Fitness to Practise Cases

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This archive contains General Pharmaceutical Council (GPhC) Fitness to Practise (FtP) case summaries, detailing regulatory decisions affecting pharmacy professionals in the UK.

Each case provides insight into professional misconduct, errors, and ethical breaches that led to sanctions such as suspension, removal, or warnings. These summaries are valuable for:

  • Pharmacists & Pharmacy Technicians – to understand common regulatory pitfalls.
  • Employers & HR Teams – to learn about professional accountability and compliance.
  • Pharmacy Students – to prepare for real-world ethical challenges in pharmacy practice.

How to use this case summary database:

  • Search for specific cases using the search box above. You can search by keyword (e.g., "controlled drugs," "dishonesty," "suspension"), by sanction type (suspension, removal, warning) or issue type (dishonesty, prescribing errors, controlled drugs, etc.)
  • Alternatively, scroll down to browse the latest FtP case summaries.

Why it matters:

The decisions in these cases shape the legal and ethical landscape of pharmacy practice. Staying informed can help pharmacy professionals avoid similar mistakes and maintain high professional standards.

Latest FtP case summaries:

Superintendent Pharmacist Warned for Failing to Maintain Any CD Registers

Date of Decision: August 26, 2025

Allegations: Failure to maintain a controlled drugs (CD) register while dispensing Schedule 2 controlled drugs. Failure to manage and assess risks associated with controlled drug handling as Superintendent Pharmacist. Breach of statutory responsibilities under the Misuse of Drugs Regulations 2001.

Outcome: Warning issued and published on the GPhC register for 12 months.

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Serious Record-Keeping Failures in Extemporaneous Medicine Manufacturing Lead to Undertakings for Retiring Superintendent Pharmacist

Date of Decision: August 28, 2024

Allegations: Failed to ensure the pharmacy was organised to comply with standards for unlicensed medicine preparation. Allowed unlicensed medicine “The Tonic” to be manufactured and supplied with inadequate manufacturing records (1,511 bottles supplied, only 120 records). Allowed unlicensed products (“Nappy Ointment”, “Hack Cream”, “Japanese 35% Peppermint Oil Cream”) to be made and sold without any manufacturing records. Failed to ensure SOP for “The Tonic” was adhered to. Failed to have SOPs for other unlicensed medicines listed above.

Outcome: Undertakings accepted in lieu of sanction, including voluntary removal from the register and commitment not to engage in pharmacy or healthcare services.

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NI GP Pharmacist Suspended for Dishonest Prescribing of Tramadol to Family and Friends

Date of Decision: May 15, 2025

Allegations: Issued and dispensed prescriptions for controlled drug (Tramadol/Maxitram) without clinical justification Prescribed medications to individuals with whom she had close personal relationships Manipulated GP clinical systems, including issuing and cancelling prescriptions Used login credentials of other staff members to conceal actions Deleted or altered patient records to hide unauthorised prescribing Acted dishonestly and without integrity over a 2½ year period

Outcome: 9-month suspension from the register

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GP Pharmacist Removed from Register Following Sexual Misconduct Towards Colleague

Date of Decision: August 20, 2025

Allegations: On 9 September 2021, while working at Monkseaton Medical Centre: Touched crotch against a colleague’s shoulder Grabbed colleague’s crotch, placing hand on his penis and rubbing it Simultaneously grabbed or squeezed his own crotch Made the remark, “You're not going to tell anyone are you?” The conduct was alleged and found to be sexually motivated

Outcome: Removal from the Register (with immediate interim suspension)

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Superintendent Pharmacist Issued Warning for Dispensing Generic Medicines against Branded NHS Prescriptions

Date of Decision: August 20, 2025

Allegations: Dispensed generic versions of POMs where branded items were prescribed without a Serious Shortage Protocol (SSP). Dispensed medication of a different strength than prescribed. Labelled medication to reflect what was dispensed rather than what was prescribed. Allegation of dishonesty in relation to the above actions (not proved).

Outcome: Warning

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Well Pharmacist Removed for Repeated Dispensing of Controlled Drugs Without Prescriptions

Date of Decision: August 19, 2025

Allegations: Dispensed controlled drugs to three patients without prescriptions over a period of several months. Self-checked the dispensing of controlled drugs in contravention of protocols. Instructed dispensers to hand out controlled drugs without appropriate pharmacist supervision. Failed to report the incidents promptly on the employer's DATIX system despite being requested to do so.

Outcome: Removal from the Register

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Superintendent Pharmacist Sanctioned for Unsafe Online Dispensing and Regulatory Breaches

Date of Decision: May 6, 2025

Allegations: Failure to maintain and retain private prescription records in accordance with Regulation 253 of the Human Medicines Regulations 2012. Failure to complete private prescription records accurately and on time. Non-compliance with pharmacy SOPs for private prescription recording. Dispensing medicines without supervision or the knowledge of the Responsible Pharmacist. Continuing unsafe online supply of POMs including controlled drugs despite warnings from the regulatory authority. Misleading the Society about cessation of online services. Failing to maintain safe, effective, and transparent pharmacy operations across multiple premises.

Outcome: Conditions Order extended for 6 months from 10 May 2025, prohibiting the registrant from acting as Superintendent Pharmacist and requiring ongoing oversight and reporting.

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NI Pharmacist Suspended for Repeated Theft and Misuse of POMs from Gordon Chemists

Date of Decision: March 13, 2025

Allegations: Dishonestly appropriated Neupro (2mg) transdermal patches from employer premises. Unlawfully obtained Neupro patches without a valid prescription. Stole various retail products on multiple dates. Unlawfully obtained and failed to record supply of Metronidazole tablets. Supplied POM to a family member without lawful authority. Abused managerial position to acquire retail and medicinal products. Breached professional and ethical standards in the conduct and handling of medications.

Outcome: Suspension for 6 months

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