Roz Gittins
A well-known figure in the field of addiction treatment, Roz Gittins stepped into the role of chief pharmacy officer and deputy registrar at the General Pharmaceutical Council (GPhC) in January 2024. She was previously president of the College of Mental Health Pharmacy (CMHP) and director of care standards and practice improvement at drug and alcohol support charity Via.
Gittins joins the GPhC at a challenging time for the regulator as it tackles a backlog of fitness-to- practise (FtP) cases, an overrepresentation of non-white pharmacists subject to FtP concerns, and scrutiny of its regulation of online pharmacies.
The Pharmaceutical Journal sat down with Gittins to discuss the GPhC’s progress on these issues and find out about her ongoing work in mental health pharmacy.
What are your main priorities at the GPhC?
This is the first time the GPhC has had a registrant on the executive and it is an interesting time. There is so much going on, not just within the GPhC, but in the external environment.
We need to make sure we respond in a timely way to things such as the changes around supervision and pharmacists qualifying as prescribers in the next couple of years.
Sometimes it can be challenging for us to provide the commentary we want to because we’re dealing with sensitive issues such as FtP cases, but there is something for me around raising the profile and awareness of what we are up to.
Inspection and the use of data and insights falls particularly to me. We are looking at how we further strengthen our clinical component to make sure that we have sufficient input into inspections where pharmacies are offering more clinical and prescribing services to make sure we have the necessary expertise in the team.
We are focused on making sure our reporting and data is as accurate as possible, also making sure that it is as unbureaucratic as possible, and that we have streamlined our systems and processes. By doing that, we are aiming to be able to inspect more pharmacy premises more frequently.
There has been a plan in place to reduce the backlog in FtP cases for a few years, but it doesn’t seem to have worked. What has gone wrong?
Working on the backlog in our FtP cases is a key priority. I’m working with colleagues, including our chief enforcement officer, Dionne Spence, to look at our processes to get those cases turned around in a more timely way.
It is in everybody’s interest that we make sure that we are focusing on turning around fitness-to-practise cases in a timely way
We know the longer that FtP processes take, the longer that leaves registrants in purgatory, and that has an impact on their wellbeing and the wellbeing of their loved ones, as well as their employers and the members of the public that have been affected.
It is in everybody’s interest that we make sure that we are focusing on turning around those cases in a timely way.
We have the opportunity to have a fresh pair of eyes look at how we might do things slightly differently. An example is getting legal and clinical expertise in to review cases earlier, to be able to speed things up.
Is the GPhC likely to meet the Professional Standards Authority’s standard for dealing with FtP cases in a ‘timely manner’ in 2024?
I think this year will be a bit of an ask to meet the PSA standard, bearing in mind that we are looking at systems and processes. Some of the cases have been quite historical.
Part of the challenge is that, as much as we work on systems and processes, we will still have some cases that take longer to reach a conclusion because of their complexity.
But hopefully we won’t end up with the backlog we have currently. We are looking at making sure we have sufficient people in post and upskilled to be able to do that work.
While we’re already putting things in place, will we meet the standard this year? I’m not sure we will, I think next year looks far more realistic for us.
What is the GPhC doing about the over-representation of non-white pharmacists in fitness to practice concerns?
In 2023, we did our in-depth analysis of the outcomes and that has highlighted that issue. We are absolutely committed to making sure that our regulated decisions are fair, lawful and free from discrimination and bias.
We are looking at recruitment to our statutory committees to make sure that we are removing unconscious biases as best we can
While we need to unpick and explore that data from the analysis, there are things that we have already started work on. We are looking at recruitment to our statutory committees to make sure that we are removing unconscious biases as best we can.
We’ve got more work to do around how we manage the information that goes forward to those committees, so we’re continuing with those pieces of work. About 70% or so of our cases come from the general public, so a lot of our work is focused around the bit that we are in more in control of in terms of the decision making.
Was the GPhC aware of issues with online pharmacies before the BBC’s investigation and why did it take that to prompt action?
We know that there have been issues with online pharmacies because they featured in the themes and trends that we found from our FtP cases and inspection issues.
In terms of those particular pharmacies, we’re still waiting on information from the BBC — that hasn’t been forthcoming as yet. I can’t comment on those cases or, allegedly, what registrants may or may not have done, because we don’t have that information. But hopefully that will be provided and will help us to be able to take prompt action.
The GPhC is looking at using mystery shoppers to monitor online pharmacies. Is that likely to go ahead?
That’s certainly something that we’re keen to explore further. We’re looking at it with both our legal colleagues and our inspectorate to understand what we can do within the regulatory powers we have.
What progress has the GPhC made in addressing concerns around safe homecare service delivery?
We register and inspect pharmacies that operate homecare delivery and, when safety concerns have been identified, we’ve issued the providers with things such as improvement action plans.
As we know that wider safety issues have been raised, we are in the midst of undertaking a review of a small sample of those pharmacies on our register that are operating it. We’re looking at where patients have reported delays in accessing medication.
How far do you think the new registration routes being proposed for overseas pharmacists will go towards alleviating workforce shortages?
I think it will contribute, but it’s not going to go all the way because it is part of a multifactorial issue.
We’ve got an in-principle framework that our council recently agreed on, which has had quite a lot of stakeholder consultation.
It’s mostly focused around making sure that overseas pharmacists are going to have the right level of training for what we need in the UK, and if any additional education and training requirements are proportionate.
There are universities with long waiting lists that are oversubscribed, so it will be a positive contribution, but it’s certainly not the only thing that needs to be addressed as part of the ‘NHS Long Term Workforce Plan‘ and the other drivers towards this. Obviously some of that goes well beyond what we’re able to do as a regulator.
Are you continuing any work in mental health pharmacy?
I’m still immediate past president of the CMHP for the next couple of years, so I’ll be supporting the new president in her role.
I’m certainly still connected to the sector. When you’ve worked in a clinical area for so long, particularly around drug and alcohol use, it’s something you feel quite passionate about.
What was your involvement with the government’s community pharmacy guidelines on delivering substance misuse services?
The CMHP were commissioned by the Office for Health Improvement and Disparities to lead on the guidelines, so we pulled together a group of key stakeholders, including community pharmacy representation.
The guidelines are aimed at community pharmacy and to future-proof further developments, which is why it covers things such as drug checking, for example.
It also includes clear expectations about when services are offered, use of language and how you go about offering such services.
It’s great to have it out now and it’s long overdue. But even though it’s out, there’s so much more that needs to happen.
Should community pharmacy do more to help with substance misuse?
Pharmacy has got a massive role to play and there’s so much potential, but we’ve got challenges with funding, challenges around adequate training, and even willingness for pharmacies to offer those services.
Now, more than ever before, is a real prime time for maximising on what pharmacy can offer
Right now, our issues of drug-related deaths just continue and we’ve increasingly got issues around highly-potent synthetics and things such as nitazenes, which are going to make everything so much worse.
Now, more than ever before, is a real prime time for maximising on what pharmacy can offer.
There have been discussions between commissioners, treatment service providers and local pharmaceutical committee representatives around having a national service-level agreement or equivalent around that.
At the moment, in England, services are fragmented. Each individual service area has its own service-level agreements, and pharmacies are paid differently depending on where in the country they are. It wastes so much resource.
For the person receiving the service, it shouldn’t matter where in the country they are, they should have access to the same level of service.
The first legal consumption room has been approved in Glasgow. Is that something you’d like to see in England?
It’s another opportunity to offer a harm reduction intervention. Other parts of the world have done it with success and we’re yet to do that properly here in the UK.
It’s going to be important to make sure that it’s supported by research, to be able to look at the outcomes from a multitude of different approaches.
With drug-related deaths, and especially with these highly-potent synthetic opioids that don’t look like they’re going away anytime soon, it’s not like an overdose prevention centre is going to be the magic solution.
It’s going to be in amongst lots of other interventions, such as ensuring good, strong take-home naloxone provision, that people are getting access to treatment in a timely way, including access to prescribed interventions, and psychosocial support and housing. It’s multifactorial.
The first regular drug-checking service recently opened in Bristol. Is that something pharmacies could offer in the future?
It’s a challenge as it is right now, with the pressures on community pharmacy. They need to be remunerated to be able to offer that and they need the training; they need the skill set to be able to do it. There isn’t the funding and resources to be able to embed this as a matter of routine.
It’s well within the potential of community pharmacy, but it’s in amongst lots of other priorities for their time and resource capacity.
Do you know what’s happening with government plans for drug checking in Scotland?
I was one of the advisers for that project. The publications as a result of that work have shown positive responses from key stakeholders, including the police. But again, it comes down to the practicalities, logistics and the costs of being able to do that and making sure that the money is available.
