Wanted: An enduring and confident professional leadership body

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Wanted: An enduring and confident professional leadership body

A senior level reorganisation at the Royal Pharmaceutical Society led some senior pharmacists to speculate that a long-term aim to transition to a Royal College had been quietly dropped. With others asking why this might be important, former chief pharmaceutical officer Dr Keith Ridge sets out how Royal Colleges and professional regulators work together to improve patient care

Back in 2008, in the days before Zoom or Teams, when Government decided to split the then Royal Pharmaceutical Society of Great Britain and form an independent professional regulator, I went on the road to explain to people what this was all about.

Here’s roughly what I said:

  • First and foremost, the professional regulator is about patient and public safety. Pharmacy practice is getting more clinical and so, in the context of Shipman, patient safety needs to be much more assured
  • The regulator – not the professional leadership body (PLB) – sets professional (regulatory) standards. The regulator assures against those standards. But in setting those standards, the regulator must take advice and consult to make sure they will have the effect intended. Where does the advice come from? Well, from a variety of sources, but the main one and most authoritative should be the PLB
  • Now some say regulators just set minimum standards, so most can get over the bar and deliver a safe service to the public. To which I would say: “Well, that depends”. I have always held the view, and I know Nigel Clarke the outgoing GPhC chair feels the same, that professional regulation is also about improving patient care
  • The most important opportunity for a forward thinking PLB is to influence the development of professional practice. But the regulator must have confidence in that PLB because its advice impacts on patient safety
  • And it’s always worth remembering: no regulator, no profession. The statute that underpins a profession is that which sets out how it is regulated.

That’s why a confident, well-informed, respected, up to date PLB is needed by the regulator, but I also need to make the case for why a fully realised profession needs a professional leadership body too, since there is a risk that pharmacy won’t develop its potential without one.

Firstly, a PLB is a fundamental part of the identity and governance of a clinical profession. Many, like the old RPSGB, were central to the very definition of a profession and the instigators of legislation that first underpinned it. The PLB today enables pharmacy to take its place alongside medicine and dentistry, and not be bound by them.

It’s a corollary of the idea that the regulator must have confidence in the PLB, that a weak or absent one might cause the regulator to stray beyond its remit, causing a lack of clarity, not least in the minds of the public and those who speak for them.

However, in its setting of professional expectations and best practice, the modern PLB does not act as a membership or representative body, like a trade union, nor is it a club that exists solely to benefit its members. Instead, it strives to underpin excellent patient care whilst explaining to others how pharmacy professionals can contribute to that.

This is how it works in medicine and other regulated professions.

Regulatory standards extend across the full spectrum of professional activity, with education being the most fundamental. That’s why a director of education at the RPS is needed, and why the fact that education merits only a tangential reference in the RPS’s 2021-26 strategy (“that the RPS will be the recognised leaders in influencing and shaping practice, policy and education, for pharmacy, pharmaceutical science and the safe use of medicines”) is troubling.

It may be a coincidence that the RPS has also decided there is no value in its membership of the international professional leadership body, The International Pharmaceutical Federation (FIP), which has in recent years expanded its remit into education, partly as a response to the global workforce challenges identified by the World Health Organization. But that decision too shows a distinct lack of ambition.

In response to something of a media storm that followed the announcement of the redundancy of the director of education post, the RPS president seemed to suggest the Royal College debate was more about a name change, and that most (if not all) of a Royal College’s functions could be carried out under the current RPS Royal Charter. Those involved in setting up the new RPS a decade or so ago knew, and they were right, that the RPS had to fundamentally change to deliver the type of advice I’ve outlined above.

They knew that the RPSGB with combined functions was primarily a regulator (albeit conflicted), not a leadership body, so it would have to completely reinvent itself to deliver effective professional leadership and advice that would lead to excellence in professional practice. And that it would take a collective effort across the profession to begin a new journey and establish a new culture to coalesce around. In other professions, such functions are mostly delivered by Royal Colleges.

Good patient care and professional development is about teamwork. Previous presidents rightly concluded that signalling such a fundamental shift to other professions, governments etc, meant working towards a name change. This was not the goal, but was intended to herald a programme of work and investment in areas such as education and leadership that would ultimately lead to much greater teamwork across professions, enhanced professional roles and improvements in patient care.

An enduring and confident professional leadership body would result, fit to advise the regulator, policymakers and governments. Understandably, expectations at the time were high, and remain so, whether within or external to the pharmacy profession.

Of course, working with and influencing the medical profession would be an important part of being an effective Royal College. But that shouldn’t mean succumbing to medicine, as some have suggested, by pleading to be part of the Academy of Medical Royal Colleges, a collaboration of 23 medical Royal Colleges and faculties.

I have worked closely with the Academy. It’s a good thing. But it is understandably focused on the medical profession, and pharmacy is likely to have little influence as a member.

Moreover, I suspect the Academy would wonder why pharmacy would want to be part of it, preferring external authoritative input. Instead, a confident Royal College of Pharmacy would embrace its experts within – from science to cancer to mental health – and collaborate strongly with medical colleagues whilst remaining independent. Pharmacy could form its own Academy, led by the Royal College, if it so wished, and would be stronger for doing so.

I have explained elsewhere how the removal of the director of education and professional development post from the Royal Pharmaceutical Society (RPS) structure was a fundamental and tragic strategic mistake that could result in an organisation driven by its publishing interests. And I do not want to detract from the importance of the RPS retaining a director of education function per se. Such a post should be fundamental to a professional leadership body, in any event.

This ‘name change’ is much more than that. Confidence generated by being an outward looking Royal College that drives towards excellence in patient care, professional practice and multi-professional teamwork. Proud members who are only too willing to represent their profession, including internationally. Working with a regulator to drive forward practice and care in a world-leading way. Respected by others for grasping the future and not gripping the past. Helping us all to deal with the huge challenges ahead.

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