IN THE FAMILY HEALTH SERVICES APPEAL AUTHORITY

Case No: 13066

Mr J D Atkinson CHAIRMAN

DR S SHARMA PROFESSIONAL MEMBER

MS V LEE MEMBER

Between

Dr V SHARMA

Appellant

and

NORTH TEES PRIMARY CARE TRUST

Respondent

ON CONSIDERATION OF THE PAPERS ONLY:

DECISION AND REASONS

The Appeal

1. This is an appeal by Dr V Sharma against the decision of the respondent dated 5 May 2006 to include her in the respondent’s medical performers list subject to conditions under the Health Services Act 1977 (as amended) and associated regulations.

The Proceedings

2. The appellant by application dated 6 February 2006 applied to be included on the respondent's medical performers list.

3. On 2 May 2006 the respondent offered the appellant inclusion on the list subject to the following conditions:

i. The appellant apply to the Northern Deanery for acceptance on the GP returner scheme

ii. The appellant successfully complete a full six months GP returner scheme or other such period as determined by the Deanery prior to practising as a general practitioner

iii. The conditions be reviewed on completion of the relevant period of training

4. On 5 May 2006 the appellant appealed to the Family Health Services Appeal Authority. Appeals to the FHSAA are by way of redetermination. By a letter dated 2 June 2006 and a letter received on 31 July 2006 from the respondent and appellant respectively, the parties agreed that the appeal be determined by way of consideration on the papers only.

The Law

5. The relevant law is to be found in the 1977 Health Services Act as amended together with associated regulations. Under The National Health Service (Performers Lists) Regulations 2004 a performer may be included on the list subject to the imposition of conditions.

The documents and evidence considered

6. The appellant and respondent submitted originating documentation together with further documentation which was compiled into a bundle paginated to 19. No other evidence was submitted for the Panel’s consideration.

Summary of the respondent’s case

7. The respondent’s case may be summarised as follows. The appellant’s application has been discussed with the Northern Deanery who recommend that inclusion of the appellant on the list without refresher training may not be in the public interest and could be prejudicial to the efficiency of the service.

8. In coming to that decision the respondent notes that the appellant is eligible to be on the performers list but that she has not practiced as a GP for 12 years, that the Deanery policy requires those who have not practiced as a GP for 5 years or more to complete a returns scheme and that the recommendation has been discussed with Deanery Associate directors who are of the same view as to the recommendation.

9. The respondent also submitted, in a letter dated 28 June 2006, that the respondent was not aware of the decision taken by the Deanery regarding the training that the appellant would be required to undertake. In addition, evidence of a meeting held on 5 July 2006 between the appellant and Drs Thornham and Harrison, associate directors of GP education at Cleveland and Durham, together with Mrs. Horner scheme manager and the appellant, suggests that there was a possibility of constructing a returners programme based on working one day per week over a period of two years, but that there were doubts about training extending over such a period.

Summary of the appellant’s case

10. The appellant’s case may be summarised as follows. The appellant trained as a GP in 1992 and is a Member of the Royal College of General Practitioners. The appellant currently works as a consultant paediatrician and as such maintains her continual professional development and is appraised annually.

11. The respondent’s decision is based on a policy designed for those who have had a long absence from clinical medicine or those who have not worked within the United Kingdom. The appellant falls into neither of those categories. Conditions should be placed on her inclusion on the list which reflect her individual circumstances and should not be based on the application of a policy which was designed for those whose circumstances are different from her own.

12. The appellant plans to continue working in hospital medicine and to supplement her income by undertaking work for Primecare by providing out of hours care to patients. The appellant is able to undertake one days training per week.

Assessment of Evidence and Findings of Fact

13. The Panel considered all the evidence and submissions and makes the following findings. The primary facts are not in issue.

14. The appellant trained as a GP in 1992 and is a member of the Royal College of General Practitioners. The appellant subsequently pursued a career in hospital medicine and currently works as a consultant paediatrician in the United Kingdom. The appellant is on the GP register maintained by the GMC.

15. The appellant maintains her professional development and is subject to annual appraisal.

16. The appellant accepts that she requires further training before she can start work as a GP.

17. The respondent together with the Northern Deanery operate a GP returner scheme designed to meet GP recruitment targets in the NHS plan of 2000. The scheme makes provision, at the discretion of the Director of Postgraduate GP education, for a GP who has been out of UK clinical practice for a significant period to be offered a period of retraining for up to 6 months or the equivalent part time. A shorter period may be appropriate on assessment of the appellant. Some doctors may re-enter practice through fulfilling an agreed personal development plan.

Decision and Reasons

18. Looking at the totality of the evidence the Panel directs that the appellant be included on the respondent’s list on the following conditions:

i. The appellant applies for acceptance onto the Northern Deanery GP returner scheme

ii. The appellant successfully complete a scheme of further training over a 12 month period with a commitment of one day per week prior to practicing as a general practitioner

iii. The conditions be reviewed upon completion of the relevant period of training set out in condition 2

19. The appellant’s inclusion on the performers list is subject to the above conditions for the following reasons.

20. A period of retraining, as is accepted by the appellant, is necessary because the appellant has not practiced as a general practitioner since 1992. The issue between the parties is the extent to which further training is required.

21. The respondent has failed to objectively justify why the appellant should be required to undertake a full time course of six months or equivalent. The respondent has failed to provide an explanation as to how the appellant’s individual circumstances have been taken into account in reaching its decision.

22. The scheme guidance indicates, at page 11 of the bundle, that a flexible approach to the training requirements of returners can be adopted so that shorter periods of training may be appropriate for some doctors.

23. The appellant falls into the latter category of doctors who require shorter training. The appellant has already qualified as a GP and is a member of the Royal College of General Practitioners. Although she has not practiced as a GP following her GP training in 1992 she has remained in clinical practice in the United Kingdom. As such she has maintained her clinical skills of history taking, examination, problem solving and communication. The appellant is subject to annual appraisal which shows that her clinical skills are not in question. In addition, as part of her practice the appellant continues to maintain her professional development.

24. Given the appellant’s individual circumstances and given the requirements of entry and exit to the scheme, as set out at page 12 of the bundle, the appellant should be able to meet those requirements by undertaking training as set out in condition ii. noted above. That condition of training for one day a week over 12 months amounts to approximately 50% of the training input involved in a full time programme over 6 months.

25. The third condition noted above makes provision for suitable review of the conditions and thereby meets any issues that might arise relating to the respondent’s concerns about the public interest and prejudice to the efficiency of the service.

Summary

26. The Panel directs that Dr V Sharma be included on the North Tees Primary Care Trust performers list subject to the following conditions

i. The appellant applies for acceptance onto the Northern Deanery GP returner scheme

ii. The appellant successfully complete a scheme of further training over a 12 month period with a commitment of one day per week prior to practicing as a general practitioner

iii. The conditions be reviewed upon completion of the relevant period of training set out in condition ii.

27. In accordance with Rule 42 (5) of the Rules the Panel hereby gives notice that a party to these proceedings can appeal this decision under Sec 11 Tribunals & Inquiries Act 1992 by lodging notice of appeal in the Royal Courts of Justice, The Strand, London WC2A 2LL within 28 days of receipt of this decision.

Signed Date

MR J D Atkinson

Chair