GENERAL PHARMACEUTICAL COUNCIL

FITNESS TO PRACTISE COMMITTEE

25 Canada Square, London E14 5LQ

Wednesday 8 June 2016

Chairman: Mr Stuart Turnock

Committee Members: Ms Elaine Donnelly

Mr Peter Jones

Committee Secretary: Miss Zarina Ndemumana

CASE OF:

ALAM, Asif

GPhC Registration No 2070147

____________________________________

MISS SARAH DAVIES, solicitor advocate, appeared on behalf of the General

Pharmaceutical Council.

MRS DIANE SOUTHALL-EDWARDS, of EPLS, appeared on behalf of Mr Alam who

was present.

_______________________________

Transcript of the stenograph notes of T.A. Reed & Co Ltd

Tel No: 01793-764614

____________________________

DETERMINATION OF THE COMMITTEE ON IMPAIRMENT OF FITNESS TO

PRACTISE.

THE CHAIRMAN: Mr Alam appears before this Committee today to face the following

allegation:

That being first registered as a pharmacist on 20 July 2009, whilst employed as a

Pharmacist and the Store Manager at Boots, 639 Cathcart Road, Glasgow, G42 8AE, (the

Pharmacy), you:

1) On one or more of the dates identified in Schedule A, caused or permitted the

registration of patients for the Minor Ailment Scheme in Scotland (MAS) as

identified in Schedule A;

2) Your actions at paragraph 1 above were dishonest in that you;

(i) knew that the patients included in the MAS registrations as set out in

Schedule A had not been consulted as to whether they wished to be

registered for MAS and/or had not provided their consent;

(ii) knew that the registrations as set out in Schedule A were not conducted

in accordance with the service specifications of MAS;

(iii) intended to deceive the National Health Service in Scotland that the

registrations had been conducted in accordance with the MAS service

specifications;

(iv) intended to deceive your employer, Boots, into believing that the

registrations had been conducted in accordance with the MAS service

specifications.

3) On one or more of the dates identified in Schedule B, you caused or permitted

the registration of patients for MAS as identified in Schedule B.

4) Your actions at paragraph 3 above were dishonest in that you:

(i) knew that the patients included in the MAS registrations as set out in

Schedule B had not been consulted as to whether they wished to be

registered for MAS and/or had not provided their consent;

(ii) knew that the registrations as set out in Schedule B were not conducted

in accordance with the service specifications of MAS;

(iii) intended to deceive the National Health Service in Scotland that the

registrations had been conducted in accordance with the MAS service

specifications;

(iv) intended to deceive your employer, Boots, into believing that the

registrations had been conducted in accordance with the MAS service

specifications.

By virtue of the matters referred to above, your fitness to practise is impaired by

reason of your misconduct.

Schedule A:

Date Number of Registrations

23 April 2011 63

14 May 2011 111

16 May 2011 56

2 Jun 2011 78

4 Jun 2011 47

23 Jun 2011 53

28 April 2012 61

22 May 2012 105

18 July 2012 51

20 July 2012 66

9 August 2012 56

Schedule B:

Date Number of Registrations

8 October 2012 48

20 February 2013 62

27 February 2013 26

28 February 2013 115

At the outset of the hearing Mr Alam admitted all of the particulars of allegation and also

accepted that, as a result, his fitness to practise is currently impaired. The Committee is

satisfied that the admissions to the facts were unequivocal.

Rule 31(6) of the General Pharmaceutical Council (Fitness to Practise and

Disqualification etc, Rules) 2010 provides that, where facts are admitted, the Chair must

announce that such facts have been found proved.

Rule 31(11) provides that the Committee must receive further evidence and hear further

submissions from the parties as to whether, on the basis of any facts found proved, the

Registrant’s fitness to practise is impaired.

Rule 31(12) provides that the Committee must consider and announce its finding on the

question of whether the fitness to practise of the Registrant is impaired, and give its

reasons for that decision. Notwithstanding Mr Alam’s acceptance that his fitness to

practise is impaired, it therefore falls to the Committee to make a determination on that

issue.

In coming to its decision, the Committee bore in mind the agreed witness statements

produced by the Council in support of its case, the oral evidence that it has heard from Mr

Alam today, and the submissions made on behalf of the Council by Miss Davies, and on

behalf of Mr Alam by Mrs Edwards.

The background to Mr Alam’s appearance before this Committee is as follows. The

Minor Ailments Service (MAS) was introduced in July 2006 to allow patients to use the

community pharmacy of their choice as the first port of call for the treatment of minor

illnesses and ailments, on the National Health Service. It is a Scottish-only service under

which patients register for the service at the community pharmacy. Under the terms of

service, eligible patients are able to access the service free of charge.

Patients eligible for the MAS scheme include patients under the age of 16, patients over

the age of 60, and the various other categories of patients who were, at that time, exempt

from prescription charges. There is now no prescription charge in Scotland, but those

eligibility criteria remain in place for the MAS.

The purpose of the scheme was for the provision of direct pharmaceutical care on the

NHS by community pharmacists to members of the public presenting with a common

illness or ailment. The objectives were to promote care via pharmacies, so as to shift the

balance of care from GPs and nurses to community pharmacies, thus potentially reducing

the demand on the time of others in the primary care team

Community pharmacies are paid for their MAS registrations depending upon the number

of patients registered for the service by the last day of each month. There are various

bands of registration numbers giving rise to different payment levels. The bands and

corresponding payment figures for the period under consideration are set out in a table as

shown out below:

Band No No of Registrations Annual payment Monthly payment

1 1-250 £7,301 £608.41

2 251-500 £9,254 £771.16

3 501-750 £11,208 £934.00

5 751-1000 £13,218 £1,101.50

6 1001-1250 £15,228 £1,269.00

Patients’ registrations for the MAS are valid for 12 months. If the patient accesses

services at the same pharmacy within the 12 months following their registration, their

registration is automatically extended for a further 12 months. If the patient does not

access the services within 12 months of registration, then their registration lapses.

Following an analysis of MAS registration patterns across Scotland in the period 1

October 2009 to 30 September 2012, NHS Scotland Counter Fraud Services (CFS)

identified specific areas of concern in relation to registrations from the Boots pharmacy at

Cathcart Road.

According to the agreed witness statement of Mr Gillespie, the reasons why those

particular registrations were identified as suspicious included the following: 51 per cent

of registrations occurred within a minute of each other; there were significant similarities

between the signatures of the patients’ representatives; the relatively high number of

registrations on each of the key dates, and in all but three of the forms submitted the

signature was that of a patient’s representative rather than the patient.

Mr Gillespie informed the pharmacy of his concerns and an internal investigation, as well

as the Counter Fraud Investigation, was commenced. The outcome of those investigations

led to Mr Alam’s dismissal from Boots and his subsequent appearance before this

Committee.

Mr Alam commenced employment as a pharmacist and store manager at Boots, 639

Cathcart Road, Glasgow, on 1 June 2010. At that time he had been qualified for less than

a year and had been working as a locum before starting at Boots. It was a job share role

and he was contracted to work three days a week, although he did not work three

consecutive days. Mr Alam told the Committee that, although he was confident as a

pharmacist, he found the management side of his role difficult.

He told the Committee that, within the first three months of starting in the store, it had

received a compliance audit which was failed. Mr Alam’s evidence was that, when he had

his first year performance review in 2011, he was informed that he was underperforming.

He was referred to the failed compliance audit and was told that, if the audit was failed

again, then he would be classed as ‘non-performing’ and put on a performance

improvement plan and that, if he could not achieve targets, then his line manager would

“get someone who could.”

Mr Alam told the Committee:

“Every day I would go in I was left with a list of problems to sort out from the

pharmacists in the previous days. On top of completing the work on my days in, I

also had to train a dispenser who was starting out in this role two weeks after I had

started. Again I worked very hard to complete the day-to-day tasks, making sure

patients were given correct and safe prescriptions, giving advice and supporting

staff learning. However, I was also getting numerous e-mails from my line

manager to complete several tasks that had been passed on him, such as reaching

targets, implementing planograms, etc. I would struggle to try and fit these tasks

into my daily routine.”

Mr Alam said that there came a point when he felt that he had to do something that would

take the pressure from his line manager off him. What he decided to do was to create a

number of MAS registrations which were completed without having obtained the consent

of the patient or complying with other requirements set out in the MAS service

specifications and detailed in the relevant Boots standard operating procedure.

The registrations created a false picture for Boots and the NHS. Although Mr Alam did

not make any direct personal financial gain, his desired effect being to seek to secure his

position at Boots, the consequences for the NHS were that it was making payments in

respect of registrations in respect of which no payment was due. So far as can be

ascertained, the amount of the overpayment relating to the false registrations set out in the

Schedules attached to the allegations amounted to around £700. In due course, the total

amount which had been received by Boots, was recovered by NHS.

When the investigations led to Mr Alam, he was interviewed by Boots on two occasions,

and was then subject to a disciplinary hearing which led to his dismissal. Mr Alam

co-operated with the investigation and admitted his involvement from the outset. He

accepted that he had signed the patient consent declaration, even though he had not

obtained the consent of the patient. He stressed that he had made no financial gain, but

had acted as he did to “make the shop look better and please the area manager”.

In his first investigatory interview Mr Alam had said “I didn’t know it was fraud, I

thought it was a Boots numbers thing”, although he accepted that he understood that

meeting targets would make the store look better. He said that he stupidly and naively

carried out the MAS registrations. Mr Alam said that he fully regrets his actions. He

stated:

“I did not think through my actions. Even when I involved my staff members, they

just took it on as a targets game. We were constantly being questioned on targets,

such as prescription collection service (PCS), free repeat prescription service

(FRPS), advantage card sign-ups, customer care survey reports, pushing

promotions, etc. Everybody felt pressure.”

Mr Alam said that he realises that he should have informed his line manager of his

concerns and the pressures that he was under rather than carry out the dishonest actions.

In the disciplinary hearing, Mr Alam admitted to knowing that, as the number of

registrations increased, Boots would be paid more.

Article 51 of the Pharmacy Order 2010 provides that a person’s fitness to practise is to be

regarded as impaired by reason of one or more of a number of circumstances. These

include, at paragraph (a), misconduct. The first step in the process, therefore, is to

consider whether there has been misconduct.

Miss Davies on behalf of the Council submitted that there had been misconduct on the

part of Mr Alam, and Mrs Edwards, on behalf of Mr Alam’s behalf, conceded that was the

case. The leading case on the meaning of misconduct is Roylance v General Medical

Council [2001] (No 2) 1 AC 311, in which Lord Clyde said:

“Misconduct is a word of general effect, involving some act or omission which

falls short of what would be proper in the circumstances. The standard of

propriety may often be found by reference to the rules and standards ordinarily

required to be followed by a...practitioner in the particular circumstances.”

It has to be established, to come within the provisions of the Article, that the misconduct

is serious.

When considering the question of misconduct, the Committee considered the General

Pharmaceutical Council’s Standards of Conduct, Ethics and Performance issued in July

2012 to identify what standards of behaviour are expected of registered pharmacists. Miss

Davies drew the attention of the Committee to the provisions of the code which she

submitted were applicable in this case.

There is a considerable overlap between a number of the provisions of the Standards, and

the Committee found that the key breaches related to the admitted dishonesty, Mr Alam’s

failures to obtain the consents of the patients, and his failure to comply with the Standard

Operating Procedures.

Standard 3.6 requires that the pharmacist must “Get consent for the professional services

you provide and the patient information you use”.

Standard 6 requires a pharmacist to “be honest and trustworthy”, noting that “Patients and

the public put their trust in pharmacy professionals. You must behave in a way that

justifies this trust and maintains the reputation of your profession”.

Specific provisions of that standard require a pharmacist to:

6.1 Act with honesty and integrity to maintain public trust and confidence in your

profession.

6.2 Not abuse your professional position, or exploit the vulnerability or lack of

knowledge of others.

6.5 Meet acceptable standards of personal and professional conduct.

6.6 Comply with legal and professional requirements and accepted guidance on

professional practice.”

Standard 7.6 requires that a pharmacist must be satisfied that appropriate standard

operating procedures are in place and are being followed.

Having considered Mr Alam’s actions and the provisions of the code, the Committee is

satisfied that the actions of Mr Alam did amount to misconduct.

The second step in the process is to consider whether at the present time Mr Alam’s

fitness to practise is impaired. Again Miss Davies submitted, on behalf of the Council,

that Mr Alam’s fitness to practise is currently impaired, and Mrs Edwards accepted that is

the case.

Case law emphasises that whether fitness to practise is impaired must be judged at the

date of the hearing before the Committee, although regard must obviously be had to the

way a person has acted or failed to act in the past.

There is no statutory definition of what amounts to fitness to practise. However, there is

reference to fitness to practise criteria at Rule 5 of the General Pharmaceutical Council

(Fitness to Practise and Disqualification, etc Rules) 2010. At Rule 5(1) it states that the

Committee must have regard to the criteria specified at paragraph 5(2). That paragraph

provides:

“In relation to evidence about the conduct or behaviour of the registrant which

might cast doubt on whether the requirements as to fitness to practise are met in

relation to the Registrant, the Committee must have regard to whether or not that

conduct:

(a) presents an actual or potential risk to patients or to the public;

(b) has brought or might bring the profession of pharmacy into disrepute;

(c) has breached one of the fundamental principles of the profession of

pharmacy; or

(d) shows that the integrity of the registrant can no longer be relied upon.”

That largely mirrors what was said in CHRE v NMC and Grant [2011] 927 (Admin) by

Cox J who said that a Committee should ask itself:

“Do our findings of fact in respect of the doctor’s misconduct, deficient

professional performance, adverse health, conviction, caution or determination

show that his/her fitness to practise is impaired in the sense that he or she:

(a) has in the past acted and/or is liable in the future to act so as to put a

patient or patients at unwarranted risk of harm; and/or

(b) has in the past brought and/or is liable in the future to bring the

medical profession into disrepute; and/or

(c) has in the past breached and/or is liable in the future to breach one of

the fundamental tenets of the medical profession; and/or

(d) has in the past acted dishonestly and/or is liable to act dishonestly in

the future.”

Cox J stated:

“The value of this test, in my view, is threefold: It identifies the various types of

activity which will arise for consideration in any case where fitness to practise is

in issue; it requires an examination of both the past and the future; and it distils

and reflects, for ease of application, the principles of interpretation which appear

in the authorities.”

Although it refers to doctors, it is of course equally practicable to other healthcare

practitioners.

In the judgment of the Committee, paragraphs (b), (c) and (d) are clearly engaged in this

case.

In the case of Cohen v General Medical Council [2008] EWHC 581 (Admin), Silber J

noted, when considering the question of impairment:

“...The Panel [must]...give substantial weight to the public interest including the

protection of patients, the maintenance of public confidence in the profession and

upholding proper standards of conduct and behaviour.”

He stated that it was highly relevant to consider whether the conduct is easily remediable,

whether it has been remedied and whether it is highly unlikely to be repeated. However,

that case was, of course, concerned with misconduct by a doctor in the form of clinical

errors and competence.

Mr Alam told the Committee that, over the last three years, and following receipt of a

letter from the Committee regarding the hearing, he has had much time to contemplate,

understand and rectify his behaviour. He stated that he had completed “many CPD cycles”

to improve and develop his areas of weakness and uncertainty, especially relating to

professional services and the Data Protection Act.

Since his dismissal from Boots, he has been able to find employment elsewhere working

as a locum, primarily for Reach Pharmacists. Since February, he has been working

full-time on a locum basis. He produced a number of testimonials from pharmacist

colleagues, and a testimonial from Reach. The director and superintendent pharmacist at

Reach Pharmacists said:

“Asif Alam has informed me of this inquiry and I have read the particulars of the

allegation which I feel is totally out of character and doesn’t square with his

personality.

Asif has locumed in all of my branches and is my preferred locum pharmacist with

whom I am totally comfortable. He has been the regular pharmacist in my

Spateston branch since April 2015, and has exceeded all my expectations through

his work ethic and commitment to his role and profession. During this time Asif

has built strong relationships with all of the surgeries and has integrated himself as

a trusted and valued healthcare professional as part of the fabric of the community.

I’ve also received extremely positive feedback from my staff and Area Manager

on his performance which confirms the pharmacy’s key performance indicators I

have set him. After his experience with Boots, Asif has made sure that SOPs have

been implemented and followed. The pharmacy is compliant, and he ensures a

safe running environment in this branch. As the owner of the business, I have no

hesitation in continuing to employ Asif in my pharmacy branches and truly feel he

is an asset to the profession, and can only wish there were more like him.”

Mr Alam said that, as a locum, he has ensured that all members of staff that he is working

with are following correct procedures, and he has been training those staff members who

are unsure of what the correct procedures are. Mr Alam accepted his responsibility at the

onset and, when questioned about MAS registrations, admitted his actions at the earliest

opportunity, gave his full co-operation throughout the investigation, and sincerely

apologised for his actions. The Committee accept that, as he says:

“At no point did I try to cover up anything. I should have asked for help from my

employers and fellow colleagues. Prior to this I had an impeccable character. I am

not blaming anyone but myself.”

He said:

“I have thought long and hard about what I would do differently if I was placed in

similar circumstances. Firstly, to prevent it happening, I would only work for

people who would not put me under the same pressure. I have worked for most

other companies as a locum since leaving Boots, and have found that the

independent pharmacies do not pressurise pharmacists and staff in the way that I

have experienced with the multiples. I now have the confidence to explain and

converse with employers and area managers.

I now know, and have the confidence to step back from a situation which would

lead me to acting in a dishonest way. I would rather suffer the short term

consequences of stepping back than do anything dishonest as I did back when I

worked for Boots.

I have suffered emotionally and physically and, having this case hanging over my

head, has made me all the more determined not to let it happen again.”

The evidence produced on behalf of the Council was that, within Boots, a pharmacy of a

certain size would be expected to have a certain number of patients eligible for the MAS

scheme.

Having heard the evidence Mr Alam gave, and considering the content of the testimonials

produced, the Committee accept that as a recently qualified pharmacist in his first

management post, Mr Alam felt himself to be under considerable pressure. To try to

relieve that pressure, he acted dishonestly. The Committee accept that was out of

character.

Mr Alam recognises that there was an abuse of trust and said: “I have not only let myself

down, but my family, my previous employers and the pharmacy profession.”

With regard to the failure to gain patient consent and not comply with the SOPs the

Committee conclude that, as a result of reflection, training and subsequent experience, Mr

Alam has shown insight and has remedied his failings. However, the Committee

recognise that dishonesty is not easily remediable.

The Committee accept that Mr Alam has shown insight into his dishonest misconduct.

That is evidenced by his co-operation with the investigations and his regulator, the fact

that he self-referred the matter to the Council in October 2013, and that he admitted his

misconduct at the outset of this hearing. He accepted that his fitness to practise is

impaired. The Committee concluded that there is no real risk of repetition of his

dishonesty.

However, the Committee bore in mind the comments of Cox J in the case of Grant in

which she said:

“In determining whether a practitioner’s fitness to practise is impaired by reason

of misconduct the relevant Panel should generally consider, not only whether the

practitioner continues to present a risk to members of the public in his or her

current role, but also whether the need to uphold proper professional standards and

public confidence in the profession would be undermined if a finding of

impairment were not made in the particular circumstances.”

The Committee is satisfied that those remarks are applicable in this case, and that it would

be failing in its duty to uphold proper professional standards and public confidence in the

profession if it failed to find Mr Alam’s fitness to practise is impaired as a result of his

misconduct.

Accordingly, the Committee find that Mr Alam’s fitness to practise is currently impaired.

----------------------------

GENERAL PHARMACEUTICAL COUNCIL

FITNESS TO PRACTISE COMMITTEE

25 Canada Square, London E14 5LQ

Thursday 9 June 2016

Chairman: Mr Stuart Turnock

Committee Members: Ms Elaine Donnelly

Mr Peter Jones

Committee Secretary: Miss Zarina Ndemumana

CASE OF:

ALAM, Asif

GPhC Registration No 2070147

______________________________

MISS SARAH DAVIES, solicitor advocate, appeared on behalf of the General

Pharmaceutical Council.

MRS DIANE SOUTHALL-EDWARDS, of EPLS, appeared on behalf of Mr Alam who

was present.

(DAY TWO)

_______________________________

Transcript of the stenograph notes of T. A. Reed & Co Ltd

Tel No: 01793 764614

____________________________

I N D E X

Page

DETERMINATION ON SANCTION 1

PLEASE NOTE: Copies printed from email may differ in formatting and/or page

numbering from hard copies

1

DETERMINATION ON SANCTION

The Committee having found that Mr Alam’s fitness to practise is impaired, it is therefore

necessary to consider the question of sanction.

At this stage of the proceedings, the Committee considered all of the material produced

previously, including the bundle of testimonials and it heard submissions from Miss

Davies on behalf of the Council and from Mrs Edwards on behalf of Mr Alam.

The sanctions available are set out in Article 54(2) of the Pharmacy Order 2010, which

provides that if the Fitness to Practise Committee determines that the fitness to practise of

the person concerned is impaired it may, in short:

Give a warning to the person and give a direction that the details of the warning be

recorded in the register;

Give a direction that the entry in the register of the person concerned be subject to

such conditions as the Committee thinks fit to impose for such period not

exceeding three years;

Give a direction that the entry in the register of the person concerned be suspended

for such period not exceeding 12 months as may be specified in the direction;

Give a direction that the entry in the register of the person concerned be removed.

In reaching its conclusions, the Committee paid due regard to the Council’s Good decision

making: fitness to practise hearings and sanctions guidance. The Committee reminded

itself that the purpose of a sanction is three fold, namely the protection of the public, the

maintenance of public confidence in the profession and the maintenance of proper

standards of behaviour. In considering sanction, the Committee exercises a discretion and

it is required to exercise that discretion in a way that is fair, reasonable and proportionate.

2

That requires the Committee, when making its decision, to weigh the interests of the

practitioner against the public interest which includes the protection of members of the

public, maintenance of public confidence in the profession and the declaring and upholding

of proper standards of conduct and performance. The application of the doctrine of

proportionality requires that the sanction imposes no greater restriction than is absolutely

necessary to achieve its objectives. It is also clear that the purpose of a sanction is not to

punish a practitioner, although a sanction may have a punitive effect.

In order to arrive at the right conclusion and to ensure proportionality, the Committee

adopted what is called a ‘stepped’ approach which involves starting with the least

restrictive sanction, considering whether that is appropriate and continuing until the right

and appropriate sanction is reached and having done so to explain why that is the case.

That approach ensures that the Committee acts in a way that is proportionate and ensures

that the sanction imposes no greater restriction than is absolutely necessary to achieve its

objectives.

In Bolton v Law Society [1991] 1 WLR 512 CA Thomas Bingham, Master of the Rolls,

said,

“The reputation of the profession is more important than the fortunes of any

individual member. Membership of a profession brings many benefits, but that is

part of the price”.

In the case of Marinovich v GMC [2002] UKPC 36 it was stated that “The Committee is

entitled to give greater weight to the public interest and the need to maintain public

confidence in the profession than to the consequences to the appellant of the imposition of

the penalty.

In considering the sanction appropriate in this case, the Committee firstly gave

consideration to the mitigating and aggravating features of the facts found proved.

In terms of aggravating features, the misconduct involved the breach of a number of key

3

standards, particularly the requirement to be honest and trustworthy. The dishonest

behaviour occurred on multiple occasions over a lengthy period and at a time when Mr

Alam was in charge of the pharmacy premises. He involved other members of staff to

some degree. Mr Alam deceived his employer and the NHS and an inevitable consequence

of his deception meant that the NHS made payments which it should not have made.

In terms of mitigation, the Committee noted that there is no disciplinary history prior to

these matters and there have been no subsequent complaints regarding Mr Alam’s conduct.

The most recent event under examination took place over three years ago when Mr Alam

was less mature and less experienced. Mr Alam admitted his misconduct at an early stage

and co-operated fully both with Boots and the Council’s investigations. Indeed he self-

reported the matter to the Council in October 2013. There was no direct financial gain to

Mr Alam and the money has now been repaid by Boots to the NHS. There was no harm or

potential harm to patients, although there was a breach of duty to them in using their

information without consent. The Committee is satisfied that Mr Alam has shown insight

which is reflected in his decision to practise as a locum since his dismissal from Boots. He

has found such employment less stressful. He also recognised that his continued

registration was precarious and he might not be able to make a long-term commitment to

an employer.

Turning to the sanction in the case and considering, firstly, the least restrictive sanction of

a warning and considering whether that is appropriate, the Council’s Good decision

Making: fitness to practise hearings and sanctions guidance gives assistance and suggests

that a warning may be appropriate where there is a need to demonstrate to a Registrant, and

more widely to the profession and the public, that the conduct or behaviour fell below

acceptable standards, or where there is no need to take action to restrict a Registrant’s right

to practise there is no continuing risk to patients or the public and where there needs to be a

public acknowledgement the conduct was unacceptable.

Whilst in this case there is no continuing risk to the public, the Committee, however, is

clear that the dishonesty findings in the case are too serious for a warning to send out a

correct message to the public and the profession. The Committee did not therefore

4

consider a warning to be appropriate.

The Committee went on to consider the next least restrictive sanction which would be to

impose conditions upon Mr Alam’s registration. The findings of dishonesty mean, in the

Committee’s view, that conditional registration is not appropriate to address such

misconduct. There are no realistic conditions which would address the misconduct and

such a sanction would fail to send out to the profession and the public a clear message that

dishonest conduct of this nature is unacceptable.

That then leaves the options of suspension or removal from the register. Again, there is

guidance to be found in Good decision making: fitness to practise hearings and sanctions

guidance. That document makes specific reference to cases which involve dishonesty.

Paragraph 6.8 states,

“Regulators ensure that public confidence in a profession is maintained. This is a

long-established principle and our standards of conduct, ethics and performance

state that registrants should act with honesty and integrity to maintain public trust

and confidence in the profession. There are some acts which, while not presenting

a direct risk to the public, are so serious they undermine confidence in the

profession as a whole. The GPhC believes that dishonesty damages public

confidence, and undermines the integrity of pharmacists and pharmacy technicians.

However, cases involving dishonesty can be complicated - committees should

carefully consider the context and circumstances in which the dishonesty took

place. Therefore, although serious, there is not a presumption of removal in all

cases involving dishonesty”.

Paragraph 6.9 reads,

“Some acts of dishonesty are so serious that the committee should consider removal

as the only proportionate and appropriate sanction. This includes allegations that

involve intentionally defrauding the NHS or an employer, falsifying patient records,

or dishonesty in clinical drug trials”.

5

Finally paragraph 6.10 reads,

“When deciding on the appropriate sanction in a case involving dishonesty, the

committee should balance all the relevant issues including any aggravating and

mitigating factors. It is important to understand the context in which the dishonest

act took place and make a decision considering the key factors. The committee

should then put proper emphasis on the effect a finding of dishonesty has on public

confidence in the profession”.

The Committee starts its considerations by recognising that for all professionals a finding

of dishonesty lies at the top end of the spectrum of gravity of misconduct. Whilst there is

no presumption that it will lead to removal it may well do so because of the damage it does

to the reputation of the profession and because it erodes public confidence in the

profession.

The Committee is satisfied that the prime motivation for Mr Alam’s dishonesty was to

enhance his reputation at work and to relieve the considerable pressure to which he fell

subject. Whilst an inevitable consequence of his actions was to cause a loss to the NHS, he

did not set out to conduct a fraud against that organisation. However, it is important that

for the effective and efficient operation of the NHS, it is able to place trust and confidence

in the honesty and integrity of pharmacists. Where that trust and confidence is broken, it

has a significant impact on the reputation of the profession and on the public’s confidence

in the profession.

Considering the options of suspension and removal, the Good decision making guidance

suggests that suspension may be appropriate where a warning is insufficient or would

undermine public confidence. It may be required when necessary to highlight to the

profession and the public that the conduct of the Registrant is unacceptable and unbefitting

of a member of the pharmacy profession and also where public confidence in the

profession demands no lesser sanction.

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Cases where the removal of registration is required are said to be reserved to the most

serious cases of misconduct. The Committee should consider this sanction when the

Registrant’s behaviour is fundamentally incompatible with being a registered professional.

Miss Davies submitted that the minimum sanction which would be appropriate was that of

suspension and such a suspension would need to be for a “lengthy period.” Mrs Edwards

submitted that the appropriate sanction would be a period of suspension, recognising that

such a period may have to start from six months upwards.

The question of the appropriate sanction is of course a matter for the independent judgment

of the Committee.

Having taken account of the Council’s guidance and submissions of the representatives,

and all of the circumstances of the case, the Committee concluded that this is a case where

the suspension of Mr Alam’s registration for an appropriate period would be proportionate.

The Committee did not consider that Mr Alam’s conduct, taking into consideration all of

the particular circumstances in this case, as outlined above, that removal of his registration

was required.

The suspension can be for a maximum period of up to 12 months. A period of suspension

is a matter for separate consideration by the Committee and again it must be proportionate

and not punitive. It must balance the interests of the Registrant with the public interest.

The question is in each individual case, and considering the circumstances of that case,

what is the minimum period of suspension that is required to meet the objectives as any

longer period would be disproportionate? Again, that is ultimately a matter of judgment

for the Committee taking into account what a fully informed member of the public might

think.

In this case the Committee concluded that a period of suspension of less than nine months

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would not send out the requisite message and if it were to impose any lesser period, it

would be failing in its duty to the public. It recognises that that length of time is a

significant period and will have serious financial consequences for Mr Alam, but it

considers it to be proportionate. Accordingly, the period of suspension imposed by the

Committee is for a period of nine months.

Article 54(3) of the Pharmacy Order 2010 provides that where a direction for suspension is

made, the Committee can direct that there should be a review prior to the expiry of the

period of suspension. At that review the Committee may, in summary, give a direction that

the entry be removed from the register, a period of suspension be extended for a further

period not exceeding 12 months or impose a period of conditions for a period not

exceeding three years.

The Council’s Guidance suggests “In some cases it may be obvious that following a short

period of suspension there will be no value in a review hearing. However, in most cases

where a suspension is imposed, the Committee will need to be sure that the Registrant is fit

to resume practice, either unrestricted or with conditions. The Committee will also need to

satisfy itself that the Registrant has fully appreciated the seriousness of the breaches they

have committed and has not committed any future breaches of the Council’s standards,

conduct, ethics and performance.

In view of the length of the period of suspension imposed in this case, the Committee has

concluded that there should be a review.

The Committee conducting the Review will be assisted at that Review by any details of

any paid or unpaid work undertaken by Mr Alam and any further references or testimonials

from fellow professionals he wishes to adduce. The Committee will no doubt also wish to

be satisfied that Mr Alam has kept up to date with pharmaceutical practice.

DETERMINATION ON INTERIM MEASURES

THE CHAIRMAN: Article 59 of the Pharmacy Order 2010 provides that the Direction for

suspension which the Committee has made in this case will not take effect until the period

8

allowed for bringing an appeal has expired, or if an appeal were to be brought until the

appeal has been concluded.

Article 60 of the Order, however, provides that the Committee may order that the entry in

the register be suspended with immediate effect if it is satisfied that to do so is necessary

for the protection of members of the public, or is otherwise in the public interest or is in the

interests of the Registrant.

Miss Davies submitted on behalf of the Council that an order is required in this case on the

grounds that it is otherwise in the public interest. She referred to what she described as the

not insignificant breaches of standards in this case which included dishonesty and the fact

that a lengthy period of suspension has been imposed. She submitted that not to make an

order would undermine the message that the sanction is intended to convey.

Mrs Edwards submitted that an order is not required. She pointed out that the default

position is that there should not be an order unless it is justified on one of the grounds set

out in the legislation. She drew attention to the fact that Mr Alam has been practising

without an interim order and there have been no complaints about his conduct. She

submitted the effect of an interim order could be to increase his suspension by, potentially,

a lengthy period of time if there was an appeal.

It is common ground between the parties that the allegations against Mr Alam, which have

been proved, do not give rise to any danger or potential danger to the public and it is not

suggested that an order is required in Mr Alam’s interests. The sanction imposed by the

Committee is to send out the requisite message to the profession and the public. After

careful consideration, the Committee decided that a period of suspension of nine months is

required. The Committee is satisfied that that period is sufficient to achieve its objective.

The default position is that a suspension does not start immediately unless an order is

justified in accordance with the legislation. The Committee is not persuaded that in the

absence of the need to protect the public, in this case the public interest requires that Mr

Alam be suspended with immediate effect.

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The Committee therefore make no order under Article 60.