IN THE FAMILY HEALTH SERVICES APPEAL AUTHORITY

 

Case Number: 12013

 

Listed at:

Harrogate

 

On:

2nd December 2005

 

 

 

 

Mr T Jones

Chairman

 

Dr R K Rathi

Professional Member

 

Mrs M A Harley

Member

 

 

 

 

 

BETWEEN

 

 

 

 

SHEFFIELD WEST PCT

                                                        Applicant

 

and

 

 

 

DR T S SINGH

(Professional Registration Number: 1030394)  

            Respondent

 

 

 

 

DECISION WITH REASONS

 

 

The Application

 

1.       On the 6th July 2005 the Applicant PCT (“The PCT”) removed the Appellants (“Dr Singh”) name from its Medical Performers List having given him an earlier opportunity to make representations. He did not make any; and, was notified on 5th July 2005 of the removal and of his right of appeal therein. He did not appeal. On the 25th August 2005 the PCT wrote to the FHSAA requesting a National Disqualification of the Respondent pursuant to Regulations 10(3) and (4)(c) as the Respondent is said to be unsuitable for inclusion in any Medical Performers List.

 

Background

 

2.       The Respondent was included in the PCT’s Supplementary List (now the Medical Performers List) on 1st August 2002. He had before retirement on 31st July 2002 being listed as a Principal General Practitioner. He sought inclusion thereafter to continue to work as a locum and for an out of hours co-operative, Prime Care.

 

3.       However, as a result of concerns, the PCT made a report to the General Medical Council (“The GMC”) by way of a letter of 5th February 2003. Further, on 30th April 2003 the PCT suspended Dr Singh from the then Supplemental List for 6 months. Subsequently, that suspension which should be seen as a neutral act, was with the agreement of Dr Singh, varied and extended by the FHSAA on 30th January 2004 until the expiration of a period of 2 months after the GMC announced its final decision with regard to Dr Singh’s performance assessment.

 

4.       On the 23rd June 2004 the GMC suspended Dr Singh’s registration for twelve months.  The PCT was informed of this decision on the 30th June 2004, the effect of it being that Dr Singh remains suspended from the PCT Performer’s List until 23rd August 2004.  The PCT then removed Dr Singh from their Performer’s List by way of a letter of 24th August 2004. Thereafter, the PCT made an application to the FHSAA for a national disqualification, in determining that appeal on the 29th November 2004 the Chairman of that Panel with his colleagues, concluded that the PCT’s actions therein, because of a change in Regulations was ultravires and unlawful.

 

5.       In the meanwhile, the GMC’s Fitness to Practice Panel further considered Dr Singh’s position. The GMC informed the PCT in June 2005 of a further decision that Dr Singh be suspended from the Medical Register for a further twelve months, because there had been no evidence that Dr Singh had sought to improve the standard of “his seriously deficient performance”. The GMC was concerned there were many areas of concern as to clinical competence and a consequent risk to patient safety. The GMC noted Dr Singh had shown no commitment to addressing the deficiencies identified in previous assessments.

 

6.       The PCT resolved to continue with the removal of the Appellant. The PCT put Dr Singh on notice of their intention to remove him from the Medical Performer’s List, allowing him twenty-eight days to make written representations against removal or to request an oral hearing.  Nothing further was heard from the Appellant in the prescribed time. The PCT proceeded to remove him from the Medical Performer’s List on the 6th July 2005, giving him a note of their decision at that time and of his right of appeal to the FHSAA.  No appeal was lodged and the PCT wrote to the FHSAA making application for national disqualification on the 25th August 2005, the Appellant being informed of his right to appeal.

 

7.       Dr Singh did write to the FHSAA on 18th September 2005 objecting to a national disqualification. He was later given notice of the hearing of the 2nd December 2005.

 

8.       At the hearing Ms Bhogal and Ms Stevenson appeared on behalf of the PCT.  A witness Dr Poyser appeared and was tendered to the Panel for questions.  Dr Singh did not appear. He made it clear in a letter of 20th November 2005 that he did not intend to appear. Though he referred to the hearing as being 5th December, we were satisfied in earlier correspondence, on more than one occasion, that he had been given timely and correct notice of the hearing by the FHSAA.

 

9.       At the hearing we were addressed briefly in terms of the PCT as are contained in the bundle of papers running to some fifty pages.  The Panel did not ask Dr Poyser any questions.

 

10.     Essentially, the PCT has sought a national disqualification following their removal of Dr Singh because Dr Singh has failed to show insight to the problems with his clinical competence and practice.  The PCT, based on GMC findings, believes his performance will not improve beyond what is considered to be a seriously deficient standard.  The Appellant has failed to recognise the extent of these deficiencies, which are noted as putting patients directly at risk.  There has been no evidence that he has engaged in any activity to develop his skills or competences, in any material fashion since suspension by the GMC.  The PCT takes the view that the performance of Dr Singh has been below an acceptable standard for a significant period of time, and there is a lack of confidence that his performance will improve, in that there is no evidence in a structured approach having been taken thus far to improve his skills.  It is felt that a further suspension by the GMC through until 10th July 2006, linked with Dr Singh’s seeming inability to accept his deficiencies, can only suggest that his performance will continue to deteriorate from a level that is already considered to be below an acceptable standard, with a risk to patient safety.

 

Our Conclusions

 

11.     The power to make a national disqualification is contained in Section 49N of the Health and Social Care Act 2001. In August 2004 the Department of Health provided guidance on national disqualifications and delivering quality primary care: PCT Management of Primary Care Practitioners Lists.

 

12.     The guidance contains two relevant propositions: “where the facts of the case are serious it would wrong to allow the doctor to offer his services to every (PCT) in turn in the hope that he will find one willing to accept him”.  Further, “unless the grounds for their decision were essentially local it would be normal to give serious consideration … to an application for national disqualification”.  Therein, we refer to paragraphs 8.12 and 8.1.5 of the guidance notes referred to above.  It is clear irrespective of Dr Singh’s comments as to how he perceives the PCT have treated him, that the GMC have for clearly stated reasons given in June of 2004 and June of 2005, found following assessment, serious deficiencies in Dr Singh’s performance which would lead patients to be exposed on a regular basis to significant risks in the provision of healthcare.  Whilst they acknowledge he had retired from NHS general practice in July 2002, following a long career as a hardworking and highly valued General Practitioner working in a deprived inner city area, demonstrating extensive language skills, they nonetheless concluded that his professional performance was seriously deficient, particularly in the areas of assessment and treatment of patients, the patients condition, record keeping and communication.

 

13.     The GMC went on to note that the demands of general practice and the expectations of patients have changed significantly over the years, they considered that Dr Singh had failed to adapt to meet these changing demands, that he had failed to keep his medical skills and knowledge up to date and where he has performance had been criticised in the past, had failed to take adequate steps to remedy the identified deficiencies. More importantly, they considered him to have demonstrated little insight into his deficiencies particularly in relation to communication skills, which noticeably, Dr Singh continued to maintain, was one of his strongest assets.

 

14.     This continued to be the situation in 2005, when despite representations made to this Panel by Dr Singh that many members of his immediate family had been ill and this has precluded his pursuing training, the GMC concluded in June 2005 that his failure to fulfil any of the requirements set out by the last hearing (in June 2004) they considered that Dr Singh will present a risk to patient safety. Indeed they noted that Dr Singh had made to them representations that they grant him an application for voluntary erasure, which they did not consider they had power to do.  The GMC concluded that Dr Singh had shown no commitment to addressing deficiencies already identified.

 

15.     In determining the application made by the PCT herein, we find that the Grounds of Application are well made out, and moreover, notwithstanding the representations made by Dr Singh in his two letters to us we also remain concerned that he shows little or no insight as to his clinical deficiencies. He has in the main in his correspondence dealt with peripheral issues rather than the core of the application, which demonstrates to us a serious lack of insight on Dr Singh’s behalf.  This linked with documented findings from the GMC of serious clinical deficiency, such that there is risk to patients, causes us grave concern.  We find that the PCT was empowered and quite right to remove Dr Singh from their Medical Performer’s List; and, in light of the Department of Health guidance as noted above have quite properly, and we find quite rightly, made an application for national disqualification. We make such findings, notwithstanding references made by Dr Singh in his correspondence to not wishing to apply to any other PCT for inclusion on their Medical Performer’s Lists, or indeed, reference made by the GMC Fitness to Practice Committee’s decision in June of 2005, wherein it was said that Dr Singh had put to them that he wished his name to be voluntarily erased.

 

Decision

 

16.     Our order is that pursuant to Section 49N(3) of the National Health Service Act as amended by the Health and Social Care Act 2001, the Respondent Dr TS Singh be disqualified from inclusion in all Performer’s Lists prepared by all Primary Care Trusts, all lists deemed to succeed or replace such lists by virtue of Regulations made there under.  In so doing, we have weighed the effects of this Order upon the Appellant against the risk to patients of an Order imposing if a national disqualification is not made. 

 

17.     We direct that a copy of this decision be sent to the bodies referred to in Regulation 47 of the Family Health Services Appeal Authority (Procedure) Rules 2001. 

 

 

 

 

 

 

……………………

Mr T Jones, Chairman

2nd December 2005

 

Either party to these proceedings has the right to appeal this decision under and by virtue of Section II Tribunals and Inquiries Act 1992.