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					                        FITNESS TO PRACTISE PANEL
                            13-23 SEPTEMBER 2010
      7th Floor, St James’s Buildings, 79 Oxford Street, Manchester, M1 6FQ

Name of Respondent Doctor:          Dr David William READE

Registered Qualifications:          MB ChB 1986 University of Liverpool

Area of Registered Address:         Lancashire

Reference Number:                   3180686

Type of Case:                       New case of impairment by reason of:
                                    misconduct.

Panel Members:                      Mrs E Carr (Lay) Chairman
                                    Mrs S Dean (Lay)
                                    Dr P Srinivasan (Medical)

Legal Assessor:                     Mr Angus Macpherson
                                    Mr Douglas Hogg (3 September 2010)

Secretary to the Panel:             Miss O Pennelle

Representation:
GMC: Ms Bernadette Baxter, Counsel, instructed by GMC Legal, represented the
Council.

Doctor: Dr Reade was present and represented by Mr Stephen Climie, Counsel,
instructed by Berrymans Lace Mawer Solicitors.

EXCLUSION OF PRESS AND PUBLIC

The Panel passed a resolution, under Rule 41 of the General Medical Council
(Fitness to Practise) Rules 2004, that the press and public be excluded from those
parts of the hearing where they considered that the particular circumstances of the
case outweighed the public interest in holding the hearing in public.

ALLEGATION

The Panel will inquire into the following allegation against Dr David William Reade,
MB ChB 1986 University of Liverpool

“That being registered under the Medical Act 1983:

      1.     Between May 2004 and January 2008, whilst working as a GP
      Principal at the Aintree Park Group Practice, Liverpool, you



                                                                                       1
a.    added Quality and Outcome Framework (QOF) Codes to patient
records indicating that an asthma review had taken place for patients;
222,1072, 2127, 4696, 5608, 995, 1910, 4501, 4950, 6200, 6508,
6565, 307 and 5071 when you

      i.     had not conducted the asthma review yourself,

      ii.    had not confirmed with the treating doctor and/or nurse
      that the asthma review had been conducted,

b.    added QOF codes to patient records indicating that a
depression screen had taken place for patients 185, 365, 21599 and
1005 when you

      i.     had not conducted the depression screen yourself,

      ii.    had not confirmed with the treating doctor and/or nurse
      that the depression screen had been conducted,

c.    added QOF codes to patient records indicating that part/s of an
annual diabetic review had taken place for patients 104, 162, 349, 862
and 21599 when you

      i.    had not conducted the part/s of the annual diabetic
      review yourself,

      ii.    had not confirmed with the treating doctor and/or nurse
      that the part/s of the annual diabetic review had been
      conducted,

d.    added QOF codes to patient records indicating that part/s of an
annual epilepsy review had taken place for patients 307 and 5182
when you

      i.    had not conducted the part/s of the annual epilepsy
      review yourself,

      ii.    had not confirmed with the treating doctor and/or nurse
      that the part/s of the annual epilepsy review had been
      conducted,

e.    on 5 January 2005, altered the patient records of patient 457, by
amending a blood pressure reading, taken on 20 December 2004, from
131/93 to 131/86 when you

      i.     had not taken a blood pressure reading yourself,




                                                                        2
             ii.    had not confirmed with the doctor and/or nurse who took
             the blood pressure reading of 20 December 2004 that the
             reading was incorrect and/or required amendment,

      f.     added QOF codes to patient records indicating that a mental
      health review had taken place and a psychiatric care plan produced for
      patients 5138 and 3172 when you

             i.    had not conducted the mental health review and/or
             produced the psychiatric care plan yourself,

             ii.    had not confirmed with the treating doctor and/or nurse
             that a mental health review had taken place and /or a psychiatric
             care plan produced,

      g.     on 12 January 2005, altered the patient record of patient 16270
      by adding an “informed dissent” code, indicating that the patient did not
      agree to investigations for or treatment of stroke quality indicators
      when you

             i.     had not taken the “informed dissent” yourself,

             ii.    had not confirmed with the treating doctor and/or nurse
             that the patient had given “informed dissent”;

Admitted and Found Proved in its Entirety.

2.    Your behaviour as set out in paragraphs 1 a to g above was

      a.   not in the best interests of the patient,
      Admitted and Found Proved.

      b.   not at a standard to be expected of a reasonably competent GP,
      Admitted and Found Proved.

      c.   misleading,
      Admitted and Found Proved.

      d.      dishonest;
      Has been found proved in relation to paragraphs 1(a)(i)-(ii) with
      the exception of Patients 307 and 5071; paragraphs 1(b)(i)-(ii),
      1(c)(i)-(ii), 1(d)(i)-(ii), 1(e)(i)-(ii) and 1(g)(i)-(ii).
      Has been Found Not Proved in relation to paragraph 1(f)(i)-(ii) and
      1(a)(i)-(ii) in respect of Patients 307 and 5071.

3.    At 05.02 hours on 4 May 2005, whilst working as a GP for the Out of
Hours Service, Urgent Care 24, you had a telephone consultation with Mrs A,
the mother of Patient A who had taken an overdose;
Admitted and Found Proved.
                                                                              3
4.    In the course of that consultation you

      a.     did not take any adequate history of the reported overdose,

      b.     did not record the medication consumed by Patient A,

      c.     did not record the quantity of medication consumed by Patient
      A,

      d.    did not record the time at which Patient A had consumed the
      medication,

      e.     did not arrange to carry out a home visit to Patient A,

      f.    did not make any or any adequate assessment of Patient A’s
      physical and/or mental condition;
Admitted and Found Proved in its Entirety.

5.      At or about 02.40 hours on 10 October 2005, whilst working as a GP
for the Out of Hours Service, Urgent Care 24, you left your base at Urgent
Care 24 to go to Copy Lane Police Station to carry out duties as a Force
Medical Examiner for Merseyside Constabulary;
Admitted and Found Proved.

6.     You remained absent from your base for Urgent Care 24 for over an
hour; Admitted and Found Proved.

7.    In the time you were absent from your base for Urgent Care 24 you
were unavailable to care for Urgent Care 24 patients; Admitted and Found
Proved.

8.    Your behaviour as set out in paragraphs 4(a) to (f), 5, 6 and 7 was

      a.    inappropriate,
      Admitted and Found Proved in relation to 4(a)-(f)
      Has been Found Proved in relation to paragraphs 5, 6 and 7.

      b.    not in the best interest of the patient,
      Admitted and Found Proved in relation to 4(a)-(f)
      Has been Found Proved in relation to paragraphs 5, 6 and 7.

      c.   not at a standard to be expected of a reasonably competent GP.
      Admitted and Found Proved in relation to 4(a)-(f)
      Has been Found Proved in relation to paragraphs 5, 6 and 7.


And that by reason of the matters set out above your fitness to practise is
impaired because of your misconduct.” Found Proved.
                                                                              4
Determination on facts

“Dr Reade:

This case concerns your conduct whilst working as a GP Principal at the Aintree
Park Group Practice in Liverpool between May 2004 and January 2008; and your
work with a GP Out of Hours Service, Urgent Care 24 during May and October 2005.

In reaching its decisions on the facts, the Panel has considered all the evidence
adduced in this case together with the submissions made by Ms Baxter, on behalf of
the General Medical Council (GMC) and those made by Mr Climie on your behalf.

Mr Climie made a number of admissions on your behalf which are reflected below in
this determination.

Ms Baxter submitted that the disputed facts in this case are made out. She invited
the Panel to find that your course of conduct, which you have accepted, represents a
widespread fabrication of QOF data and that you dishonestly entered that data into
the patient records. She further submitted that your behaviour whilst working for the
out of hours service, Urgent Care 24, on 10 October 2005, was inappropriate, not in
the best interests of the patient and not at a standard to be expected of a reasonably
competent GP.

Mr Climie submitted that when looking at the overall factual context of your conduct,
the Panel should have regard to the character of the person who made those entries.
He submitted that the last conclusion the Panel should draw is that you were acting
dishonestly. So far as your behaviour on 10 October 2005 is concerned, Mr Climie
was content for the Panel to draw its own conclusions.

Legal Advice:
In relation to the burden and standard of proof, the Legal Assessor advised the
Panel that the burden of proof rests on the GMC, and that the standard is the civil
standard, namely the balance of probabilities. This means that a fact will be proved if
the Panel is satisfied that it was more likely than not that an event had occurred.

With regard to the word ‘dishonest’ he advised the Panel that it should use the
ordinary definition of the word unless counsel required a direction, which they did
not. He indicated that there was no necessity to draw the attention of the Panel to
the case of R v Ghosh [1982] Q.C. 1053, 75 Cr.App.R.154 by reason that you did not
state that you did not realise that anybody would regard what you had done as
dishonest.

The Legal Assessor advised the Panel that it should have regard to your good
character but that good character is not in itself a defence. However the Panel
should take it into account when considering the issues of your credibility and
whether or not you were likely to have acted dishonestly.

In reaching its decisions on the outstanding paragraphs, the Panel has assessed the
credibility of all the witnesses and given their evidence the appropriate weight. It has
                                                                                       5
also taken account of the many testimonials which were submitted on your behalf
which attested to your integrity and honesty.

Admissions:

You have admitted and the Panel has found proved paragraphs: 1 in its entirety,
2(a)-(c), 3, 4 in its entirety, 5, 6, 7 and 8(a)-(c) in relation to paragraph 4(a)-(f).

Paragraph 1:

       “Between May 2004 and January 2008, whilst working as a GP Principal at
       the Aintree Park Group Practice, Liverpool, you

              a.    added Quality and Outcome Framework (QOF) Codes to patient
              records indicating that an asthma review had taken place for patients;
              222,1072, 2127, 4696, 5608, 995, 1910, 4501, 4950, 6200, 6508,
              6565, 307 and 5071 when you

                      i.     had not conducted the asthma review yourself,

                      ii.    had not confirmed with the treating doctor and/or nurse
                      that the asthma review had been conducted,

              b.    added QOF codes to patient records indicating that a
              depression screen had taken place for patients 185, 365, 21599 and
              1005 when you

                      i.     had not conducted the depression screen yourself,

                      ii.    had not confirmed with the treating doctor and/or nurse
                      that the depression screen had been conducted,

              c.    added QOF codes to patient records indicating that part/s of an
              annual diabetic review had taken place for patients 104, 162, 349, 862
              and 21599 when you

                      i.    had not conducted the part/s of the annual diabetic
                      review yourself,

                      ii.    had not confirmed with the treating doctor and/or nurse
                      that the part/s of the annual diabetic review had been
                      conducted,

              d.    added QOF codes to patient records indicating that part/s of an
              annual epilepsy review had taken place for patients 307 and 5182
              when you

                      i.    had not conducted the part/s of the annual epilepsy
                      review yourself,
                                                                                          6
                  ii.    had not confirmed with the treating doctor and/or nurse
                  that the part/s of the annual epilepsy review had been
                  conducted,

           e.    on 5 January 2005, altered the patient records of patient 457, by
           amending a blood pressure reading, taken on 20 December 2004, from
           131/93 to 131/86 when you

                  i.     had not taken a blood pressure reading yourself,

                  ii.    had not confirmed with the doctor and/or nurse who took
                  the blood pressure reading of 20 December 2004 that the
                  reading was incorrect and/or required amendment,

           f.     added QOF codes to patient records indicating that a mental
           health review had taken place and a psychiatric care plan produced for
           patients 5138 and 3172 when you

                  i.    had not conducted the mental health review and/or
                  produced the psychiatric care plan yourself,

                  ii.    had not confirmed with the treating doctor and/or nurse
                  that a mental health review had taken place and /or a psychiatric
                  care plan produced,

           g.     on 12 January 2005, altered the patient record of patient 16270
           by adding an “informed dissent” code, indicating that the patient did not
           agree to investigations for or treatment of stroke quality indicators
           when you

                  i.     had not taken the “informed dissent” yourself,

                  ii.    had not confirmed with the treating doctor and/or nurse
                  that the patient had given “informed dissent”.”

     This has been admitted and the Panel has found proved in its entirety.

Paragraph 2:

     “Your behaviour as set out in paragraphs 1 a to g above was

           a.     not in the best interests of the patient,

           b.     not at a standard to be expected of a reasonably competent GP,

           c.     misleading…”

     These have been admitted and found proved.
                                                                                   7
Paragraph 3:

     “At 05.02 hours on 4 May 2005, whilst working as a GP for the Out of Hours
     Service, Urgent Care 24, you had a telephone consultation with Mrs A, the
     mother of Patient A who had taken an overdose.”

     This has been admitted and found proved.

Paragraph 4:

     “In the course of that consultation you

            a.     did not take any adequate history of the reported overdose,

            b.     did not record the medication consumed by Patient A,

            c.     did not record the quantity of medication consumed by Patient
            A,

            d.    did not record the time at which Patient A had consumed the
            medication,

            e.     did not arrange to carry out a home visit to Patient A,

            f.    did not make any or any adequate assessment of Patient A’s
            physical and/or mental condition.”

     This has been admitted and found proved in its entirety.

Paragraph 5:

     “At or about 02.40 hours on 10 October 2005, whilst working as a GP for the
     Out of Hours Service, Urgent Care 24, you left your base at Urgent Care 24 to
     go to Copy Lane Police Station to carry out duties as a Force Medical
     Examiner for Merseyside Constabulary.”

This has been admitted and found proved.

Paragraph 6:

     “You remained absent from your base for Urgent Care 24 for over an hour.”

     This has been admitted and found proved.

Paragraph 7:

     “In the time you were absent from your base for Urgent Care 24 you were
     unavailable to care for Urgent Care 24 patients.”
                                                                                   8
          This has been admitted and found proved.

Paragraph 8:

                 “Your behaviour as set out in paragraphs 4(a) to (f), 5, 6 and 7 was

                        a.     inappropriate,

                        b.     not in the best interest of the patient,

                        c.   not at a standard to be expected of a reasonably
                        competent GP.

          This has been admitted and found proved in relation to paragraphs 4(a)
to (f).

Outstanding paragraphs:

You made no admissions in respect of paragraph 2(d) neither in relation to
paragraph 1, nor in respect of paragraphs 8(a)-(c) in relation to paragraphs 5, 6 and
7. The Panel considered each of these remaining paragraphs separately and made
the following findings:

Paragraph 2:

Paragraph 2 reads:

          “Your behaviour as set out in paragraphs 1(a)-(g) above was

                 …d.    dishonest.”

The Panel first considered the ordinary meaning of the word ‘dishonest’ as advised
by the Legal Assessor and it took the meaning from Collins English dictionary, which
is:

          “Not honest or fair; deceiving or fraudulent.”

In approaching its decision on paragraph 2(d), the Panel considered each patient
individually and whether your behaviour set out in paragraphs 1(a)-(g), as admitted,
was dishonest. The Panel took into account your evidence that you would not have
entered any QOF data into patient records unless you had a proper reason to do that
and therefore you were not acting dishonestly.

Paragraph 1(a)(i) and 1(a)(ii):
This paragraph relates to your retrospective entries into the particular patients’
records stating that these patients’ had received an asthma review when you had not
conducted the review yourself, or checked with the treating doctor or nurse that it
had been conducted.

                                                                                        9
The Panel has found paragraph 2(d) proved in respect of patients: 222, 1072, 2127,
4696, 5608, 995, 1910, 4501, 4950, 6200, 6508, 6565 referred to in paragraph 1(a).

The Panel has found paragraph 2(d) not proved in relation to patients 307 and 5071.

Reasons:
In relation to Patient 222, the Panel took account of the witness statement of
Ms A, dated 28 July 2010, who confirmed that she had never completed an asthma
check for the purposes of QOF and therefore could say with certainty that she did
not complete an asthma monitoring check during her consultation with this patient on
25 July 2005. Further, the Panel relied on the expert evidence of Dr C who stated
that there was no evidence in the patient’s record in the preceding months which
may have justified you entering the QOF code for asthma review on 29 July 2005.
Moreover, you have advanced no specific reason for having made the entry.
Accordingly, the Panel concluded that this was a false entry and that your behaviour
was dishonest.

In relation to Patient 1072, the Panel took account of the oral evidence of
Dr B. He confirmed that he had not completed an asthma check on 9 August 2006,
and remarked that it would be a strange thing to undertake when the patient
presented with a sore nipple. Further, the Panel relied on the expert evidence of Dr
C who stated that there was no evidence in the patient’s record in the preceding
months which may have justified you entering the QOF code for asthma review on
17 October 2006. Moreover, you admitted in evidence that there was no basis for
your assumption that an asthma monitoring check had been done. Accordingly, the
Panel concluded that this was a false entry and that your behaviour was dishonest.

In relation to Patient 2127, the Panel took account of the witness statement of
Dr D, dated 25 July 2010, who stated that this was a patient who had presented with
lower back pain, and that it was unlikely that she had carried out an asthma check on
4 April 2005. Further, she stated that, if she had, she would have entered it in the
original consultation details. The Panel also took account of the evidence of Dr C
who stated that, in his opinion, your recording of an asthma check on 29 July 2005
‘sits uncomfortably with a consultation for lower back pain’. Moreover, you admitted
in evidence that there was no basis for your assumption that an asthma monitoring
check had been done. Accordingly, the Panel concluded that this was a false entry
and that your behaviour was dishonest.

In relation to Patient 4696, the Panel took account of the evidence of Dr C who
explained to the Panel that this patient had presented with a sore throat on 25 July
2006 and had a failed encounter for asthma review on 9 October 2006. You admitted
in evidence that there was no basis to justify entering a QOF code for an asthma
review on 17 October 2006. Accordingly, the Panel concluded that this was a false
entry and that your behaviour was dishonest.

In relation to Patient 5608, the Panel took account of the witness statement of
Dr F, dated 3 June 2010, who stated that this was a patient with a urinary tract
infection and a complex gynaecological problem. Further, she stated that to the best
of her knowledge and belief she did not carry out an asthma monitoring check on this
                                                                                   10
patient during her consultation on 10 May 2005. Dr C stated that there was no
evidence in the patient’s record in the preceding months which may have justified
you entering the QOF code for asthma review on 20 September 2005. In evidence
you acknowledged that you could not explain the entry as it made ‘no sense at all’.
Accordingly, the Panel concluded that this was a false entry and that your behaviour
was dishonest.

In relation to Patients 995, 1910, 4501, 4950, 6200, 6508 and 6565, whilst the Panel
considered these individually, it has borne in mind you made entries in all of these
patients records on 18 May 2004.

In reaching its decision, the Panel took account of the transcript of the interview
conducted by Mr G of NHS Counterfraud. Mr G interviewed you on 5 March 2009, in
relation to allegations that you had fabricated QOF entries on patients’ records.
During this interview, you volunteered no explanation for your entries and stated that
you ‘couldn’t envisage a reason’. However, during your evidence before this Panel
you explained that this was done at a time when the computer systems had been
changed. You advanced a theory that this data may have been lost during this
process and the entries may have been entered from paper records. The Panel did
not find this explanation credible as you did not advance this explanation during the
interview with Mr G in 2009 which would have been closer in time. Also, if this theory
was correct, there was no reason for you not to have entered these details in the
consultation section of the patient’s records as retrospective entries and no reason
for you not to have stated the reason for the entries. Further, Dr C stated that there
was no evidence from the patients’ records to justify these entries. Accordingly, the
Panel concluded that these were false entries and that your behaviour was
dishonest.

In relation to patients 307 and 5071 the Panel noted that there was some evidence
of respiratory examinations. A referral letter from Dr I, dictated on 17 November
2005, regarding Patient 307 was sent to the local Chest Unit following a consultation
on that date, although it was not recorded as an asthma check. Dr I in his statement
dated 10 August 2008 stated that the patient did appear in an asthma disease
register dating back to 1997. In relation to Patient 5071 Dr H in a consultation dated
29 June 2005 had a discussion concerning this patient’s asthma even though she
did not record this as an asthma check. Accordingly, the Panel was not satisfied, on
the balance of probabilities, that an asthma check had not taken place in respect of
both these patients. The Panel concluded that there was insufficient evidence to
warrant the conclusion that the entries you made in these patients’ records on 2
December and 20 September 2005 respectively were dishonest.

Paragraph 1(b)(i)-(ii):
This paragraph relates to your retrospective entries into the particular patients
records stating that they had received a depression screen when you had not
conducted the review yourself, or checked with the treating doctor or nurse that it
had been conducted.

In relation to Patient 185, the Panel noted the witness statement of Dr I, dated 10
August 2010, who confirmed that to the best of his knowledge he did not ask the
                                                                                      11
necessary questions of this patient required as part of a depression screening during
a consultation on 4 September 2006. Dr C told the Panel that there was no
justification for the entry of a QOF code for depression screening by you on 9
October 2006 without asking Dr I. You explained to the Panel that you could not
imagine a patient going for a diabetic review without a depression screening taking
place. You stated that it would be ‘inconceivable’. However, the Panel found that
your explanation was inconsistent with a later amendment you made to Patient 104’s
record on 29 January 2007. At this time you made a number of entries relating to a
diabetic review but did not include a QOF code for a depression screening. The
Panel did not accept your explanation and found that this was a false entry and that
your behaviour was dishonest.

In relation to Patient 365, the Panel noted the statement of Dr I, dated 10 August
2010, who stated that he had not carried out a depression screening using the
questions during a consultation on 18 November 2006. Further, he stated that if he
had, he would have recorded it. On 12 December 2006, you entered a QOF code to
indicate that a depression screening had taken place during this patient’s
consultation with Dr I. Dr C told the Panel that there was no justification for this entry.
You offered no explanation for your amendment. Accordingly, the Panel concluded
that this was a false entry and that your behaviour was dishonest.

In relation to patient 21599, the Panel noted the undated witness statement of
Dr J. He stated that he had carried out a home visit on 24 November 2006 to this
patient who was complaining of a rash. He confirmed that he thought it was ‘very
unlikely’ that he would have carried out a depression screening. Furthermore, Dr J
explained that as his training GP, you regularly reviewed his records within a few
days of his visits and if you felt this code should have been entered, you had a
perfect opportunity to discuss this with him. Additionally, the Panel noted that Dr C
stated that there was no justification for entering the QOF code for depression
screening on 31 January 2007. Accordingly, the Panel concluded that this was a
false entry and that your behaviour was dishonest.

In relation to Patient 1005, the Panel noted the statement of Dr I, dated 10 August
2010, who stated that, to the best of his knowledge and belief that he had not
conducted a depression screening using questions during a consultation on 13
December 2007. Again, Dr C stated there was no justification for your amendment to
include the QOF code for depression screening on 3 January 2008. You advanced
no explanation for this entry. Accordingly, the Panel concluded that this was a false
entry and that your behaviour was dishonest.

Paragraph 1(c)(i)-(ii):
This paragraph relates to your retrospective entries into the particular patients
records stating that they had received a diabetic review when you had not conducted
the review yourself, or checked with the treating doctor or nurse that it had been
conducted.

In relation to Patient 104, the Panel noted the evidence of Dr C who stated that it is
extremely unlikely that Nurse K would have carried out a diabetic review on 23
January 2007 as nurses do not generally do this check. Also, there was nothing in
                                                                                        12
the patient’s records to suggest that one had taken place. The Panel noted that you
could not explain the reason for entering a diabetic review QOF code on 29 January
2007, and that you conceded during cross examination that your entry appeared to
be fabricated. Accordingly, the Panel concluded that this was a false entry and that
your behaviour was dishonest.

In relation to Patient 162, the Panel noted the witness statement of Ms L, Practice
Nurse, dated 12 August 2010. She stated that during the consultation with the
patient on 14 December 2004, the patient refused a flu jab and a diabetic review.
Therefore, she would not have carried out a foot check. You explained that you
thought your entry related to a prompt from a letter dated 5 January 2005. However,
on examination, this letter was from a dietician and did not warrant your QOF code
entry on 18 February 2005 that a foot check had been carried out. Accordingly, the
Panel concluded that this was a false entry and that your behaviour was dishonest.

In relation to Patient 349, the Panel took account of the witness statement of Ms M,
dated 14 May 2010 who stated that the patient came to see her at the practice
because of cellulitis of the legs on 29 November 2005. She explained that you had
made substantial amendments on 16 December 2005 to the record of her
consultation which she did not authorise. This included a fundoscopy and a
microalbumin test as part of the QOF data for a diabetic review. Dr C told the Panel
that it would not be the best time to do a diabetic foot check when a patient had
presented with cellulitis of the legs. He added that without discussing this with
Ms M, you had no way of knowing whether any of these checks had been done. You
advanced no explanation for your amendments. Accordingly, the Panel concluded
that this was a false entry and that your behaviour was dishonest.

In relation to Patient 862, the Panel noted the evidence of Dr C who stated that there
was no consultation record for this patient on 19 July 2004 when you inserted the
QOF code for a diabetic review. Therefore, he concluded that there was no
justification for this entry as it would have required a physical examination. You
advanced no explanation and conceded during cross examination that ‘it doesn’t
make any sense’. Accordingly, the Panel concluded that this was a false entry and
that your behaviour was dishonest.

In relation to Patient 21599, the Panel noted the undated witness statement of
Dr J who confirmed that during a home visit on 24 November 2006 for a rash, he did
not carry out a diabetic review. Furthermore he stated if he had, he would have
needed to take equipment with him to enable him to undertake the review. The Panel
has noted that you changed this particular patient’s record, on 31 January and 6
February 2007, entering two different codes for two different reviews which had not
taken place. Accordingly, the Panel concluded that this was a false entry and that
your behaviour was dishonest.

Paragraph 1(d)(i)-(ii):
This paragraph relates to your retrospective entries into the particular patients
records stating that they had received an annual epilepsy review when you had not
conducted the review yourself, or checked with the treating doctor or nurse that it
had been conducted.
                                                                                   13
In relation to Patient 307, the Panel took account of the witness statement of Dr N,
dated 10 May 2010, who stated that he conducted a home visit on 4 May 2006
because the patient had a painful right-sided parotid swelling. Dr N stated that an
annual epilepsy review was not clinically indicated and had he undertaken such a
review, he would have entered the QOF code at the time. The Panel relied on the
expert evidence of Dr C who told the Panel that there was no evidence in the
patient’s record of an annual epilepsy review that would have justified you entering
the QOF code in the patient’s record on 17 October 2006. You advanced no
explanation for your amendment to the patient’s record. Accordingly, the Panel
concluded that this was a false entry and that your behaviour was dishonest.

In relation to Patient 5182, the Panel noted that this patient telephoned the practice
on 21 September 2007 having received a recommendation for a change of
medication from the Walton Centre. A member of staff at the practice then spoke to
Dr I who issued a prescription for the change of medication. Dr I in his statement
dated 10 August 2010 stated that he did not obtain information from the patient to
justify your retrospective amendment to the patient’s record on 21 November 2007
when you entered a QOF code indicating that an epilepsy review had taken place.
The Panel noted Dr C’s evidence that whilst the letter from the Walton Centre dated
24 September 2007 provided some explanation, it was not sufficient to make this
amendment without a consultation with the patient. Accordingly, the Panel concluded
that this was a false entry and that your behaviour was dishonest.

Paragraph 1(e)(i)-(ii):
This paragraph relates to your retrospective entries into Patient 457’s record
amending a blood pressure reading taken on 20 December 2004 when you had not
taken the reading yourself, or checked with the treating doctor or nurse that it was
correct.

In reaching its decision on this paragraph, the Panel noted the statement of Ms
Wharton, dated 28 July 2010, who entered the patient’s blood pressure reading as
131/93 mm Hg on 20 December 2006. She stated that she had entered this reading
in the patient’s records contemporaneously. The Panel noted Dr C’s evidence that
your alteration on 5 January 2005 meant that the patient met the QOF target for
hypertension. He told the Panel that this change is particularly significant, because
the patient had previously had uncontrolled blood pressure readings. You stated to
the Panel that you could not explain the entry and thought it was ‘inconceivable’ that
you would have altered the blood pressure reading to 131/86 mm Hg without good
reason. However, you advanced no explanation based on patient’s records for the
amendment which you made and the Panel concluded that this was a false entry and
that your behaviour was dishonest.

Paragraph 1(f)(i)-(ii):
This paragraph relates to your retrospective entries into the particular patients
records indicating that a mental health review had taken place and a psychiatric care
plan produced, when you had not conducted the review yourself, or checked with the
treating doctor or nurse that it had been conducted.

                                                                                       14
In relation to patients 5138 and 3172 the Panel noted that there was some evidence
in both of these patient’s records to indicate that some sort of mental health
discussion or psychiatric review had taken place. The Panel noted that during a
consultation between Patient 5138 and Dr R on 14 July 2006, there was some
evidence of this. Dr N, in his statement dated 10 May 2010 acknowledged that he
was probably conducting a mental health review with Patient 3172 on 20 July 2006
and that he was implicitly compiling a psychiatric care plan although he did not think
these assumptions could be made by you. Your retrospective amendments in both
these patients’ records on 11 October 2006 may have reflected your belief that
mental health reviews had taken place and psychiatric care plans produced.
Therefore, the Panel was not satisfied, on the balance of probabilities, that your
behaviour was dishonest.

Paragraph 1(g)(i)-(ii):
This paragraph relates to your retrospective entries into Patient 16270’s record by
adding ‘informed dissent’ code, indicating that the patient did not agree to
investigations for or treatment of stroke quality indicators when you had not taken the
informed dissent yourself, or checked with the treating doctor or nurse that the
patient had given informed dissent.

The Panel noted the witness statement of Dr E, dated 16 June 2010, who stated that
he saw the patient on 13 and 20 December 2004. You subsequently, removed this
patient from the hypertension database by inserting an informed dissent code on 12
January 2005. Dr E accepted that it may have been reasonable in respect of an 89
year old patient. However, Dr C explained that the effect of inserting this code in the
patient’s record was to remove him from regular review and to exclude him from the
QOF target. You stated that you assumed you had received a message or there had
been a discussion which justified your entry. However, you conceded, during cross
examination that if the informed dissent code had been added without talking to the
patient it was a false entry. Accordingly, the Panel concluded that this was a false
entry and that your behaviour was dishonest.

Paragraph 8:

      “8.    Your behaviour as set out in paragraphs …5, 6 and 7 was

             a.     inappropriate,

             b.     not in the best interest of the patient,

             c.   not at a standard to be expected of a reasonably competent
             GP.”

      This paragraph has been Found Proved in its Entirety.

This paragraph relates to your absenting yourself from the out of hours service,
Urgent Care 24 on 10 October 2005.



                                                                                    15
In reaching its decision, the Panel considered paragraphs 5, 6 and 7 individually. It
formed the view that whilst you were on duty with and working for Urgent Care 24
your responsibilities lay with them as your employer. The Panel noted the evidence
of Mr O, Head of Service Delivery and Operations Manager at Urgent Care 24, who
told the Panel that whilst there was no policy regarding working for other
organisations whilst on duty in October 2005, he would expect a doctor on duty to
work exclusively for Urgent Care 24. It also notes the letter from Dr P, Medical
Director, Urgent Care 24, dated 18 October 2005 stating that it is not possible for you
to combine your work as a Police Surgeon with shifts for Urgent Care 24. You told
the Panel that you were helping the police out that night and that you had made
reception at Urgent Care 24 aware of where you were going. This was evidenced by
the email to Mr Q dated 10 October 2005. You stated that you were contactable and
that Copy Lane Police Station was only a short distance away from your base at
Urgent Care 24. The Panel concluded that it was inappropriate to leave the base of
Urgent Care 24 whilst you were working for them to carry out duties for another
employer, even if you had made Urgent Care 24 aware of your movements. Further
it concluded that it was inappropriate for you to remain absent from the base of
Urgent Care 24 for over an hour and to be unavailable to care for Urgent Care 24
patients. The very nature of out of hours work requires doctors to be available at
short notice.

You remained absent from the base and this resulted in you being unavailable to
respond to any calls and therefore unable to perform your duties. The Panel found
that this was not in the best interests of the patients who might require the service of
Urgent Care 24. On this basis, it finds that your actions were not at the standard
expected of a reasonably competent GP.

Having reached findings on the facts, the Panel invite Counsel to adduce further
evidence and make any further submissions as to whether, on the basis of the facts
found proved, your fitness to practise is impaired.”

Determination on impaired fitness to practise

“Dr Reade:

The Panel has considered whether, on the basis of the facts found proved, your
fitness to practise is impaired. It has taken account of all the evidence adduced,
together with Ms Baxter’s submissions on behalf of the General Medical Council
(GMC) and those by Mr Climie on your behalf.

Ms Baxter submitted that this is a case of serious professional misconduct. She went
on to outline the definition of such from the leading authorities. Ms Baxter submitted
that your misconduct was serious. She noted that you admitted, in cross
examination, serious breaches of Good Medical Practice. Ms Baxter stated that it is
clear that the issue of dishonesty breaches the fundamental tenets of the medical
profession. She submitted that all three aspects of the public interest, as outlined by
the authorities are applicable in this case and these facts amount to misconduct.



                                                                                      16
In addressing the issue of impairment, Ms Baxter referred to the relevant authorities
and drew the Panel’s attention to the framework outlined in those cases. She stated
that the Panel should also consider the issue of remediability. She acknowledged
that your conduct in relation to Urgent Care 24 may have already been remedied.
She stated that your misconduct may have occurred at a time when you were
spreading yourself too thinly. However, she submitted that the Panel should not look
at that issue in isolation. It should consider the issues of dishonesty, in relation to the
false entries of QOF data in the patients’ records. She argued that dishonesty was
only capable of being remedied in this case if you had accepted that you were
dishonest and acknowledged why it happened. She concluded, that taking into
account the guidance outlined in the authorities, there is clear evidence that your
fitness to practise is impaired.

Mr Climie, on your behalf, endorsed the framework outlined in the authorities which
Ms Baxter brought to the Panel’s attention. He stated that he makes no submissions
in relation to misconduct in respect of the Panel’s findings of dishonesty. Mr Climie
invited the Panel to consider whether your behaviour in relation to Urgent Care 24
amounted to misconduct and stated that based upon the authorities outlined, your
behaviour does not fall foul of those principles.

In terms of impairment, Mr Climie invited the Panel to look forward but to take
account of the context of your dishonesty. He stated that based on all the information
available to the Panel, the likelihood of repetition of your dishonesty was ‘incredibly
low’ on any basis. He invited the Panel to take into account your character, based on
the testimonials provided at stage one and stage two. Mr Climie stated that the Panel
can be satisfied that you have always accepted the fact that you made the entries in
the patients’ records. You did so with your partners, in interview, at the outset of this
hearing and during your evidence. Further, he submitted that you accepted that your
behaviour was inappropriate and misleading. He submitted that looking back you
accepted that your behaviour flew in the face of everything you believe in as a
medical practitioner. Mr Climie invited the Panel to consider the limited number,
nature, level and purpose of your misconduct.

The issue of impairment is one for the Panel to determine, exercising its own
judgement. The Panel has considered the need to protect patients and the public, to
maintain public confidence in the profession, and to declare and uphold proper
standards of conduct and behaviour.

The Panel’s attention was drawn to the following relevant judgments:

   •   Cheatle v GMC [2009] EWHC 645 (Admin);
   •   Calhaem v GMC [2007] EWHC 2606 (Admin);
   •   Meadow v GMC [2006] EWCA Civ 1390;

Neither the Medical Act 1983 (as amended) nor the Rules define what is meant by
impaired fitness to practise. However, its meaning was considered by Cranston J in
Cheatle v GMC [2009] EWHC 645 (Admin). He said:


                                                                                        17
       “Impairment of fitness to practise” is a somewhat elusive concept. In her fifth
       Shipman Report …, Dame Janet Smith opined that its advantage was that it
       was capable of embracing the range of problems which the GMC habitually
       encountered, [She] helpfully set out the reasons why a decision-maker might
       conclude that a doctor was unfit to practise or that his fitness to practise was
       impaired. Four reasons recurred in the examples she had examined:

              “… (a) that the doctor presented a risk to patients, (b) that the doctor
              had brought the profession into disrepute, (c) that the doctor had
              breached one of the fundamental tenets of the profession and (d) that
              the doctor’s integrity could not be relied upon. Lack of integrity might
              or might not involve a risk to patients. It might or might not bring the
              profession into disrepute. It might be regarded as a fundamental tenet
              of the profession. I think it right to include it as a separate reason why
              a doctor might be regarded as unfit to practise, because it is relevant
              even when it arises in a way that is quite unrelated to the doctor’s work
              as a doctor. ”

The Panel is of the view that all four elements were applicable in this case.

The Panel has noted the GMC’s publication Good Medical Practice (2001) and
(2006). The latter version states on the opening page:

       “Patients must be able to trust doctors with their lives and well-being. To
       justify that trust, we as a profession have a duty to maintain a good standard
       of practice and care…in particular as a doctor you must:

              Make the care of the patient your first concern…
              Be honest and open and act with integrity…”

Further, paragraph 2, under the heading Good clinical care, states:

       “Good clinical care must include:

              “adequately assessing the patient’s conditions, taking account of the
              history (including the symptoms, and psychological and social factors),
              the patient’s views, and where necessary examining the patient.”

Further, in relation to probity, paragraphs 56 and 57, under the heading Being honest
and trustworthy, it states:

       “Probity means being honest and trustworthy, and acting with integrity: this is
       at the heart of medical professionalism.

       You must make sure that your conduct at all times justifies your patients’ trust
       in you and the public’s trust in the profession.”

The publication contains similar advice in paragraph 63 which states:

                                                                                      18
       You must be honest and trustworthy when writing reports, and when
       completing or signing forms, reports and other documents.”

In reaching a decision as to whether your fitness to practise is impaired, the Panel
followed the two stage process. Firstly, the Panel determined whether the facts
found proved were serious enough to amount to misconduct and secondly, whether
that misconduct amounted to an impairment of your fitness to practise. Not every act
of misconduct necessarily amounts to an impairment of fitness to practise.

Misconduct:
In deciding whether your actions amount to misconduct, the Panel considered the
various relevant paragraphs of Good Medical Practice which you have breached, as
outlined above and the factors outlined in the relevant authorities. In reaching this
decision, it considered your conduct in entering false QOF data into patient records
separately to your conduct in relation to a patient who had taken an overdose and on
another occasion when you absented yourself from Urgent Care 24 whilst on duty.

First, the Panel considered your conduct at Urgent Care 24 in dealing with a patient
who had taken an overdose. The Panel is clear that this was a serious incident. A
patient had taken an overdose but you failed to ascertain the seriousness of the
incident. You did not take any adequate history of the reported overdose. You did not
record the medication consumed by the patient, nor the quantity. You did not record
the time at which the patient had consumed the medication. You did not arrange to
carry out a home visit to see the patient and you did not make any or any adequate
assessment of the patient’s physical and/or mental condition. You have admitted that
these actions were inappropriate, not in the best interests of the patient and not at
the standard expected of a reasonably competent GP. The Panel concluded based
on this, that you have breached fundamental aspects of Good Medical Practice and
that this amounts to misconduct.

Further, in absenting yourself from the base at Urgent Care 24, whilst on duty, to
attend to another employer, the Panel found your actions were inappropriate, not in
the best interests of the patient and not at the standard expected of a reasonably
competent GP. The Panel concluded that based on this you have breached
fundamental aspects of Good Medical Practice which amounts to misconduct.

Second, in relation to your conduct in entering false QOF data into patient records,
the Panel has taken into account that you have admitted that these actions were
inappropriate, not in the best interests of the patient and not at the standard
expected of a reasonably competent GP. You did not admit, but the Panel found in
all but four incidents, that your conduct was dishonest. By entering false data into
patient records, you put patients at risk. Any other clinician responsible for their care
would not have had an accurate medical history. Also, this could have had serious
consequences for some of those patients because it effectively removed them from
the reminder prompts at the practice for medical checks. These checks included
asthma review, depression screening, annual diabetic review, annual epilepsy
review, hypertension, mental health review and psychiatric care planning and stroke
indicators. Moreover, this behaviour was not a single incident. It occurred on a
number of occasions over a period of 4 years. The Panel found that this course of
                                                                                       19
conduct was serious, it puts patients at risk, it has brought the profession into
disrepute, damaged the public confidence in the profession, breached Good Medical
Practice and demonstrated a lack of integrity.

For these reasons the Panel has concluded that your actions and behaviour, in
relation to adding fabricated QOF data to patient records, amounted to misconduct.

Impairment:

The Panel next considered whether your misconduct has the consequence that your
fitness to practise is impaired. In so doing, the Panel took into account the words of
Silber J in the case of GMC v Cohen [2008] EWHC 581 (Admin):

          “It must be highly relevant in determining if a doctor’s fitness to practice is
          impaired that first his or her conduct which led to the charge is easily
          remediable, second that it has been remedied and third that it is highly
          unlikely to be repeated.”

In considering whether your misconduct is remediable, the Panel considered
whether or not you demonstrated any evidence of insight and remediation. The
Panel accepts that at the outset of the proceedings, by your admissions, and in the
course of your oral evidence, you demonstrated some insight. However, you did not
admit that your actions were dishonest, only that you have accepted the Panel’s
findings in this respect. Further, you were unable to explain why you introduced false
data into the patients’ records. Whilst the Panel has seen some evidence of limited
insight, it does not consider that your misconduct has been remedied.

The Panel accepts that other than in respect of the matters in question, you are an
honest person. It has been provided with many testimonials which attest to the high
regard you are held professionally, within your family and within the community. The
Panel has noted your deep remorse, embarrassment, and shame in respect of your
conduct. It recognises that you were a highly respected doctor working at a very
senior level within your practice and within other organisations. The Panel has
therefore concluded that your dishonest behaviour is unlikely to be repeated.

However, doctors occupy a position of privilege and trust in society and are expected
to act with integrity and to uphold proper standards of conduct. The Panel has a
responsibility to protect the public interest. This includes, amongst other things, the
protection of patients, the maintenance of public confidence in the profession and the
declaring and upholding of proper standards of conduct and behaviour.

Your misconduct represented a serious and repeated failure to uphold the proper
standards of conduct and behaviour expected of a registered medical practitioner.
You have shown a disregard of the fundamental tenets of Good Medical Practice
and your misconduct brings the profession into disrepute. The Panel is of the view
that such dishonesty undermines the confidence that the public is entitled to place in
the medical profession, damages its reputation, and shows a marked lack of
integrity. The Panel finds that the level of seriousness of your misconduct relating to
dishonesty, if capable of remedy, has not been remedied.
                                                                                       20
In respect of Urgent Care 24, the Panel has borne in mind that you have made
admissions in relation to these matters. There were investigations by your employer
to which you responded and apologised. You continued to work for them after these
incidents. There has been no evidence of any other incidents relating to the care of
patients. Therefore, it does consider that the action taken by you with regard to your
conduct demonstrated that you had responded appropriately with insight.
Accordingly, the Panel finds that your misconduct in this regard has been remedied.

In all the circumstances, particularly taking into account the need to declare and
uphold standards of conduct and behaviour, the Panel determined that your fitness
to practise is impaired by reason of your misconduct.

The Panel will now invite submissions as to the appropriate sanction, if any, to be
imposed on your registration. Submissions on sanction should include reference to
the Indicative Sanctions Guidance (revised August 2009), using the criteria as set
out in the guidance to draw attention to the issues which appear relevant to this
case.”

Determination on sanction

“Dr Reade

Having determined that your fitness to practise is impaired by reason of your
misconduct, the Panel has now considered what sanction, if any, should be imposed
upon your registration. It has taken account of all of the evidence adduced in this
case including that of Mrs P, together with Ms Baxter’s submissions on behalf of the
GMC and those by Mr Climie on your behalf.

Ms Baxter submitted that the appropriate sanction in this case is, at the least,
suspension. She stated that your dishonesty was serious and persistent and that you
had not gone as far as you should have done in acknowledging this. However, she
observed that by going through this process and hearing someone state the obvious,
namely that your behaviour was dishonest, you may well have gained greater insight
and understanding. She noted that you are a doctor, with years ahead of you in your
medical career. Ms Baxter stated that suspension of your registration, at the very
least, would send a message to you and to those looking in that this type of conduct
is unacceptable.

Mr Climie encouraged the Panel to take account of your deep remorse, considerable
shame and your genuine and full acceptance of your responsibility in respect of
these events. He explained that you instructed him to place your interests at the
bottom of the list in the balancing exercise the Panel will be undertaking, making the
public interest its first concern. Mr Climie acknowledged that your motivation was not
clear but observed that you had gained nothing in consequence of your conduct but
have suffered financial loss, loss of your good name and loss of your reputation.
Further, he stated that you have already been through a period of suspension initially
by the practice and the PCT. On 17 March 2009 interim conditions were imposed on
your registration by an Interim Orders Panel of the GMC.

                                                                                    21
Mr Climie also drew the Panel’s attention to the bundles of excellent testimonials
including one from a director of Urgent Care 24. He reminded the Panel that all the
individuals who wrote the testimonials were aware of the allegation against you. He
pointed out that many were written by senior professional colleagues.

Mr Climie accepted that to take no action in this case would be inappropriate and
invited the Panel to mirror the conditions imposed on your registration by the Interim
Orders Panel. He stated that the imposition of conditions would sufficiently reflect the
need to protect patients and to serve the public interest.

In reaching its decision, the Panel has taken account of the GMC’s Indicative
Sanctions Guidance (2009) and has exercised its own judgement. It has borne in
mind that the purpose of a sanction is not to be punitive, though it may have a
punitive effect. The Panel has applied the principle of proportionality and has
balanced your interests with the interests of the public. The public interest includes
the protection of patients, the maintenance of public confidence in the profession,
and the declaring and upholding of proper standards of conduct and behaviour.

The Panel is mindful of the judgment of Lord Bingham, Master of the Rolls, in the
case of Bolton v Law Society [1994] 1 WLR 512, 517-519, in which he stated:

      ‘” …The reputation of the profession is more important than the fortunes of
      any individual member. Membership of a profession brings many benefits, but
      that is a part of the price.’

The Panel first considered whether it would be sufficient to conclude your case
without taking any action on your registration. By reason of the Panel’s finding of
misconduct based on dishonesty, it has determined that to take no action would be
wholly inappropriate.

The Panel then went on to consider whether a period of conditional registration
would be sufficient. Any conditions must be appropriate, proportionate, workable and
measurable. Given the breaches of Good Medical Practice and your dishonesty, the
Panel does not consider that conditional registration is appropriate because it would
not mark the seriousness of your misconduct. Moreover, this was not a case of
deficient professional performance.

The Panel next considered whether a period of suspension of up to 12 months would
be sufficient. In doing so it considered paragraph 69 of the Indicative Sanctions
Guidance, which states:

       “Suspension has a deterrent effect and can be used to send out a signal to
       the doctor, the profession and public about what is regarded as behaviour
       unbefitting a registered medical practitioner. Suspension from the register also
       has a punitive effect, in that it prevents the doctor from practising (and
       therefore from earning a living as a doctor) during the period of suspension.
       Suspension will be an appropriate response to misconduct which is
       sufficiently serious that action is required in order to protect patients and
       maintain public confidence in the profession. However, a period of suspension
                                                                                     22
      will be appropriate for conduct that falls short of being fundamentally
      incompatible with continued registration and for which erasure is more likely to
      be the appropriate response (namely conduct so serious that the Panel
      considers that the doctor should not practise again either for public safety
      reasons or in order to protect the reputation of the profession). This may be
      the case, for example, where there may have been acknowledgement of fault
      and where the Panel is satisfied that the behaviour or incident is unlikely to be
      repeated. The Panel may wish to see evidence that the doctor has taken
      steps to mitigate his/her actions...”

The Panel went on to consider the aggravating and mitigating factors in this case.

The Panel noted that in behaving as you did, you failed to honour the trust placed in
you in your positions as GP trainer, QOF Lead and Clinical Governance Lead in your
own practice and in the wider NHS. This made your behaviour the more
reprehensible. As the Panel has already announced, doctors occupy a position of
privilege and trust in society and are expected to act with integrity and to uphold
proper standards of conduct.

The Panel accepts that you have acknowledged the seriousness of its findings and it
has noted your deep remorse and shame.

The Panel has been provided with evidence that you have sought professional help
from your XXXXX. The Panel notes that you have engaged with the Department of
Post Graduate General Practice Education, Liverpool University and have taken
steps to address issues of probity. The Panel noted the letter dated 17 August 2010
from Dr Q, a GP and your supporter in the Doctors in Difficulty programme. He
states:

      “My first contact with David was in my supporting role for Doctors in Difficulty
      on behalf of the Department of Post Graduate General Practice Education.
      This was around April 2009 when David started a Back on Track programme.
      He was very receptive to the help offered to him and engaged in a very
      constructive fashion in the whole process. We concentrated on probity as a
      major part of the PDP work. I was so impressed with David that I felt the next
      ideal move for him was to consider the opportunity of joining us as a Senior
      Salary Doctor at our Equitable Access Project at St Helens Hospital. This he
      did initially on a locum basis, which was our arrangement at that time for a
      number of doctors, but on the 1st September 2009 he commenced formal
      salaried employment with us on a BMA contract.

The Panel has been provided with two bundles of testimonials from professional
colleagues, family, friends and your supervisors and noted their contents. They
establish that you are a good doctor and a good clinician. It accepts that, other than
in respect of the matters in question, you are honest. The Panel accepts that your
dishonest behaviour is unlikely to be repeated.

Notwithstanding these mitigating factors, the Panel has a responsibility to protect the
public interest. The Panel considers that you have damaged public confidence in the
                                                                                     23
profession and fallen short of the proper standards of conduct and behaviour
expected of a registered medical practitioner.

However, the Panel has been impressed by the testimonial evidence. It also noted
Ms Baxter’s acknowledgement that the process of this fitness to practise hearing will
have been a very unpleasant and humiliating experience for you and that you may
have needed to undergo that process in order to develop insight. When Ms Baxter
cross examined you about your behaviour, you acknowledged that what you did had
the appearance of dishonesty. The Panel recognises that you will have had difficulty
in coming to terms with what you have done because in all other aspects of your life,
you are held in high regard by your friends and peers. In the light of this, the Panel
has concluded that a period of suspension represents a proportionate and
appropriate sanction. It will send out a message to both the public and the profession
that serious misconduct of this nature is wholly unacceptable.

In determining the period of suspension, the Panel has borne in mind the need to
maintain public confidence in the profession by marking the gravity of your
misconduct on the one hand, and its wish not to deprive the public and your patients
of a competent doctor on the other. The Panel has determined that the appropriate
period of suspension of your registration is six months.

In reaching a decision as to whether to review your case, the Panel has noted that
you have always taken responsibility for your actions, you sought help professionally
and have been working as a salaried GP for the last year. The Panel notes that
during your period of suspension by the PCT for approximately 18 months you were
able to keep your medical knowledge up-to-date. For these reasons, and because
the Panel accepts that you have confronted the reality of your behaviour through the
course of this hearing, it has determined not to review your case.

The effect of this decision is that, unless you exercise your right of appeal, this
decision will take effect 28 days from when written notice of this determination is
deemed to have been served upon you. A note explaining your right of appeal will be
supplied to you.

Having reached the decision to suspend your registration from the Medical Register
for a period of 6 months, the Panel will now invite submissions from both Counsel, in
accordance with section 38(1) of the Medical Act, as to whether your registration
should be suspended with immediate effect.”


Determination on immediate sanction

“Dr Reade:

The Interim Order currently imposed on your registration is hereby revoked.

Having determined that your registration should be suspended for a period of six
months, the Panel has considered in accordance with Section 38 of the Medical Act

                                                                                   24
1983, as amended, whether your registration should be subject to an immediate
order of suspension.

The Panel has noted Ms Baxter’s submissions on behalf of the GMC that the GMC’s
position in this respect is neutral. Mr Climie submitted that an immediate order is not
necessary in this case.

The Panel has determined, given the serious nature of its findings, that it is
necessary to maintain public confidence in the medical profession to make an order
suspending your registration immediately.

The substantive order for suspension, as already announced, will take effect 28 days
from today, unless you lodge an appeal in the interim. If you do lodge an appeal, the
immediate suspension will remain in force until the substantive direction takes effect.

That concludes this case.”



                                      Confirmed

23 September 2010                                                            Chairman




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