In the Family Health Services Appeal Authority                        case no: 11419

Heard at Harrogate


On 9 December 2004








Mr J D Atkinson (Chairman)

Dr R K Rathi

Mrs C J Greene


















For the Appellant:                        None in attendance

For the Respondent:                        None in attendance






The Appeal


1.      This is an appeal by Dr R Ahmad against the decision of the Central Liverpool Primary Care Trust  dated 2 August 2004 to refuse his application for inclusion on its performers list under the  Health Services Act 1977 (as amended) and associated regulations.


The Proceedings


2.      On 2 August 2004 the Respondent refused the application for inclusion on the performers list on the grounds that:


         i. the Respondent was not satisfied with the references provided


3.      By notice dated 2 September 2004 the Appellant set out the grounds of his appeal.


4.      The Appellant and Respondent by letters dated 23 September 2004 and 25 October 2004 respectively asked that the appeal be  determined on consideration of the papers only. 


5.      At the hearing, the Panel had a bundle of documents numbered to 46. They are a matter of record and it is not necessary to set out the contents of that bundle here.


The Law


6.      The relevant law is set out in section 28DA of the National Health Service Act 1977(as amended) and associated regulations. It  may be summarised so far as is relevant  as follows:


         The National Health Service (Performers Lists) Regulations 2004, regulation 4(2)(f) provides that…


         on  an application for inclusion on the performers list, the performer shall


          provide names and addresses of two referees who are willing to provide clinical references relating to two recent posts (which may include any current post) as a performer which lasted at least three months without a significant break and where this is not possible, a full explanation and the names and addresses of alternative referees



         Regulation 6(1)(b) of the same regulations provides that…


         the grounds on which a PCT may refuse to include a performer on its performers list are…


         …having contacted the referees provided by him under regulation 4(2)(f) considered, [the PCT] is not satisfied with the references


Findings of Fact


7.      The Appellant is currently employed as a Consultant Renal Physician at the Royal Liverpool and Broadgreen University Hospitals NHS Trust. The Appellant by virtue of a certificate dated 6 November 1996 also holds an acquired right to practise in the social security system of the United Kingdom as a general medical practitioner. The certificate does not extend to the right to practise as a principal without satisfying additional training regulations


8.      In or about October 2003 the Appellant applied to be included on the relevant medical list held by the Respondent under the then prevailing regulations (GMS Supplementary List 2001). The Appellant supplied the names of Dr J Iqbal and Dr S A Razvi as his referees.


9.      The Respondent considered the written references provided by Dr Iqbal dated 7 October 2003 and Dr Razvi (undated). By letter dated 27 October 2003 the Respondent  informed the Appellant that the references did not meet the requirements of the prevailing regulations which required references relating to  clinical posts covering a period of 3 months or longer without a significant break.


10.    By letter dated 1 November 2003 the Appellant informed the Respondent that he had been undertaking locum work in the practice of his wife, Dr Bilquis Ahmad, at Radnor Medical Centre, since 1984 at an average rate of 1 in 4 every Saturday, to a week or two per year. The Appellant suggested that Dr E Toke, a former partner at the Radnor practice and  Drs R Rustom and  J M Bone, Consultant colleagues, could be contacted for clinical references.


11.    By letter dated 12 December 2003 the Respondent stated that the references from  Drs Rustom and Bone had not yet been taken up because they were unable to provide relevant comments about the Appellant’s work in general practice. The Respondent also stated that references from the Appellant’s  wife  did not satisfy the regulations and that a reference from Dr Toke would not be sufficiently up to date. The Respondent suggested that the Appellant, in consultation with the Regional Director of Postgraduate Education in General Practice, work for a period of 3 to 6 months in a training practice under the supervision of an approved trainer.


12.               Following an exchange of further correspondence, on 16 June 2004 the Appellant wrote to the Respondent suggesting references be obtained from Dr Dillon an associate GP at the Radnor Medical Practice who had worked with the Appellant. On 23 June 2004 the Respondent contacted Dr Dillon by telephone to obtain his views. Thereafter the Respondent made arrangements for Appellant’s application to be considered by the Medical Practitioner Committee.


13.    On 2 August 2004 the Respondent made the decision against which the appeal is now brought.


14.    On 28 September 2004 Dr Dillon and Dr Toke wrote separate letters supporting the Appellant’s application.



The Appellant’s and Respondent’s submissions


15.    The Respondent made written submissions which may be summarised as follows. The references provided by Drs Iqbal and Razvi do not meet the requirement of the regulations because they do not relate to a recent clinical post covering a period of three months or longer without a significant break. The references of Drs Bone and Ruston were not taken up because they would not relate to the Appellant’s skill and ability in primary care. A reference from Dr Toke would not be satisfactory because he had retired from general practice in 1992 and would  therefore not be up to date.


16.    The Appellant was assisted in making written submissions by Joanne Alliston of the British Medical Association. The submissions may be summarised as follows. A reference provided by the Appellant’s wife should have been considered. The Appellant’s wife was the most appropriate professional to provide a clinical reference because she had worked with the Appellant for sometime. The Appellant has proposed seven referees and as such there is sufficient information for a reasonable decision to be made by the Respondent


Decision and Reasons


17.    The Panel considered all the available evidence, including written references from Dr Bilquis Ahmad, Dr Dillon, Dr Toke, Dr Iqbal and Dr Razvi.   


18.    The Panel dismisses the appeal and directs that the Appellant’s application for admission onto the Respondent’s performers list be refused.


19.    The Panel finds that the Appellant has not provided satisfactory references. The references are not satisfactory in that they do not show that the Appellant has the necessary clinical skills and experience to perform primary medical services. The reference from Dr Bilquis Ahmad, the Appellant’s wife, cannot be reasonably described as objective given their relationship and therefore carries little weight. The reference from Dr Dillon, a salaried GP at the Appellant’s wife’s practice, is brief, limited in its observations and is based on his having worked in ‘parallel’ with the Appellant whilst covering leave in October 2003. Dr Dillon’s reference therefore also carries little weight. The reference of Dr Toke relates back to a period when the Appellant worked as a locum between 1984 and 1992. Dr Toke’s reference therefore carries little weight because of the passage of time. The references of  Dr Iqbal and Dr Razvi do not relate to the Appellant’s recent clinical  experience in general practice for a significant period of time. The Appellant did not rely on or adduce evidence of references from his consultant colleagues  Drs Rustom and Bone.


20.  The Panel takes account of the Appellant’s high standing as a consultant and his work in general practice amounting to approximately 12 Saturdays plus a week or two  per year. The Panel further notes that the Appellant has a certificate dated 6 November 1996 indicating that he holds an acquired right to practice as a general medical practitioner and that he is not entitled to practise as a principal without further training.


21.    The Panel finds on the totality of the evidence that the Appellant has failed to provide satisfactory evidence which shows that he has the necessary clinical skills and experience to perform primary medical services. The Panel takes notice of the many changes in general practice over recent years and of the suggestion, by the Regional Director of Postgraduate Education in General Practice, that the Appellant should undertake a period of three to six months supervised work in a training practice. The Panel notes that the Appellant has not worked in general practice for a significant continuous period of time, even taking into account his locum work within his wife’s practice when  aggregated over any recent 12 month period.




22.    The appeal is dismissed. The Appellant’s application for inclusion on the Respondent’s performers list is refused.


23.  Any party to these proceedings has the right to appeal this decision under and by virtue of section 11 of the Tribunals and Inquiries Act 1992





Signed                                                                                                                    Date



MR J D Atkinson



Dr R K Rathi - Professional Member


Mrs C J  Greene - Lay Member