Arora v General Medical Council
| Jurisdiction | England & Wales |
| Judge | MR JUSTICE BLAIR |
| Judgment Date | 22 May 2008 |
| Neutral Citation | [2008] EWHC 1596 (Admin) |
| Date | 22 May 2008 |
| Court | Queen's Bench Division (Administrative Court) |
| Docket Number | CO/1884/2008 |
[2008] EWHC 1596 (Admin)
IN THE HIGH COURT OF JUSTICE
ADMINISTRATIVE COURT
QUEEN'S BENCH DIVISION
Mr Justice Blair
CO/1884/2008
Miss Fiona Neale (instructed by Messrs Radcliffes LeBrasseur, London SW1P 3SJ) appeared on behalf of the Appellant
Ms Catherine Callaghan (instructed by GMC Legal, London Nw1 3JN) appeared on behalf of the Respondent
This is a statutory appeal by Dr Om Arora from a decision of the General Medical Council's Fitness to Practise Panel dated 25th January 2008, which determined that his fitness to practise was impaired by reason of misconduct and deficient professional performance, in respect of which a sanction of erasure was imposed.
Dr Arora (“the appellant”) comes from a family of doctors. He qualified in 1971. The facts relating to the present matters are somewhat tangled. The position is that between January and July 2003 the appellant worked part-time as a clinical assistant in genito-urinary medicine at Birmingham Heartlands Hospital. He started work as a prison medical officer and general practitioner in Wandsworth in south London on 15th September 2003. It is right also to note that between April 2005 and April 2006 he worked as a locum at Acocks Green in Birmingham, doing, I am told, some 22 locum sessions.
In August 2003 concerns were raised with the General Medical Council (“GMC”) about the appellant's performance in the Birmingham hospital. Between 11th and 26th May 2004 a performance assessment was carried out by Dr Harker and a team. This is the first of two performance assessments that Dr Harker was to carry out. It was a very detailed assessment. Overall, the assessment team found evidence of seriously deficient performance. Phase 1 consisted of interviews and reviews of medical records, and phase 2 consisted of tests of competence.
So far as phase 1 was concerned, there were seven areas which were deemed unacceptable and four areas deemed to give cause for concern.
So far as phase 2 is concerned, the objective structured clinical examination was acceptable, but knowledge and simulated surgery tests were unacceptable. The precise figures perhaps do not matter, but it is right to say that they were much lower than would have been expected.
Though this had been prompted by complaints as regards the Genito-Urinary Medicine Unit, the performance assessment covered the appellant's work as a doctor generally. Various conditions were recommended by Dr Harker and his team.
I now turn to a feature of this case which are the various lists that an NHS doctor like the appellant is required to be on. Following regulations enacted in 2004, from 1st April 2004 every general practitioner is required to be on a so-called Performers List maintained by a Primary Care Trust. In practice, this is usually the one where he or she is based. Additionally, from 1st April 2006 the GMC has maintained a list of registered medical practitioners for general practitioners like the appellant. For the avoidance of doubt, I should point out that these lists are not the same as the GMC Register of Medical Practitioners, which the appellant has been on at all material times up to the hearing in January 2008.
I now pick up the story on 27th May 2005, when the appellant applied to so on the Wandsworth PCT list. I should note that earlier that year he had been asked to be removed from the Liverpool PCT supplementary list, since he had moved to London. There is no doubt that his application was received by the Wandsworth PCA because a stamped receipt appears on the application dated 31st May 2005. Though there is some dispute about this, a file note may at least be taken to suggest that a request to process the application was in due course provided. The appellant in his evidence said that he had delivered the documents required, such as his passport, via the hospital internal post.
On 13th to 16th March 2006 the first performance assessment hearing took place before a GMC Fitness to Practise Panel. This was concerned with the assessment that Dr Harker had carried out in March 2004. It concluded that the appellant's fitness to practise was impaired in various respects, and placed him under conditions for a period of 18 months. These began to run from 27th April 2007, but that was only because an appeal had been brought as regards the March 2006 findings. That was abandoned on 27th April 2007 and the 18-month period began to run from that time.
The conditions included the following. First, the appellant was required to restrict his practice to posts under the supervision of a remedial supervisor approved by the Postgraduate Dean, who had to approve a personal development plan initiated by the appellant. The personal development plan had to address the areas of deficiencies as previously identified by the assessment team and found proved. That particular matter became relevant in due course in the January 2008 hearing.
Perhaps more fundamentally, the appellant was required to confine any general practice which he undertook to multi-handed practices, in which he would be supervised to the same level as a GP registrar. He was to undertake no practice as a single-handed GP. He was not to work in prison medicine and he was not to undertake any locum or out-of-hours work.
One other aspect of the appellant's practice also caused difficulties. He had worked for a while as an ophthalmic medical practitioner in Birmingham. On 11th April 2006 he was subject to an assessment in that regard by Dr Sudhir Patel. Dr Patel concluded that the appellant was not fit to test sight. Indeed, he said that he thought that the appellant was “unsafe”.
But all this was engulfed in April 2006 by a further problem which overtook the appellant. On 13th April 2006 the Eastern Birmingham Primary Care Trust wrote to the appellant as regards the Performers List. It said as follows:
“It has come to the attention of the Eastern Birmingham Primary Care Trust that you have been working as a General Medical Practitioner with Dr Sen-Gupta, 999 Warwick Road, Acocks Green, Birmingham.”
I interpose to say that the appellant accepts that he did indeed work as a locum, doing 22 sessions.
The letter continues as follows:
“No medical practitioner shall perform medical services unless he is included in the medical Performers List for a Primary Care Trust in England. The General Medical Council has established a List of Registered Medical Practitioners from the 1 April 2006 and, had your name been on a Performers List in any PCT in England, your name would have been included in the Register.
I understand that you have advised Mrs Y Hull, Birmingham Primary Care Shared Services Agency, that you are on the Wandsworth PCT Performers List but they are unable to confirm this and you need to provide me with written evidence of registration on the Wandsworth list and the GMC Register.
I would reiterate that you must not perform medical services until you are included on the Register. If you are on a Performers List for any PCT, please advise me immediately in order that we can confirm the position.
I would confirm that the General Medical Council has been informed of the PCT's concern. The PCT will be undertaking further investigations into this matter.”
The appellant replied to this letter by a handwritten letter of 18th April 2006, which has been the subject of much attention at this hearing. He said as follows:
“I wish to bring it to your kind notice that I am working as regular (full time) GP Medical Officer with Wandsworth P.C.T. My employment started on 15-09-2003 with regular ten sessions per week.”
I interpose to say that that is a reference to his job with Wandsworth Prison:
“The original employment contract [is] enclosed here for yourself to view and certify to confirm.
Actual performance list started as per GMC ruling on 01-04-06. But before this period performance list was not strictly in force although many GPs were in regular employment with respected P.C.Ts.
Following a recent decision by GMC Wandsworth P.C.T. is going to move my job to different G.P. surgery but still with in PCT jurisdiction.”
I interpose to say that that is a reference to the result of the hearing of the Fitness to Practise Panel in March 2006, which imposed certain conditions on the appellant which he needed to move away from his existing job to be able to meet.
Then the letter concludes with the following sentence:
“I therefore present my evidence (indirect) to state that I am on Wandsworth P.C.T. performance list.”
The response came swiftly. On 20th April 2006 the Eastern Birmingham PCT wrote to the appellant as follows:
“We have now received confirmation from Wandsworth PCT that you have never been on the Performers List of Wandsworth PCT. We have been informed that you submitted incomplete documentation to the PCT. I would again reiterate that you must not perform any further medical services in England until you are properly registered with the General Medical Council and have written confirmation that you are on a PCT Performers List. Clearly your future work in general practice will depend on the outcome of the GMC's Fitness to Practise Panel and the appeal process.
This matter was discussed at the meeting of the PCT's Assessment Group on 19 April 2006. In view of the seriousness of the fact that you have been working as a GP whilst not on a PCT Performers List, including the Acocks Green Medical Centre, would you please submit: …”
Then various further...
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