Rowlands Pharmacist Issued Warning for Falsifying Controlled Drug Records and Failing to Maintain Governance

The General Pharmaceutical Council (GPhC) reviewed the conduct of the registrant, who worked as a Responsible Pharmacist at a Rowlands Pharmacy branch. Following the merger of two pharmacy branches, the registrant was responsible for maintaining governance, particularly around Controlled Drug (CD) management and error monitoring.

However, the GPhC found that the registrant:

• Knowingly failed to maintain accurate CD registers, including for methadone.
• Falsified CD records to indicate that balance checks had been performed when they had not.
• Did not complete near-miss logs, which are essential for identifying and learning from dispensing errors.
• Failed to raise concerns about the difficulty in meeting standards due to workload or staffing pressures.

Findings

The GPhC Investigating Committee concluded that:

• The registrant’s actions represented a serious lapse in professional integrity, particularly regarding falsifying CD records.
• The failure to speak up when standards could not be met was a breach of professional duty.
• The registrant had demonstrated some insight and reflected on their failings, showing a commitment to avoiding similar issues in the future.

A direct quote from the committee’s warning stated:

“Even in times where workloads and pressure increase, the registrant must uphold the very highest levels of pharmacist conduct and integrity.”

The panel acknowledged mitigating factors, including workload stress and the challenges of managing systems during a pharmacy merger. However, these factors did not excuse the misconduct.

Sanction

The GPhC issued a formal warning, which:

• Will be published on the public register for 12 months.
• Serves as a reminder to maintain governance standards, even in challenging circumstances.
• Warns that any repetition will likely result in more serious regulatory action.

The committee also reminded the registrant that if future circumstances affect their ability to meet professional standards, they must:

• Raise concerns promptly.
• Seek support from management or colleagues.

Key Learning Points for Pharmacy Professionals

1. Controlled Drug records must be accurate and up to date – Falsifying CD registers is a serious breach of professional standards.
2. Professional integrity must be maintained under pressure – Increased workload does not justify dishonesty or the failure to meet legal obligations.
3. Speaking up is a professional duty – When safety or governance issues arise, pharmacists must escalate concerns rather than conceal or compensate through falsification.
4. Leadership includes accountability – Responsible Pharmacists must lead by example and ensure proper procedures are followed.
5. Warnings serve as a public marker of misconduct – Even where there is insight and no patient harm, dishonesty can still result in reputational consequences.

Conclusion

This case highlights the importance of accurate record-keeping and professional integrity, particularly in the management of Controlled Drugs. The 12-month warning serves as a reminder to all pharmacists that governance failures—even under pressure—can result in regulatory action. Raising concerns early and upholding ethical standards is essential for safe and effective pharmacy practice.