Raising a concern about education and trainingJanuary 2020

Use this form to raise a concern about the quality of a pharmacy course or a training placement. We will use the information you provide to decide whether we can investigate your concern.

Please make sure you have read the information on our website to make sure that:

we can deal with the issues you are concerned about you understand how we deal with concerns and what this involves.

Please give as much information as you can. It will allow us to decide how best to deal with your concern.

If you are a pharmacy professional raising concerns about someone or something at your place of work, please read our guidance on raising concerns.

You can fill in this form by hand or using a computer, but you will need to print it out and sign it, if you give your consent for us to investigate your concern.

Submit your form by sending the completed scanned document, and any supporting documents to educationconcerns@pharmacyregulation.org. We will acknowledge your concern within five days, and keep you up to date on the progress of any investigations we carry out.

1. Contact details We will use these details to contact you about your concern. We will usually contact you by email. You can let us know if below if you have any specific communications needs.

Title: Mr Mrs Ms Miss Other

Name      

Phone      

Email      

Address     

 

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GPhC registration number or pre-registration training number (if applicable)

  

           

     

1.1. Do you have any specific communication needs?

Yes No

If ‘Yes’, please give details below.

     

1.2 Please select from the dropdown how are/were you involved with the education or training provider or programme of study:

I was involved as a - Select -

1.3 Have you raised this concern with the GPhC before?

Yes No

If yes, please give the reference number if you have it:

                    

2. Education or training detailsPlease provide details about the provider, course or training premises to which your concern relates. You may need to fill in more than one section.

a) education or training provider(s)

Name      

b) accredited or approved pharmacy course

Name      

c) name and address of the approved pre-registration training premises (if this applies)

Name      

Address     

 

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GPhC training site or premises registration number

  

           

     

3. Your concern3.2 Please give a summary of your concern.

     

d) Have you already raised this with someone other than the GPhC?

Yes No

If ‘Yes’:

a) who did you raise it with?

Name      

b) what was the outcome?

     

3.3 Have you enclosed any supporting documents?

Yes No

If ‘Yes’, please list them below:

     

4. Your consentPlease read this information carefully and indicate if you give your consent for us to investigate your concern by signing and dating the form below.

Even if you do not give your consent, we will still consider the concern you have raised. If you withdraw your consent later, we will still look to see if we can carry on with our investigation.

Important: we are unlikely to be able to fully investigate your concern without your consent and co-operation.

We will always tell you if we are going to disclose your information.

We will only disclose information:

that we need to, to continue with an investigation

if it is in the public interest, or

if the law says we must

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We will not disclose your contact details, such as your address or phone number, to the person or organisation you are raising a concern about.

I consent to the GPhC investigating my concern, and:

a. I understand that the GPhC will decide whether my concern can be investigated.

b. I understand that in raising this concern, I may be identifiable to the person(s) or organisation(s) I am concerned about.

c. So that it can investigate my concern efficiently and effectively, the GPhC has my consent to disclose details of my concern to: the relevant employer, education or training provider; contracting bodies; and other agencies or public bodies.

Signed Date

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