CASE NO

CASE NO. 12051

IN THE FAMILY HEALTH SERVICES APPEAL AUTHORITY

Mr D Pratt - Chair

Dr H Freeman - Professional Member

Mrs L White - Member

BETWEEN:

BILLERICAY, BRENTWOOD & WICKFORD PRIMARY CARE TRUST

Applicant

-and-

DR ANTHONY WILLIAM JAMES WALTON

(GMC No. 3157998)

Respondent

DECISION AND REASONS

APPLICATION

1. This is an application by Billericay, Brentwood & Wickford Primary Care Trust (“the PCT”) for National Disqualification of Dr Anthony William James Walton (“Dr Walton”) under the provisions of Section 49N (4) of the National Health Service Act 1977, as amended. This application is consequent upon the removal of Dr Walton’s name from the Performers’ List maintained by the PCT, with effect from 25 July 2005. Dr Walton did not appeal against that removal.

DECISION

2. Our decision is that the application be granted, for the reasons following.

REASONS

3. By a letter dated 13 October 2005 Howrey LLP, solicitors instructed on behalf of Dr Walton through his medical defence union, wrote to the FHSAA to state that Dr Walton is not practising and has no intention of practising medicine. The letter continued:

“In the circumstances, Dr Walton will not be opposing the application for National Disqualification. However, Dr Walton wishes to make it clear that he refutes the allegations which have been made against him. Dr Walton will be addressing these allegations in response to any investigation which is pursued by the GMC…

Dr Walton also denies the allegations which relate to non-clinical matters…

In the circumstances, Dr Walton will not be attending the hearing of the application for his National Disqualification”

4. The PCT (again through solicitors, Radcliffes LeBrasseur) wrote to the FHSAA on 21 October 2005:

“the PCT are content for the hearing to be conducted as a paper exercise only and will not be attending or represented at the hearing and will not be calling witnesses to give oral evidence…”

5. The Panel were invited to read the papers submitted by the PCT with the Grounds of Application. These comprised correspondence between the PCT and Dr Walton as to the removal from the Performers’ List, a 60 page document entitled “Final Report of Essex Performance Advisory Group on Dr A W J Walton” dated 30 March 2005 [“the PAG Report”], and some 57 Appendices to that report.

6. The Panel met on 19 December 2005 and considered that material. We were satisfied that the parties agreed that we determine the appeal without an oral hearing, so that the requirements of Regulation 38 of the Family Health Service Appeal Authority (Procedure) Rules 2001 were satisfied. But Dr Walton expressly denied the allegations and we therefore considered each with care. We directed ourselves that we should make our findings of fact on the balance of probabilities. However we noted that a number of the allegations were serious, and in a few cases may amount to criminal or quasi criminal conduct, and we therefore recognised that in the case of these allegations, cogent and compelling evidence was required if were to find them proved. We considered that in this latter category of serious allegations were those appearing under the following lettering in the PCT’s Grounds of Application (to which we attach a shorthand account of the substance of the allegation):

A. prescribing a beta blocker to an asthmatic patient which was clinically inappropriate and required him to override the warnings on the practice computer, so as to expose the patient to risk;

B. prescribing an injectable form of testosterone, purportedly as a placebo (which it is not) to a patient who was not impotent, who had not been investigated to establish whether he needed it, and who was known to be a body builder;

C. Prescribing Xenecal, a drug used to treat obesity, to a patient who had no therapeutic need for it, and without following the prescribing protocol;

E. and F: giving the drugs Nandrolone and Co-codamol to an elderly relative, who was in a Residential Home, without informing her treating GP who was otherwise managing her, or recording that they had been given, when in fact the Nandrolone was given inappropriately, in apparent reliance (as he subsequently explained) on a 1980’s South African edition of Mims, and the Co-codamol was additionally given although she was already on the maximum dosage.

G. Inciting a patient to alter a prescription he (Dr Walton) had written out in the wrong name and address.

H. Attempting to appropriate for himself a drug (quinine sulphate) which had been prescribed for a patient of a Residential Home.

I. Sale to an NHS patient of Ripping Gel, which had no therapeutic value, so as to obtain a pecuniary benefit for himself;

K. Advising 3 different NHS patients to seek physiotherapy at the Grace Christian Fellowship Church, for payment either to the Church (in which he was active) or to himself. In two of the cases he received fees for providing the physiotherapy himself. In no case did he make an appropriate NHS referral. In each case he sought or obtained a pecuniary benefit for himself or his Church and the evidence suggested a dishonest implied representation that such treatment would either not be available under the NHS or would more effectively be provided by himself.

L. Miscellaneous allegations of what were termed “inappropriate behaviour” of which the serious matters were:

a. Downloading material from gay pornographic websites using the NHS net at his NHS practice premises.

b. Advising an NHS patient that he needed treatment for his foot which would cost £25 per episode, totalling about £400, but offering to waive the fees if he would give dancing lessons at the Grace Christian Fellowship Church.

c. Failing to make a proper distinction between NHS treatment and other care for which he could properly solicit a fee, receiving over £600 from one identified patient for physiotherapy provided by him at his Church.

d. Intemperate and offensive behaviour to patients, including throwing pills and a urine specimen across the consultation room.

e. Breaching his terms of service by failing to make appropriate deputising arrangements for his practice when he was on call, instead arranging for a nurse practitioner to take emergency calls.

f. Asking a local pharmacist to accept supplies of medication on his behalf, following his departure from a local GP practice. The allegation was initially denied by him but subsequently explained as reflecting his need to obtain non-prescription medication for use in his physiotherapy practice, when in fact such medication can be delivered to any address and does not require a registered pharmacy or medical surgery address.

Finally we noted and treated as a serious the allegation that from the end of June 2004 Dr Walton had failed to co-operate with the Performance Advisory Group investigation.

FINDINGS OF FACT

7. In considering the voluminous documentary evidence we have confined ourselves to consideration of the allegations set out in the Grounds of Application and have considered the background evidence only insofar as relevant to those allegations, ignoring so far as possible material which concerned other matters such as Dr Walton’s financial relationship with the Grace Christian Fellowship Church. We have therefore also disregarded the matters listed in the PAG Final Report paragraph 11 (“new concerns”) under headings (l), (m) and (p).

8. We find that with the limited exception of the allegation mentioned above at paragraph 6 (f), all the allegations set out in the Grounds of Application are substantially made out by the evidence we have seen, and we find them to be proved.

9. As to that allegation concerning an attempt to arrange delivery of prescription drugs to a local pharmacy after he ceased to be in practice as a GP locally, we find that on his own admission Dr Walton did approach at least one pharmacist with such a request, but cannot be satisfied to the required standard that his purpose was to receive prescription-only drugs, in particular anabolic steroids, as alleged in the body of the PAG report.

CONSIDERATION OF DR WALTON’S SUITABILITY AND EFFICIENCY

10. We note that in almost every important area of a General Practitioner’s professional life, Dr Walton was seriously deficient. His clinical competence was seriously flawed. His habitual prescribing of drugs (such as pain relief medication or paediatric antibiotics) in amounts which were significantly in excess of the recommended maximum, sometimes by as much a twice the amount, was a source of justifiable concern to his GP partners. While cautioning ourselves that he did not leave his former GP practice on good terms with his former partners, we note that his former senior partner expressed the view that “I believe Dr Walton was out of his depth medically”.

11. He appears to us to have been cavalier in his approach to the prescribing and administration of drugs for reasons which could not be justified by a therapeutic need; that such drugs were in one proven case given to a known body builder who was not even resident within the normal geographical area of the PCT is of serious concern. His record keeping was defective and on occasion could imperil a patient as other doctors would not be aware medication given by him.

12. His interest in body building, when viewed in the context of his downloading of explicit gay pornography via his NHS computer within the NHS practice where he was working, is of concern, particularly when coupled with his inappropriate referrals of NHS patients to his own private physiotherapy services given at a local Church where he was a leading figure. By way of example one patient was given massage for a hypertensive condition.

13. His failure to utilise appropriate free NHS referrals for patients who needed physiotherapy or other treatment, but instead to arrange private referrals to himself at the Grace Christian Fellowship Church, so that he or (in some cases) his Church profited financially, was an abuse of his position of trust. Doctors on the Performers’ List obtain access to patients who expect objective and honest advice as to the availability of NHS services to treat their medical needs.

14. Dr Walton’s communication with and relations with his patients was poor and in the alleged instances so far below the acceptable minimum as to give rise to a concern that he was not capable of making a genuine improvement. The evidence we have read indicates a background of a high level of patient complaints, and a failure by him to engage in genuine apology or explanation. The specific instances we have found proved include offensive comments to a patient as to whether he was entitled to wear a Normandy veterans’ tie, gratuitous and ill-founded attacks on the efficacy of pills prescribed elsewhere, which involved him throwing the pills across the room, and a loss of self-control throwing a urine sample across the room. This aggression has no place in acceptable GP practice. If there were extraordinary circumstances causing uncharacteristic behaviour, we would expect a full explanation and apology.

15. We have looked to see what explanations Dr Walton gave. In respect of some of these allegations Dr Walton gave very limited explanations to the PAG investigators, when offered the opportunity. Some amounted to admissions of fact coupled with an explanation (for example that the prescribing was based on his long-established practice). Other explanations were inconsistent and contradictory. In the case of a significant number of allegations no explanations were offered and they were ignored. His withdrawal of any co-operation from the investigation after July 2004 indicates an unwillingness to acknowledge his conduct, still less to take any effective remedial step. Nothing he is recorded as having said, or caused solicitors to write on his behalf, demonstrates any insight at all into his considerable deficiencies.

16. It is difficult to avoid reaching the conclusion that the PCT had overwhelmingly strong evidence to justify its conclusion that Dr Walton was unsuitable to be included in the Performers’ list maintained by them, and his continued inclusion would also be prejudicial to the efficient administration of the general medical services. We agree.

NATIONAL DISQUALIFICATION

17. The question which we must consider is whether this should lead to a National Disqualification. Our starting point was that National Disqualification is a serious measure adversely affecting the ability of a doctor to pursue his profession within the NHS, and therefore to be imposed only in a serious or intractable case. In our view this was such a case. The various heads of complaint set out above were serious, and occurred over a long period without real evidence of improvement or even of recognition by Dr Walton that the conduct of his practice was in any way deficient or called for change and improvement.

18. These issues concerned matters which were not peculiar to the locality in which Dr Walton was practising, but related to his suitability to practise at all on a Performers’ List, wherever that may be, or to do so without impairing the efficiency of the medical services wherever he may be.

19. We are entitled to bear in mind the explanations given by Dr Walton, such as they are. We have weighed the prejudice to Dr Walton of a National Disqualification against the potential prejudice to patient safety and the efficiency of the service. We remind ourselves that while raising a bare denial of the allegations made against him, Dr Walton does not oppose the application for National Disqualification. One of the few representations he has made is that he no longer practises nor has any intention of doing so. We conclude that it is reasonable and proportionate to impose a National Disqualification upon Dr Walton.

20. Accordingly we direct that Dr Anthony William James Walton (GMC registration number 3157998) is hereby disqualified from inclusion in all lists, prepared by all Primary Care Trusts, referred to in Section 49F(1) of the National Health Service Act 1977, as amended, and all lists deemed to succeed or replace such lists by virtue of regulations made thereunder.

21. We further direct, pursuant to Rule 47(1) or the Family Health Services Appeal Authority (Procedure) Rules 2001, that a copy of our decision be sent to the Secretary of State, the National Assembly of Wales, The Scottish Executive, the Northern Ireland Executive and the Registrar of the General Medical Council.

22. The attention of both parties is drawn to the provisions of Rule 43 of the 2001 Rules.

23. Finally, in accordance Rule 42(5) of the Rules we hereby notify the parties that they may have rights of appeal from this decision under section 11 of the Tribunal and Inquiries Act 1992. Any party wishing to do so should lodge notice of appeal in the Royal Courts of Justice, The Strand, London WC2A 2LL within 14 days from the date of this decision

Dated this 2nd day of February 2006

Duncan Pratt

Chair of the Panel appointed to hear this application