A bleak house

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A bleak house

 By Outsider

I have a confession to make. My email footer for work still contains the post-nominals MRPharmS, although I haven’t renewed my fees since before the pandemic. 

This hasn’t really bothered me much. There is a cachet to be had from using post-nominals, but I stopped seeing any benefit from the Society after the local branches were abandoned. Now, however, the thought of sending any communication and thinking MRPharmS might matter is just embarrassing. 

When I did my pre-registration year, the requirement for my cohort to attend one local branch meeting was either the first thing that got completed or the last, depending on how active your area was. Friends in urban centres like Bradford or Leeds were whisked off to their meetings almost before they’d been till trained. For those of us in more rural areas, it was more difficult, but there was still an awe, a thrill of being in the room where – well, nothing happened, but lots of seemingly clever people were talking about seemingly clever things.

When John Bell, William Allan and friends sat round the table in the pub setting up the Pharmaceutical Society, they believed they were setting a bar, raising the level somehow in comparison to other sellers of potions, powders and the like. The remit was clear – better and common standards, education and training. The apothecaries had formed their trade body, the physicians and the surgeons had started their colleges – it was a time not to be left out in the cold. And it all seemed to be going well, at least for 170 years or so.

The regulatory framework of medicines and medical practice got built out and the Society gained the power to own the register and put people on it.

When the regulatory split happened in 2010 and the Society lost the registration bit, it still had 170 years of history to fall back on. Standards. Education and training. In a world where medicines are ever more complex, where operating models are changing with the encroachment of automation, and international ties are essential due to the complexity of workforce and people flows, standards, education and training would continue to be vital.

Key, then, it would seem, to have really strong leadership in pharmacy operations and education. Director level positions. Important maybe, to be part of an international federation of similar organisations too. Clearly not. And don’t even get me started on insurance.

There’s been a lot of talk about the lack of ambition for the Society to develop into a Royal College-type organisation. The RPS claims it can do everything it wants to do without needing to become one. 

What it really means is that it wants as many members as it can get, so it can’t afford to disenfranchise those who would not qualify. To be a Royal College is to be meritorious. It’s about setting standards. It’s about training and education. Lifelong learning. That is why newly qualified physicians and surgeons have to shadow for so long and study so hard for those college entrance exams. They’re already registered medics, they can medic to their heart’s content. But there’s the cachet of being accepted amongst your peers in the meritocracy of the college.

What a time it would be if we had strong national leadership just as the Government launches its consultation on hub and spoke 2.0. A bit like web 2.0, it seems sleeker, shinier and a lot easier to use. But, also like web 2.0, the devil
is in the detail and it could all go horribly wrong.  

The good news, at least on the face of it, is that the regulatory change is a lot simpler to understand. Whether this is a consequence of no longer having to comply with the EU Medicines Directive or a genuine scaling back of intent is not clear. The proposed model is essentially a combination of spoke-to-hub-to-spoke and spoke-to-hub-to-patient.  

The cost model is rather mysterious, although reading the consultation documents is illuminating. Apparently, while it costs £1.20 per item to dispense in a pharmacy currently, in a hub this will be reduced to 40p. How they know this is not clear; the impact assessment just states it as fact. What this means for the current funding model and the conceit of retained margin is not discussed or even hinted at, but that should be making everyone in the sector just a bit scared.

It’s reassuring, therefore, to see the national negotiator organising a massive communications campaign, including local and national meetings over the next few weeks leading to a vote of all contractors towards the end of May. However, this is not about the existential threat to the funding model just published. Instead, it is the final death throw of what was the Wright Review into contractor representation.

At a time when the sector needs representation and leadership the most, is there any to be found?

Outsider is a community pharmacist

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