REFLECTION ON PHARMACY AS A CAREER IN SOUTH
AFRICA
On
Wednesday 8 December, 2021, I tuned in to the South African Pharmacy Council's (SAPC)
Master Class on the process of recording one's Continuing Professional
Development activities, as had been advertised on their Facebook page. As an
aside, I am continually puzzled by the need of a regulatory body, and of professional
associations, to make use of social media platforms, such as Facebook, to
communicate with their members. After all, it is not an officially recognised
medium, and not everyone who has an email address is partial to signing up for
a presence on Facebook. The reluctance is surely greater since we learned from
a whistleblower who went public recently, about the doings at Mark Zuckerberg's
world-famous mega enterprise, and now known as Meta Platforms. The older
generations are more prudent about sharing information on social media.
I
registered as a qualified pharmacist in January 1962, and a few months l later
I joined the Pharmaceutical Society of South Africa (PSSA). I also became a
member of the Royal Pharmaceutical Society (RPS) in 1965. I have remained a member of both ever since. When
I switched my career path to hospital pharmacy in the 1970s, I became a member
of the South African Association of Hospital and Institutional Pharmacists
(SAAHIP) of which I am still an active member. The history of SAAHIP is one of
my keen interests. One remarkable fact about SAAHIP is that its leaders have
been passionate about providing continuing education to its members.
Documentation dating back to the years since the organisation's inception can
attest to this fact. Some examples include pharmacology courses that were
arranged in the 1950s, mini seminars on a Saturday were held in the 1980s, and speakers
provided informative lectures as an item on the agendas of meetings over the
years. Then, in 1987 SAAHIP started holding annual conferences at which members
shared their innovations in the workplace, and these conferences became a
platform for Continuing Professional Development (CPD). Thus, CPD has been part of SAAHIP's raison d'etre
since its beginnings.
When I
retired from the KwaZulu Department of Health in 1998 I accepted an offer to
work in retail pharmacy in the United Kingdom. Not content in retail, I joined
a UK locum agency and started doing locums in hospitals. In September 2010 the General Pharmaceutical
Council (GPhC)came into being and took over the regulatory side of the RPS. That was when recording of CPD started and I received
all the information regarding the system. It was made easier because the Pharmaceutical
Journal, the official journal of the RPS, published CPD articles every week,
with guidance on how to record CPDs.
Soon
thereafter, the SAPC started murmuring about making the recording
of CPD compulsory. As it turned out, they had acquired the same programme
that the GPhC was using for recording CPD. So, it was easy for me to duplicate
what I had recorded on the UK system, onto the SAPC system. I have recently
checked the archives of my CPD on the SAPC website and my recorded CPDs
starting in 2012 and over subsequent years, are still to be found there.
The SAPC's
programme was made available to pharmacists in 2012 but it was not until 2018
that the SAPC published its proposed legislation for making CPD compulsory, The proposed legislation was published for
comment and, as it turned out, once again, pharmacists displayed their
apathetic attitude towards their
profession, by ignoring an opportunity to have their say on an event that would
have a profound effect on their practice as a pharmacist. Having had first had
experience with the proposed system, I seized the opportunity to have my say.
As it turned out, I later learnt that only one pharmacist took the trouble to
submit comment to the Council. I have no idea what the PSSA, SAAHIP, and the other
sectors, had to say on behalf of their members. What troubled me the most was
that the GPhC in the UK no longer used the very system that the SAPC was now
proposing as a compulsory CPD system for South Africa's registered pharmacists.
I wrote:
Now that the SAPC has finally
drafted regulations for making the online recording of CPD mandatory, it is
notable that the General Pharmaceutical Council has recently changed its
approach to CPD by changing to a system referred to as Revalidation. https://www.pharmacyregulation.org/revalidation (https://www.pharmacyregulation.org/sites/default/files/document/gphc_revalidation_framework_january_2018.pdf)
Fortunately, the SAPC agreed to having six recorded CPDs
instead of the original twelve, per annum.
To complicate matters, the system included domains and competencies,
and there now exists a forty-six-page Guidance Document for CPD, published as
Board Notice 82 of 2020. I printed the document after the MasterClass because I
realised that the one, I had in my possession was outdated, having been
approved by the SAPC on 17 February 2016. The latest document now included
Behavioural Statements for each competency, a subtlety that I had not missed
all these years.[SB1]
As I sat through the Masterclass presentation in which a
step-by-step explanation was being given to an unknown number of registered
pharmacists, whose livelihood depended on recording six continuing professional
development activities for this past year, 2021, a niggly feeling of resentment
started creeping up on me. I had already recorded the required number of CPDs
for 2021. I had done the same during the previous year, presumably to the
satisfaction of the assessors, as I was in possession of a letter from the
Council thanking me for my efforts, but I was also aware that the Council had
extended the deadline by several months for 2020 submissions. Something was
wrong with the picture.
Why were pharmacists being singled out for such stringent
requirements for practicing their profession? In my comments to the proposed
compulsory CPD regulations I had pointed out the following:
"I have checked to determine
what is required by other professions and the overview provided on the Health
Professions Council of South Africa (HPCSA) website reads as follows:
Healthcare practitioners have a
responsibility to continually update their professional knowledge and skills
for the end benefit of the patient or client. To this end the HPCSA has
implemented a Continuing Professional Development programme. Every practitioner
is required to accumulate 30 Continuing Education Units (CEUs) per twelve-month
period and five of the units must be on ethics, human rights and medical law.
Each CEU will be valid for 24 months from the date on which the activity took place
(or ended, in the event of post-graduate studies) after which it would lapse.
This means that practitioners should aim to accumulate a balance of 60 CEUs by
the end of their second year of practise, and thereafter top-up the balance
through additional CPD as each 24 –month validity period expires. 4
Mandatory random audits are
conducted to ensure compliancy. Once a practitioner’s name has been selected,
they are required to submit a CPD portfolio to Council within 21 days.
Non-compliant practitioners will be given six months in order to comply. After
the period of 6 months a practitioner will again be audited and if there is
still non-compliance, the Professional Board will consider appropriate action.
Practitioners are only required to submit their CPD portfolios when their names
are drawn from a random sample audit and when requested to submit their
completed form CPD 1 IAR with accompanying proof of CPD activities undertaken.
This appears to be a more
reasonable requirement. The activities are fewer in number, and some can be
rolled over into the following year."
The Health
Professionals Council of South Africa (HPCSA), together with the 12
Professional Boards under its ambit, is established to provide
for control over the education, training and registration for practicing of
health professions registered under the Health Professions Act. This is also
the same reason for the existence of the SAPC. This, then, begs the question,
what is so special about the pharmacy profession, that their CPD has to be so
micromanaged?
This also leads
to further reflection. When I embarked on my pharmacy career, the South African
Pharmacy Board (SAPB) controlled the profession. Back then the Pharmacy Board was
half the size of the present SAPC, and most of the members were pharmacists
elected by registered pharmacists, unlike the government controlled present
SAPC. The exams for every subject were set by external examiners appointed by
the SAPB. The courses were undertaken at pharmacy schools within Technical Colleges.
In the 1950s there was a pharmacy school in Cape Town, Durban, Port Elizabeth,
and Johannesburg. As a result, every student doing pharmacy had to be au fait
with the syllabus of every subject when writing the board exams. Pharmacy was
renowned for being a difficult course because of the system of board exams. It
was not unheard of that some students wrote an exam three or four times, before
passing. Also, at that time students did their "apprenticeships"
before writing their finals. I did my first year, then did a two-year
apprenticeship, before doing my last two years of study. There was no need for
a pre-registration examination, because all pharmacists wrote and passed board
examinations. Since the 1960s, pharmacy courses have been introduced by the
universities and pharmacists now register with a four-year BSc degree and a one-year
internship. But in order to ensure that
registrants conform to the same standards, a pre-registration examination has
to be passed. In addition, the government introduced a compulsory one-year
community service a couple of decades ago, to ensure that remote hospital
pharmacies could be assured of at least one pharmacist on their staff.
Could it be
that the SAPC is concerned that the pharmacists that are being turned out by
the universities, and are doing internships and community service, within
government hospitals, are incompetent at keeping up to date with developments
in their chosen profession of pharmacy? Why is it necessary for professionals
to be spoon fed with CPD throughout their careers? Why do they have to record
what they have learnt and provide proof thereof?
What is it
costing the SAPC to assess the thousands of CPD submissions submitted annually?
Going through each pharmacist's submissions, checking if they are two step or
four step, whether they fit into the correct domain, the correct competencies,
and fit the correct behavioural statements?
I had decided
to become a pharmacist because I considered it a suitable career for a woman. I
have been a dedicated pharmacist to this present day. For me it has not been a
job, it has been a profession. I did not stop being a pharmacist when I retired
and went on pension from my full-time job. I belong to my professional
organisations. I have worked in various fields, and in each field, whether it
be retail, hospital, wholesale, quality control, quality assurance, no matter
which country I worked in, I made sure that I was capable of performing the
work expected of me. I still consider
myself a pharmacist, even though I have not been in paid employment for a
number of years. I read pharmaceutical journals, I participate in webinars, and
I am active in my professional organisations.
To me, it
is insulting that the SAPC has seen fit to designate pharmacists as being
either active or not active, or practicing or non-practicing. One is either a
pharmacist or one is not. If one is a pharmacist, one must behave
professionally. Does a university even include what it is to be a professional
in its courses? If the SAPC is concerned about the quality of graduates that
are being turned out by the universities, it should be devoting more time to
ensuring that the universities are turning out well equipped, intelligent,
professional pharmacists, who understand the importance of remaining abreast of
developments in their field of expertise. Then perhaps the Council can be
assured of a quality service being provided by registered pharmacists.
What
distinguishes pharmacists from other health professionals? if the HPCSA is
satisfied that its members may submit an accumulation of points to remain
registered, why does the SAPC require its pharmacists to record in detail what
activities they have undertaken and to categorise the activities into domains
and competencies, and then write lengthy descriptions of what has been learnt
and why. Do I need to worry about the competency of the next doctor I consult,
or the surgeon who may perform emergency surgery on one of my loved ones? What
about the dentist who has to repair my teeth?
After
spending sixty plus years of my life as a pharmacist, I have no intention of
bowing out gracefully from the profession, as many of my colleagues have done. It is my intention to remain on the SAPC
register as an active, practicing pharmacist, although I do not intend to work
for remuneration. But I want to describe myself as a pharmacist; I will behave
professionally, and I will continue keeping myself informed about developments
in the world of pharmacy, and I still wish to continue having opinions on what
takes place within the field of pharmacy, and hopefully inspire younger
pharmacists to do the same. I end this piece with a quotation that has stuck in
my mind for fifty years:
If all pharmacists were laid end to end, would
they even care?
