CASE NUMBER 10474
APPEAL ON 29TH MAY 2003
(GMC
Registration Number 1034996)
and
EAST
LONDON AND THE CITY FHS AGENCY
Appeal by the Appellant against the Respondent’s refusal to include the Appellant in its Supplementary List on the ground set out in Regulation 6(1)(c)
of The National Health Service (General
Medical Services Supplementary List) Regulations 2001
Appeal dismissed.
1. By letter dated 3rd February 2003, the Respondent (working on behalf of Tower Hamlets, City & Hackney and Newham Primary Care Trusts) informed the Appellant that his application for inclusion on the Newham PCT’s Supplementary List of Non-Principals had been refused.
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2. Regulation 4(2)(i) of The National Health Service (General Medical Services Supplementary List) Regulations 2001 (the Regulations) provides that when a doctor makes an application to join the Supplementary List, he shall provide 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.
3. Regulation 6(2)(c) of the Regulations provides that one of the grounds on
which a Health Authority may refuse to include a doctor on its Supplementary List is, that having contacted referees provided by the doctor under regulation 4(2)(i), the Health Authority is not satisfied with those references.
4. In its aforementioned letter the Respondent relied upon this ground. More specifically, the Respondent informed the Appellant that it considered the latest reference provided by the Appellant was from too long ago.
5. In a letter dated 17th February 2003 the Appellant appealed to the Family Health Services Appeal Authority (the FHSAA) against the Respondent’s decision. His ground of appeal was that he had been working in the UK for a very long time with experience of both hospital and GP work. He worked full-time in a GP post from 1982 to 1987 and then sporadically at various locum posts until December 1999. He had given general details of his CV since 1961 and specific details for the last six years. Earlier on he had worked in posts for long periods (and for well over the specified three months) and he pointed out that he had worked full-time in one London GP practice for one year ending in May 1996. Later on he had chosen to work for shorter periods. He had been abroad when the Health and Social Care Act 2001 came into force and he had only applied for inclusion on the Supplementary List in October 2002. As his more recent jobs were of short duration and very often in the absence of the practice principals, he had not given their names as referees. The referees he had given were not recent but they could vouch for his experience and professional work over a considerable period of time. He considered his application had been refused on the basis of the age of his references and not for any professional negligence, mistake or misdemeanour.
6. The Respondent opposed the Appellant’s appeal. In its letter dated 17th March 2003 it recognized the Respondent could not provide two recent clinical references as he had not been in any recent posts for the requisite three months, but it was concerned that in every case the posts were of very short duration and locum agencies had confirmed the Appellant had not worked through them for many years. It submitted the PCT would expect references to be from individuals who could assess the doctor’s skills and capabilities within a general practice setting and would relate to posts within the last two years. Refusal of the Appellant’s application had been on account of his references not coming within this category and the lack of information upon which to adequately assess his suitability to work as a GP in Newham.
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1. We carefully considered all of the evidence before us. We noted the Appellant’s age but we were satisfied this would not necessarily create any problem, as the 70- age limit which applies to the medical list does not apply to the Supplementary List. We also noted that the Respondent had confirmed that its policy for 70+ doctors applying to join its Supplementary List was to allow conditional inclusion, subject to annual health checks and the implementation of the standard NHS fast-track appraisal scheme for GPs.
2. We were also aware that non-principals returning from overseas might have difficulty in complying with all the criteria specified in Regulation 4(2) of the Regulations and that we should exercise a flexible and pragmatic approach.
3. The Respondent’s ground for refusal was its dissatisfaction with the Appellant’s references. The Appellant had provided three written references which we considered in their entirety and which can be summarized as follows:
Dr F I Watson (dated 31st March 2003) – knew the Appellant from when he
had been his locum for two or three weeks in 1995 when Dr Watson had been
off work through illness. He confirmed the Appellant had been very well liked
by both staff and patients, had not stinted in any way and had coped very
well with the difficulties of a rural practice. He unhesitatingly recommended
the Appellant as an excellent doctor, popular with patients and most
industrious. Having retired and joined the Supplementary List himself, Dr
Watson gave this reference fully aware of what would be required of the
Appellant.
Dr S S Rafiq (received by the Respondent on 14th October 2002) – completed
a standard clinical reference form which indicated the Appellant had worked as
a locum in his practice when he had been off work for two or three weeks at a
time in 1999. Dr Rafiq had not had any concerns about the Appellant’s clinical
abilities and his general conduct, time-keeping, record-keeping and teamwork
had been “OK” (no further or more detailed comments) and he would employ
him again.
Dr S N Gupta (received by the Respondent on 11th October 2003) - completed
a standard clinical reference form which indicated the Appellant had worked as
a locum in his practice on and off for ten years, sixteen years ago. Dr Gupta
had never had any concerns about the Appellant’s clinical abilities and his
general conduct, time-keeping and record-keeping had been “very good”, his
teamwork had been “good” (no further or more detailed comments) and he
would employ him again.
4. We noted the Appellant’s reasons for supplying references from so long ago. We did not know if he had recently been working in India. If he had not, we might have been concerned about his lack of recent experience, but that was not within our remit; if he had, we wondered why he had not supplemented the references he
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had provided with more recent references from India as the Regulations make it clear that where it is not possible to comply with the requirement for clinical references from two recent posts of at least three months duration, an applicant should provide a full explanation and alternative referees. If this requirement had caused problems the Appellant should have given a full explanation of the difficulties he had encountered. Neither the Appellant’s grounds of appeal nor his CV explained what he had been doing since December 1999. Moreover, between May 1996 and December 1999 his locum jobs had been intermittent and very brief, with none lasting more than three weeks and many only lasting for a day or two.
Having carefully considered all the evidence available to us we unanimously made the following findings of fact:
1. That for the purposes of Regulation 4(2)(i) of the Regulations the Appellant failed to provide names and addresses of two referees who were 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.
2. That for the purposes of Regulation 4(2)(i) of the Regulations the Appellant failed to provide a full explanation and alternative referees.
1. For the above reasons we find that the Respondent’s refusal of the Appellant’s
application for inclusion on the Supplementary List on the ground it was not
satisfied with his references was justified.
2. Accordingly, we uphold the Respondent’s decision and refuse the Appellant’s
appeal.
Finally, in accordance with Rule 42(5) of the Family Health Services Appeal Authority (Procedure) Rules 2001, we hereby notify the Appellant that he may have rights relating to appeals under Section 11 of the Tribunals and Inquiries Act 1992.
………………………………………….
Chairman of the Panel
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