It could be argued that a “coherent, federated, UK-wide professional leadership framework with strong governance” and a “transitional, collaborative Pharmacy Leadership Council” looks like another layer of talking shop — but here is why good leadership matters.
It is no surprise to me, not only that a past chair of the Royal College of Physicians should be appointed by the four national chief pharmaceutical officers (CPhOs) to co-chair the Commission, but that the perspective of professional leadership bodies (PLBs) from other professions should be writ large in its work.
Three non-pharmacy PLBs – the Royal College of Anaesthetists, the Royal Society of Chemistry and the College of General Dentistry – presented to the Commission; the chair of the Royal College of General Practitioners, Professor Martin Marshall, was a member of its leadership working group.
As the Commission heard, these PLBs have much in common. They work with regulators to develop professional standards and with higher education institutions and others on education and training programmes, assessment and credentialling. They foster research and innovation in knowledge, including the defining and redefining of roles and responsibilities (the scopes of practice) of the professions and of their specialisms. They collaborate to encourage the sharing of good practice, and they communicate with and engage with a wide range of audiences, to promote understanding of and confidence in the professions they represent.
Above and beyond all of that, however, is that patients and the public are right at the centre of what they do. Promoting excellence and safe practice. Raising standards. Improving education. All fundamentally done for the benefit of patients and wider society.
Setting a path
These attributes are writ large in the history of the Royal Pharmaceutical Society. The early Pharmaceutical Society of Great Britain may have looked like a Victorian gentlemen’s club, and in some respects it was, but its early activity was clearly focused on setting a path for a new profession. One which was rooted in science and in learning for members of the day and with an eye on future generations of members.
The founders were the elite of their day. They were committed to demonstrating, to the public and the powers of the day, why they should be trusted with oversight of the production and use of medicines/poisons. And they took that argument to Parliament. Many times. They won rights for those who joined them and they persevered until the role of pharmacists was codified in the law of the land.
Across the years, significant men and women within the profession, always with an eye on the public good, argued for examinations, the registration of fit and proper persons, restrictions on the use of titles and the registration of pharmacies, Charter objects aspiring to excellence, and for degree-level entry.
When the Association of Pharmacy Technicians (APTUK) was founded in 1952, education and the public interest were front and centre for pharmacy technicians too.
Whenever new roles and accountabilities emerged that might create internal conflict with these high ideals, or run the risk of diminishing the profession in the eyes of the public, pharmacy’s leaders sought clarity, through the courts and by establishing new bodies such as the Proprietary Articles Trade Association or the Retail Pharmacists Union (now the NPA) to take on those new roles and responsibilities and reshape the professional landscape at the same time.
That vision and those achievements had another effect. The PSGB, as it once was, was the authoritative voice of the pharmacist profession. The campaigning organisation that sought legal backing for the changes it argued would keep patients safe, became a trusted adviser, consulted on high profile policy changes. On the regulation of the profession and of medicines. On the Medicines Act. On the prescription charge exemption list. On POM to P switches.
For more than 150 years, generations of RPS leaders built the organisation’s credibility, authority and expertise for and on behalf of the profession. It had influence. The removal of regulation to a separate body – the General Pharmaceutical Council (a split first suggested in the 1920s) – should have left the PLB that emerged freer to continue to pursue the excellence in practice that marked out its first century-and-a-half as a leadership body.
It got off to a good start. As the Leadership Commission itself points out, many of its recommendations will build on firm foundations, including work already being pursued by the three PLBs (the RPS, APTUK and Pharmacy Forum Northern Ireland), or one of the specialist groups that have come to prominence.
Read the recommendations of the Leadership Commission and you will find elements of what it dubs a professional leadership framework in the RPS Faculty and in its mentoring programmes, in APTUK’s professional frameworks, and in the credentialling programmes of groups like the College of Mental Health Pharmacy. The nascent RPS won plaudits too for its early media work. Early years practice now has firmer foundations.
But the early promise of 2007’s ‘engaging to transform’ programme, with the adoption of the frameworks for general and advanced level practice developed by the Competency Development and Evaluation Group and the establishment of the Faculty itself, seems to have been lost in the last few years.
The departure of two senior RPS executives in the middle of last year raised questions for some about its commitment to the education brief. The RPS turned its back on more than a century of history by leaving the international pharmacists’ body it helped to found [a decision since reversed]. Timing suggests these were the red flags that prompted the CPhOs to order a review; the Commission picks out the loss of local networks along the way as another mistake.
The Commission used the medical PLBs as a benchmark against which to assess the pharmacy PLBs, and found them “not approaching their roles and responsibilities in the same way, or adopting comparable high aspirations for excellence”. For example: “in the case of postgraduate education, where medical PLBs would usually be closely involved, there has been less progress within pharmacy leading to an impact on integrated career pathways, continuing professional development and career progression.”
We often hear it said that “pharmacists are experts in medicines”, but expertise and excellence do not stand still. Complex co-morbidities and new medicine technologies makes keeping patients safe dependent on continuous improvement in the standards of practice and the evolution of roles.
For any profession, these standards are the province of a PLB, acting in the public interest. Chip away at that, and credibility and authority are lost too. Members start to question the value of belonging. External parties looking for a credible source of information from and about a profession start to look elsewhere. That’s a spiral downwards nobody wants.