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Equality and discrimination

Transparency required to prove fitness-to-practise process is non-discriminatory

Mind the gap logo The pharmacy regulator must be more transparent about how it conducts fitness-to-practise investigations if trust in its ability to do a fair job is to be maintained.

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Source: JL / Jizak

“Sunlight is said to be the best of disinfectants,” said Louis Brandeis, US Supreme Court justice, when discussing how airing a problem can help uncover appropriate solutions.

And this approach will hopefully lead to a similar outcome after the release of data by the General Pharmaceutical Council (GPhC) on their fitness-to-practise (FTP) process, following a request from Jizak under the Freedom of Information Act.

These data show that, of the 200 pharmacists suspended or removed from the register between 1 January 2016 and 31 December 2018, almost half (47%) were black, Asian or of an ethnic minority (BAME). If pharmacists who did not provide their ethnicity are removed from the analysis, 57% of those removed or suspended are BAME.

These figures are meaningless on their own, but when compared with the ethnic make-up of the pharmacist register, they look disproportionate. Some 45% of pharmacists on the GPhC register identify as BAME; 45% identify as as white and 10% give no ethnicity.

This is likely to be a multifactorial problem and this is not unique to the GPhC; it affects other healthcare regulators and reflects a larger societal problem

However, the data supplied are partial and so it is difficult to make any firm conclusions. The overall numbers are small, there are a significant proportion without any ethnicity specified and the regulator has not released data on specific ethnic groups, for reasons of confidentiality.

We know that some ethnic groups are more likely to have concerns raised about their professional conduct, but we don’t know who are raising these complaints or whether BAME pharmacists are more likely to have a complaint proceed to a FTP panel, or whether after this they are more likely than white pharmacists to receive a harsher sanction.

To its credit, the GPhC says it is worried about these data and that it will be conducting an equality impact assessment of its FTP processes in 2019. This is likely to be a multifactorial problem and this is not unique to the GPhC; it affects other healthcare regulators and reflects a larger societal problem.

But transparency will be vital to ensure continued confidence in the regulator. It should aim to be as open as possible about the data it holds in this area. It should also heed the calls from pharmacy leaders and other experts for an independent review of its FTP process. This would enable a comprehensive look at the GPhC’s procedures — including individual cases — and should be able to identify any patterns which require correction. 

This has precedent in that the GPs’ regulator — the General Medical Council (GMC) —  in 2014 after it found that black and minority ethnic doctors were overrepresented in its FTP procedures. The researchers analysed 187 randomly selected cases and found no evidence of bias or discrimination overall, but did recommend areas for improvement.

The GPhC should also work with pharmacy employers and NHS organisations to understand why some ethnic groups are more likely to have concerns raised about their professional conduct and ensure that any bias is routed out early on in the process.

Facing an FTP panel can be a career-ending move, and so the profession must be clear that these life-changing decisions are completely unbiased. Publishing these data is a good first step, but there is more that can be done to ensure the regulation of pharmacy is as transparent and demonstrably fair as possible.

Citation: Jizak DOI: 10.1211/PJ.2019.20206237

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