The High Court in the appeal case of Dr Belal v GMC  EWCA 2859 (Admin) has upheld a decision of the General Medical Council (GMC) to erase a doctor’s name from the register, who breached a Conditions of Practice Order made by an Interim Orders Tribunal (IOT). The doctor applied for work abroad and failed to inform the GMC that he had done so. In accordance with the conditions imposed upon him by the GMC he was obligated to inform the GMC that he was applying for work overseas.
The IOT Conditions of Practice were imposed in the following terms:
“1. You must notify the GMC promptly of any professional appointment you accept for which registration with the GMC is required and provide the contact details of your employer and PCT on whose Medical Performance List you are included.
2. You must allow the GMC to exchange information with your employer or any organisation for which you provide medical services.
3. You must inform the GMC of any formal disciplinary proceedings taken against you, from the date of this determination.
4. You must inform the GMC if you apply for medical employment outside the UK.
5. You must confine your medical practice to work at the NHS general practice where you are currently a General Practice Principal.
6. You must not undertake any locum posts.
7. You must not undertake any out-of-hours work or on-call duties for an out-of-hours or deputising service. This does not preclude you from out-of-hours care of patients in your own practice.
8. You must not carry out any private practice other than for patients who are patients of your own practice.
9. You must inform the following parties that your registration is subject to the conditions listed at (1) to (8) above. (a) Any organisation or person employing or contracting with you to undertake medical work. (b) The PCT in whose Medical Performance List you are included, or seeking inclusion (at the time of the application).”
The doctor had sought to work outside of the UK and had not informed the GMC that he was doing so. The appeal court judge, Lloyd Jones J, determined that:
“The fact that the GMC became aware of his application
at a relatively early stage was entirely fortuitous, was due to the
suspicions of Dr. U. and was not brought about in any way by Dr.
Belal. Furthermore, it was far from a technical breach. The purpose of
the condition was to ensure that the GMC was aware in advance of any
application for medical appointment outside the United Kingdom so that
it would be able to notify the relevant authorities in the State
concerned of the true position in relation to Dr. Belal’s registration.
Dr. Belal’s conduct undermined the safeguard which the condition was
intended to create.”
The doctor also appealed (within the same appeal) to the High Court on a number of additional appeal grounds, which concerned other additional GMC allegations and GMC findings of serious deficient performance. The appeal court judge made some modifications to the overall determinations on certain of those other matters but upheld the erasure sanction because it was deemed proportionate in light of the overall evidence against the doctor. [Read the full Law Report (External Link)]
Discussion: A doctor is obligated to adhere to all of the Conditions of Practice that a GMC panel imposes, otherwise they risk suspension or erasure. Any breach of Conditions will increase the risk of a more serious interim or final-order sanction being imposed, if the relevant GMC panel forms the view that the doctor can no longer be trusted to work to Conditions. The GMC panel will be required to look at all cases on their own facts, in forming a view as to the doctor’s willingness to comply with Conditions.
GMC panels are aware that errors do occur, in good faith, on occasions, for which a doctor should not be penalised for what is an innocent mistake. Nevertheless, where it can be shown that the doctor intentionally ignored a Conditions of Practice Order, or that the doctor was wholly irresponsible and reckless in failing to ensure that the Conditions were complied with, then there is a considerable risk that a doctor’s career will come to an end because they cannot be trusted. Probity is considered to be a central tenet of the practice of medicine and it therefore goes to the heart of any doctor’s suitability to practise, and their ability to demonstrate that they can work to the letter of the law and policy. A doctor needs to demonstrate that they are a safe practitioner, so that the public can have ongoing confidence in them. Conditions do not have to last for a doctor’s lifetime career. Conditions will be subject to review from time to time and may only continue to be imposed where on the evidence (as submitted by both the GMC and the doctor) that Conditions are necessary.
Conditions of Practice (restrictions on practice) can be imposed by an Interim Orders Tribunal or a fitness to practise panel. Doctors must ensure that they at all times work to the letter of the Conditions otherwise they will be considered to be in breach. Conditions of Practice may be imposed in relation to clinical or other work, or in relation to a doctor’s private life (for example, to abstain from consuming alcohol, in health-related cases).
If you are a doctor who has breached Conditions or who wishes to interpret the scope of a condition then you might take legal advice at the earliest opportunity, so as to protect your position. Doctors Defence Service can represent doctors at GMC hearings and advise doctors on GMC Conditions of Practice Orders generally, including the interpretation of the terms of the Conditions and the scope of such an Order in the public and private clinical arenas, and in their private life.
[Article by Doctors Defence Service 18 November 2011]
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