IN THE FAMILY
HEALTH SERVICES APPEAL AUTHORITY
CASE NUMBER 11690
Mr. C. Barker - Chairman
Dr. I. A. Lone - Professional Member
Mr. M. L.Rayner - Member
BETWEEN:
DR. K.L. GUPTA
(GMC NO. 1535150)
Appellant
and
THE PRESTON PRIMARY CARE TRUST
Respondent
DECISION
Firstly, the Appellant appeals against the Respondent’s decision, made on 25th January 2005, to remove him from its Performers List (the List) on the ground set out in Section 49F (1) and (2) of The National Health Service Act 1977 (the 1977 Act), as inserted by Section 25 of The Health and Social Care Act 2001 (the 2001 Act) and in Regulation 10 (3) and (4) (a) of The National Health Service (Performers Lists) Regulations 2004 (the Regulations), namely that the Appellant’s continued inclusion in the List would be prejudicial to the efficiency of the services which those included in the List undertake to provide or perform (an efficiency case). The Respondent opposes the Appellant’s appeal. Under Section 49M(3) of the 1997 Act, the appeal is by way of redetermination of the Respondent’s decision to remove and, under Section 49M(4) of the 1977 Act, we may now make any decision which the Respondent could have made.
Secondly, if the Panel’s Decision is to refuse the appeal and remove the Appellant from the List, the Respondent applies for a national disqualification to be imposed on the Appellant under Section 49 (N) of the 1977 Act. The Appellant opposes this application.
The case was first listed before us on 27th May 2005, when it was adjourned part heard to 7th July 2005. At the conclusion of the hearing on 7th July 2005, the Panel decided to reserve its Decision and this is that reserved Decision.
The Appellant was represented by Mr. J. Hyam of Counsel and the Respondent by Mr. P. Anderson of Counsel.
Prior to the hearing, all three members of the Panel had signed a declaration to the effect that they did not have any “interest” in the appeal and the application which would preclude them from hearing them in an independent and impartial manner and this fact was communicated to the parties at the outset of the hearing on 27th May 2005. Counsel for both parties confirmed that they had no objection to the case being heard by any member of the Panel.
Prior to and at the hearing, both parties produced written evidence and written submissions. They are contained in the Case Papers and the documents are numbered from page 1 to 263. The Panel have read and considered all the documents therein and certain pages are referred to in this Decision for ease of reference.
In addition, during the course of hearing, the Panel heard evidence called on behalf of the Respondent from Mrs. Susan Rigg (the Respondent’s Director of Primary Care), Dr. Peter Old (an Associate Director of the National Clinical Assessment Service) and Dr. T. L. Phillips (the Respondent’s Medical Advisor). The Panel also heard evidence, called on behalf of the Appellant, from Dr. Qudratulla Omar Khan (the Appellant’s medical partner). Although the Appellant himself was present throughout the whole of the hearing, he did not give evidence before the Panel.
Summary of Background and Chronology
The Appellant was on the Medical List of the North West Lancashire Health Authority as a principal in partnership for about 18 years from 1977 to 1995. However, in 1995, he was found guilty by the General Medical Council (GMC) of serious professional misconduct in connection with the prescribing of controlled drugs. He was, therefore, removed from the GMC’s register until January 1997. Thereafter, he practised as a locum and, from 2001, as a part time partner of Dr. Khan.
In 2000, after an interview for a single handed vacancy, the North West Health Authority raised concerns about the Appellant’s clinical abilities and recommended that he sat an Entry Level Multiple Choice Questionnaire Assessment (MCQ). He did so in November 2000 but failed. The pass mark was 64% and the Appellant’s mark was 61.6% compared with a mean of 73.1% (page 118 of the Case Papers). The Appellant sat a second Entry Level MCQ in December 2002 but failed again. On this occasion, the pass mark was 64% but the Appellant’s mark was only 59% compared with a mean of 74.39 (p120). This examination had originally been fixed for April 2002 but was deferred at the Appellant’s request until December 2002.
As a result of these failures and because of concerns about his clinical skills, the Appellant agreed to undergo an assessment by the National Clinical Assessment Authority (NCAA) in February 2003. The NCAA reported in November 2003 and their report is set out at pages 28 to 46 of the Case Papers. The NCAA’s conclusions (p43 to 45) expressed serious concerns about the Appellant’s clinical, consultation and other skills and concluded that he was significantly underperforming and that there were concerns about the potential for serious/critical incident and misdiagnosis.
The NCAA’s report made a number of recommendations (p45 and 46) and three of them are of particular significance in the context of the present case. They are those numbered 1, 6 and 7:
“1. The doctor needs supervision. He should receive detailed, intensive coaching in knowledge, skills and the practice of medicine.”
6. The PCT needs to identify, provide, fund and monitor a system of intensive coaching using resource external to the practice and including weekly tutorials, direct observation of consultations and review sessions.
7. The PCT should seek evidence that the doctor can meet the standards required to pass the Summative Assessment in repsect of consultation skills, audit and knowledge after coaching for no longer that 12 months.”
The Respondent was concerned that the setting up of this intensive coaching may take several weeks but, at the same time, it wished to take immediate action to ensure the safety of the Appellant’s patients. Consequently, having taken advice from the NCAA, the Respondent reached an agreement with the Appellant that the Appellant would cease forthwith all clinical practice with effect from 21st November 2003 and that the Respondent would provide appropriate funding to the Appellant’s practice. A written agreement embodying these and other terms was signed by the Appellant and the Respondent on 21st November 2003 (p68 and 69) and, thus, the Respondent contingently removed the Appellant from the List on condition that he ceased all clinical practice. This was effected by letter of 8th December 2003 (p71).
In conjunction with Dr. Bailey, the Deputy Director of Postgraduate General Practice Education, the Respondent then tried to arrange the appropriate training for the Appellant in accordance with the recommendations in the NCAA report. To this end, a meeting of interested parties took place on 6th January 2004 (p122 and 123), at which Dr. Bailey suggested that it would be in the Appellant’s best interest for him to be placed in a training practice initially for 3 months and he envisaged that he would be able to identify such a practice within 4 weeks, although, in a letter to the Appellant on 13th January 2004, Dr. Bailey informed the Appellant that he could not guarantee this.
The interested parties held an Action Planning meeting on 8th January 2004 (p105 to 107). At that meeting, it was confirmed that a training placement for 3 months would be secured and that, at the end of the placement, the trainer would produce a report on the Appellant’s progress. After consideration of the report, the Respondent, in conjunction with the trainer, would then reach a view on (i) whether the Appellant was fit to return to independent practice with mentorship or (ii) if not, whether the Appellant may be fit to return after a further 3 months or (iii) whether it was likely that the Appellant would never be fit to return to independent practice. Furthermore, the meeting recorded that (i) the opportunity for the Appellant to achieve the necessary improvement was finite, (ii) that the aim was for him to demonstrate that he could reach the required standard to practice as a GP without supervision within 12 months and (iii) that he would be required to pass a Summative Assessment (the Exit Level MCQ) within 12 months of the beginning of his training placement (later agreed as starting on 13th April 2004).
Finally, the meeting recorded that (i) if a training placement did not become available, a further meeting would take place to determine what appropriate action should be taken and (ii) that, if at any stage, the Appellant felt that he was not being treated fairly, he had the right to request a Summative Assessment. However, there was a risk in the Appellant making this request because, if he failed the Summative Assessment, “it would prevent his return to general practice.”
Unfortunately, however, Dr. Bailey was unable to find a training placement for the Appellant and the difficulties he faced are set out in his witness statement (p91-94). Consequently, efforts were made to find other means of training for the Appellant, although the Appellant himself was undertaking study of his own volition to assist him in passing the MCQ. One alternative, suggested by Dr. Rambihar, the GP Tutor for Chorley and South Ribble, at a meeting with the Appellant and Respondent on 23rd March 2004, was that a number of individual training practices could each focus on a particular component of the Summative Assessment and work with the Appellant to enable him to achieve the required standard (p157). In any event, the Respondent and Dr K. Chaudhri (the Appellant’s tutor), made some interim training arrangements, which enabled the Appellant to spend two sessions per week in the surgery of Dr. H. Levycky (the Respondent’s Medical Training and Education Lead), observing Dr. Levycky dealing with and treating patients. These sessions started on 13th April 2004 and lasted for 8 weeks. Furthermore, during the same period, it was arranged that Dr. Chaudhri himself would spend 1 hour per week with the Appellant, at which cases and topics could be discussed. It was still hoped at this stage that a training placement would become available and these interim arrangements were not meant to be a substitute for the placement itself. Moreover, Dr. Chaudhri produced an Action Plan for the Appellant (p164), in which he set out study and reading which the Appellant himself could undertake, and possible alternative solutions until a training contract could be found.
As Dr. Bailey had still been unable to arrange a formal training placement, representatives of the Respondent met with Dr. Bailey, Dr. Old and others on 3rd June 2004 in order to determine the way forward in the light of the NCAA’s report and the unavailability of a formal training placement. Neither the Appellant nor his representative, Dr. G. Gilmartin, were invited to that meeting. However, a further meeting took place on 8th June 2004, which the Appellant attended. However, Dr Gilmartin was not present at this second meeting, although, according to the Respondent, the Appellant confirmed that he was happy to proceed without Dr. Gilmartin’s attendance. Finally, a further meeting took place on 15th July 2004 between representatives of the Respondent, the Appellant and Dr. Gilmartin.
The outcome of these meetings was that the Appellant, who was not himself anticipating failure, would sit the Exit Level MCQ and undertake a Simulated Patient Surgery in September 2004. If he was successful, this would be positive evidence that the Respondent ought to provide further support to the Appellant in his efforts to complete the NCAA’s recommendations and would help in persuading a practice to offer a formal training placement. If he was unsuccessful, the Respondent would then give consideration to removing him from its List.
In the light of these new arrangements, the Respondent then arranged for a local medical practice at Berry Lane to provide 8 x 3 hour training sessions between 6th July 2004 and 26th August 2004. In these sessions, the Appellant was able to take consultations under the supervision of an experienced trainer in general practice, from whom the Appellant would receive feedback. In addition, the Appellant attended a Familiarisation Workshop on 29th June 2004 organised by the Trent Deanery.
However, the Appellant again failed the Exit Level MCQ in September 2004 (p80). The pass mark was 66% and the Appellant’s mark was 57.69% compared with a mean of 74.39%. In addition, in the Simulated Patient Surgery, the Appellant passed on Clinical Consulting Skills but failed on Patient Satisfaction (p81). He took this assessment again in October 2004. However, he again passed on Clinical Consulting Skills but failed on Patient Satisfaction (p87).
In view of these failures, the Respondent then wrote to the NCAA by letter of 18th October 2004 (p83), seeking advice on whether it had fulfilled its obligations to the Appellant and whether it would now be appropriate for the Respondent to remove the Appellant from its List. The NCAA replied by letter of 21st October 2004 (p86) to the effect that the Respondent did have sufficient evidence to remove him from its List on the efficiency ground and suggesting that the Respondent should give serious consideration to applying for a national disqualification.
In December 2004, the Appellant again sat the exit Level MCQ of his own volition. He failed again. On this occasion, the pass mark was 68% and the Appellant’s mark was 60.16% compared to a mean of 75.36%.
The Respondent accepted the suggestion by the NCAA and took steps to remove the Appellant from its List. After a hearing on 18th January 2005, the Respondent decided to do so. The Respondent’s decision and its reasons for removal are set out in a letter to the Appellant dated 25th January 2005 (p47-57).
No doubt in view of the fact that, at the removal hearing, Dr. Gilmartin expressed the view that the MCQ test and Summative Assessment were not appropriate tests for a doctor in the Appellant’s position, the Respondent raised this issue with Dr. Bailey. In his letter of 15th February 2005, Dr. Bailey confirmed that they are appropriate (p111).
Again of his own volition, the Appellant sat the Summative Assessment MCQ examination on 4th May 2005. He again failed. On this occasion, the pass mark was 69% and the Appellant’s mark was 67.59%. A mean mark is not given (p256).
Finally, after a hearing on 7th June 2005, the Interim Orders Panel (IOP) of the GMC concluded that it was necessary for the protection of members of the public, in the public interest and in Dr. Gupta’s own interests to make an order imposing conditions on his registration for a period of 18 months. Consequently, the IOP placed the following conditions on Dr. Gupta’s registration:
The IOP directed that their order will be reviewed within 6 months and stressed that this was an interim order and that there had been no finding against the Appellant (p247).
We were not aware at the hearing before us on 27th May 2005 that there had been any referral to the GMC and we only became aware of this fact when we received a copy of the IOP’s decision letter on a date between the two hearings before us. At the hearing on 7th July, however, it became clear that this referral to the GMC was an automatic referral as a result of the Respondent’s decision to remove.
(i) that the Appellant’s clinical knowledge and skills are insufficient and lacking to the extent that his continued inclusion on the Respondent’s List would be prejudicial to the efficiency of the services which those included in the List undertake to provide or perform;
(ii) that this is amply evidenced by the serious concerns revealed in the NCAA’s report, his failures to pass the MCQ examination on five occasions, which is “shocking and startling,” and his failure in the Simulated Patient Surgery on two occasions; furthermore, although a number of patients express satisfaction in the Appellant’s Patient Satisfaction Sheets (p 191-26), 14% express dissatisfaction;
(iii) that the primary concern of any Primary Care Trust (PCT) must be patient safety and allegations that the Respondent has not acted fairly in its dealings with the Appellant should be considered against that factor;
(iv) that the Respondent had to rely on the Deanery for arranging a training contract;
(v) that the NCAA’s recommendations are not in any event binding on the Respondent;
(vi) that, in any event, the onus is on the Appellant to ensure that his skills are up to the required standard and that, under the GMC’s “Good Medical Practice”, the Appellant has a duty to be clinically and professionally competent and the responsibility falls fully on the Appellant to ensure this;
(vii) that, although with hindsight, it may well have been preferable for the Respondent to have checked whether the recommended intensive coaching in the form of a 3 month training contract was available before agreeing to that course of action, the Appellant has not been prejudiced by the Respondent’s failure to do so because, had the Respondent realised at the outset that such training could not be found, the Respondent was likely to have either (a) removed the Appellant at the outset or (b) required him to pass the MCQ Summative Assessment without any training at all;
(viii) that the Respondent acted fairly towards the Appellant and did its reasonable best to comply with the NCAA’s recommendations. In that respect, the Respondent expressed concern at the outset as to its capacity to comply with the recommendations and made it clear that it would be heavily reliant on support from the Deanery (letter on p 234 and notes of meeting on p 122); furthermore, that the Respondent gave no guarantee that a 3 month training placement would be available (letter to the Appellant on p 96) and made it clear from the outset that, if such a placement was not found, then another meeting would be held to determine what further action was appropriate (paragraph numbered 11 on p 107); that that further meeting became necessary when Dr. Bailey was unable to find a training placement, at which a new way forward was agreed;
(ix) that the revised agreement reached at meetings in June and July 2004 was that the best way forward was for the Appellant to sit the MCQ examination and Simulated Patient Surgery in September 2004 and that the Respondent made it clear to the Appellant that, if he failed, removal from the List may very well follow;
(x) that the Appellant and his representative, Dr. G. Gilmartin, were in full agreement with this revised course of action, that the Appellant was confident of success in the September examinations and that no request was made by the Appellant or Dr. Gilmartin for more time; nor did either of them express any reservations or complaints about the revised plan at the meeting on 15th July 2005 (letter from Dr. Gilmartin to the Appellant on p 176 to 179);
(xi) that, in the absence of a formal training placement, the Respondent arranged interim training sessions with Dr. Levycky, Dr. Chaudhri and at the Berry Lane Surgery (p 158, 160 and 173);
(xii) that, having failed the MCQ examination in September 2004 and December 2004 and the Simulated Patient Surgery in September and October 2004, the Respondent was justified in removing the Respondent from its List on 25th January 2005; and the Panel should now take the same view;
(xiii) that a contingent removal from the List would not be appropriate or workable but that, if the Panel deemed otherwise, they should follow the conditions imposed by the IOP of the GMC; and
(xiv) that a national disqualification is appropriate because the issues raised in the case are not local to the Respondent.
(b) that, although the Respondent was aware that the Appellant failed the first MCQ examination in November 2000, the Respondent did not deem it necessary to take any action until the referral to the NCAA in February 2003 and that, if the Respondent had had real concerns at any time, it would have reported the matter to the GMC;
(c) that the Respondent had never received any complaints direct from patients (the evidence of Susan Rigg) nor had Dr. Khan (the evidence of Dr Khan himself);
(d) that, despite the fact that the Appellant has not received intensive coaching as recommended by the NCAA and the 3 months training placement, as initially agreed by the Respondent, there is clear evidence that the Appellant has improved and that, given more time, he could pass the MCQ examination. In that respect, the Appellant only failed the examination in May 2005 by 1.05%; furthermore, he passed the Clinical Consulting Skills aspect of the Simulated Patient Surgeries in September and October 2004 (p182 and 185); and, in addition, Dr. Chaudhri (p 243) and Dr. Rambihar (p 244) confirm his improvement. Thus, the Respondent ought to have given the Appellant more time to satisfy their requirements;
(e) that the Respondent should have established whether the intensive coaching and the 3 month training placement were available to the Appellant before accepting the NCAA’s recommendations;
(f) that the Respondent gave the Appellant a legitimate expectation that he would receive the intensive coaching in accordance with the NCAA’s recommendations;
(g) that, although the Appellant agrees that the NCAA’s recommendations are not legally binding on the Respondent, the Respondent, having agreed on the initial course of action to provide intensive coaching, was legally obliged to provide it;
(h) that, although the Respondent provided the training with Dr. Levycky, Dr. Chaudhri and at the Berry Lane surgery, the Respondent ought to have explored other avenues of training, as suggested by Dr. Chaudhri (p 165) or with Dr. Rambihar;
(i) that the Respondent’s response in June and July 2004 that the Appellant should sit the MCQ in September (ie “1 strike and you’re out”) was not a fair response, given that the Respondent had been unable to provide the recommended training and given that Dr. Chaudhri had advised that the Appellant would be at a disadvantage (p 166 to 168);
(j) that, in any event, the Appellant was forced into the revised arrangements in June and July 2004 or, alternatively, only agreed to them because he is always willing to help others (see the comment to that effect in paragraph 2.4 on p 33);
(k) that the caveat to the agreement reached between the parties on 8th January 2004 was that, if the intended training placement could not be put in hand, there would be a further meeting to determine further appropriate action (para. 11 on p 107). However, the further meeting was on 3rd June 2004 and neither the Appellant nor Dr. Gilmartin were present;
(l) that, before making its decision to remove, the Respondent should have obtained reports from Dr. Levycky, Dr. Chaudhri and the Berry Lane surgery, from whom the Appellant had received training, especially in view of the fact that the reports which the Appellant has now obtained from Dr. Chaudhri (p243) and Dr Rambihar (p 244) show that the Appellant has improved;
(m) that the Appellant’s continued inclusion on the List would not be prejudicial to the efficiency of the services which those included on the List undertake to provide or perform;
(n) that the Respondent’s decision to remove him from the List was not a proper, just or proportionate decision on the facts put forward by the Respondent and that the decision was precipitate, premature, unfair and unreasonable;
(o) that the IOP of the GMC consider that the Appellant can practise under conditions (p 247) and have not seen fit to suspend him; that the GMC’s conditions are “wholly workable.” However, if the Panel take a different view, the Panel should remove him contingently and recommend to the Respondent that they should either find him a training replacement or other less formal training.
The Panel accepts that the burden of proving that a removal and national disqualification are justified lies on the Respondent. The Panel also recognises that the allegations of inefficiency etc are serious allegations and that cogent and compelling evidence is required if they are to be found to be proved. When considering whether we are satisfied on the balance of probabilities that an allegation is established, we bear in mind that the more serious the allegation the less likely it is that it occurred and the stronger should be the evidence before we conclude that the allegation is established. After so directing ourselves, we are satisfied that:
(a) the Appellant’s continued inclusion on the Respondent’s List would
be prejudicial to the efficiency of the services which those included in the
List undertake to provide or perform.
In that respect, the NCAA’s report reveals serious and disturbing inefficiencies with a potential for misdiagnosis and for serious critical incident. We accept the findings and conclusions in the report. Indeed, the Appellant himself, in not giving evidence, did not seek to contradict them in any way; furthermore, we reject Dr. Khan’s evidence that all the report means is that the Appellant needs “a little bit of touching up and that’s it.” In our opinion, this is a gross understatement.
The Panel bears in mind as well that the Appellant has failed either the Entry or Exit Level MCQ on five occasions between November 2000 and May 2005. We accept that these examinations may be more suitable for new entrants to the profession than mature doctors in the Appellant’s position. However, we accept the evidence of Dr. Old and Dr. Phillips that the failure rate is low and that they are “the low point of the bar of assessment, which people should be expected to pass” (Dr. Old) and that both tests “should be easy for a doctor” and are “minimal requirements” (Dr. Phillips). We also accept the opinion of Dr. J. S. Bailey in his letter of 15th February 2005 that the tests are “appropriate, reliable and reproducible ways of assessing a doctor’s competence” and his reference to the findings of the Shipman Enquiry, which support that view (p 111 and 112).
Furthermore, the Panel reaches this conclusion, having taken into consideration that (i) the Appellant has been successful on two occasions in passing the clinical assessment element of the Simulated Patient Surgery (p 182 and 185), (ii) there have been no complaints from patients and (iii) the written evidence of Dr. Chaudhri (p 243) and Dr. Rambihar (p 244).
(b) the onus is on the Appellant to ensure that his skills are up to
the required standard and that, under the GMC’s “Good Medical Practice,” the
Appellant has a duty to be clinically and professionally competent and the
responsibility falls fully on the Appellant to ensure this. The Appellant has
failed in this duty since 2000.
(c) that, in all the circumstances, the Respondent did not act
unfairly, unreasonably or prematurely and did its reasonable best to comply
with the NCAA’s recommendations and provide training for the Appellant.
In this respect, the Panel accepts that, with hindsight, the Respondent ought to have established whether “intensive coaching” and a 3 month training contract were actually available before agreeing to the NCAA’s recommendations. However, the Appellant was not prejudiced in any way by that. Furthermore, it is clear that, at the outset, the Respondent was concerned as to whether it had the capacity to comply with the recommendations and made it clear that it was heavily reliant on the Deanery for their support (p 234). The Panel also finds that the Deanery itself made it clear to the Appellant that they could not guarantee finding a training contract (p 97) and that it was always anticipated that, if a training placement did not become available, a further meeting would be arranged to determine what appropriate action should be taken (para. 11 on p 107).
Furthermore, once it became clear that a training contract was not available, the Respondent arranged, or was instrumental in arranging, the interim training arrangements with Dr. Levycky and Dr. Chaudhri and, later, at Berry Lane. In that respect, the Appellant suggests that the Respondent ought to have done more and, in particular, at an established training centre in the Rusholme Health Centre or with Dr. Rambihar. The Panel notes, however, that the Appellant does not appear to have taken any steps himself to enquire whether any other avenues of training might be available to him.
The Panel does not accept the Appellant’s contention that the revised arrangements were unfair or that he was forced into the revised arrangements and only agreed to them because of a willingness to help others. Although we do accept that neither the Appellant nor Dr. Gilmartin were present at the initial meeting on 3rd June 2004, the Appellant himself was present at the meeting on 8th June 2004 and agreed to proceed without Dr. Gilmartin being present. Furthermore, both the Appellant and Dr. Gilmartin were at the meeting on 15th July 2004 and Dr. Gilmartin’s detailed letter to the Appellant of 2nd August 2004 does not in any way suggest that either the Appellant or herself were not content with the revised arrangements and the agreed way forward (p 176 to 179). Moreover, that letter confirms that the Respondent had made it clear that a failure in the MCQ would probably lead to a removal from the List by the Respondent.
Finally, the Appellant criticises the fact that the Respondent did not obtain reports from Dr. Levycky, Dr. Chaudhri and the Berry Lane surgery before making its decision to remove him. In their evidence, Mrs. Rigg and Dr. Phillips stated that this was because they were not recognised trainers. However, had the Appellant believed that such reports would have been helpful to him, he could have requested them himself. He did not do so and has not done so for the purposes of the hearing before us.
(d) that a contingent removal of the Appellant from the List under
Section 49G of the 1977 Act and Regulation 12 of the Regulations is not
appropriate for the following reasons, namely that:
(i) concerns about the Appellant’s skills and knowledge have existed since 2000 and such a situation should not be allowed to continue further or indefinitely;
(ii) the NCAA’s report reveals serious and disturbing inefficiencies;
(iii) the NCAA’s report recommends that, in order to remove these inefficiencies, the Appellant requires supervision and detailed, intensive coaching in knowledge, skills and the practice of medicine, using resources external to his practice. There is no guarantee that such coaching will remove the inefficiencies and there is no realistic prospect of the Appellant reaching the required standard;
(iv) in any event, despite extensive efforts since January 2004 to find the necessary level of coaching and training, it is still not available after 1 year and 7 months;
(v) despite the suggestion from Dr. Chaudhri in his letter of 4th May 2005 (p 242), there is no evidence whatsoever that the necessary level of coaching is now available or, indeed, is likely to become available in the reasonably near future;
(vi) the IOP of the GMC have, on 7th June 2005, attached 4 conditions on the Appellant’s registration for a period of 18 months. The first of those is that the Appellant shall only practise in NHS posts approved by his Postgraduate Director of General Practice Education or Postgraduate Dean where his work is supervised by a fully registered medical practitioner. Dr. Bailey is the Deputy Director of Postgraduate General Practice Education and it seems clear from his letter of 29th June 2005 (p 252 and 253) that the only registered medical practitioners whom he would approve are those who are “experienced trainers in training practices” or a practitioner who could “demonstrate that the practice reached the same standards as required for a training practice in the North West Deanery and that the doctor could demonstrate that they had the necessary skills in teaching and assessment.”
Dr. Bailey has been unable to find an experienced trainer in a training practice for the Appellant for 1 year and 7 months and there is no evidence that one is likely to become available in the future. Furthermore, there is no evidence before us that any other doctor, who is not a trainer and not in a training practice, is either suitable or available or is likely to become available and would be approved by Dr. Bailey.
In our opinion, therefore, it would be unrealistic and inappropriate for the Panel to remove the Appellant contingently and attach the same conditions as those attached as an interim measure by the IOP of the GMC;
(e) in view of the above, and in all the circumstances, the Appellant
should be removed from the List; and
(f) a national disqualification of the Appellant is justified.
In that respect, the Panel concludes that the Appellant’s inefficiencies are not “local” and relevant only to the Appellant and the Respondent. The Panel also concludes that, because of those inefficiencies, the Appellant’s inclusion on the List of any Primary Care Trust would be prejudicial to the efficiency of the services which those included on those Lists perform or undertake to provide.
For the reasons given above
(i) we dismiss the Appellant’s appeal;
(ii) we order that the Appellant be removed from the Respondent’s List; and
(iii) we impose a national disqualification upon the Appellant.
Finally, in accordance with Rule 42 (5) of the Rules we hereby notify that a party to these proceedings can appeal this decision under Sec11 Tribunals & Inquiries Act 1992 by lodging notice of appeal in the Royal Courts of Justice, The Strand, London WC2A 2LL within 14 days from receipt of this decision.
Dated this 29th day of July 2005.
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C. Barker - Chairman