DR MANSOOR ALI

(GMC NO: 5201218)

Appellant

and

MORCAMBE BAY PRIMARY CARE TRUST

__________

On the 3^rd August 2005 the Appellant (Dr. Ali) applied for inclusion in the Respondent’s (PCT) performers list to provide primary medical services at the Meadowside Medical Practice, Lancaster for a period between 3^rd August 2005 and 2^nd August 2006.

Following consideration of the application the PCT determined it was not satisfied with the references and refused the application under Rule 6(1) (b) of The National Health Service (Performers Lists) Regulations 2004 (the Regulations).

Dr Ali has appealed against the decision and appeared assisted by his wife. The Respondent appears through Mr. S. Karim of Counsel instructed by Messrs. Hill Dickinson, Solicitors.

With some exceptions to which we will refer the Panel declined to consider a large bundle of written material submitted by Dr. Ali on the morning of the hearing in part because of the volume, in part because it seemed to include material dated after the decision not to include on the list and which from a casual viewing may have been prejudicial to Dr. Ali, and also because he had ample opportunity before the hearing to submit the bundle. He was advised he could refer singly to any of the documents in the bundle when he gave evidence.

In completing the application form the Appellant gave the names of two referees, Dr. P. V. Harrison and Dr. Sue Ireland both of the Royal Lancashire Infirmary. Upon being requested by the PCT to provide a reference Dr. Harrison felt he could not do so but referred the PCT to Dr. Bukhari, Consultant Rheumatologist at RLI. Dr. Ireland said that references had to be given by Dr. Clare Peckham, supervising consultant.

Without consulting Dr. Ali the PCT obtained references from the two alternative referees and relied on those references to refuse the application, a decision communicated by letter to the Appellant dated 7^th October 2005.

The Appellant feels strongly that the PCT should not have contacted the alternative referees without first contacting him and asking him if it was appropriate to do so or giving him the opportunity of identifying other referees. The reason is that he was and remains in active dispute with the hospital trust over issues involving Dr. Bukhari which occurred during his time working at the hospital. He is sure his continuing dispute with the hospital is responsible for both somewhat lukewarm references and is part of a common design by a number of persons to frustrate his ambition of becoming a General Practitioner. He puts to us that we should disregard Dr. Bukhari’s reference entirely and treat Dr. Peckham’s reference with circumspection bearing in mind his dispute with the hospital.

We have of course read the references provided by Drs. Peckham (page 127 of the bundle before the Panel) and Bukhari (Page 32). We need not recite the detail as they rather speak for themselves. We have also read three JCPTG log books/assessments and three applications for the Appellant to proceed to full registration with the GMC, all retrieved by the Appellant from the bundle brought to the hearing.

Kay Wilson the Contracts Service Manager at the Respondent trust gave evidence of the manner in which the application was dealt with. A number of points emerge:-

A confirmed failure to give Dr. Ali an opportunity to provide alternative references when it became clear his named referees would/could not give references

Although an experienced Contract Service Manager this was her first decision to refuse an application. She did so without taking full and proper recorded guidance from any supervising body beyond a seemingly cursory conversation with the Director of Primary Care, leaving an impression she failed to fully appreciate the significance of the refusal on Dr. Ali

An error readily admitted in evidence that she included in the refusal letter reference to provisions in the Performers List Regulations which plainly did not apply

An unseemly lengthy period of some months between the refusal and disclosure of the references to the Appellant, causing much distress and an inability by the Appellant and his advisers to consider how best to proceed with matters as they had been left after the refusal.

Guidance from the Department of Health outlines the responsibility of Primary Care Trusts to ensure any doctor admitted to its Performers List is an appropriate person with the necessary clinical skills, qualifications and experience to perform primary medical services. Regulation 6(1) entitles a PCT to refuse to include a performer in its list if it is not satisfied with references.

If we disregarded Dr. Bukhari’s reference in our re-determination it would mean the application to join the list was supported by Dr. Peckham’s reference only and not two clinical references required by the Regulations. Although the obligation to have two references can be waived we venture that would only be in exceptional circumstances which we cannot find here.

Although unimpressed by some of the procedures adopted by the PCT in obtaining references and dealing with the application we agree it was right for it (as do we) to take into account the contents of both references. Each reference includes positive remarks and in part reflect comments in the log books/assessments referred to at 8 above. We are entitled, and do (as did the PCT), to conclude the views expressed were the honestly held professional opinions of the authors and make our decision accordingly. Dr. Ali has come nowhere near satisfying us of the grievous allegation that either or both references were given or made in personal conscious bad faith intending, as part of a larger design, to derail his career.

We have considered afresh the merits of the application; the references; documents at para.8 and Dr. Ali’s evidence and submissions and after doing so disallow the appeal and refuse Dr. Ali’s application to join the PCT’s Performers List.

Finally, in accordance with Rule 42 (5) of the Rules we hereby notify 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 with 28 days from receipt of this decision.

Dated this day of 2006.

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Paul Kelly - Chairman