pharmacy leadership bodies such as the College of Mental Health Pharmacy (CMHP) and the UK Clinical Pharmacy Association (UKCPA) were starting to emerge and take responsibility for supporting professional development in their fields.  

Government, however, was determined to make the most of community pharmacy and so the Centre for Pharmacy Postgraduate Education (CPPE) was born, based at the University of Manchester. As community pharmacy developed NHS clinical services, there was CPPE ready and funded to deliver the necessary clinical training. A major achievement by the two civil servant who created it (Peter Noyce and Jeannette Howe). Years went by and CPPE thrived. New services were negotiated and CPPE was always there to deliver the training.  

When I first took up the post of Chief Pharmaceutical Officer for England I commissioned an independent review of CPPE, just to check all was well. The review concluded it was a centre of excellence in what it did. Subsequently it expanded further, and gently stepped into the world of supporting hospital pharmacy while always successfully rising to a new challenge like the development of GP practice pharmacists.

However, compared to other professions, the oddity of not having the expertise of CPPE embedded in professional leadership functions like the medical Royal Colleges remains – and the life blood of most professional leadership bodies is the expertise acquired through postgraduate development.  

While the CPPE budget has increased significantly over the years and now sits in the several millions, its not surprising that some elements of professional leadership in pharmacy are not as developed as they could be, notwithstanding that bodies such as CMHP and UKCPA do a great job in offering professional development. 

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