Confidence and professionalism.

Graham Phillips wrote an interesting article in the PJ last week (PJ VOL 282 P133-134) with was actually talking about the new General Pharmaceutical Council but included a section on what amounted to confidence.

Vision

It was apparent to me, when I joined the Royal Pharmaceutical Society’s Council over four years ago, that the absence of a collective vision for the profession — a vision in which the members’ views were deeply embedded and in which their hearts and minds were engaged — was a critical failure that had to be  remedied if progress were to be made.

I believe that deficit has been fully remedied with the publication of the White Paper for pharmacy in England and its equivalents in the devolved countries.

So my starting point:

1. What would a fit-for-purpose pharmacy profession look like if it were to be able to fully deliver everything in the White Paper?
2. What are the necessary roles of the two new pharmacy bodies created by the demerger of the Society, in delivering this fit-for-purpose profession?
3. What should be the inter-relationships between the two new bodies in order to ensure and assure delivery?

I view the GPhC and the new professional body as mirror images of each other — the left and right hands of the same strategy. The inter-relationships between them should, of course, allow for and stimulate challenge and debate. An appropriate degree of “creative tension” is crucial to delivery and to protect the public.

Role of regulation

I believe that pharmacists have been over-regulated and under-supported professionally and that there has been a great failure to articulate pharmacists’ professional aspirations to do more for patients and the public.

If we promulgate this scenario into the future the resulting stasis will continue and the profession will never be enabled to deliver on its potential. Thus I believe that the arguments I am advancing are public interest arguments.

Pharmacists are intimidated from practising their profession to the full. I see this even in members of my own teams — and we aspire to be leading edge community pharmacy practitioners.

We pharmacists are often reluctant to accept clinical responsibility: “Ask the doctor”, is a far easier default position than dealing with the complexities of patient care and lay health belief.

This is nowhere better illustrated than when Jim Smith, a former chief pharmaceutical officer for England, wrote to The Pharmaceutical Journal in frustration, because of his experience of community pharmacists being unwilling to make an emergency supply of a salbutamol inhaler in a case of genuine clinical need (PJ, 1 July, 2006, p11).

It is all too easy to play the blame game here, and to criticise the individual practitioner for unduly defensive practice and a failure to be sufficiently patient-centred but we have to analyse why we are where we are and why this attitude is commonplace.

I believe there is a complex of reasons which has led pharmacy to this state: one is excessive regulation, another is a lack of professional support, and still another is a lack of professionalisation during the undergraduate years.

I make these comments with reference to the experiences of other health professionals and based on my three years’ experience chairing  the Society’s Education Committee.

The overbearing regulatory agenda surrounding the practice of pharmacy has led to a culture of risk avoidance rather than risk management. This is especially the case for community pharmacists who practise in considerable isolation and with little peer support or clinical supervision.

As a patient, I would want health professionals to accept clinical responsibility (but always within their competences, of course).

As a health professional, I recognise that this involves applying my knowledge and skills within an ethical and professional framework in circumstances where there are often no “rights and wrongs”, just shades of grey.

As a clinician, I am happy to take clinical responsibility for “my” patients and make judgements. In return, I expect the regulator to recognise that on occasions, I will be making clinical decisions in the light of all the available evidence and sometimes the outcome will not be the desired one. So long as my judgement is reasonable, within my competence and is patient-centred I would not expect to be censured.

Returning to my example above of the lending of a salbutamol inhaler, many pharmacists have experienced criticism by Society inspectors for lending medicines to patients when surgeries were open.

Such supplies were regarded as being outside the emergency supply rules and pharmacists have been intimidated from acting in patients’ best interests as a result.

So I hope it is clear from this practical example that pharmacists do not feel themselves sufficiently empowered to make clinical judgements.

For the full article please click on the link below:

http://www.pjonline.com/news/time_to_break_the_silence_around_the_new_general_pharmaceutical_council

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