Richard Hough, Deepika Raino and Eddy Martin take independent pharmacists through the General Pharmaceutical Council's revised guidance on hearings and outcomes…

The General Pharmaceutical Council (GPhC) has recently released updated its guidance on fitness to practise hearings and outcomes. The revised guidance was published following consultation with various stakeholders on how to strengthen advice for fitness-to-practise (FtP) committees in order to eliminate potential discrimination in hearing outcomes.

The result of this consultation is revised guidance, which stresses how seriously concerns involving discrimination need to be taken. It also emphasises that FtP committee members must thoughtfully consider cultural sensitivities during hearings and when determining a pharmacy professional’s FtP.

The guidance explicitly defines discrimination and how it can take form, such as through victimisation and harassment. The statutory definition of discrimination is cited as “treating someone unfairly because of a protected characteristic.”

In defining discrimination in its guidance, the GPhC is aiming to ensure that such important terms are clearly understood by registrants and others involved in the FtP process. It emphasises that any allegations of discrimination must be investigated thoroughly and impartially, including taking the time to understand the contexts and specifics of the allegation to avoid biases influencing outcomes.

The outcomes of discrimination are also explored. Where treatment is not provided due to discrimination, the physical, emotional and psychological wellbeing of a patient may be adversely impacted, which can in turn affect how patients access health services in the future. Further, any discrimination towards colleagues in a pharmacy setting can also impact on patient safety by fracturing the collaborative working that is needed to deliver safe patient care.

The guidance also highlights expectations of pharmacy professionals to recognise diversity and cultural differences to ensure everyone is treated fairly, regardless of their beliefs and values. Pharmacy professionals must not impose their own beliefs on others and must take responsibility to make sure person-centred care is not compromised due to personal beliefs.

Training for panel members on cultural competence and anti-discrimination practices is also recommended, the aim of which is to raise understanding of unconscious biases and the impact of systemic discrimination and to promote a fair and unbiased approach to decision-making.

Ongoing professional development in the form of keeping up to date about best practices and evolving standards in respect of cultural sensitivities and discrimination will also help reduce any discrimination in the process.

Cultural differences and how they affect the way people communicate

The guidance emphasises the importance of being aware of, and taking into account cultural differences and how they can affect the way people communicate. This will include recognising when English is not a pharmacy professional’s first language and when conventions of an individual’s first language are used to construct sentences or statements. Examples of this could include differences in intonation, which could alter the intended meaning when spoken in their second language.

An understanding of these nuances will allow panel members to acknowledge differences in sentence construction, vocabulary use and overall communication styles.

An example of how cultural differences play out can be seen by the way people express apologies. How apologies are communicated can differ across cultures and are often affected by religion and beliefs. In some cultures, apologies are not the norm.

What may seem like a lack of remorse in one cultural context could be a profound expression of it in another. Panels are encouraged to take these differences into account when evaluating a pharmacy professional’s insight and responsiveness to the issues raised.

In addition, the guidance advises committees to be aware that a neurodiverse individual may also express their remorse or sorrow in a different way to non-neurodiverse individuals.

There may also be differences in the way individuals use non-verbal cues to communicate. This will include, among other things, facial expressions, eye contact and gestures. For example, a pharmacy professional with a sight impairment may have difficulty making eye contact with committee members.

The committee should be aware of and sensitive to these issues when deciding how a pharmacy professional expresses their insight and remorse, and in judging their behaviour and attitude during the hearing. The committee should be conscious of these issues when assessing what weight to give relevant factors in determining sanctions.

The committee should note that it is not just about how individuals communicate, and it should also consider the support that pharmacy professionals may need to understand the information that is communicated to them during the hearing.

Testimonials (or references) can also have an important bearing on the outcome of a FtP hearing. Due to this, FtP committees should be aware that in some circumstances, there may be cultural reasons why a professional may not want to request testimonials (or references).

For example, sharing information about their investigation with family members or colleagues may adversely affect private lives. Panel members should bear this in mind and avoid making assumptions if a registrant does not provide references.

The guidance also provides recommendations for supporting those who have experienced discrimination or cultural misunderstandings. This includes access to counselling services and clear communication about their rights and the processes of complaint.

This new guidance is welcomed at a time where other regulators, including the GMC, have had accusations of racism and discrimination in the FtP process levelled at them.

Richard Hough is a partner at Brabners and a former pharmacist. His co-author Deepika Raino is a legal director in Brabners’ regulatory and professional conduct department and healthcare sector team.