GP erased for lack of insight and poor performance
A doctor’s name was erased from the medical register by a Fitness to Practise Panel following persistent poor performance which the doctor made no attempt to rectify.
Between 1977 and 2003, the doctor worked as a general medical practitioner before retiring from the NHS and working as a private medical practitioner.
In April 2003, an assessment team appointed by the GMC carried out an assessment of the doctor’s performance.
It found that his performance was unacceptable in relation to one area of the GMC’s guidance Good Medical Practice (GMP) – record keeping – and a cause for concern in three areas. It concluded that his performance was deficient, but was likely to be improved by remedial action.
The GMC prepared a Statement of Requirements which identified the remedial actionto be taken and which the doctor agreed with.
A second assessment of the doctor’s performance took place in December 2005. It found that his performance was unacceptable in relation to three areas of GMP – record keeping, constructive participation in audit, assessment and appraisal, and working within laws and regulations – and a cause for concern in five areas. It concluded that his performance remained deficient, was unlikely to be improved by further remedial action, and recommended that he should cease professional practice.
The Panel acknowledged that there had been no suggestion that the doctor had harmed patients or put patients at risk of harm. However, it was concerned that the deterioration of his performance between the two assessments presented a risk to patients. The Panel also noted that as the doctor had not practised since December 2005, it was likely that he had become further de-skilled.
Good Medical Practice (May 2001) states:
‘You must keep your knowledge and skills up to date throughout your working life. In particular, you should take part regularly in educational activities which maintain and further develop your competence and performance.’
The Panel noted that the doctor referred to his first assessment as basic and elementary. When asked by the assessors to comment on his performance in the second assessment, he said that it had been ‘a piece of cake’. He had, however, performed poorly. The doctor informed the Panel that he did not take the assessment seriously. The Panel concluded that these comments indicated the doctor’s serious lack of insight into the deficiencies of his performance. It noted that GMP states:
‘You must co-operate fully with any…complaints procedure which applies to your work. You must give, to those who are entitled to ask for it, any relevant information in connection with an investigation into your own, or another healthcare professional’s conduct, performance or health.’
The doctor informed the Panel that he was aware of the requirements of Good Medical Practice but as an experienced doctor he did not always consider it necessary to follow this guidance and had devised ‘short cuts’ to manage patients more efficiently.
The Panel accepted the findings that there were serious deficiencies across a broad range of areas in the doctor’s practice. It was concerned about his failure to comply with several fundamental principles of GMP and that he had made little attempt to address the deficiencies identified or comply with the Statement of Requirements. It considered that this demonstrated a lack of insight and a failure to co-operate with his regulatory body. It concluded that the doctor’s fitness to practise was impaired.
The Panel did not doubt that it might be possible by intensive training to remedy some of the deficiencies in the doctor’s practice. However, it concluded that the doctor’s lack of insight was part of a persistent, deep seated attitudinal problem that had been evident for more than five years, and that he did not appreciate the standard of performance required of a general medical practitioner.
The Panel determined that it was proportionate and in the public interest that the doctor’s name be erased from the medical register.