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Who defines the boundaries of accepted professional practice? Should boundaries exist? Who gives guidance on what pharmacists should be doing in those roles that may still be in development?
Ray Fitzpatrick
Consultant Editor
This journal has always published articles with a breadth of content reflecting the diversity of practice in an environment where medicines change rapidly. For pharmacists this is an exciting and diverse environment to practise in, with many opportunities for us to apply our skills as medicines experts.
However, the question must be asked: who defines the boundaries of accepted professional practice, and if boundaries should be drawn at all who provides guidance on what we should be doing in those roles that may still be in development? One answer may be to look to our regulatory bodies. However, there is likely to be reticence to ask regulators, which consider fitness-to-practise issues, about the scope of one’s own professional practice. Also, regulators will consider issues against what is set down in law and what is established practice, which may result in conservative responses.
In the UK, the professional body and the regulator are a single organisation – the Royal Pharmaceutical Society of Great Britain. However, these roles are to be split, so there will be a regulator run by the government (the General Pharmaceutical Council) and a separate professional leadership body with voluntary membership. The latter is the focus of much debate. Coverage in this edition includes Gill Hawksworth’s article on page 35 and Laurence Goldberg’s report on the recent Guild of Hospital Pharmacists/UK Clinical Pharmacy Association conference (page 43).
There are clear advantages to the regulator and professional leadership body being separate, since the regulator will tend to take a more conservative approach to practice. Therefore, in a time of rapid change, individual practitioners need to be supported and guided, not hindered, particularly where roles are developing.
Obvious roles for a leadership body are guiding individual practitioners on professional practice and acting as an advocate for the profession in terms of relations with the regulator, government and public. These are important functions, but, I would suggest, extremely difficult to deliver in today’s rapidly changing environment, since individual pharmacists may be pushing back the frontiers of professional practice.
So where does professional leadership really come from? In hospital pharmacy practice in particular, because we are salaried staff, leadership has historically come from innovative practitioners and managers who have seen opportunities for improved patient care by extending pharmacists’ roles. Clinical pharmacy did not develop because governments or professional bodies decided it was a good thing, but because forward-thinking pharmacists realised they could apply their considerable knowledge of medicines at the bedside. I myself recall managing warfarin treatment in an outpatient clinic some 20 years ago, long before pharmacist prescribing became enshrined in UK law.
Pharmacists are highly educated, and, in a world where medicines play a vital role in improving health outcomes, we have an enormous contribution to make to safe, rational, economic use of often complex medicines. So the message to professional leadership bodies both new and established is to help individuals practise safely and competently, while supporting practice development by listening to the membership
and learning from practice in different countries via journals such as HPE and its companion website, pharmacyeurope.com
As former US President Dwight Eisenhower said: “You do not lead by hitting people over the head – that’s assault, not leadership.”
