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Equality and equity are not the same thing


Equality and equity are not the same thing

Proposed reforms to the PSNC and LPCs provide a once-in-a-generation opportunity to repurpose community pharmacy representation, but Nick Kaye is not sure independents realise what is at stake…

I often think about what the future of community pharmacy could be and should be like, and how we are going to get there. Which is probably why, as well as being a pharmacy owner, I am also involved in pharmacy politics - locally at LPC level and nationally as an NPA board member.

Although meetings can be the sometimes frustrating, a theme that has come up frequently in recent committee meetings is around equality and equity, and how these are two very different things. Treating everyone the same does not necessarily result in equal outcomes and fairness, which I find a fascinating truth.

In pondering pharmacy’s future this truth is relevant to the pharmacy representation review that is ongoing in England, in which the future of PSNC and local pharmaceutical committees is being considered.

The process seems quite fixated on treating all contractors equally, and as a concept surely that is right. However, if equality and equity are different then obtaining equitable outcomes for all parts of the sector should be the key. In the pharmacy sector treating everyone the same is not likely to result in a fair situation given the broad and diverse nature of contractors, from large corporates to single independents.

Among the papers I have been studying is an NPA paper which is suggesting that we should be seeking equity, which will mean respecting the differences between different types of contractors rather than treating them all the same in the vote to come.

Recently we had proposals from the Review Steering Group (RSG) on how the vote to determine the future of pharmacy representation will be taken. What is proposed by the RSG is a single contractor vote. This ignores the huge difference in the likelihood of a block vote of, say, 1,800 votes being cast by Boots versus the challenge of getting 1,800 individual votes from independents to be cast in a similar way.

These are independents who are struggling with the overwhelming pressures of the day job, and to whom the Wright Review and RSG feel alien, and they may not understand the impact of the changes that could be coming their way. The NPA has been arguing for an approach which requires a clear majority of each part of the sector to be demonstrably committed to whatever changes are proposed, but this idea was rejected for an ‘equality’ solution which I suspect won’t deliver equity at all.

A one-size-fits-all vote, in essence, could be passed by CCA members voting on their own and supported by one or two hundred other votes. That’s not an equitable solution. What would it mean, for example, if the Review Steering Group recommends a corporate board made up of individual contractors alongside a few independent, non-executive, directors? And these contractors would perhaps be in proportion to the scale of that part of the sector?

I suspect CCA and AIMp quite rightly will want to be able to elect and support their own reps. But independents will have no such recognised body, and without that back-office support I suggest those independents will be at a disadvantage, and therefore the whole of the independent sector will have no chance of equity in those board meetings.

We must acknowledge that what some parts of the sector might want are not what other parts of the sector might want, and that’s ok. Sometimes when you listen to people in the sector, it sounds like the message is ‘big is bad and small is good’. I personally don’t think that is the case. All of these different types of businesses are legitimate.

People might have different business models and be keen to argue for different things with government, but it’s not bad versus good, it’s just different. As independents we all need to be asking whether all parts of the sector are to be treated equitably. It therefore must follow that all contractors at the new board are directly appointed, or is everyone represented by a trade association?

The RSG could be a once-in-a-generation chance to repurpose community pharmacy representation at a national and local level. I am not sure that independents have realised what’s at stake.

Nick Kaye is a community pharmacist based in Newquay and vice-chair of the National Pharmacy Association. These are his personal views.

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