Set 1: For each scenario, select the most appropriate legal or professional action.
A. Dispense the prescription because all FP10 prescriptions are valid for 6 months
B. Supply the full quantity as an emergency supply and ask for a prescription later
C. Do not supply because the Schedule 2 controlled drug prescription is outside its legal validity period
D. Amend the prescriber’s date to today and dispense
E. Supply 5 days only because any prescription error can be corrected by the pharmacist
F. Refer the patient to buy an OTC alternative
G. Dispense if the patient signs the back of the prescription
H. Do not make a patient-requested emergency supply of a Schedule 2 controlled drug; signpost urgently to an appropriate prescriber or urgent care route
1. A regular patient presents on Saturday evening requesting morphine modified-release capsules because they have run out. Their GP surgery is closed, and there is no prescription. The patient says the pharmacy has supplied it before and asks for “just a few days to get through”.
Which option is most appropriate?
2. A patient presents an FP10 prescription for oxycodone modified-release tablets. It is correctly written, signed and dated, but the appropriate date was 35 days ago. The patient says they forgot to bring it in earlier.
Which option is most appropriate?
Set 2: For each scenario, select the most appropriate pharmacist action.
A. Withhold supply temporarily if clinically unsafe, contact the prescriber or substance misuse service urgently, and document the decision
B. Supply all missed methadone instalments together because the prescription is still valid
C. Destroy patient-returned Schedule 2 CDs appropriately with a witness and record according to SOP; do not return them to stock
D. Put returned morphine into pharmacy stock if the pack is unopened
E. Give methadone even if the patient appears intoxicated because instalment prescriptions must always be followed exactly
F. Ask the patient to alter the instalment direction themselves
G. Accept the returned CDs but leave them unrecorded until the annual CD balance check
H. Ignore repeated missed supervised doses if the total quantity on the prescription is unchanged
3. A patient brings back unopened morphine modified-release tablets after a relative has died. The dispenser asks whether they can be returned to stock because the box is sealed and in date.
Which option is most appropriate?
4. A patient prescribed daily supervised methadone has missed three consecutive doses. They attend late in the day, appear intoxicated and are slurring their speech. They insist they must receive today’s dose.
Which option is most appropriate?
Set 3: For each scenario, select the most appropriate action.
A. Allow the pharmacy to operate normally because the responsible pharmacist signed in that morning
B. Do not hand out a prescription requiring counselling or professional judgement until the pharmacist can assess and counsel the patient
C. Let any trained staff member clinically screen new prescriptions during the pharmacist’s absence
D. Do not continue activities requiring a responsible pharmacist if the RP absence is not lawful or safe; follow SOP and protect patients
E. Sell all P medicines without pharmacist involvement if the shop is busy
F. Leave the pharmacy open without any RP notice displayed
G. Let the accuracy checker clinically assess a high-risk new medicine
H. Dispense unchecked prescriptions because the prescriber is responsible for safety
5. The responsible pharmacist signs in at 9 am, then leaves the premises for an external meeting lasting more than 3 hours. They are not contactable. The team continues to sell P medicines and hand out new high-risk prescriptions.
Which option is most appropriate?
6. A patient arrives to collect a newly prescribed methotrexate prescription. The bag is accuracy checked, but the pharmacist is in a private consultation and has not yet counselled the patient. The patient is new to methotrexate and does not know the dose schedule.
Which option is most appropriate?
Set 4: For each scenario, select the most appropriate action.
A. Give the information because relatives have a right to know
B. Provide a full printout of the patient’s medication history to anyone who asks in person
C. Refuse to cooperate with all police requests, even if there is immediate risk of serious harm
D. Post the patient’s medication list publicly so the family can check it
E. Do not disclose identifiable information without consent or a clear lawful basis; seek advice and document the decision
F. Maintain confidentiality, explain the need for consent, and consider whether any public-interest or safeguarding exception applies
G. Discuss the patient’s HIV medicine loudly at the counter because the pharmacy is busy
H. Send information by unencrypted personal email because it is faster
7. A woman phones the pharmacy and asks whether her husband is taking HIV PrEP. She says she is worried he is hiding something from her. The patient has not given consent to share information.
Which option is most appropriate?
8. A police officer attends the pharmacy and asks for a list of all patients receiving methadone “to help with local enquiries”. There is no warrant, court order or immediate serious risk described.
Which option is most appropriate?
Set 5: For each scenario, select the most appropriate action.
A. Assess Fraser competence, provide confidential care where appropriate, but explore safeguarding concerns and escalate if risk of harm is identified
B. Refuse to speak to the young person unless a parent is present
C. Assess capacity for this specific decision, involve the patient as far as possible, and act in their best interests only if they lack capacity
D. Follow the daughter’s request automatically because family members decide for adults with dementia
E. Supply emergency contraception but ignore possible exploitation
F. Tell the care home to crush all medicines covertly without a best-interests process
G. Ask the police to arrest the patient because they seem confused
H. Refuse all treatment to anyone lacking capacity
9. A 15-year-old requests emergency contraception. She appears anxious and says her 28-year-old partner is waiting outside and does not want her to speak to anyone. She does not want her parents told.
Which option is most appropriate?
10. A care home resident with dementia refuses a new sedating antipsychotic. The patient can explain some concerns about drowsiness and falls. The daughter demands that it is hidden in food because “mum is difficult”.
Which option is most appropriate?
Set 6: For each scenario, select the most appropriate professional action.
A. Supply any POM requested if the patient seems genuine
B. Refuse the sale, explain the safety concern, document where appropriate and signpost to suitable care
C. Consider an emergency supply of insulin if legal requirements are met, supply an appropriate quantity, counsel and document
D. Supply antibiotics as an emergency supply for a new infection without prescriber involvement
E. Supply pseudoephedrine repeatedly because it is a P medicine
F. Refuse insulin because emergency supplies are never allowed
G. Supply sildenafil despite current nitrate use because the patient accepts the risk
H. Supply a Schedule 2 controlled drug as emergency supply because the patient is regular
11. A regular patient with type 1 diabetes is away from home and has lost their insulin pen. You can verify previous use from the patient’s records and the patient knows their regimen. They have no insulin left.
Which option is most appropriate?
12. A customer repeatedly requests pseudoephedrine from different staff members and becomes aggressive when questioned. They refuse to answer basic safety questions and have bought similar products several times recently.
Which option is most appropriate?
Set 7: For each scenario, select the most appropriate governance action.
A. Ignore the incident because the doctor prescribed the medicine
B. Ensure the patient is clinically assessed, be open and honest, apologise, report and investigate the dispensing error
C. Destroy all evidence to protect the pharmacy
D. Record the near miss, review contributing factors and share learning to reduce recurrence
E. Blame the dispenser publicly so others learn
F. Only record incidents that lead to death
G. Tell the patient nothing unless they complain
H. Continue working without changing the process because near misses do not matter
13. A patient was supplied warfarin 5 mg tablets instead of 1 mg tablets and took the wrong strength for 3 days. They now report bruising and nosebleeds.
Which option is most appropriate?
14. During final checking, the pharmacist notices that amlodipine was selected instead of amitriptyline. The medicine had not reached the patient.
Which option is most appropriate?
Set 8: For each scenario, select the most appropriate action.
A. Supply the special because patient preference always overrides licensing status
B. Import an unlicensed medicine without records or justification
C. Supply sildenafil privately despite nitrate use because it is the prescriber’s responsibility
D. Refuse or query the sildenafil supply because concomitant nitrate use makes it clinically unsafe; contact the prescriber/service where appropriate
E. Query the prescription and consider a licensed suitable alternative before supplying an unlicensed special
F. Use the specials route only because it is more profitable
G. Tell the patient unlicensed medicines are illegal in all circumstances
H. Ignore identity checks for remote/private prescribing
15. A prescription requests an unlicensed liquid special for a patient with swallowing difficulty. A licensed dispersible tablet of the same medicine appears clinically suitable and available.
Which option is most appropriate?
16. An online private service sends a prescription for sildenafil. The patient’s shared record shows they use GTN spray for angina and had chest pain last week.
Which option is most appropriate?
Set 9: For each scenario, select the most appropriate action.
A. Do not supply under the PGD unless the practitioner is authorised, trained and working within the PGD; refer to an appropriate clinician
B. Report the suspected reaction through the Yellow Card scheme, especially because black triangle medicines are under additional monitoring
C. Ask the patient to self-certify that the PGD applies
D. Supply under a PGD even if the patient is outside the inclusion criteria
E. Report only if the adverse reaction is definitely proven
F. Ignore non-serious suspected reactions to black triangle medicines
G. Allow an untrained staff member to use the PGD if the pharmacy is short-staffed
H. Use a PGD to supply any controlled drug without checking legal restrictions
17. A pharmacy technician who is not named or authorised on a PGD is asked to supply an antibiotic under that PGD because the pharmacist is busy. The patient also falls outside one of the PGD inclusion criteria.
Which option is most appropriate?
18. A patient recently started a newly marketed black triangle medicine. They develop a suspected adverse reaction that is not serious but is unusual and not clearly listed in the leaflet.
Which option is most appropriate?
Set 10: For each scenario, select the most appropriate governance action.
A. Use the vaccines if they look clear and the expiry date has not passed
B. Change the fridge log retrospectively so the pharmacy passes inspection
C. Quarantine affected stock, label it “do not use”, document the incident and seek appropriate advice before deciding on use
D. Refuse to falsify records, raise the concern through the appropriate route and escalate if patient safety remains at risk
E. Sell the stock at a discount
F. Ignore the fridge alarm if no patient has complained
G. Dispose of all medicines immediately without checking whether they can be used
H. Ask patients to decide whether they want potentially compromised vaccines
19. The vaccine fridge alarm shows the temperature rose to 14°C overnight. The duration of the excursion is unclear. Several vaccine packs are still in the fridge.
Which option is most appropriate?
20. A manager tells a trainee to rewrite the controlled drug balance and fridge temperature records so they “look right” before an inspection. The trainee believes medicines may have been supplied from compromised stock.
Which option is most appropriate?
Answers and Rationale
1. H
A patient-requested emergency supply is not generally permitted for Schedule 2 controlled drugs such as morphine. The pharmacist should not supply, but should help the patient access urgent care or an appropriate prescriber.
2. C
Schedule 2 controlled drug prescriptions are usually valid for 28 days from the appropriate date. A prescription presented after this period cannot be supplied legally.
3. C
Patient-returned controlled drugs must not be returned to stock, even if unopened. They should be handled and destroyed according to SOP, with appropriate witnessing and records.
4. A
Missed methadone doses and signs of intoxication create a serious safety risk. The pharmacist should not automatically supply; they should contact the prescriber or substance misuse service and document the professional judgement.
5. D
The responsible pharmacist arrangements must be lawful and safe. If the RP absence is not lawful or safe, activities requiring the responsible pharmacist should not continue as normal, and the SOP should be followed.
6. B
Methotrexate is high-risk and new patients require counselling on weekly dosing, folic acid, monitoring and toxicity signs. Handing it out without pharmacist assessment would create avoidable risk.
7. F
The patient’s medicine information is confidential. A spouse or relative does not automatically have a right to know. Disclosure requires consent or a clear legal/public-interest/safeguarding justification.
8. E
Police interest alone does not automatically justify disclosure of identifiable medication information. The pharmacist should seek a lawful basis, disclose only what is necessary if justified, and document the decision.
9. A
A young person can receive confidential sexual health care if competent, but the age gap, anxiety and controlling partner raise safeguarding concerns. The pharmacist should assess competence and risk, and escalate if needed.
10. C
Capacity is decision-specific. The patient should be involved as far as possible. Covert administration requires a proper capacity and best-interests process, not simply a family request.
11. C
Emergency supply of insulin may be appropriate if legal requirements are met and previous treatment can be verified. The pharmacist should supply an appropriate quantity, counsel and document.
12. B
Repeated pseudoephedrine requests, refusal to answer safety questions and aggression suggest possible misuse or diversion. The pharmacist may refuse sale, explain the concern and signpost appropriately.
13. B
A dispensing error causing possible harm requires urgent clinical assessment, openness, apology, documentation, reporting and learning. The patient should not be left to manage possible over-anticoagulation alone.
14. D
A near miss caught before reaching the patient still provides important learning. Recording and reviewing contributing factors helps reduce future risk.
15. E
A licensed medicine should generally be used when clinically suitable. If a licensed dispersible formulation is appropriate, the unlicensed special should be queried before supply.
16. D
Sildenafil with nitrates such as GTN is clinically unsafe due to severe hypotension risk. The pharmacist should refuse or query supply and contact the prescriber or service where appropriate.
17. A
PGDs can only be used by authorised, trained professionals working within the PGD criteria. A non-authorised person or a patient outside inclusion criteria cannot be supplied under that PGD.
18. B
Black triangle medicines are under additional monitoring. Suspected adverse reactions should be reported via Yellow Card even if not serious and even if causality is uncertain.
19. C
A cold-chain breach requires affected stock to be quarantined, labelled not for use, documented and assessed using appropriate advice. Appearance alone does not confirm vaccine quality.
20. D
Falsifying controlled drug or fridge records is a serious governance and patient safety concern. The trainee should refuse, raise concerns through the appropriate route and escalate if risk remains.
Here are 20 extended matching questions designed to mimic the GPHC exam itself. At the bottom of the page you will find answers and rationale for each question.