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In the Family
Health Services Appeal Authority case no: 11419
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Heard at Harrogate |
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On 9 December 2004 |
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Before
Mr J D Atkinson (Chairman)
Dr R K Rathi
Mrs C J Greene
Between
Dr R AHMAD
Appellant
and
CENTRAL LIVERPOOL PRIMARY CARE
TRUST
Respondent
Representation:
For the Appellant: None in attendance
For the Respondent: None in attendance
DECISION AND REASONS
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.
Summary
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
Chairman
Dr R K Rathi -
Professional Member
Mrs C J Greene - Lay Member