Reflection and Fitness to Practise
Posted: Monday, July 1st, 2019
Reflection is a core part of the GPhC’s revalidation model, and pharmacy professionals are encouraged to reflect with others through peer discussion. The position is similar in other healthcare professions.
The use of reflective material in fitness to practise cases was an issue examined by the panel chaired by Professor Sir Norman Williams which was set up by the then Secretary of State to review of the Bawa Garba manslaughter case. The panel heard “widespread fears from healthcare professionals and representative groups that personal reflection where things have gone wrong, and in particular written reflection, might be used as evidence against them in criminal or regulatory proceedings".
The panel was also “concerned to learn that some clinicians are choosing not to engage with reflective learning for fear it could be used against them.”
The Williams report recommended that the General Medical Council and General Optical Council should no longer be able to require registrants to provide reflective material when investigating fitness to practise cases. The panel considered that such a change would help ensure healthcare professionals are not afraid to use their notes for open, honest reflection which supports improvements in patient care.
On 18 June, the GPhC announced that it had issued a statement jointly with the UK’s other 8 healthcare regulators, entitled “Benefits of becoming a reflective practitioner”[i]. The joint statement includes this passage:
“We will not ask those who are on our registers to provide their personal written reflections in order to investigate a concern about them. Registrants can choose to offer them as evidence of insight into their practice.”
New NHS terms of service for SSPs
Posted: Sunday, June 30th, 2019
The NHS terms of service for pharmacies[i] are amended with effect from 1 July 2019, to enable medicines to be supplied under a serious shortage protocol (SSP).
Ordinarily, a pharmacy owner must supply a prescribed product with reasonable promptness. If the prescribed product is the subject of a SSP:
- the pharmacy owner must consider whether it is reasonable and appropriate to supply in accordance with the SSP instead of in accordance with the prescription and may refuse to supply what is on the prescription.
- the pharmacy owner may provide a different product or different quantity to what is prescribed if –
- this can be done with reasonable promptness;
- it is in accordance with the SSP; and
- the supply is by or under the direct supervision of a pharmacist who is of the opinion, in the exercise of his or her professional skill and judgement, that supplying a different product or quantity is reasonable and appropriate.
If a supply is made under an SSP –
- prescriptions must be endorsed appropriately for remuneration purposes
- pharmacy owners must notify prescribers of a supply under a SSP if DHSC has published a recommendation to do so
- patients must be informed of the different supply by including information on the dispensing label.
If an SSP is in place, pharmacy owners do not have to use it. If a pharmacy owner is of the opinion in the exercise of his or her professional skill and judgement that supplying a different product or quantity is unreasonable or inappropriate and is able to supply the prescribed product or quantity within a reasonable timescale, they are allowed to do this and are absolved from the requirement to supply with reasonable promptness. It is to be inferred that “reasonable timescale” involves a longer period than “reasonable promptness”, but the actual period on either case would necessarily depend on the precise facts and circumstances.
Similarly, if a pharmacist is of the opinion, in the exercise of his or her professional skill and judgement that supplying a different product or quantity under a SSP is unreasonable or inappropriate and is unable to provide a different product within a reasonable timescale, a supply under the SSP can be refused. In that case, the patient must be referred back to the prescriber.
[i] Schedule 4 to the National Health Service (Pharmaceutical and Local Pharmaceutical Services) Regulations 2013
Good character as an aspect of fitness to practise
Posted: Tuesday, May 28th, 2019
Good character, which is an aspect of fitness to practise, came up for consideration in the recent Privy Council case of Layne v Attorney General of Grenada  UKPC 11.
The Appellant, Layne had been convicted of murder following a coup in Grenada in 1979 in which the Prime Minister was murdered. After serving a lengthy prison sentence during which he studied law, he applied for admission to the Bar of Grenada. By the time of his application, Layne was by all accounts a model citizen. His application was nevertheless refused on the ground that his conviction meant he was not of good character. Layne appealed to the Judicial Committee of the Privy Council after exhausting the Caribbean appeals process.
Layne argued that “of good character” meant present good character and that he had demonstrated that he met this requirement.
The Privy Council (by a 4-1 majority) dismissed the appeal. The Privy Council held that:
- Good character must be related to the profession in question.
- Good character has two facets: the candidate’s attributes; and the risk of damage to public confidence in the profession (to which previous convictions were necessarily relevant).
- In relation to public confidence, the question to be considered was whether the public can reasonably be expected to have confidence in the admission of the candidate. This follows from the leading case of Bolton v The Law Society, a decision that is frequently referred to in GPhC determinations.
- Public confidence must be well-founded: and any lack of confidence by the public must be justifiable on an objective basis. It is not enough that the public would misguidedly not have confidence in a particular candidate. As Lady Arden put it: “It is not part of [the decision-maker’s] function to assuage public opinion”.
Seminar presentation links now fixed
Posted: Tuesday, May 14th, 2019
Apologies to anyone who was unable to access the seminar presentations on our website yesterday. The links have now been fixed and you can access the presentations at https://www.plea.org.uk/events.htm
Seminar presentations now on our website
Posted: Monday, May 13th, 2019
We are pleased to confirm that the presentations given at our annual seminar on 9 April are now on the Events page of our website https://www.plea.org.uk/events.htm
Legal challenge to SSPs fails in the Court of Appeal
Posted: Sunday, May 12th, 2019
The Good Law Project appealed to the Court of Appeal against the refusal by Mr Justice Supperstone to grant permission to apply for judicial review of the amendments to the Human Medicines Regulations that allowed ministers to issue serious shortage protocols. You can read David Reissner's Chemist & Druggist blog published before the hearing by clicking on this link https://www.chemistanddruggist.co.uk/opinion/stop-politicising-medicines-supply-resisting-shortages-powers. The Court of Appeal refused to overturn the refusal of permission. The Good Law Project has said on its Twitter feed that it does not intend to pursue its case further.
Disputing the findings of a FtP tribunal at a review hearing
Posted: Thursday, May 2nd, 2019
When registrants deny a fitness to practise allegation and are suspended from practice, they may face tricky decisions about how to present their case at a review hearing. For example, if they are found to have lied to the Fitness to Practise tribunal, do they admit at a review hearing that they lied to the Fitness to Practise tribunal? What if they maintain at the review hearing that they had been telling the truth, even though the Fitness to Practise tribunal disbelieved them? Will maintaining that the Fitness to Practise tribunal’s decision was wrong be seen as a lack of insight that will stop the registrant being allowed to resume practising? These issues were addressed in Blakely v General Medical Council  EWHC 905 (Admin).
Dr Blakely had been suspended for 6 months by the Medical Practitioners Tribunal after she carried out a botched investigation into her suspicions about another doctor. The Tribunal had held she had acted dishonestly in misleading patients. Before the end of her suspension Dr Blakely attended a review hearing at which she maintained she had not acted dishonestly. The Tribunal found that her fitness to practise remained impaired and suspended her for a further 9 months.
On appeal to the High Court, Mr Justice Lewis ruled:
- On a review hearing, the original findings of fact could not be re-opened.
- The doctor was entitled not to accept those findings, but not to go behind them.
- She did not have to admit the misconduct but it was relevant for the Tribunal to know if she continued to deny the facts underpinning the finding of misconduct in order to show that she understood the gravity of the offending and would be unlikely to repeat it.
- Continued dishonesty or a lack of candour at the hearing itself might be a relevant consideration.
- At the review hearing, it was up to the doctor to demonstrate she had the requisite insight, which was not the same as accepting she had done what she had been accused of. Examples of how to do this were:
1 Accepting with the benefit of hindsight that she had acted dishonestly, even if she did not thing so at the time;
2. Accepting that members of the public might regard her behaviour as dishonest even if she did not;
3. Indicating that she understood why the tribunal felt that the public would regard her conduct as dishonest.
Dr Blakely’s appeal was dismissed.
Serious Shortage Protocols in the Court of Appeal
Posted: Thursday, May 2nd, 2019
We reported recently that Mr Justice Supperstone had refused an application by The Good Law Project for permission to apply for judicial review of amendments to the Human Medicines Regulations that empower Ministers to introduce Serious Shortage Protocols.
Last week, Lord Justice Hickinbottom granted The Good Law Project permission to appeal against the refusal to the Court of Appeal. There is a single ground of appeal, namely that Ministers did not have power to make the Regulations. Lord Justice Hickinbottom said he found Mr Justice Supperstone's judgment "compelling", but was persuaded that The Good Law Project should have an opportunity to argue its case at a hearing.
Because the case partly depends on whether the UK has a no-deal Brexit, the judge directed an expedited hearing.
New GPhC guidance on online pharmacy and hub & spoke
Posted: Tuesday, April 16th, 2019
Last year, PLEA responded to a General Pharmaceutical Council consultation on the provision of online pharmacy services. The GPhC has just published new guidance on this and on hub & spoke dispensing. The guidance is detailed. Here are some of the key points:
The provision of pharmacy services at a distance, particularly online, carries particular risks by its nature. Risk assessments should be carried out.
If a pharmacy works with prescribers or prescribing services operating outside the UK, they should make sure that:
- they manage the extra risks that this may create
- they have sufficient indemnity insurance in place to cover
- the prescriber is registered in their home country where the prescription is issued and can lawfully issue prescriptions online to people in the UK
- the prescriber is working within national prescribing guidelines for the UK
Pharmacies should carry out a regular audit and keep records of
- decisions to make or refuse a sale
- any information about pharmacy services on the website
- how the pharmacy’s information security policy meets the Payment Card Industry Data Security Standard (PCI DSS) and data protection law
- feedback from people who use pharmacy services
- concerns or complaints received
- activities of third parties, agents or contractors
When parts of a pharmacy service take place at different locations (such as in a ‘hub and spoke’ or ‘click and collect’ service) pharmacies must be clear about which pharmacist is accountable and responsible for each part of the service, and which pharmacy technician and other staff are involved. When medicines are not given to the person or their representative in the registered pharmacy, but are delivered by a member of staff or an agent to the person’s home or workplace, there may be more risk of medicines being lost or delivered to the wrong person. Pharmacies must make sure there are clear lines of accountability and responsibility in these circumstances. If pharmacies contract out any part of your pharmacy service to a third party, pharmacies are still responsible for providing it safely and effectively. They should carry out ‘due diligence’ in selecting any contractors.
When there is no face-to-face contact, pharmacies should consider what information they and their staff record and keep to show that the pharmacy service provided is safe.
Pharmacy websites should be clear and not mislead pharmacy service users about the identity or location of the pharmacies involved in providing pharmacy services. This includes the identity and location of any online prescribing service.
Pharmacies should be able to show how they are assured that all prescribers, whether medical or non-medical, follow relevant guidance.
Websites should ensure that a person cannot choose a POM and its quantity before there has been an appropriate consultation with a prescriber.
Websites should display prominently:
- the name of the prescriber and the address of the prescribing service
- the prescriber’s registration number and the country where they are registered in
- whether the prescriber is a doctor or a non-medical independent prescriber
- check that the person receiving pharmacy services is who they claim to be, by carrying out an appropriate identity check (for example by keeping to the Identity Verification and Authentication Standard for Digital Health and Care Services, which provides a consistent approach to identity checking across online digital health and care services)
- make sure people receiving pharmacy services have the opportunity to ask questions about their medicines
- identify requests for medicines that are inappropriate, by being able to identify multiple orders to the same address or orders using the same payment details – this includes inappropriate combinations of medicines and requests that are too large or too frequent
- a prescriber, that the pharmacy chooses to work with is aware that some categories of medicines are not suitable to be supplied online unless further safeguards have been put in place
Finally, the guidance says that websites should look professional.
Bawa-Garba review decision
Posted: Wednesday, April 10th, 2019
Dr Haditha Bawa-Garba's review hearing at the Medical Practitioners Tribunal was taking place at the same time as our annual seminar, making our presentation on gross negligence manslaughter even more topical. During the presentation, we learned that Dr Bawa-Garba had been allowed to resume practice subject to conditions. The MPTS decision can be found here https://www.mpts-uk.org/hearings-and-decisions/medical-practitioners-tribunals/dr-hadiza-bawa-garba-apr-19
These news items are not exhaustive but are selected according to their relevance to pharmacy practice, NHS community pharmacy contracts and the regulation of the pharmacy profession. If you wish to add any items that you think we have missed, contact our news editor.