How we have improved fitness-to-practise and inspection processes

It is one year since we joined the General Pharmaceutical Council (GPhC), full of enthusiasm, energy and excitement for the challenges ahead. These were new roles — Dionne Spence as chief enforcement officer and Roz Gittins as chief pharmacy officer — developed to address some of the longstanding difficulties that the GPhC was experiencing around inspection and fitness-to-practise (FtP) functions. 

Chatting after our first day, we confidently agreed that we would not rush into solution mode, but we would instead take our time to observe and assess what was needed. We still laugh about that approach lasting until the end of the first week.

We knew our teams had to work better together. We needed clarity in the GPhC’s organisational processes, and more robustness and consistency in our decision making, such as in determining when enforcement action was required if registered pharmacy premises were not meeting our standards. We were fortunate to work with colleagues who felt the same way, meaning that these changes were easier to implement. 

The GPhC’s triage function considers all concerns that are raised against pharmacies and pharmacy professionals, to consider if further investigation is needed. We knew it was taking longer than was reasonable to make an initial decision, compounded by the significant and consistent increases in the number of concerns received each year — up by 83% between 2022 when it was just 3,000, to almost 5,500 in 2024. 

It was important to incorporate advice from our experienced inspectors, all of whom are pharmacists or pharmacy technicians, including some with specialist knowledge in prescribing alongside clinical areas, such as aesthetics and psychiatry. An early restructure of our clinical team, which has created clearer leadership and better utilisation of their specialist expertise, has enabled greater assurance in the quality of decision making at this early stage and ensured that we did not open investigations unnecessarily. By the end of December 2024, the average time taken to make these decisions had reduced to less than four weeks, from almost six weeks in 2023. 

We fully recognise the significant impact that an FtP investigation can have on pharmacy professionals and are committed to minimising the time that investigations take. The GPhC currently holds a cohort (about 10%) of aged cases over 3 years: this includes those which have had to be put on hold owing to third party investigations. In its 2023/2024 assessment, our oversight regulator the Professional Standards Authority (PSA) determined that the GPhC had not met its standard on timely investigations. Sustainable change takes time, especially where legal processes are involved and there is a myriad of other competing priorities, but we have worked hard over the past year to greatly reduce the number of aged cases. 

Investigations take a long time, but since January 2024, our oldest active investigations — those that are more than two years old from the date we received the concern — have already reduced by over 25%: investigations that are over one year old have also reduced by almost 50% for the same period (from 270 to 200 investigations and from 164 to 86 investigations, respectively). Although there is still a long way to go, our teams are continuing to work hard to minimise the time taken, while ensuring that we are proportionate and fair in our work. We feel confident that with our renewed approach, we are heading in the right direction. 

It was clear that we needed to better understand our FtP data. In November 2024, we co-presented our initial findings at Clinical Pharmacy Congress North in Manchester and, while we are aware of the continued over-representation of non-white professionals referred to FtP, it was reassuring to find no statistically significant relationship between ethnicity and the concerns subsequently investigated, or the statutory decision of our independent committees. 

During 2024, we also spent time with community pharmacy staff and secured feedback from external stakeholders and other representative bodies. We recognise that we had to make changes to our inspection processes to enable a more proportionate and risk-based approach and ensure that we had robust systems in place to respond to particular safeguarding or wellbeing concerns. Our plans have been shared with our council and, thus far, have been well received during their implementation. 

We are under no illusion that there is more work to do and, alongside our GPhC colleagues, we are looking forward to our next year in post.

So, what’s next for 2025? 

We are not expecting the pace of change to slow down, but we also do not want our colleagues (or us) to burn out in the process. The GPhC will soon be sharing a new five-year strategy and some notable publications, including the much-awaited update to guidance on providing pharmacy services online. Having focused on improving internal ways of working in 2024, we are hopeful that in 2025 our improvements will be felt more, externally. 

We want to help the public and our professionals better understand the role of the GPhC; for example, how our remit differs to other regulators and how our role differs from that of professional leadership bodies, unions, commissioners and community pharmacy representative organisations.

Of course, being recognised by the PSA for meeting all standards is important, but we are not chasing this. Our priority is to provide a robust regulatory function that trains, develops and supports our sector to provide safe and effective pharmacy services. We are grateful for the support from the sector in helping us to deliver this.

Roz Gittins is chief pharmacy officer and Dionne Spence is chief enforcement officer at the General Pharmaceutical Council