If you think education is expensive, try ignorance

The news that Health Education England is to shed 315 full-time equivalent posts in order to reduce its running costs by 30% is not a surprise, but must raise questions about the future education and training of NHS staff.

Nobody seriously thinks that a four year university course can ever provide all the information anyone will need for a successful career in pharmacy; and while the recent proposals for revalidation from the General Pharmaceutical Council perhaps represent a more practical approach than GPhC has hitherto taken, it does not concern itself with who – if anyone – is going to provide the training that pharmacists and technicians realise they need. That is not GPhC’s business. Registrants will just have to sort something out.

There are, of course, plenty of one day courses – we run some ourselves under the PM Academy banner – but perhaps part of the great success of CLIP in Scotland has been that participants have seen a structure for their training that makes achieving their educational goals much easier than having to compile a basket of offerings. As we roll CLIP out to Ireland (don’t worry, Wales and England, you’re next!) we’ve learned from the Scottish experience and we’ll do it even better.

We’re committed to making our educational opportunities as useful as we can. When you book one of our events you can be sure that we will do everything possible to make it so, and your feedback really helps, because we use that to tweak it for future events.

One of the key features of our partnerships with various bodies is to provide top class education. Their reputation is your guarantee of quality. We are confident that they would not want to be associated with anything that was inadequate.

And we must not forget our peer-reviewed journals. Their independent editor ensures that everything is done in the right way.

While other bodies are contracting Pharmacy Management is going from strength to strength. We must be doing something right!

Making things clear

There is a recognised procedure that lawyers follow when they are trying to work out what a law means.

They begin by looking at the plain English meaning of the law. Thus, if a law refers to a car, it does not include a bus or a van. They will try to construe the law so as to cause the fewest possible conflicts with another law. There are a number of legal maxims that relate to this, but wrapping up the process is the question “What mischief was being addressed?”

There is a logic behind this. It is that Parliament means what it says (hence the plain language rule), that it does not contradict itself (hence the conflicts rule) and that what it does has a purpose (the mischief rule). It is assumed that Parliament would not waste its time discussing something that has no purpose, so if you find out what Parliament was trying to put right, you can construe the law on the assumption that it did, in fact, put the mischief right. Thus if, for example, the preamble to an Act of Parliament says that it is a law to prevent the sale of football boots on Thursdays, you try to read the law in a way that would achieve that. In my particular daft example, the law does not seem to intend to prevent the leasing of football boots (if anyone does such a thing).

We have attempted this explanation because it is clear that some people are confused by the policy on management of Potential Conflicts of Interest promulgated by NHS England and are interpreting it in a way that was never intended. It does not say that all contact with outside agencies or companies is naughty or to be avoided; it says that all contacts involving transfers of value have to be reported so that managers can evaluate whether there is anything improper about them. It is unfortunate to say the least that the press seem to think that there is something wrong about a leading doctor accepting research funding, or a pharmaceutical adviser being paid for their time in offering advice where that interaction has been properly declared. Declarations of conflicts of interest are made so that they can be managed properly, and managing these, like managing risk, is not best achieved by eradicating it. Nobody would suggest managing risk to a child by locking him in his bedroom for eighteen years, yet some people think that the NHS is trying to avoid potential conflicts of interest by forbidding all contact.

Because Pharmacy Management works with both industry and the NHS (not to mention having to work with each national health system in the devolved administrations) we spend a lot of time on promoting transparency. Unfortunately the systems operated by the pharmaceutical industry and the NHS do not dovetail perfectly – there are occasions when the industry has to disclose something that the NHS professionals are not obliged to report, and vice versa – and in our view the disclosure systems do not always distinguish clearly enough between a transfer that could be diverted and one that cannot.
Let us explain that a bit further. If I receive a £10,000 grant for some research there needs to be some system whereby I can prove I spent it on appropriate things because there is a risk that I might not. If I receive the same sum by way of having my fees paid to attend a university course I have undoubtedly benefitted but there was no way that I could have used the money in any other way.

The funding model that Pharmacy Management uses for its events is well-tested and we consult widely within the NHS to ensure that it meets current expectations of probity and transparency. For example, in 2015 we introduced our Transparency Certificates. These are produced for each event to show who has funded Pharmacy Management’s provision. This matters because the attendees do not receive funding directly from any particular company and therefore, on the face of it, there would be no need to make a declaration of potential conflict of interest. However, the training they receive at these events undoubtedly has a value and they might feel uncomfortable if they said nothing at all about it. Following the mischief rule, if the purpose of the NHS policy is to ensure that governance managers can ensure that nothing untoward has taken place, giving them the Transparency Certificate meets the purpose of the policy even though, on a strict reading of the policy, there may have been no requirement to make a declaration.

That value is hard to calculate for large events, because no two delegates may have followed the same programme during the day, but we will calculate one for those events where every delegate follows the same timetable during the day. This goes beyond the requirements of the NHS in allowing people to say “I attended this meeting and my place was worth £66 which was contributed to by these four companies.” There is nothing wrong or embarrassing about making such a declaration – you received training without charge to the NHS and without creating any potential obligation to those who indirectly funded it. It will probably have cost less than comparable training directly purchased; and it comes with our guarantee that we will defend the probity of the process on your behalf if questions should be asked. Any governance manager who wants to know how a meeting was run can contact our Chairman or our Chief Executive Officer and will receive a prompt and personal reply. That’s a promise.

Not only that – we distinguish clearly between the promotional and non-promotional parts of our events (the Academy and CLIP have no promotional element at any time). There are specified exhibition areas and times and no promotional activity takes place elsewhere. The Chairman of the meeting has to certify that in his or her report.

We are proud to have been in the forefront of promoting transparency. We intend over the next few months to take more steps to safeguard our reputation and, most importantly, yours. If you have any suggestions or concerns we would be delighted to hear of them so that we can ensure that you have the greatest protection possible against scurrilous accusations.

Let us add one more thing. We do not believe that our partner organisations (whom you can see listed on our website) would have anything to do with us if they were not convinced that we conduct our business in a proper and transparent way.

Wearing purple

It is, apparently, the second best-known contemporary poem, though few know who wrote it, or can remember much beyond the opening lines:
When I am an old woman I shall wear purple
With a red hat which doesn’t go and doesn’t suit me…

It was written by Jenny Joseph when she was 29 – she is now 84, by the way, and you can see her reading her poem at https://youtu.be/8cACbzanitg.

Since it is my birthday today, it seemed a good time to look at how we imagine our old age will be when we are still young. I have reached an age which, as a child, I thought was officially Very Old. It seemed to me that men as old as I am were just biding their time till the Grim Reaper called – after all, two of my grandparents didn’t make it to this age.

Without wishing to become drawn into political argument, it is clear from the speeches and writings of Nye Bevan that when he was crafting the NHS he had an idea of old age in mind. By providing care that was free at the point of delivery he wanted to remove any disincentive to ask for help early. That much we all know; but it is often forgotten that he thought the more important part of the work he was doing was the arrangements he made to put public health medicine on a sound footing, because ultimately he hoped to contain demand by improving the health of the whole population. In Bevan’s model, people would not necessarily live longer, but they would have a better quality of life. In fact, since 1900 we have added about seven years of adult life expectancy, but those are not usually seven good quality years. The pattern has increasingly become one of progressive and prolonged frailty requiring high levels of care, and that is why most health economies have been working hard on trying to manage (and postpone) that frailty.

It also explains why this year’s Pharmacy Management National Forum is focussing on frailty.and long term conditions. We hope that good evidence-based treatment of all age groups will help us to arrive at our later years in better health with less need of a high level of intervention.

I was also fascinated to learn of The Red Hat Society, an organisation devoted to helping women enjoy fun and fitness, which takes its symbol from the poem. Avoiding frailty matters to our patients, and to the NHS. Both will have a much better future if we can improve our care, and we look forward to hearing on 16th November of the initiatives that pharmacy is developing to do just that.

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A Grand Day Out (x4)

If pushed, we are prepared to concede that there is probably more work involved in organising an Olympic Games than our national meetings. However, the IOC has one great advantage – they only have one at a time and they’ve got years to do the planning. Pharmacy Management currently has no less than four national meetings on the stocks!

First, we have the National Forum for Scotland on 24th August. On 7th October we’ll be in London for a southern version of our successful JoMO-UKCPA meeting on medicines optimisation in diabetes. Just six weeks later, on 16th November, we’ll stage our flagship Forum Workshop in London on medicines optimisation in the frail and elderly patient, a group in whom the management of multiple long term conditions adds real complexity. And on 1st February next year we’ll collaborate with UKCPA once more, this time on medicines optimisation in respiratory conditions.

These collaborations work really well. Professional colleagues help us identify topics with high relevance to the audience, and then to find good speakers to deliver them. Despite the difficult conditions we all face today, there is no shortage of appetite for good learning opportunities.

It’s very easy to tell ourselves we’ll try to sort out our CPD in the odd moments between elements of the day job, but it rarely seems to happen. Days like these four give us a break to refresh, recharge and renew. They make a grand day out for a team too.

When you arrive we put a cup of coffee in your hand and let you start networking. it’s not much of an Opening Ceremony, but it’s been a popular one.

Vive la différence!

Around 6 out of every 7 people in the UK live in England. Most of the pharmaceutical industry is based within its borders. The greater part of the hospitals and the primary care organisations are in England. For some of our competitors, that’s a reason for concentrating on England.

We’ve never done that. We work in all the home countries, each of which is producing good work that can profitably be shared with neighbours. Just today we’re putting finishing touches to the PM Academy meeting in Wales, working on the publicity for the PM National Forum for Scotland and setting up meetings to progress a Clinical Leadership in Pharmacy project for the whole of Ireland. On our Events page we have separate listings for each of the countries.

What can we say about the five countries? The people are different. The NHS is different – of course, it does not extend to the Republic of Ireland. The issues they face are different. There is no single answer to all those challenges – but then we’ve always known there isn’t in England either. Whether it’s Portsmouth and Southampton, Newcastle and Sunderland or Leeds and Bradford, you don’t have to go far to find real differences. We’re not a company that believes that one trick we know will work everywhere.

It’s good that we’re different and that each nation is making its own choices on health. We’re ready to do our bit to support them all.