Kathie Cashell: ‘You can’t protect the public without an empowered profession’

Starting her career as a nurse, Kathie Cashell quickly pivoted into healthcare regulation. 

Then, she went on to what was planned to be an 18-month secondment to work in police complaints, which turned into almost 20 years in the role, culminating in her taking on the job of deputy director general at the Independent Office for Police Conduct.

In March 2026, Cashell joined the General Pharmaceutical Council (GPhC) as chief executive, for which her background in complaints seems apt, considering that the regulator is now receiving almost 10,000 fitness-to-practise (FtP) complaints each year — its highest number on record.

The Pharmaceutical Journal spoke to Cashell to find out how she is settling into her role and what her plans are for the organisation.

Tell us about your background and what led you to the role of chief executive at the GPhC.

I did my degree in nursing and then I practised for a little while, which certainly gave me some insight into what it feels like to be in a regulated profession. I then set up and ran some recruitment companies, but I’m a public servant at heart, so that didn’t really feel right to me. 

I then went into healthcare regulation. I worked at the Healthcare Commission for a while and did quite a lot of work on NHS complaints — which used to go through the regulator at that time — redesigning those processes.  

I saw an opportunity to go and do something similar in police complaints and misconduct, I went on a secondment for 18 months and stayed for more like 18 years, because it was fascinating.

But I would describe healthcare as my first love, and improving public services through regulation and empowering the professionals that are delivering them feels important, so I was pleased when I saw this; it was time for me to do something new, but also it ticked my boxes of doing something that really matters.

How are you finding the role so far?

I’m absolutely loving it. It’s been a bit of a whirlwind. I’ve been really welcomed, not just by the staff here and the council, but by the many stakeholders that I’ve met in my first couple of months, who have been generous with their time and knowledge. 

I am struck by how much I have to learn. I consider myself to be a fairly well-informed member of the public, particularly when it comes to healthcare and regulation, but being honest, I was surprised by how uninformed I was about what pharmacists and pharmacy technicians do. It’s a much more clinical frontline than perhaps I’d appreciated as a member of the public, and that tells us something about what more can we do to highlight the profession to the general public. 

Paul Stuart

You said you wanted to move the GPhC away from being a “pay and punish” organisation towards a model that empowers pharmacy staff. What will that shift look like? 

I used “pay and punish” because I saw it on a comment board for something and it chimed with my experience as a newly qualified nurse — where you have worked so hard and done your degree to get your PIN number (as they call it at the Nursing and Midwifery Council [NMC]). You’re so proud of it when you get it, but quite quickly you move into hearing about all the ways that you might lose your PIN number — “if you make that mistake, the NMC will do this and that.” So, on one hand, it’s really important that we make sure that only the people who are qualified and fit to practise have got the registration number, but we also need to keep in perspective that regulation isn’t just about pay and punish — it’s not just about reacting when things go wrong.

We’ve all got that shared view of patient protection but the way you do that is by empowering the profession to be confident, and particularly in pharmacy, where they’re being asked to do more and more clinically complex work, regulation needs to support that and empower that, not make people frightened to do it. 

You can’t protect the public without an empowered profession, so we’re continuing the work that we’re doing on the standards for pharmacists that make it clear and hopefully support them to understand what good looks like. And then we shore those up with more of the guidance work — that’s a really important part about being ahead of what’s happening and empowering people. 

What changes are you planning to implement to reduce the timelines for FtP cases?

This is a real challenge for the organisation and for many regulators that are in this field. Certainly, coming from my previous role, this was a perennial problem.

Our chief enforcement officer responsible for that, Dionne Spence, has already started what will be a two or three-year improvement programme. We’ve put more resources in, so we’re spending a greater proportion of the budget in that area. 

We’re clearing out some of our oldest cases, we are turning things around more quickly and we’ve changed how we triage cases, so that we’re clearing out the ones that aren’t for us. 

We’re expecting more than 10,000 concerns to come in the door, which is a 77% increase on a couple of years ago, so a huge uptick, but the proportion that we’re taking through to FtP isn’t changing. We’re still taking a tiny number through, so we want to move through those as quickly as we can, but obviously dealing with those 10,000 concerns is taking quite a lot of resource. 

We’ve already issued acceptance criteria for concerns to let the public know what is a concern that is for us and what perhaps is for somewhere else, and that will hopefully stem the flow.

We’re also looking at whether we will pilot an alternative resolution service. The vast majority of those 10,000 concerns are more of what I would deem as service failure issues, e.g. “I had to wait too long for my medication” or “The pharmacy wasn’t open”. They’re not FtP issues, but they still need resolving. So, I’m interested in piloting something like that. 

We still think, even with that 10,000 coming in, that we can triage them within an average of five weeks. The vast majority get closed at that stage, and then we are looking at speeding up our investigations. We’re going to do those in an average of about 40 weeks and then we have got plans this year to increase our capacity to hold hearings by an additional 50%.

Paul Stuart

What do you think is driving the increase in concerns?

There’s never one answer. Complaints are on the increase everywhere; we were certainly seeing it in policing. I think there’s something about public expectation and their willingness to engage in services like that.

I also think, as the role of pharmacy teams expands and they’re having more interactions with the public, that naturally creates more space for there to be concerns. 

The GPhC has failed for six years in a row on its timeliness standard set by the Professional Standards Authority. Why does this keep happening?

I think it is about the huge number of concerns that we’ve had to deal with. We also do inspections and all the education and the standards work, and we’re a small organisation — there’s only 300 people — which I raise my eyebrows at almost daily for the amount of services that we have to run.

It’s disappointing to have missed the standard. I’ve learned from dealing with backlogs elsewhere that once you’ve created a timeliness problem, it takes a long time to get back to where you need to be. You’ve got to get through the pain, clear out all the old stuff and then you’ll be back on track. I am confident we will get there. 

Registrants with protected characteristics are disproportionately subject to complaints, how do you plan to address that?

I think it’s a depressing reflection of society sometimes, isn’t it? I think our acceptance criteria will hopefully help with that, because that’s about the types of concerns that we will take forward. 

Obviously, we can’t control what people are going to raise with us, but where we look at our decision making — the cases we take through to investigation, the outcomes at our investigations committee and our FtP hearings — they show no disproportionality in our decision making, and that’s the bit that I think is the most important.

What can we do about people raising concerns? I suppose that all we can do is really highlight where those concerns are for us and not for others, but I think all complaint handlers very sadly see that disproportionality.

Paul Stuart

You said the GPhC must “stay in our lane” when the Pharmacists’ Defence Association raised the issue of regulating pharmacy employers, yet many pharmacists say employer pressures drive unsafe practice. Where is the boundary, in terms of regulation, and should it shift?

The thing you see across all regulators is it’s quite a crowded landscape. You’ve got us, the Care Quality Commission, the MHRA, services that the NHS are commissioning, so there’s quite a few different players with very distinct but sometimes overlapping roles. For me, one of the first things is making sure that we are collaborating, sharing intelligence and really understanding the changing responsibilities of the sector.

Although I’m keen that we stay in our lane and we do what we need to do well, that doesn’t mean that we don’t speak to others and think about how our roles can complement each other.

I think the other thing is us being clear that patient safety and delivery of safe and effective services trumps everything else in terms of regulation. That’s where we need to be, and we know that that’s where the profession is.

If the GPhC can’t regulate employers directly, what role can it play in addressing unsafe workloads and commercial pressures?

I don’t want say that we can fix it all but, certainly, if we see issues that we think risk affecting patient safety or disempowering the profession, we should be talking about those, we should be raising them, we should be shouting about them, and getting people around the table to discuss what we, all together, can do about it. 

Is there anything you’d like to add?

I’m really encouraged by what I see in the organisation. I think that no organisation is ever finished with changing and improving. I think we’re good, but let’s be great, let’s be exceptional, and that for me is about being high performing, efficient and effective. 

I’ve also talked about us being transparent and accountable. We need to be transparent about what we’re doing and why we’re doing it. People might not always agree with the decisions that we make, but we need to explain them, so people understand them. 

I’m used to being in organisations that are spending taxpayers’ money. I’m conscious that we are spending registrants’ fees and we need to demonstrate that we are value for money, that we are spending every pound carefully and driving value for the profession through it. 

Finally, it’s about being a forward thinking and trusted voice, even in areas that perhaps aren’t for us to fix, but driving forward and talking about what’s important to patient safety and to the profession. They’re being asked to make a huge amount of change, so we want to be ahead of that and be supporting them. 

Paul Stuart