Appellant

And

Leicester West City Primary Care Trust

Respondent

DECISION WITH REASONS

This is an application by Leicester West City Primary Care Trust

1. (herein after referred to as the PCT) for a National Disqualification pursuant to Section 49 Health and Social Care Act 2001.

2. The papers before us were limited. We considered the following correspondence:-

(i) PCT to FHSAA requesting National Disqualification.

(ii) PCT to Dr Patel dated 22 July 2004 advising him of his removal from the Performance List.

(iii) PCT to Dr Patel dated 20 August 2004.

(iv) Letter from Dr. Patel’s solicitors to FHSAA dated 21 October 2004.

(v) PCT to FHSAA dated 8 November 2004.

3. At the hearing on 25 November 2004, the panel considered the matter on the papers, without the parties attending. Dr Patel indicated through his solicitors by their letter dated 21 October 2004 that he did not intend to practise in the future and did not wish to make representations in relation to the PCT's application. He would not attend the hearing and would not be represented. In response to that letter, the PCT by letter dated 8 November 2004, requested that the matter be considered by the panel on the papers only, without the need for anybody from the PCT to be in attendance. Being satisfied that the parties both agreed in writing, we agreed to determine the appeal on the papers without an oral hearing pursuant to our powers under paragraph 38 (1) Family Health Service Appeal Authority (Procedure) Rules 2001.

Background: -

4. On 19 July 2004, the PCT Reference Committee effected the removal of Dr Patel from their Performance List, pursuant to Regulation 10 (4) (c) of the National Health Service (Performance Lists) Regulations 2004 on the grounds that he was unsuitable to be included in that Performance List.

5. Dr Patel did not attend nor was he represented at that hearing. The Reference Committee considered medical reports from Dr Gaind, Dr Critchley, Professor Cartlidge and Dr Jamie and correspondence with Dr. Patel’s solicitor.

6. They set out their reasons for the removal due to unsuitability in a letter to Dr. Patel dated 22 July 2004 which stated:

“This unsuitability is based upon the above medical reports which indicate a recent deterioration in your health and cognitive abilities such that the PCT has serious concerns about your ability to practise to an appropriate standard and meet the needs of your patient population.”

Also, in that letter there was reference to a recent court appearance by Dr Patel, although no further detail was given. The PCT informed the FHSAA in their letter dated 8 November 2004 that “as a result of these (medical) reports and the fact that Dr Patel confirmed his intention never to practise again that the criminal trial was ceased.”

7. Dr. Patel was advised by the PCT of his right of appeal to the FHSAA and that national disqualification would prevent him from practising as a GP in England for the NHS and included locum and out of hours work. There was also reference to unrelated matters not before us, such as his pension.

The Law

8. In reaching our decision, the Panel have considered:

(i) S.49 N Health and Social Care Act 2001;

(ii) S.49 N (8) (a) Health and Social Care Act 2001 as amended by paragraph 19 National Health Service (Performance List) Regulations 2004 re: review periods on National Disqualification

(iii) Article 6 of the European Convention on Human Rights.

9. As a panel we are re-determining not merely reviewing the decision of the PCT. Applying he principles of natural justice, which are enforced by Article 6 ECHR, we have an overriding obligation to ensure that Dr Patel has the right to a fair hearing. Both before the PCT and this re-determination before the FHSAA, he has been represented by solicitors but has chosen not to make representations. He did not appeal the decision of the PCT to remove him from the Performance List. We are satisfied that the PCT clearly set out the application they were making to nationally disqualify him, the evidence on which they would rely and the serious consequences that disqualification would have for Dr. Patel. We are satisfied that he has had a full opportunity to challenge the basis on which the PCT reached their conclusions.

10. We conclude that Dr Patel should be Nationally Disqualified from all lists contained in Section 49 (1) a-c (inclusive) Health and Social Care Act 2001.

11. Reasons

(i) Four different medical specialists concluded that Dr. Patel’s health and cognitive functions had reduced to such a degree that he was no longer fit to practise. These reports are confidential to Dr. Patel and he has not asked us to consider them or to draw any different conclusions from them.

(ii) It is of real concern that Dr Patel took no steps to cease practise on the grounds of his ill health and impaired ability before the PCT became involved. .

(iii) Dr Patel has not challenged the fact of criminal proceedings being taken against him. Any criminal proceedings against a medical practitioner is a matter for concern, although of course we do not assume that had they concluded, Dr Patel would have been found guilty.

12. Dr Patel through his solicitors advised the FHSAA that he does not intend to practice in the future. The PCT concern was that despite that intention, the Reference Committee wanted the security of ensuring that should his condition improve in the future he would not be able to take up locum work in another PCT area. We are of the view that, without National Disqualification, Dr Patel’s situation might be difficult to monitor. We are satisfied that National Disqualification is the correct course, given the serious concerns raised about Dr Patel's suitability to practise and that no lesser disqualification would suffice. The right course, in what seems the unlikely event of him ever wishing to practise again is that he should apply to the FHSAA for a review of that National Disqualification after two years. On the limited evidence before us we do not conclude that the professional conduct of Dr Patel is such that there is no realistic prospect of a further review ever being successful.

13 Any party to these proceedings has the right to appeal this decision under and by virtue of S.11 Tribunal and Inquiries Act 1992.

Dated this day of 2004

ME Lewis

Chairman

For and with the approval of

Dr D Kwan - Professional Member

Mrs J Alderwick - Lay Member