DR MURIAL COATES
Registration No. 0149196
DECISIONS AND REASONS
(1) The Appeal was heard by Mrs J Crisp (Chairman); Dr S Sharma (Professional); and Mr A J Lloyd (Lay).
(2) Prior to the Hearing all three Panel Members confirmed that they had no prior involvement or knowledge of the case. This fact was communicated to the parties at the outset of the Hearing.
(3) The Appellant was unrepresented. The Respondent was represented by Mr A R Mowat. The Panel heard oral evidence from the Appellant, Sally Fletcher and Martin Clayton on behalf of the PCT. The Panel also considered the bundle of papers together with supplemental documentation and references filed.
1. On 7th February 2003 the Appellant met with Mrs Lesley Mort, Director of Services and Clinical Governance at Rochdale PCT, and Dr Dawes to discuss issues raised by Chorley and South Ribble PCT and her position on Rochdale PCT’s Supplementary List.
2. On 10th February 2003 Mrs Mort wrote to the Appellant to advise her that she would be retained on their Supplementary List until the end of February 2003 only.
3. On the 14th March 2003 the Appellant applied to join the Supplementary List of Chorley and South Ribble PCT.
4. On 17th March 2003 the Respondent wrote to the Appellant requesting outstanding documentation not received with her application.
5. By letter of the same date the Respondent wrote to both referees requesting a clinical reference.
6. On 6th May 2003 the Appellant’s application was forwarded to the PCT’s Practitioner Panel. The Panel determined that the application should not be considered until two clinical references had been received and clarification sought from Rochdale PCT regarding the reasons why the Appellant had been removed from their Supplementary List.
7. On 3rd June 2003 the Practitioner Panel refused the application and notified the Appellant by letter dated 17th June 2003, received by her on 24th June 2003.
8. On 4th July 2003 the Appellant appealed against the Respondent’s decision on two grounds:
i) That the PCT had not looked into the matter very carefully and the Appellant had no evidence that this had been done;
ii) That the Appellant had no knowledge of any complaint in respect of her work at Dr Singa’s Practice, who had taken over from Dr Boro after retirement, in September 2002.
9. At the commencement of the Appeal the Respondent confirmed, after questioning from the Panel, that the application to refuse the admission of the appellant to the Chorley and South Ribble PCT was proceeding under Paragraph 6(1)(b), 6(1)(c) and 6(1)(e) of the National Health Service (General Medical Services) Supplemental List Regulations 2001.
10. The Appellant gave evidence in respect of the two specific complaints. In respect of the lady who was expecting twins, the Appellant stated that both the lady and her partner were aggressive and demanded that a referral be made to a second Obstetrician. The Appellant confirmed that matters were out of control and refused the referral on the basis that she did not wish to undermine the original Obstetrician and was fearful of litigation which may follow. In addition the Appellant knew nothing about either the referral or the results thereof. The Appellant confirmed that she did tell the lady’s partner he did not have any rights and further that he was not keeping her as she was on benefit.
11. In respect of the second complaint, the Appellant stated that she did not examine a 78-year-old man as she had taken a history and felt that this was sufficient. The Appellant had identified that he was suffering from T.I.A. and blackouts were a frequent complaint. She maintained that she would not admit him to Hospital despite the daughter’s insistence.
12. The Appellant confirmed that there were problems in the Practice arising out of the shortage of staff and that she personally did not receive any support over this period.
13. The Appellant confirmed that she knew two clinical references had to be provided from willing referees. She further confirmed that she had not spoken directly to Dr Swainy to ensure that she would be willing to provide a reference, assuming that as one had been provided the previous year there would not be a problem.
14. The Appellant stated she was unaware of any problems with her application until she received the letter dated 17th June 2003 from Martin Clayton.
15. Sally Fletcher stated concerns were raised following a written complaint received from the lady expecting twins. The Practice Manager, who was very experienced, had dealt with the complaint but referred the complaint to Miss Fletcher due to her concern over the issues raised. Miss Fletcher confirmed that the complaint raised serious concerns about the Appellant’s judgemental nature and due to the language of the complaint it was clear that the complainant was extremely distressed.
16. In respect of the second complaint, the examination was perfunctory and again the family were distressed about the attitude of the Appellant.
17. When the PCT Panel met to consider the application, further verbal complaints about the Appellant’s behaviour were raised.
18. Miss Fletcher confirmed that staff were placed in the Eaves Lane Surgery after the Practice Manager was suspended, to support both the patients and the staff.
19. Martin Clayton confirmed that when the application was initially received various documents were missing and on three separate occasions, namely 17th March, 25th March and 2nd April, the PCT had contacted the Appellant to obtain the missing documents.
20. He accepted that the PCT were very short of GPs and therefore any decision not to include a person on any list would not be taken lightly.
21. The Appellant was not asked to provide a separate reference and the reference from Dr Swainy, despite the efforts of the PCT, had not materialised.
22. Mr Clayton confirmed that there was no procedure to hold oral hearings to put any problems to GPs requesting admission arising from the application form.
23. He confirmed that several attempts had been made to obtain the reference from Dr Swainy.
24. At the Appeal Hearing one further reference was supplied. This however was not a clinical reference, written by a Practice Manager and dated back to work conducted up to the end of the year 2000.
25. The Panel find that the Appellant has failed to provide two clinical references from willing referees despite bringing another reference to the Hearing.
26. Under Section 4(2)(i) of the National Health Service (General Medical Services Supplementary List) Regulations 2001, on an application by a doctor for inclusion of his name on the Supplementary List 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 doctor which lasted at least three months without a significant break, and where this is not possible, a full explanation and alternative referees must be provided.
27. The Panel find that no explanation or alternative satisfactory references have been provided by the Appellant. Only one reference has been provided.
28. In respect of the first complaint, the Panel find that the comments made to the lady’s partner were both insensitive and inappropriate and fall below the standard of good medical practice of the GMC. The Appellant’s actions during the consultation would have caused distress. At no time during the Appeal Hearing did the Appellant show any insight, remorse or regret about her attitude.
29. In respect of the second complaint, the Panel find that the Appellant failed to perform her clinical duty, by failing to examine the elderly patient. During the Appeal Hearing the Appellant would not accept any fault, stating history was all important not the examination. The Panel find that this falls below good clinical practice standard of the guidelines of the GMC.
30. The Panel find that the PCT have failed to communicate adequately with the Appellant concerning her application for admission. The PCT has similarly failed to discuss the concerns raised directly with the Appellant prior to reaching their decision not to admit the Appellant to their List.
31. The Panel find that the PCT did adequately staff the Eaves Lane Practice during the period in September 2002.
32. The PCT in final submission withdrew one of the grounds of refusal, namely 6(1)(b) of the said Regulations, relying solely on 6(1)(c) and 6(1)(e).
33. The Panel find the PCT did consider the application fully and, further, made significant efforts to obtain the reference.
34. The Panel find that the Appellant would have been aware of the complaint at Eaves Lane Surgery as she had received and replied to the complaint personally.
35. The Panel find that the Appellant is a GP of considerable experience. However, the Appellant has difficulty in managing the demands required of a GP currently working within the NHS.
36. Under Section 6(1) of the National Health Service (General Medical Services Supplemental List) Regulation 2001 the grounds on which a Health Authority may refuse to include a doctor in its Supplementary List are:
c) that having contacted referees provided by the doctor under Regulation 4(2)(i), the PCT are not satisfied with the references;
(e) that there are grounds for considering that admitting the practitioner to the List would be prejudicial to the efficiency of the service which he would undertake:
37. The Panel find that for the purposes of Section 6(1)(c) of the said regulations, the Appellant has failed to provide the names and addresses of two referees who are willing to provide clinical reference relating to two recent posts (which may include any current post) as a doctor, which lasted at least three months without a significant break, and where this is not possible a full explanation and alternative referees.
38. The Panel find that the level of both verbal and written complaints will impact upon the Practice and as such that there are grounds for considering admitting the Practitioner to the List would be prejudicial to the efficiency of the service which he would undertake.
39. The Panel find that the Respondent was justified in refusing the Appellant’s application on the ground of efficiency.
40. Accordingly the Panel uphold the Respondent’s decision and refuse the Appellant’s appeal.
41. Finally, in accordance with Rule 42(5) Family Health Services Appeal Authority (Procedure) Rules 2001, we hereby notify the Appellant that she may have rights relating to Appeal under Section 11 of the Tribunal and Enquiries Act 1992.
Dated this 7th day of October 2003
Judith R Crisp
Chairman of the Panel
Dr S Sharma
Mr A J Lloyd