Partnership dispute leads to disciplinary investigation

By Dr Kirsa Morganti, Medicolegal Consultant, Medical Protection

GP Dr X contacted Medical Protection after receiving a telephone call from the Performance Management Team at NHS England, advising her that she had been suspended from the Performer’s List and was required to stop working immediately. This was an unexpected call but with the background of an acrimonious partnership dispute.

It transpired her partner had collated information regarding what he considered deficient clinical performance and had submitted this to NHSE. Unfortunately the number of alleged concerns, spanning a range of topics including poor record keeping, unsafe prescribing and inadequate management of chronic diseases, raised sufficient patient safety concerns that NHSE had decided the most appropriate course of action was immediate suspension of Dr X until the concerns could be properly investigated. This was naturally extremely upsetting to Dr X, who was seeking advice on how to challenge the suspension. She had received correspondence by email after the call from NHSE, which had advised her of her right to request an oral hearing to have the suspension reviewed, which she opted for.

How Medical Protection assisted

Dr X was allocated an experienced medicolegal consultant (MLC) at Medical Protection. Due to the extremely distressing events and the perceived urgency of the situation, Dr X had a lengthy telephone conversation with her MLC to discuss her situation. The MLC explained to Dr X the legal basis on which NHSE had taken this action and the prospect of success from an oral hearing to immediately challenge the suspension decision. Such a decision is rarely reversed unless there is a clear indication that the concerns are unjustified, for example the doctor’s identity having been mistaken. 

Dr X conceded that due to the stress of her current partnership situation there was a possibility that her clinical performance may have been adversely impacted. She had also, unfortunately, received several recent patient complaints, lending some credibility to the allegations. There was limited information available regarding the concerns at that time, preventing a detailed analysis of the relevant patient records that may have provided supportive information for Dr X to present. However, Dr X agreed that it was extremely unlikely that she would be able to refute all of the allegations being considered.

It was explained to Dr X that although the suspension may appear deeply punitive, it was in fact a financially supportive action that had been taken by NHSE. Under the legislation, a doctor is entitled to suspension payments from NHSE to ensure they are not financially disadvantaged by a suspension. A risk to challenging a suspension decision includes NHSE amending the suspension to conditions attached to the doctor’s inclusion on the Performer’s List. Such conditions, which may include direct supervision of the doctor’s work, may in effect prevent any work as a GP, with no financial protection afforded.

It was clear to the MLC, also a qualified doctor, that Dr X herself was unwell and this was explored sensitively during the call. Dr X was signposted to suitable support including contact with her GP and the Practitioner Health Programme. The MLC offered to correspond with NHSE on Dr X’s behalf regarding both the suspension and arrangements for her to receive suspension payments, removing that additional stress from Dr X so she could focus on receiving help for her health prior to engaging in a disciplinary process with NHSE. Dr X was also signposted to contact her local LMC to seek their assistance with her partnership difficulties. 

Outcome

Dr X remained suspended for a number of months. During this time, she received treatment for her health, leading to a full recovery that enabled her to carefully review all the concerns that had been raised regarding her performance. NHSE provided details of the patient records that required her review prior to her providing a detailed response on the concerns that had been raised. Dr X worked closely with her MLC to provide a detailed response that demonstrated the insight and learning that she had achieved since the concerns had been first raised. Dr X also attended an interview with the NHSE clinical adviser for her case, accompanied by her MLC. Following this, her response was amended to ensure it included sufficient detail regarding all of the topics raised as being of particular concern to NHSE by the clinical adviser.

Dr X’s case was reviewed by the Performer’s List Decision panel after receipt of her submission in relation to the concerns. It was recognised by NHSE that the concerns were raised in the context of a difficult partnership relationship and attention was focused on the clinical concerns that NHSE had been able to substantiate from the medical records. Dr X had demonstrated appropriate insight into those clinical failings and, with the support of her MLC, had completed relevant and applicable CPD to remediate.

By this point, Dr X’s health was such that she was anxious to return to work. Her partnership issues had improved after mediation, with Dr X recognising that her poor health leading up to the suspension decision had created a vicious cycle of poor decision making on her part which had increased the stress and workload upon her partner, resulting in a further deterioration in their relationship.

After reviewing Dr X’s submission, NHSE were agreeable to lifting the suspension, enabling Dr X to return to work under conditions that included supervision. This required her to meet with an approved GP colleague once a fortnight to have case-based discussions. The supervisor also submitted supervision reports regarding Dr X until such time NHSE were reassured she was safe to practise without ongoing conditions.

Almost 18 months after the initial telephone call suspending her, Dr X had all conditions lifted and was able to resume practice as an independent GP.

Learning points and discussion

The initial reaction to news of a suspension is understandably to challenge this. However, doctors have a professional obligation to ensure their clinical performance is maintained at a satisfactory level and not adversely affected by their health. Immediate contact with Medical Protection ensured Dr X did not harm her position further by seeking to object to the suspension, demonstrating a lack of insight into her clinical deficiencies. Her close contact with her MLC ensured she was supported throughout a difficult disciplinary process to achieve a satisfactory conclusion and appropriately signposted to assistance for her health and partnership difficulties.

This case occurred before the COVID-19 pandemic. In line with restrictions around the world, Medical Protection teams are not currently able to provide face-to-face assistance to members in person, as demonstrated in this case, but we are committed to continuing the same levels of support and reassurance via virtual means. Many members have already commented positively on this approach, which has saved on the time and disruption caused by lengthy travel.