In this season of goodwill, peace has broken out between Terry Maguire and the Pharmaceutical Society of Northern Ireland
Pax Hibernia
Peace has broken out between myself and the Pharmaceutical Society of Northern Ireland (PSNI) regulator. Readers may remember that I was disgruntled when subjected to a Fitness to Practice (FtP) investigation back in February. Following my acquittal, I asked the PSNI Council to consider stipulating explicitly that Freedom of Speech be an area out-with (what does he mean here?) the FtP process. It is my view that this was regulatory over- reach. I am grateful to the Council for their deliberations yet still disappointed my request was rejected.
However, I am surprisingly content and now see the matter as being resolved. My petty concerns are only a small, if not unimportant, part of the ongoing debate within our profession that is so important to its development. Too few pharmacists are willing to grab a megaphone and get involved in this great debate as the perceived threat of censure is unhelpful — which was the motivation for my letter of complaint, dated 16 April, to the Council.
In his reply, which I received on 14 October, the Chief Executive Canice Ward made it abundantly clear that the PSNI Council viewed the right of every pharmacist to freedom of expression. And I agree with him that, in the right to free expression, there are responsibilities and recognised limits. Indeed, in my letter to the PSNI, I accepted that all pharmacists have a responsibility to express themselves in a non-harming way. My concern was the ability and competence of a Registrar to properly recognise these limits.
For example, had I said in an article that ‘vaccination is genocide’, then I would rightly be taken to task. This statement is factually and scientifically incorrect and has the potential to cause significant public harm. It would, in this case, be ‘strictly necessary’ and ‘proportionate’ for the Registrar to initiate an FtP investigation.
If, however, I was to state that ‘cloth face-masks don’t stop the spread of Covid-19’, this would be less clear. Making this statement during the Covid pandemic in the UK was illegal — therefore, I would have broken the law and I could have been subjected to an investigation. But the statement is factually correct, as shown by numerous well-designed studies. Saying it now, when Covid regulations no longer exist and it is not illegal, it would be wrong to initiate an FtP process, since it is factually correct.
Social media is, of course, a much greater concern for professional regulators generally. A professional person might get engaged in a debate outside their professional field and might make a statement that could bring their profession into disrepute.
For example, a racist remark would be unacceptable from a person who enjoys the privileges of a professional life. The Bar Standards Board, which regulates barristers, has very clear guidance on this. It seems that profession may be particularly fond of getting stuck into risky polemics late at night after a few. ‘Is he saying they are racist?’
In my specific case, a complaint about an opinion piece in a respected UK pharmacy magazine on a subject that was in the public interest, is — I strongly believe — something that should never have been investigated in an FtP process. It was not ‘strictly necessary’, nor was it ‘proportionate’. These are the two criteria that the Council believe must be considered before the Registrar initiates a case.
However, I am unlikely ever to get an apology for this regulatory over- reach and the attempt to silence me. I have, however, caused the Council to meaningfully consider the matter and I suspect these deliberations will ensure that a Registrar, in making a call on a future petty and vexatious compliant about what a pharmacist said, will back off from a knee-jerk response of making it a case to answer. I am content, and I see the matter resolved.
Birthday celebrations
And so, to the PSNI’s 100th birthday celebrations, which are being marked with a series of events and podcasts. Three podcasts have appeared to date on the PSNI website, which I can recommend as good listening. Past- president Tom Eakin — who achieved global success with his stoma-care business, which he started from his Belfast pharmacy in the 1970s — is such an inspiration and still goes to work most days at the age of 91. In one of the podcasts, he sits down with current President Geraldine O’Hare to discuss his life and work.
The past is a different country Registered in 1951, the pharmacy practice he describes will seem Dickensian to current registrants. Completing an apprenticeship based on a curriculum set out by the PSNI Council and offered at Belfast Technical College, he was one of 130 student apprentices in his year. A few of his contemporaries took a different route, completing a BSc at Queen’s and then a forensic examination offered by PSNI. He fondly describes practice in the 1950s and 1960s, when most medicines were compounded in the pharmacy, with 90 per cent being liquids produced from the galenicals on the pharmacy shelves.
How things have changed. In 1971 in Northern Ireland, pharmacy became a degree entry profession
and it was at that time that the School of Pharmacy was set up at Queen’s University. Tom was President in 1975 during the 50th birthday celebrations and remembers the debates and discussions held that year on modernising the profession. Some argued on the need to move to greater professionalism while embracing clinical roles, while others countered that pharmacists need to make a living and should stick to commercialism. This debate was settled amicably, he felt. I’m not so sure.
Registered in 1951, the pharmacy practice
he describes will seem Dickensian to current registrants
The debating chamber
I was a student in 1975 and when I entered pharmacy politics a decade later, this debate was still raging and the protagonists from each side in 1975 were still in the Council chamber.
Members included two colossuses, Josh Kerr and Tos O’Rourke; newer members Terry Hannawin and Ronnie McMullan; and Sean O’Hare from hospital practice — all considerable sparring partners in any debate. I joined the fray in 1986 and got bruised regularly attempting to establish standards: For CPD; introducing the pre-reg examination; and getting consensus on Vision 2020, our future strategy published in 1999.
For me, then and now, the essence of all pharmacy politics is a struggle between the professional and the commercial. Our professionalism is the professional standards we set and adhere to in our day-to-day work. These standards are in the interests of the public and this gives us special privileges. Our commercialism, what we are paid for, gives us our living. When properly balanced, we succeed — out of balance we fail, and when we fail, the public loses out.
Arising out of those debates (going back to at least 1975), we are achieving the necessary modernisation through standard setting and implementation. Pharmacy has always been professional with high standards of practice, and we now focus on a wider professionalism involving our clinical roles. We also remain commercial, which is a good thing as we run extremely efficient businesses that are open and accessible to the public, unlike so much of the modern health system.
Health Plus Pharmacy
One particular debate in recent times, not strictly linked to the PSNI, was the struggle to implement contractual standards in a scheme called Health Plus Pharmacy (H+P). Based on the English Healthy Living Pharmacies model, H+P aimed to provide a commissioning framework for the public health roles which pharmacy was developing. There was enthusiasm from the Department of Health, the Health
Board, the Public Health Agency, and indeed pharmacists generally. An Assembly was formed from key stakeholders and we worked hard over many months to agree on a framework. One of the H+P standards related to the products that Health Plus Pharmacies could not sell, which included vapes, sunscreens below SPF30, and non- medical confectionary.
Community Pharmacy Northern Ireland kicked back strongly, viewing this as commercial restriction — and Boots unilaterally made it clear that it would not be participating. It was disappointing, as there had been great support and enthusiasm, and for 18 months I provided the course that delivered the training standards for the scheme, which was completed by the vast majority of community pharmacists across Northern Ireland. With the raging debate on commercial restrictions, however, H+P was quietly dropped.
But it was not all for nothing, as out of this we did get our commissioned Living Well service and we went on to get vaccination and more comprehensive Pharmacy First offerings — but without the H+P accreditation and its associated standards.
Clearly Tom Eakin was wrong. 1975 did not see the end of the professional vs commercial debate. This great debate will rage on for another 100 years. And it must always be unrestricted, open, honest, and passionate.
Happy 100th Birthday, PSNI! And a very happy Christmas and New Year to all.
Terry Maguire owns two pharmacies in Belfast. He is an honorary senior lecturer at the School of Pharmacy, Queen’s University Belfast. His research interests include the contribution of community pharmacy to improving public health.
