PUBLIC RECORD. Record of Determinations Fitness to Practise Panel. Dates 07 May May Medical Practitioner. Dr John Stanley Partington

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1 PUBLIC RECORD Dates 07 May May 2015 Name of Medical Practitioner Dr John Stanley Partington Primary medical qualification MB BS 1987 University of Newcastle upon Tyne GMC reference number Type of case Review - Misconduct Review - Deficient professional performance Summary of outcome Conditions, 18 months. Review hearing directed Outcome on impairment Not Impaired Impaired Panel Lay Panellist (Chair) Lay Panellist Medical Panellist Legal Assessor Secretary to the Panel Mr Brian Alderman Mr John Ennis Dr Candida Borsada Mr Iain Harris Ms Angela Carney Attendance and Representation Medical Practitioner Medical Practitioner s Representative GMC Representative Present and not represented N/A Ms Kathryn Johnson, Counsel Attendance of Press / Public The hearing was all heard in public. 1

2 Determination on Impairment Dr Partington: Background 1. In November 2014 you appeared before a fitness to practise Panel hearing in relation to your misconduct and deficient professional performance. Misconduct 2. The 2014 Panel found that you failed to obtain medical indemnity insurance cover for work carried out by you as a sessional General Practitioner between March 2011 and January That Panel found that your actions fell well below the standard expected of a registered medical practitioner, were in breach of a fundamental tenet of the medical profession and amounted to serious misconduct. The 2014 Panel was concerned that you showed little insight as to the serious nature of your misconduct, mentioning nothing about patients or patient safety. It found that you did not demonstrate any insight or offer any explanation regarding the implications of your actions. You also failed to provide that Panel with any reflection on the impact your actions would have had upon the Practice. 3. The 2014 Panel acknowledged that during the hearing you had admitted the seriousness of your repeated failure to have proper indemnity insurance cover. However, it was concerned by the prolonged period that you did not have indemnity cover and by your failure to offer an apology for your actions. Deficient Professional Performance 4. Between October and November 2013 you underwent an assessment of your professional performance. Your performance was found to be unacceptable in the areas of assessment and treatment and to be cause for concern in the areas of record keeping, maintaining Good Medical Practice (GMP) and working with colleagues. 5. With regard to the deficient professional performance element of the allegation, the Panel found insufficient evidence of remediation or motivation and that you had failed to provide evidence of any substantial work on your part to address the issues raised. 6. The 2014 Panel concluded that your fitness to practise was impaired both by reason of your misconduct and deficient professional performance and imposed a six month suspension on your registration. 7. The 2014 Panel recommended that a Panel reviewing your case would be assisted by receiving: 2

3 A targeted Personal Development Plan (PDP) to address the performance deficiencies raised in the performance assessment; A complete record of CPD which may include certificates and proof of courses undertaken, a log of your professional reading with notes of your reflections on this, and/or a reflective diary to provide a commentary on how effective and helpful your CPD is; Reports from any professional colleagues, trainers or mentors regarding your progress and engagement with the remediation process; Testimonials which may be personal or professional; and Any other supporting documentation or information which you feel is relevant 8. This Panel has noted your PDP which identifies the areas of prescribing to alcohol and drug dependent patients, risk assessment of depressed patients, sexual health and reproductive health issues, support in addressing professional development issues and safeguarding children. 9. The Panel has also noted your learning diary which records your Continuing Professional Development (CPD) carried out by e-learning and attending courses. As part of your CPD you attended a 6 hour GP Update course. You have also provided three Significant Event Reports describing and analysing the index events. 10. The Panel has seen the letter dated 11 March 2015 from Dr A, Head of Continuing Practice at Health Education North East, in which he confirmed that he had met with you on one occasion, 22 January At that meeting he offered the assistance of a local GP Tutor. He also confirmed that you are receiving support from Dr B, Gateshead GP Tutor. He stated that at the meeting you appeared to be sincere, engaged fully, reflective and willing to meet the demands being placed upon you the best you could. 11. The Panel has noted the two reports dated March 2015 and 22 April 2015 from Dr B, in which she confirms that she has met with you on three occasions, 12 February 2015, 18 March 2015 and 22 April In her March report Dr B stated that you have completed 21.5 hours of CPD, attended the GP update course and focused your other learning on topics that were highlighted as deficient in the original hearing. In her April 2015 report Dr B stated that there were no new learning events to discuss since your meeting on 18 March She stated that you planned to undertake e-modules on safeguarding children in the next couple of weeks and provide the Panel with the certificates of the completed modules. She also stated that at your meeting in March 2015 you had discussed writing some of the previous complaints/issues using the Significant Event Analysis SEA template, but had not done so at that time. She confirmed that your next meeting is scheduled for 3 June

4 Oral Evidence 12. In your oral evidence you stated that following your 2014 fitness to practise hearing you were initially reluctant to seek assistance and had not contacted Dr A until January You said that the delay in contacting Dr A was because you were coming to terms with your suspension. You told the Panel that you had done your best to target the areas of deficiency identified but conceded you could have done more. You referred the Panel to your PDP and said that it would normally be carried out over a year but you have completed four out of the five objectives in four months. You confirmed to the Panel that the last CPD episode you did was in March 2015 since when you have been on holiday and preparing for this hearing. You also stated that you have found it difficult to attend certain courses due to distance and financial constraints. 13. You said that during your suspension you have contacted medical charities to offer assistance. However, most of the charities you contacted required unrestricted GMC registration. You stated that you contacted the Prostate Cancer UK charity some time ago and have recently been contacted by them. 14. You told the Panel that in the past you have found it difficult to engage with appraisal and new computerised systems as you were too busy, set in your ways or had an attitudinal problem. You said that with the support you have received in the last six months you now have enthusiasm to return to work in order to use your skills and knowledge. 15. You told the Panel that you are aware that you have not been in clinical practice for almost two and a half years and that you accept that you will need to undergo re-training before returning to unrestricted practice. 16. With regard to your misconduct relating to your failure to obtain medical indemnity insurance you told the Panel that following your fitness to practise hearing and in retrospect you realise that it was a very stupid thing to do. You said that you now recognise that it put both patients and the practice at risk. You said that at the time you were only thinking of yourself which was completely wrong and that you fully regret your actions. You said that you recognised that it was good medical practice to have insurance and you would you never practise in the future without insurance. However, you recognise that it may now be difficult to get insurance. You told the Panel that you now recognise that having insurance is your personal responsibility. Submissions 17. Ms Johnson, on behalf of the GMC, submitted that your fitness to practise remains impaired by reason of your misconduct and deficient professional performance. She submitted that your misconduct was a matter for the Panel. She said that you had not demonstrated fully how you have improved or reflected on 4

5 previous matters. In relation to your deficient professional performance she said it was a significant fact that you have not been in clinical practise for two and a half years and that you accepted that you would require a period of retraining before returning to clinical practice. 18. You told the Panel that you are aware that you have not practised for two and a half years so that it was difficult to argue that you are not impaired. You accepted that retraining would be necessary and appropriate before returning to unrestricted practise and having retrained you could demonstrate your fitness to practise at a later date. The Panel s Decision 19. In reaching its decision on impairment the Panel has exercised its own independent judgment. Misconduct 20. The Panel noted in your oral evidence you told the Panel that at the last hearing you did not have proper insight into your misconduct. Today you acknowledged the risk to patients and the practice and recognised the importance of the principles of Good Medical Practice. The Panel considers that you have reflected on the implications for patients, the practice and yourself and demonstrated insight and remorse. The Panel considers that your misconduct is remediable and is unlikely to be repeated. Accordingly, the Panel finds your fitness to practise is not currently impaired by reason of your misconduct. Deficient Professional Performance 21. The Panel has noted that the GMC Performance Assessment Team, in October and November 2013 and the Fitness to Practise Panel in November 2014 found your performance to be unacceptable in the areas of Assessment and Treatment. They also found cause for concern in the areas of Record Keeping, Maintaining Good Medical Practice and Working with Colleagues. The 2014 Panel found that some of the areas of concern had been partially addressed but there was too little evidence before it to demonstrate sufficient insight into your shortcomings and that not enough had been done to address them. 22. Since the previous hearing the Panel has noted that you have sought advice and support from Health Education North East (HENE). However, it is concerned that you did not contact HENE until January You told the Panel that you were coming to terms with your suspension. The Panel has noted that you have produced a PDP. You are working to complete the agreed actions and goals and have already completed 21.5 hours of CPD. 5

6 23. The Panel is encouraged by the reports from Dr B. However it noted in her letter dated 22 April 2015 she stated that you planned to undertake e-modules on safeguarding children and to produce the certificates at this hearing. She went on to record that this had not been done. You did not produce such certificates to the Panel. 24. The Panel considers that you have developing insight into the deficiencies identified in your practise but those deficiencies have not yet been fully remediated. The Panel also noted that you have not been in clinical practice for almost two and a half years and that you recognise a period of retraining will be necessary before returning to unrestricted practise. It considers that patients would not be protected and public confidence in the profession would not be maintained should a finding of impairment not be made. 25. In the circumstances, the Panel has determined that your fitness to practise is impaired by reason of your deficient professional performance. Determination on Sanction Dr Partington: 1. Having determined that your fitness to practise is impaired by reason of deficient professional performance, the Panel has now considered what action, if any, it should take with regard to your registration. 2. In so doing, the Panel has given careful consideration to all the evidence adduced, together with Ms Johnson s submissions on behalf of the General Medical Council (GMC) and those made by you. Submissions 3. Ms Johnson submitted that the appropriate sanction in your case is conditions. She stated that conditions will enable you to safely work towards unrestricted practice. She further stated that it is fair to recognise the progress you have made and that you have developed some insight into your deficiencies. 4. You submitted that you will need a period of retraining before returning to unrestricted practice and agreed that conditions would be the appropriate sanction to enable you to do so safely. The Panel s Approach 5. The decision as to the appropriate sanction to impose, if any, in this case is a matter for this Panel exercising its own judgement. 6

7 6. In reaching its decision, the Panel has taken account of the GMC s Indicative Sanctions Guidance (revised 2014) (the ISG). It has borne in mind that the purpose of the sanctions is not to be punitive, but to protect patients and the wider public interest, although they may have a punitive effect. 7. Throughout its deliberations, the Panel has applied the principle of proportionality, balancing your interests with the public interest. The public interest 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. The Panel s Decision 8. In coming to its decision as to the appropriate sanction, if any, to impose in your case, the Panel first considered whether to conclude the case by taking no action. The Panel determined that in view of the Panel s findings on impairment, it would be neither sufficient, proportionate nor in the public interest, to conclude this case by taking no action. 9. The Panel next considered whether it would be sufficient to impose conditions on your registration. It has borne in mind that any conditions imposed would need to be appropriate, proportionate, workable and measurable. 10. The Panel has noted paragraphs 56 and 62 of the ISG which state: 56 Conditions are likely to be appropriate where the concerns about the doctor s practice are such that a period of retraining and/or supervision is likely to be the most appropriate way of addressing them. 62. When deciding whether conditions might be appropriate the Panel will need to satisfy itself that most or all of the following factors (where applicable) are apparent having regard to the type of case...this list is not exhaustive: -Identifiable areas of the doctor s practice in need of assessment or retraining. - Potential and willingness to respond positively to retraining, in particular evidence of the doctor s commitment to keeping his/her knowledge and skills up to date throughout his/her working life, improving the quality of his/her work and promoting patient safety... - Patients will not be put in danger either directly or indirectly as a result of conditional registration itself. 7

8 - It is possible to formulate appropriate and practical conditions to impose on registration. 11. The Panel considers that you have developing insight into your deficient professional performance and that you are making progress to address those deficiencies. The Panel is satisfied that you have a positive attitude towards remediation and are motivated to return to safe practice. 12. The Panel has concluded that it is appropriate, necessary and proportionate to impose conditions on your registration for a period of 18 months. An order of conditions will protect patients and maintain confidence in the profession. It considers that the period of 18 months will provide you with sufficient time to retrain, to return to safe practice and undergo a Performance Assessment should the GMC deem it necessary. The Panel considers that nothing would be gained by imposing a further period of suspension. 13. The following conditions relate to your employment and will be published: 1. You must notify the GMC promptly of any post you accept for which registration with the GMC is required and provide the GMC with the contact details of your employer and the NHS England Area Team on whose Medical Performers List you are included, or the local Health Board/Health & Social Care Board if employed in Scotland, Wales or Northern Ireland. 2. At any time that you are providing medical services, which require you to be registered with the GMC, you must agree to the appointment of a workplace reporter nominated by your employer, or contracting body, and approved by the GMC. 3. You must allow the GMC to exchange information with your employer or any contracting body for which you provide medical services. 4. You must inform the GMC of any formal disciplinary proceedings taken against you, from the date of this determination. 5. You must inform the GMC if you apply for medical employment outside the UK. 6. You must work with your responsible officer (or their nominated deputy), to fulfil the requirements in your Personal Development Plan and to remedy any omissions. In particular, you should address the deficiencies in the following areas of your practice: a. assessment b. treatment 8

9 c. record keeping d. maintaining Good Medical Practice e. working with colleagues. 7. You must meet with your responsible officer (or their nominated deputy) on a regular basis to discuss your progress towards achieving the aims set out in your Personal Development Plan. The frequency of your meetings is to be set by your responsible officer (or their nominated deputy). 8. You must allow the GMC to exchange information about the standard of your professional performance and your progress towards achieving the aims set out in your Personal Development Plan with your responsible officer (or their nominated deputy), and any other person involved in your retraining and supervision. 9. At any time that you are employed, or providing medical services, which require you to be registered with the GMC, you must place yourself and remain under the supervision of an educational supervisor, as agreed by the GMC. 10. You must undertake an assessment of your performance, at a date specified by the GMC, unless notified by the GMC that this assessment is not necessary. 11. You must disclose the Assessors Report of the assessment of your professional performance to: a. Any current and prospective employers or contracting body, (at the time of application) b. The NHS England Area Team in whose Medical Performers List you are included or are seeking inclusion (at the time of application), or the local Health Board/Health & Social Care Board, if employed in Scotland, Wales or Northern Ireland c. Any other individual involved in your retraining and supervision. 12. You must obtain the approval of the GMC before accepting any post for which registration with the GMC is required. 13. You must confine your medical practice to posts within the National Health Service and not undertake any private practice. 9

10 14. You must confine your medical practice to general practice posts where your work will be supervised by a named GP Trainer. 15. You must not undertake any locum posts of less than two months duration. 16. You must inform the following parties that your registration is subject to the conditions, listed at 1 to 15, above: a. Any organisation or person employing or contracting with you to undertake medical work b. Any locum agency or out-of-hours service you are registered with or apply to be registered with (at the time of application) c. In the case of locum appointments, your immediate line manager at your place of work (at least 24 hours before starting work) d. Any prospective employer or contracting body (at the time of application). e. The NHS England Area Team in whose Medical Performers List you are included, or seeking inclusion (at the time of application), or the local Health Board/Health & Social Care Board if employed in Scotland, Wales or Northern Ireland. f. Your responsible officer (or their nominated deputy) 14. Shortly before the end of the period of conditional registration, your case will be reviewed by a Fitness to Practise Panel. A letter will be sent to you about the arrangements for the review hearing. At this next hearing, the Panel reviewing your case will wish to be assured that you have addressed all your shortcomings. The future review Panel may be assisted by the following information: Report(s) from your educational supervisor Report(s) from your responsible officer (or deputy) Evidence that you have addressed the areas of deficiencies identified in the 2013 Performance Assessment Report Evidence that you have kept your medical knowledge and skills up to date Evidence of your Continuing Professional Development Testimonials from professional colleagues Any other supporting documentation or information which you feel is relevant 15. The effect of this direction is that unless you exercise your right of appeal, these conditions will take effect on 9 June 2015 when the current period of suspension expires. 10

11 16. That concludes this case. Confirmed Date 08 May 2015 Mr Brian Alderman, Chair 11

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