PUBLIC RECORD - MPTS · 2020-03-05 · Record of Determinations – Medical Practitioners Tribunal...

Record of Determinations –

Medical Practitioners Tribunal

MPT: Dr ABBASI 1

PUBLIC RECORD Dates: 03/06/2019 - 20/06/2019 and 10/12/2019 - 12/12/2019

Medical Practitioner’s name: Dr Shakeel ABBASI

GMC reference number: 4688178

Primary medical qualification: MB BS 1992 University of Punjab (Pakistan)

Type of case Outcome on impairment New - Misconduct Impaired

Summary of outcome

Suspension, 4 months. Review hearing directed

Tribunal:

Legally Qualified Chair Mr Rob Ward

Lay Tribunal Member: Mr Peter Scofield

Medical Tribunal Member: Dr Candida Borsada

Tribunal Clerk: Mr Edward Kelly

Attendance and Representation:

Medical Practitioner: Present and represented

Medical Practitioner’s Representative: Mr Jonathan Storey, Counsel, instructed by The Law Firm Solicitors

GMC Representative: Mr Terence Rigby, Counsel

Attendance of Press / Public In accordance with Rule 41 of the General Medical Council (Fitness to Practise) Rules 2004 the hearing was held in public. Overarching Objective Throughout the decision making process the tribunal has borne in mind the statutory overarching objective as set out in s1 Medical Act 1983 (the 1983 Act) to protect,



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promote and maintain the health, safety and well-being of the public, to promote and maintain public confidence in the medical profession, and to promote and maintain proper professional standards and conduct for members of that profession. Determination on Facts - 20/06/2019 Background 1. Dr Abbasi qualified in 1994 and prior to the events which are the subject of the hearing Dr Abbasi was a practising GP Partner at Nye Bevan House Surgery, Rochdale, (‘the Surgery’), a post he held since 2011. 2. There are various allegations against Dr Abbasi centring around three incidents and a complaint regarding fictitious appointments allegedly created by Dr Abbasi. 3. On the morning of 31 December 2014, Dr Abbasi held a telephone consultation with Patient A, regarding facial swelling and fever symptoms, before concluding his daily morning surgery at the practice and leaving to carry out home visits. Patient A later came to the Surgery and was treated on the basis that she was suffering from anaphylactic shock. She was given oxygen, adrenaline, prednisolone and Piriton, before receiving intravenous hydrocortisone by ambulance staff, taking her to Fairfield General Hospital. It is alleged that Dr Abbasi failed in his care of Patient A. 4. On 22 May 2015, following suspension from clinical practice, but not from his responsibilities as a partner at the Surgery, Dr Abbasi is alleged to have gone to the Surgery and confronted a locum GP, Dr B. Dr Abbasi is said to have been rude and aggressive to Dr B. Dr B raised this issue with the Practice Manager, Mrs C and the matter was subsequently reported to NHS England and the GMC. 5. It is alleged that on 28 September 2017 Dr Abbasi went to the Surgery with a number of cheques and was then aggressive to Miss D before grabbing her head with both hands and shaking it. Miss D formally complained the next day to the GMC. 6. Following many months of management disputes at the Surgery between the partners, Dr Abbasi and Dr E, Mrs C began keeping a log of Dr Abbasi’s use of the Surgery computer appointment system, EMIS. Mrs C alleged that Dr Abbasi was misusing the computer system and inventing appointments in order to inflate his own hours and work productivity. The Outcome of Applications Made during the Facts Stage 7. The Tribunal determined to allow expert report evidence from the GMC, under Rule 34(1) of the GMC Fitness to Practise Rules 2004, as amended (‘the Rules’). The Tribunal’s full decision on the application is included at Annex A.



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8. The Tribunal determined to grant the GMC’s application, made pursuant to Rule 17(6) of the Rules to amend the Allegation. The Tribunal’s full decision on the application is included at Annex B. 9. The Tribunal determined to grant Dr Abbasi’s application, made pursuant to Rule 17(6) of the Rules to amend the Allegation. The Tribunal’s full decision on the application is included at Annex C. The Allegation and the Doctor’s Response 10. The Allegation made against Dr Abbasi is as follows:

1. On 31 December 2014, whilst working as a GP partner at Nye Bevan House (‘the Surgery’), you consulted with Patient A by telephone and you failed to take appropriate urgent action, in that you did not:

i. call Patient A an ambulance; To be determined

ii. advise Patient A to call an ambulance; To be determined

iii. advise Patient A to urgently attend Accident and Emergency; To be determined

iv. ensure that you were present at the Surgery upon Patient A’s arrival at the surgery; To be determined

v. ensure that you directly delegated the medical assessment of Patient A to Dr B. To be determined

2. On one or more dates as set out in Schedule 1 you: a. added a patient to your appointment list; Admitted and found

proved

b. changed the appointment status; Admitted and found proved c. made a corresponding entry in the patient’s medical records.

Admitted and found proved

3. On 22 May 2015 you approached Dr B and: a. stood very close to her; To be determined

b. spoke rudely and loudly towards her; To be determined



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c. refused to move away from her when she asked you to; To be

determined d. waved your finger aggressively at her To be determined

4. On 28 September 2017 you:

a. spoke to Miss C in an aggressive tone; To be determined

b. made a phone call in Miss C’s presence and said that Miss C was

refusing you entry to the surgery, or words to that effect; Admitted and found proved

c. grabbed Miss C’s head with both hands; To be determined

d. dug your fingers into Miss C’s head; To be determined e. shook Miss C’s head up and down. To be determined

5. When you: a. carried out the actions referred to at paragraph 2 you knew:

i. the appointments as set out in Schedule 1 were not

genuine; To be determined

ii. the information in the medical records as set out in Schedule 1 was untrue; To be determined

b. made the phone call referred to at paragraph 4b you knew Miss C had

not refused you entry to the surgery. To be determined

6. Your conduct as described in paragraphs 2 and 4b above was dishonest by reason of paragraph 5. To be determined

The Admitted Facts 11. At the outset of these proceedings, Dr Abbasi made admissions to some paragraphs and sub-paragraphs of the Allegation, as set out above, in accordance with Rule 17(2)(d) the Rules. In accordance with Rule 17(2)(e), the Tribunal announced these paragraphs and sub-paragraphs of the Allegation as admitted and found proved.



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The Facts to be Determined 12. In light of Dr Abbasi’s response to the Allegation made against him, the Tribunal was required to determine whether Dr Abbasi acted in the manner alleged. Factual Witness Evidence 13. The Tribunal received evidence in person, on behalf of the GMC, from the following witnesses:

• Mrs C, Practice Manager at the Surgery; • Miss D, former receptionist at the Surgery; • Mr F, Health Care Assistant (‘HCA’) at the Surgery;

• Miss G, receptionist at the Surgery; • Dr E, Partner GP at the Surgery; • Dr B, former Locum GP at the Surgery.

14. Dr Abbasi gave oral evidence at the hearing and provided a witness statement dated 16 May 2019. 15. The Tribunal received evidence in person, on behalf of Dr Abbasi, from the following witnesses:

• Mrs H, Dr Abbasi’s wife; • Miss I, former receptionist at the Surgery; • Miss J, former receptionist at the Surgery;

• Miss K, former receptionist at the Surgery; • Miss L, former Practice Nurse at the Surgery.

Expert Witness Evidence 16. Dr M, GMC Expert, gave evidence in person and provided two reports for the Tribunal, dated 14 June 2018 and 19 April 2019. Documentary Evidence 17. The Tribunal had regard to the documentary evidence provided by the parties. This evidence included, but was not limited to:

• Witness statement of Mrs C, dated 28 March 2019; • Witness statement of Mr F, dated 8 April 2019; • Witness statement of Dr B, dated 20 June 2018; • Witness statement of Miss D, dated 8 March 2018;

• Witness statement of Miss G, dated 7 March 2018; • Witness statement of Dr E, dated 19 February 2018;



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• Grievance letter from Mrs C to Dr E, dated 6 July 2015; • Significant Event Record sheet (re: Patient A), dated 31 December 2014; • Timeline of events (re: Patient A), dated 31 December 2014;

• Screen shots of patient records, various dates; • Statements of Mr F for NHS England investigation, dated 18 September 2015

and 2 October 2015; • Mr F’s contract of employment at the Surgery, dated 15 June 2013; • Statement of Dr B’s notes of recollections regarding incident of 22 May 2015,

undated; • Anonymous complaint regarding Dr Abbasi sent to GMC, undated; • Complaint regarding Dr Abbasi sent to the GMC by Dr E, dated 6 July 2015; • Complaint regarding Dr Abbasi sent to the GMC by Miss D, dated 29

September 2017; • NHS England report to the Performance Advisory Group regarding concerns

into Dr Abbasi, dated 4 December 2015; • Conclusion of Performers List Decision Panel (‘PDLP’), dated 21 July 2016; • GMC Expert report of Dr M, dated 14 June 2018; • Statement of Dr Shakeel Abbasi for NHS England, 29 October 2015; • Minutes of NHS England Professional Affairs Meeting, dated 29 October 2015;

• Patient A’s records, dated 31 December 2014; • Curriculum Vitae of Dr Shakeel Abbasi, current; • Exhibits of Dr Shakeel Abbasi, various dates; • Witness statement of Mrs H, dated 15 May 2019; • Exhibits of Mrs H, various dates;

• Witness statement of Miss J, dated 16 May 2019; • Witness statement of Miss N, dated 18 May 2019; • Witness statement of Miss O, dated 20 May 2019; • Witness statement of Miss I, dated 18 May 2019; • Witness statement of Miss P, undated;

• Witness statement of Miss K, dated 14 May 2019; • Witness statement of Miss L, dated 20 May 2019; • Papers relating to Patient A, various dates; • Witness statement of Miss D, undated; • Audio File and Transcript, various dates;

The Tribunal’s Approach 18. In reaching its decision on facts, the Tribunal has borne in mind that the burden of proof rests on the GMC and it is for the GMC to prove the Allegation. Dr Abbasi does not need to prove anything. The standard of proof is the balance of probabilities, i.e. whether it is more likely than not that the events occurred. 19. The Tribunal reminded itself that it must form its own judgement about the witness evidence heard before it, and the reliability of witnesses, including



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Dr Abbasi. It noted that it must decide whether to accept or reject such evidence, and where it is accepted, what weight to attach to it. 20. The Tribunal accepted the submission from the GMC of the relevance of the case of Ivey v Genting Casinos (UK) Limited (t/as Crockfords Club) [2017] UKSC 67 (‘Ivey’) and the legal test for dishonesty set out therein, which is as follows:

‘…first ascertain (subjectively) the actual state of the individual’s knowledge or belief as to the facts…once his actual state of mind as to knowledge or belief as to facts is established, the question whether his conduct was honest or dishonest is to be determined by the fact finder by applying the (objective) standards of ordinary decent people. There is no requirement that the defendant must appreciate that what he had done is, by those standards, dishonest’

21. The Tribunal also bore in mind that it should assess and determine each paragraph and sub-paragraph of the Allegation separately. It noted that while it can draw inferences from the evidence, it must not speculate as to any further evidence that has not come before it.

22. The Tribunal took account of the requirement to give sufficient and clear reasons for its determination. The Tribunal’s Findings 23. The Tribunal has considered the outstanding paragraphs of the Allegation separately and has evaluated all of the evidence, including oral, documentary and audio evidence, in order to make its findings on the facts. The Tribunal had regard to the submissions from Mr Rigby, on behalf of the GMC and Mr Storey, on behalf of Dr Abbasi. Paragraph 1 24. The Tribunal considered whether Dr Abbasi failed to take appropriate urgent action in relation to Patient A on 31 December 2014. It is accepted that on the morning of 31 December 2014, at approximately 10.30am, Dr Abbasi had a telephone consultation with Patient A and advised her to attend the Surgery as a priority. Subsequently, Dr Abbasi left the surgery to undertake home GP visits. Patient A attended the Surgery at about 1.30pm and, after treatment from Dr B and paramedics, was taken to Fairfield General Hospital in an ambulance. 25. Dr Abbasi gave evidence that when he had the consultation, Patient A was:

“…on the telephone, comfortably speaking to me and narrated her history of developing right sided, facial swelling. On specific questioning, she was not



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breathless, wheezy or confused, she was complaining of mild fever and swelling.”

26. The Tribunal considered that any doctor who made an initial telephone diagnosis that a patient was suffering from, or in danger of, anaphylactic shock would know this condition was an urgent and life threatening situation and would have insisted on immediate ambulance attendance. Dr Abbasi asserted that he did not have reason to suspect anaphylaxis, but was more concerned about a gum infection, particularly as Patient A was diabetic. The situation needed to be assessed and the decision for antibiotics needed to be made by a clinician, in person. The Tribunal had concerns that Dr Abbasi did not take a note of the consultation with Patient A at the time, but accepted that Dr Abbasi may have intended to write up notes later during the face to face consultation, when a diagnosis and treatment would be established. 27. The Tribunal noted that the telephone consultation with Patient A was at approximately 10.30am, but that she did not go to the Surgery until three hours later, at about 1.30pm, indicating a lack of urgency felt by Patient A and her partner. Paragraph 1a 28. The Tribunal noted an entry made in the Surgery diary on 31 December 2014 in relation to Patient A. That entry referred to a request made by a nurse seeking a home visit, and referring to “swollen face, blisters”. Although untimed, the Tribunal concluded that prior to the subsequent telephone consultation a nurse had not felt that Patient A required an ambulance or immediate attendance at a hospital. 29. The only evidence available to the Tribunal in respect of the telephone consultation with Patient A is that of Dr Abbasi himself. He stated that she did not require an ambulance, at that time, and that assertion is consistent with his evidence as a whole as to her reported condition at that time. The Tribunal had regard to the GMC’s submission that he must have known that she required very urgent attention, and that her condition during the telephone consultation was “highly likely” to have been very similar to her presentation on arrival. However, mindful of the subsequent delay of about three hours, the Tribunal felt it unsafe to accept that submission. Consequently, it found paragraph 1a not proved. Paragraph 1b 30. Having accepted Dr Abbasi’s evidence that at the time of the telephone consultation, Patient A did not require the attendance of an ambulance, it follows (for the reasons given above) that there was no requirement for him to take appropriate urgent action by advising her to call an ambulance. The Tribunal found paragraph 1b not proved.



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Paragraph 1c 31. The Tribunal noted some inconsistency in Dr Abbasi’s evidence over time, in that in his statement to NHS England, dated 29 October 2015, he said that Patient A “needed to be seen quickly” and that he therefore explained to her that it was “best for her to attend at the accident and emergency department”. In his statement for these proceedings, dated 16 May 2019, he said “based on my assessment, she did not warrant emergency services/an A&E referral”. 32. Whilst mindful of that inconsistency, there is no direct evidence available to the Tribunal as to the content of the telephone consultation, other than that of Dr Abbasi. Whether or not he did advise her to go to A&E, there is insufficient evidence adduced by the GMC to satisfy the Tribunal that he failed in a duty, at that time, to advise the patient to attend A&E as a matter of urgency. It therefore found paragraph 1c not proved. Paragraph 1d 33. In a statement dated 18 September 2015, Mr F, a Health Care Assistant (‘HCA’) at the Surgery, said that he had been approached by Dr Abbasi at about 11.00am, and that he had been informed that Patient A would be arriving at about 1.00pm – 1.30pm that day. He said that Dr Abbasi told him the patient “had probably had an allergic reaction” and that “she might need prednisolone or adrenaline”. He also stated that Dr Abbasi told him he would be there. In his oral evidence Mr F maintained his version of events, and when challenged in cross examination as to the alleged reference to adrenaline, he said firmly, “those were his words”. 34. The Tribunal considered Mr F to be an honest witness, who appeared quiet and unassuming in his evidence, but nevertheless maintained his position firmly under cross-examination. However, the Tribunal also had regard to Mr Storey’s submission, on behalf of Dr Abbasi, that there might well have been some misunderstanding on Mr F’s part, arising from the attendance of another patient, about whom he had been informed, and who was to attend at a similar time. 35. Dr Abbasi, in his statement to NHS England, said that he had formed the clinical opinion that Patient A may have had an infection in her gums, that she needed an examination, and that he asked her to attend the surgery “as a priority”. He maintained, in both his written statements and in his oral evidence, that it had been his intention to be present when Patient A arrived. However, he said he had in fact left the surgery in order to carry out home visits and to make enquiries about the condition of his sick mother.



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36. The Tribunal was of the view that having held the telephone consultation with Patient A, it would have been desirable for him to have been present at the time of Patient A’s arrival. That would especially be the case on the basis of Mr F’s evidence. The Tribunal also noted Dr Abbasi’s oral evidence in relation to Patient A, to the effect that she had learning difficulties, that she was a diabetic and that a gum infection in a diabetic patient had the potential to get worse and needed to be prioritised. 37. However, Dr Abbasi had competing priorities, and his departure from the surgery, in itself, did not constitute a culpable failure to take appropriate urgent action. The Tribunal therefore found paragraph 1d not proved. Paragraph 1e 38. Dr B, the locum GP at the Surgery, told the Tribunal that when Patient A arrived she had no idea of her history. She said that on arrival Patient A’s face was swollen, her eyes were closed, and that she was sweating profusely. Dr B said that she was worried the patient would go into cardiac arrest. The Tribunal noted the treatment subsequently provided by Dr B. 39. In his statement to NHS England, Dr Abbasi said “I also went to speak to Dr B… I thanked her for helping out the practice staff and explained that I might need her assistance if any issues arose”. The Tribunal, however, accepted Dr B’s evidence that there had been no conversation with Dr Abbasi, and noted her oral evidence in which she said “I should not have been there. If my clinic had finished in time I would have gone”. 40. Dr Abbasi, in his statement for these proceedings, said that Dr B had been “very busy with her patients list and tight schedule, and when I had left for home visit I had not been able to delegate with her properly… neither did I feel that the situation would turn out to be so serious later on”. 41. The Tribunal has not found that Dr Abbasi was under a duty to ensure he was present at the Surgery upon Patient A’s arrival. However, the Tribunal determined that when he left he had a personal responsibility to ensure that Dr B would still be present in his absence, and to provide her with an adequate handover in relation to Patient A’s history and his own clinical assessment of her condition during the earlier telephone consultation. The evidence showed that Dr Abbasi had not fulfilled his duty. It therefore found paragraph 1e proved. Paragraph 2 and 5a i and 5a ii 42. The Tribunal went on to consider paragraph 5a i and ii of the Allegation in relation to the admitted paragraph 2. It heard considerable evidence regarding the usage and application of the EMIS Surgery appointment system. The Tribunal



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acknowledged that each user might have a different understanding and working knowledge of the system. The Tribunal was assisted by Dr M who is a GP with experience of the EMIS system, albeit a slightly different version of the programme. It noted that the Practice Manager and reception staff would have different levels of access and programme functionality than that of GPs. Further, it accepted the evidence of Dr M and Dr Abbasi that GPs are unable to input new additional appointment slots directly, rather that this is an operation performed by reception staff. 43. The Tribunal heard evidence from Dr M that it is common practice for GPs to have extra consultations when their computer appointment list is full and afterwards input the appointments in a different available slot. This is for auditing and recording purposes. Dr M stated in her report:

“…if Dr Abbasi did consult with the Patient earlier in the day for an appointment, documented an appropriate assessment but taken the time of 16.20 hrs to allocate for that appointment… then this is not below standard. This is because all GPs frequently move Patient times and slots depending on daily work load and as long as the same number of appointments are available each day in a fair distribution, then doing this is not below standard”

44. Miss I gave evidence that the above procedure was common practice in the Surgery and is a practice utilised in her new, different surgery, where she performs similar reception duties. 45. The Tribunal carefully considered the evidence of each witness, in particular that of Mrs C. It heard from Mrs C that she had been actively searching for evidence that Dr Abbasi was making ‘ghost’ appointments. The Tribunal acknowledged that while Mrs C would have a good operational knowledge of the Surgery computer appointment system, being Practice Manager, she did not have complete knowledge of all the ways clinicians manage and input their appointments. The Tribunal had some reservations in accepting untested hearsay evidence provided to Mrs C in the course of her investigation. The Tribunal did not have clear evidence of what was asked and in what context, or if the patient gave a clear and unequivocal answer. It identified that it may be possible that the patient may not have wanted to cause any friction, or may have been mistaken or unintentionally misled, and denied a clinical interaction which actually took place. The Tribunal was unable to test this and could only rely on the EMIS system and the account of Dr Abbasi. 46. Mrs C asserted that the appointments were entirely fictitious. The Tribunal assessed each appointment in Schedule 1. It determined that there was clear evidence that patients had been seen by Dr Abbasi and that it is entirely possible that he utilised the EMIS appointment system in the way he, Miss I and Dr M, describe. The Tribunal declined to accept the assertion of the GMC that Dr Abbasi had gone to the lengths of inventing patient appointments in order to falsify his level



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of productivity in the Surgery. All evidence suggested that Dr Abbasi was, in fact, a hardworking and committed clinician who cared about his patients. 47. In relation to Patient D, the Tribunal determined that it is entirely plausible for Dr Abbasi to have conducted a consultation for a lady who has brought her young daughter with her, and then undertake a further consultation immediately if the parent indicates their child also had symptoms. The Tribunal accepted that Dr Abbasi was unable to ‘add’ a slot to the EMIS system, rather he inputted an appointment in an available slot after the consultation. Dr Abbasi gave evidence that it would not prevent reception adding more appointment slots, should they be required, and thus he did not gain an advantage or avoid further work by making the appointment for his patient’s daughter after the consultation. The Tribunal recognised that the consultation did not take place at 4.20pm, and Dr Abbasi would have known it did not. However, the Tribunal accepted that the EMIS appointment system was widely utilised in the fashion stated by Dr Abbasi, Dr M and Miss I, and that, on the balance of probabilities, Dr Abbasi did carry out the consultation that he recorded. 48. Regarding Patient F, the Tribunal accepted the submissions of Mr Storey, that Dr Abbasi made a note of the patient’s symptoms and the patient subsequently came in to the Surgery and Dr B listed the same symptoms. It was more likely than not that the patient spoke with Dr Abbasi who advised the patient to continue the treatment and to come in if their condition did not improve. 49. In relation to Patient G, the Tribunal determined that these were two genuine consultations, evidenced by the medical records. It is plausible that Mrs C is mistaken in her interpretation. 50. Regarding Patient I, Mrs C stated that no such patient arrived. Having accepted the evidence of Dr M and Dr Abbasi relating to the use and operation of the EMIS system, the Tribunal concluded that Mrs C may have misinterpreted the situation and that there is clear evidence, in the form of a clinical record and a prescription, showing that Dr Abbasi did have the consultation, albeit not at the exact time recorded on the system. 51. In relation to Patient J, the Tribunal acknowledged that Dr Abbasi saw the patient and performed a brief examination and recorded his findings, which then justified being recorded as an appointment slot. 52. The Tribunal considered that Mrs C had a genuine desire to improve the quality of patient satisfaction and care at the Surgery and that she was very perturbed by the ongoing issues between the GP partners, Dr Abbasi and Dr E. Further, the Tribunal considered Mrs C was an honest witness who attempted to give a true account of the events which led to the Allegation. However, the Tribunal had reservations in unconditionally accepting the reliability of her evidence.



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It recognised that Mrs C had made complaints about Dr Abbasi which might mean her evidence was not entirely objective. 53. The Tribunal determined that the GMC had not presented enough cogent, tested and reliable evidence for the Tribunal to conclude that the appointments in Schedule 1 were not genuine and that Dr Abbasi fictitiously invented the patient appointments for any personal motive. It determined that, on the balance of probabilities, Dr Abbasi did conduct the consultations and that he utilised the EMIS appointment system in the way he specified. Therefore, the Tribunal found that the action of inputting patients on to his appointment list, changing the appointment status and making corresponding entries to patient medical records was genuine and not untrue. Hence, it found that, in relation to paragraph 2, paragraphs 5a i and 5a ii of the Allegation were not proved. Paragraph 3 54. The Tribunal had careful regard to the audio recording, provided by Dr Abbasi, of the incident on 22 May 2015. The Tribunal did have some reservations about this evidence because it was not a full recording of everything that was said on the day, rather it was a 90 second recording of the exchange between Dr Abbasi and Dr B. However, it concluded that it was the best evidence available in relation to that exchange. Paragraph 3a 55. In the audio recording, Dr B is heard to say “can you just stand back from my space”. This is consistent with her evidence that “he stood close to me”. When asked about the recorded comments by Dr B, Dr Abbasi said “it was not unreasonable that she was uncomfortable”. The Tribunal was therefore satisfied that at some time during the incident Dr Abbasi was standing very close to Dr B, and therefore found paragraph 3a proved. Paragraph 3b 56. It was clear from the recording that there was no shouting or strongly raised voices. This point is in contradiction to the evidence of Mrs C and Dr B who both gave written and oral evidence that Dr Abbasi was shouting at Dr B. The Tribunal thought that Dr Abbasi addressed Dr B in what appeared to be a calm and measured tone of voice, although it is clear that they were having a difficult discussion. The Tribunal noted that it was Dr Abbasi who first suggested to Dr B that she was being confrontational. 57. Further, the Tribunal noted that Dr Abbasi did not appear to have been rude towards Dr B. Rather, he was questioning her as to why she was at the surgery. This question was fair because Dr Abbasi understood her to have finished working at the



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Surgery. Therefore, the Tribunal concluded that Dr Abbasi did not speak rudely and loudly towards Dr B as alleged, and found paragraph 3b not proved. Paragraph 3c 58. In her statement Dr B said “I asked him to move away from me… but he didn’t move”. However, Dr B gave evidence at the hearing that Dr Abbasi did in fact move away “at some point”. In the audio recording Dr B asked Dr Abbasi to move once and did not ask again, the inference being that Dr Abbasi moved when he was asked to. Dr Abbasi gave evidence to support this suggestion. The Tribunal therefore determined that Dr Abbasi did not refuse to move away from Dr B when she asked him to, and found paragraph 3c not proved. Paragraph 3d 59. In her statement Dr B maintained that Dr Abbasi waved his finger at her aggressively. Dr Abbasi denied that he had done so. It is impossible to determine from the audio recording whether or not Dr Abbasi waved his finger, aggressively or otherwise, but on balance the Tribunal considered that the tone and content of the recorded conversation was inconsistent with that allegation. Thus, the Tribunal found paragraph 3d not proved.

Paragraph 4a 60. Neither in her written nor in her oral evidence did Miss D state that Dr Abbasi spoke aggressively towards her. Having considered the evidence of all the relevant witnesses it was clear to the Tribunal that any argument as to entry to the Surgery was primarily between the two receptionists and Mrs H, rather than Dr Abbasi himself, and therefore it found paragraph 4a not proved. Paragraph 4b in relation to Paragraph 5b 61. Miss G, the receptionist to whom both Dr [Abbasi] and Mrs H first spoke, accepted the suggestion put to her by Mr Storey that it was possible Dr Abbasi had “got the wrong end of the stick” and thought she was refusing entry both to him and his wife. She also described Dr Abbasi as “confused” at that time. Accordingly, the Tribunal concluded that there was insufficient evidence to find that he knowingly made any false statement, and therefore found paragraph 5b, in relation to 4b not proved. Paragraph 4c, 4d and 4e 62. Miss D was adamant, both in her written and in her oral evidence, that Dr Abbasi had grabbed her head with both hands, dug his fingers into her head and shook her head up and down. Dr Abbasi denied that allegation, and stated that he was merely extending his hand over her head in what has been described as an



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“Asian greeting” (albeit that such an action could take place at any time during a interaction). 63. The Tribunal found Miss D to be credible and reliable in her evidence. Furthermore, it considered her account was consistent with the evidence of Miss G and Dr E. Miss G heard Miss D’s reaction, describing it as a “high-pitched distressed scream”. She also said that she heard Miss D saying “no you can’t do this, you can’t touch me, really loudly, like she was in pain”. Dr E described her as “tearful and panicky” and “very distressed”. In his statement, he said that she told him Dr Abbasi had “hit her”. The Tribunal noted the apparent inconsistency between Miss D’s account and the words “hit her”, but in answer to Tribunal questions Dr E gave a verbal and physical description of what Miss D had said which was entirely consistent with her own evidence. 64. Dr Abbasi, in his oral evidence, said that touching a woman’s head is prohibited, and described his action as being “like an umbrella, showing that someone is under the protection of Allah”. He said he was scared and shocked at Miss D’s reaction. Mrs H supported her husband’s account in her evidence. 65. The Tribunal gave serious consideration to the possibility that Miss D might have misinterpreted Dr Abbasi’s action and intention, and even that she may have jumped up and touched his hand with her head accidently. However, her own evidence, together with the evidence of Miss G and Dr E, made that suggestion highly improbable. She was so distressed by Dr Abbasi’s actions that she felt compelled to make a formal written complaint to the GMC the following day. 66. The Tribunal considered that it was unlikely that Dr Abbasi had any intent to hurt Miss D, rather that it may have been an impulsive action with the intention of belittling or undermining Miss D. 67. The Tribunal found paragraphs 4c, 4d and 4e to be proved. Paragraph 6 68. The Tribunal found paragraph 5 not proved in relation to both paragraph 2 in its entirety and in relation to paragraph 4b, and therefore paragraph 6 falls and the Tribunal found that Dr Abbasi’s conduct was not dishonest. The Tribunal’s Overall Determination on the Facts 69. The Tribunal has determined the facts as follows:



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1. On 31 December 2014, whilst working as a GP partner at Nye Bevan House (‘the Surgery’), you consulted with Patient A by telephone and you failed to take appropriate urgent action, in that you did not:

a. call Patient A an ambulance; Found Not Proved

b. advise Patient A to call an ambulance; Found Not Proved

c. advise Patient A to urgently attend Accident and Emergency; Found Not Proved

d. ensure that you were present at the Surgery upon Patient A’s arrival at the surgery; Found Not Proved

e. ensure that you directly delegated the medical assessment of Patient A to Dr B. Found Proved

2. On one or more dates as set out in Schedule 1 you: a. added a patient to your appointment list; Admitted and found

proved

b. changed the appointment status; Admitted and found proved c. made a corresponding entry in the patient’s medical records.

Admitted and found proved

3. On 22 May 2015 you approached Dr B and: a. stood very close to her; Found Proved

b. spoke rudely and loudly towards her; Found Not Proved c. refused to move away from her when she asked you to; Found Not

Proved d. waved your finger aggressively at her. Found Not Proved

4. On 28 September 2017 you:

a. spoke to Miss C in an aggressive tone; Found Not Proved



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b. made a phone call in Miss C’s presence and said that Miss C was refusing you entry to the surgery, or words to that effect; Admitted and found proved

c. grabbed Miss C’s head with both hands; Found Proved

d. dug your fingers into Miss C’s head; Found Proved e. shook Miss C’s head up and down. Found Proved

5. When you: a. carried out the actions referred to at paragraph 2 you knew:

i. the appointments as set out in Schedule 1 were not

genuine; Found Not Proved

ii. the information in the medical records as set out in Schedule 1 was untrue; Found Not Proved

b. made the phone call referred to at paragraph 4b you knew Miss C had

not refused you entry to the surgery. Found Not Proved

6. Your conduct as described in paragraphs 2 and 4b above was dishonest by reason of paragraph 5. Found Not Proved

Determination on Impairment - 11/12/2019 1. The Tribunal now has to decide in accordance with Rule 17(2)(l) of the Rules whether, on the basis of the facts that it has found proved, Dr Abbasi’s fitness to practise is impaired by reason of misconduct.

The Evidence 2. In determining whether Dr Abbasi’s fitness to practise is impaired, the Tribunal carefully considered all the documentary and oral evidence adduced during the facts stage of these proceedings. At the impairment stage, through his representative, Dr Abbasi provided the Tribunal with a bundle of testimonials and a recent appraisal report, which the Tribunal took into account in its decision-making. No further evidence was adduced by the GMC.



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Submissions 3. On behalf of the GMC, Mr Rigby submitted that Dr Abbasi’s actions in relation to paragraphs 1e and 4c to 4e amounted to serious misconduct and that his fitness to practise is currently impaired by reason of that misconduct. He submitted that Dr Abbasi had breached a fundamental tenet of the profession. 4. In relation to paragraph 1e, Mr Rigby submitted that Dr Abbasi should not have delegated Patient A’s assessment to Mr F and that this action amounted to serious professional misconduct. He submitted that Patient A was placed at risk of harm by his actions because Dr Abbasi had identified serious symptoms when he spoke to Patient A by telephone and did not delegate Patient A to Dr B, which he should have done. 5. In relation to paragraph 3a, Mr Rigby submitted that the GMC does not contend that this was serious misconduct, in itself. 6. In relation to paragraphs 4c, 4d and 4e, Mr Rigby referred the Tribunal to its determination on facts in which it stated:

“it [Dr Abbasi’s actions] may have been an impulsive action with the intention of belittling or undermining Miss D”

7. Mr Rigby submitted that Dr Abbasi’s actions amounted to assault with the intention of intimidating and domineering Miss D. He drew the Tribunal’s attention to paragraph 109g of the Sanctions Guidance (‘SG’), describing this instance as ‘violence’. He submitted that Dr Abbasi’s conduct had caused Miss D to scream out and become hysterical and had not only affected her at the time of the incident but afterwards also. Mr Rigby went further to submit that this action was serious professional misconduct which would cause the public and fellow professionals to be appalled. 8. Mr Rigby submitted that Dr Abbasi had breached a number of paragraphs of Good Medical Practice (2013) ('GMP') including paragraphs 15c, 35, 45 and 65. He submitted that Dr Abbasi had shown no insight, expressed no apology and had not remediated his conduct. Mr Rigby acknowledged Dr Abbasi’s previous good character and the positive testimonials. However, he concluded that a finding of impairment was required to maintain confidence in the profession and to uphold professional standards. 9. On behalf of Dr Abbasi, Mr Storey submitted that he agreed with the submission from GMC in relation to paragraph 3a of the Allegation that this did not amount to misconduct that was serious, and that the Tribunal should also reach this conclusion. He submitted that the conduct could be viewed as unpleasant and regrettable, but it could not amount to misconduct. 10. Mr Storey submitted that Dr Abbasi has had six months to process the Tribunal’s determination on facts and reflect on his actions. He submitted that Dr Abbasi has



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demonstrated in his statement and in oral evidence that he accepts that he made mistakes and accepts that he should have delegated the care of Patient A appropriately. However, Mr Storey contended that, on the evidence of Dr M, there was no evidence that Patient A was in anaphylactic shock and nor that she was in danger. He further submitted that this was an isolated incident in the context of an unblemished 25-year career, during a difficult personal and professional time for Dr Abbasi and that there has been no repetition of this conduct since the incident which happened nearly five years ago. He submitted that this was a regrettable incident and that while it is serious, the Tribunal should be satisfied that this does not amount to serious professional misconduct. 11. In relation to paragraphs 4c, 4d and 4e, Mr Storey submitted that this was certainly an unpleasant and regrettable incident which warrants concerns over Dr Abbasi’s fitness to practise. He submitted that Dr Abbasi has regret and remorse for his actions and has reflected on his conduct. He further submitted that Dr Abbasi accepts that his actions were inappropriate and serious and has taken into account the vulnerability of Miss D. 12. Mr Storey asserted that there were no patient safety concerns in this situation, that this incident happened over two years ago, that there has been no repetition of his conduct and that this was a single isolated incident, not in a clinical setting. 13. Mr Storey submitted that this incident needs to be interpreted in context. Dr Abbasi was experiencing considerable difficulty in his personal and professional life and was already suspended from the GP Performer’s list. Mr Storey added that Dr Abbasi has had an interim order placed on his registration, had significant financial issues resulting from losing his job, and his reputation has been adversely affected. He submitted that this does not detract from the seriousness of the incident, but that a reasonably informed member of public might accept that Dr Abbasi has had time to learn, reflect and develop since that time. Mr Storey directed the Tribunal’s attention to Dr Abbasi’s expressions of regret in his statement, the specific targeted training he had undertaken and the extensive bundle of testimonials which all demonstrate that Dr Abbasi is a well-regarded, well trusted and valued member of the medical profession. He submitted that the actions were so out of character that the Tribunal should find that the risk of repetition is very low. 14. Mr Storey submitted that taking all of these considerations into account, the Tribunal should be satisfied that Dr Abbasi’s fitness to practise is not currently impaired. The Relevant Legal Principles

15. The Tribunal reminded itself that at this stage of proceedings there is no formal burden or standard of proof and the decision on impairment is a matter for the Tribunal’s judgement alone.



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16. In approaching its decision, the Tribunal was mindful of the two-stage process to be adopted. First, whether the facts found proved were sufficient to amount to misconduct that was serious. Secondly, whether as a result Dr Abbasi’s fitness to practise is currently impaired by reason of such misconduct. 17. The Legally Qualified Chair (‘LQC’) directed the Tribunal’s attention to relevant case law and to the test as set out in the case of CHRE v NMC and Paula Grant [2011] EWHC 927 Admin.

“a. Has in the past acted and/or is liable in the future to act so as to put a patient or patients at unwarranted risk of harm;

b. Has in the past brought and/or is liable in the future to bring the medical profession into disrepute;

c. Has in the past breached and/or is liable in the future to breach one of the fundamental tenets of the medical profession;

d. [not relevant]”

18. The Tribunal also reminded itself of the statutory overarching objective which is to protect, promote and maintain the health, safety and well-being of the public, to promote and maintain public confidence in the medical profession, and to promote and maintain proper professional standards and conduct for members of that profession. The Tribunal’s Determination 19. In considering the question of impairment, the Tribunal has taken account of all of the evidence, as well as the submissions of Mr Rigby on behalf of the GMC, and those from Mr Storey on behalf of Dr Abbasi. Misconduct 20. The Tribunal reminded itself that misconduct is a word of general effect, involving some act or omission which falls short of what would be proper in the circumstances. The standard of propriety may often be found by reference to the rules and standards ordinarily required to be followed by a medical practitioner in the particular circumstances. For the doctor’s conduct to amount to misconduct it must be linked to the practice of medicine or else it must be conduct that otherwise brings the profession into disrepute, and it must be serious. As to seriousness, the Tribunal noted that this must be given its proper weight: it is conduct which would be regarded as deplorable by fellow practitioners.



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21. At the facts stage the Tribunal determined that paragraphs 1e, 3a, 4c, 4d and 4e of the Allegation were proved and must be considered. Paragraph 2 relates to matters of factual situation rather than relating to conduct or dishonesty and therefore could not amount to misconduct. Paragraph 1e 22. The Tribunal has taken into account all the circumstances of the incident. It noted that Dr Abbasi knew that Patient A was intending to come into the surgery but that he had not informed the only other doctor present. This action breached the standards expected of a doctor as set out in GMP, particularly the duty outlined to “make the care of the patient your first concern”, and it was minded that Dr Abbasi had a duty to ensure continuity of care. 23. The Tribunal has accepted that Dr B would not normally have been at the surgery because she would usually have finished work when Patient A attended. However, in this situation, she was present and as she would be the only remaining clinician on site, Dr Abbasi had a duty to delegate the patient to her, to maintain continuity of care. 24. The Tribunal also accepted that Dr Abbasi did not view this as an emergency situation after speaking to Patient A by telephone, although he did consider it to be a priority case. He made an initial judgement regarding the patient’s symptoms, which the GMC expert, Dr M, acknowledged was appropriate. When Dr Abbasi spoke to Patient A by telephone, she presented symptoms of a gum infection. Patient A delayed attending the surgery for another three hours, which indicates that she did not view it as an emergency at the time of the telephone call. 25. The Tribunal was of the view that Dr Abbasi, by failing to delegate the medical assessment of Patient A to Dr B, failed in his duty to put his patient first. It determined that this amounts to misconduct. However, it concluded that it does not amount to serious misconduct because of the unique circumstances surrounding the incident, namely that Patient A did not present symptoms that required emergency treatment at the time of the telephone call, that no harm came to Patient A, and that Dr Abbasi’s evidence was that he was available to return to the surgery from home visits to see Patient A. 26. The Tribunal considered that Dr Abbasi’s actions would not be seen as deplorable by members of the public and profession. The Tribunal exercised its judgement and determined that Dr Abbasi’s failure did amount to misconduct but that it did not amount to misconduct that is serious.



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Paragraph 3a 27. The Tribunal accepted the submissions from parties that the action of standing close to Dr B did not, in itself, amount to misconduct that was serious. The Tribunal noted its decision at facts stage that Dr Abbasi was not rude, the tone of the conversation, from him, was not aggressive and that he moved away when asked to do so. Therefore, the Tribunal did not find paragraph 3a to be misconduct. Paragraphs 4c, 4d and 4e 28. The Tribunal determined that Dr Abbasi, by his behaviour set out in the Allegation, and as described by Miss D, breached the following paragraph of GMP:

36. You must treat colleagues fairly and with respect.

29. The Tribunal noted that Dr Abbasi’s action caused significant distress to Miss D, both on the day of the event and afterwards. 30. While the Tribunal acknowledged in its determination on facts that Dr Abbasi’s action was ‘impulsive’, this does not detract from the seriousness of the conduct, the impact his behaviour had on Miss D or the potential damage to the reputation of the profession. 31. The Tribunal determined that members of the public and the profession would be appalled by Dr Abbasi’s behaviour and that it was a significant departure from the standards set out in GMP. Therefore, the Tribunal determined that Dr Abbasi’s actions, as set out in paragraphs 4c, 4d and 4e of the Allegation amounted to misconduct that was serious. Impairment 32. Having determined that Dr Abbasi’s actions in relation to paragraphs 1e and 3a did not amount to misconduct that was serious, it went on to consider whether his misconduct in relation to paragraphs 4c, 4d and 4e of the Allegation, which were found to be serious misconduct, meant that his fitness to practise is currently impaired. Paragraphs 4c, 4d and 4e 33. The Tribunal took into account the circumstances which led to the incident. It has borne in mind that this incident is an isolated occurrence in the context of a 25-year unblemished career and that there has been no evidence of repetition. The Tribunal also acknowledged the numerous positive testimonials on behalf of Dr Abbasi, and took into account the oral evidence from Dr Abbasi and Miss D.



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34. The Tribunal had regard to Mr Rigby’s submissions that Dr Abbasi’s actions amounted to violence. However, it preferred Mr Storey’s submission, that those actions were not “intended to cause hurt” and did not constitute “extreme force”. 35. The Tribunal noted that Dr Abbasi denied that he had made contact with Miss D and has not offered any apology or demonstrated remorse for his behaviour in relation to this incident, nor for the impact his conduct had on Miss D. The Tribunal took into account Dr Abbasi’s reflections in his statement and the targeted learning he has undertaken, but concluded that this does not represent sufficient or acceptable development of insight or remediation. Therefore, the Tribunal considered that because his insight was incomplete, it could not find that it was ‘highly unlikely’ such behaviour would be repeated. 36. The Tribunal found that this serious misconduct would be likely to bring the medical profession into disrepute because members of the profession and the public do not expect doctors to assault members of staff. Furthermore, such behaviour was clearly a breach of one of the overriding duties and principles of the medical profession, namely treating colleagues fairly and with respect. 37. In regard to the first limb of the overarching objective, the Tribunal did not view this misconduct as putting patient safety at risk. 38. The Tribunal considered that this misconduct was potentially able to be remedied. The Tribunal noted that it would have been greatly assisted by further evidence from Dr Abbasi in the form of reflection, evidence of an apology and demonstration of remorse. It noted that Dr Abbasi has had six months since the facts were found proved. During that time he could have demonstrated his remorse and reflected on his behaviour towards Miss D. 39. The Tribunal was mindful of the need to maintain public confidence in the profession and uphold proper standards. The Tribunal concluded that Dr Abbasi has not demonstrated sufficient insight or remediation. The Tribunal therefore concluded there was still a risk of repetition, albeit limited. The Tribunal concluded that Dr Abbasi’s misconduct would place the reputation of the profession at risk of harm. 40. The Tribunal concluded that public confidence in the profession would be undermined if a finding of impairment were not made. The Tribunal has therefore determined that Dr Abbasi’s fitness to practise is currently impaired by reason of his misconduct.



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Determination on Sanction - 12/12/2019 1. Having determined that Dr Abbasi’s fitness to practise is impaired by reason of misconduct, the Tribunal now has to decide in accordance with Rule 17(2)(n) of the Rules on the appropriate sanction, if any, to impose. The Evidence 2. The Tribunal has taken into account evidence received during the earlier stages of the hearing where relevant to reaching a decision on sanction, together with submissions made by Mr Rigby on behalf of the GMC, and Mr Storey on behalf of Dr Abbasi. Submissions 3. On behalf of the GMC, Mr Rigby submitted that the appropriate sanction in this case would be erasure of Dr Abbasi’s name from the Medical Register. He submitted that this is both necessary and proportionate in order to satisfy the statutory overarching objective. 4. Mr Rigby directed the Tribunal’s attention to the Sanctions Guidance (November 2019 edition)(‘SG’). Further, he directed the Tribunal’s attention to its determination on impairment in which it identified the breach of paragraph 36 of Good Medical Practice (2013) ('GMP'). Mr Rigby reminded the Tribunal of its findings including the distress caused to Miss D, the seriousness of the misconduct, the damage to the reputation of the profession and in relation to a doctor’s overriding duty. 5. Mr Rigby submitted that assaulting a colleague was at the higher end of the spectrum of seriousness as it involved violence. Mr Rigby submitted that at the very least Dr Abbasi’s actions were reckless and that they had an immediate and continuing effect. 6. Mr Rigby submitted that there were no exceptional circumstances that would justify taking no action. In relation to the imposition of conditions on Dr Abbasi’s registration, Mr Rigby submitted that these would not be appropriate or proportionate; they would be neither sufficient to maintain public confidence in the profession nor to uphold standards. In addition, in cases of violent misconduct, he submitted that it is difficult to formulate conditions that are workable and measurable. 7. Mr Rigby recognised there were clear mitigating factors in this case including Dr Abbasi’s previously unblemished 25-year career as a GP, numerous testimonials attesting to him being a competent and conscientious GP, and a decent and kind-hearted man. Further, he accepted that there were no patient safety concerns in this case. Despite this, he submitted that the sanction of suspension would not be sufficient



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to satisfy public confidence. He went further to say that Dr Abbasi’s misconduct was so serious and his lack of insight and remediation so significant, that his behaviour was fundamentally incompatible with continued registration. 8. Mr Rigby referred the Tribunal to paragraph 109 of the SG. He submitted that the following limbs are all engaged in this case:

“109. Any of the following factors being present may indicate erasure is appropriate (this list is not exhaustive).

a. A particularly serious departure from the principles set out in Good medical practice where the behaviour is fundamentally incompatible with being a doctor. b. A deliberate or reckless disregard for the principles set out in Good medical practice and/or patient safety. c. Doing serious harm to others… d. Abuse of position/trust (see Good medical practice, paragraph 65: ‘You must make sure that your conduct justifies your patients’ trust in you and the public’s trust in the profession’). g. Offences including violence. j. Persistent lack of insight into the seriousness of their actions or the consequences.”

9. Mr Rigby concluded that, balancing all of the evidence, in order to maintain confidence in the profession and to uphold proper standards, it is necessary for the Tribunal to erase Dr Abbasi’s name from the Medical Register. 10. On behalf of Dr Abbasi, Mr Storey submitted that the Tribunal had already identified that there were no patient safety concerns in this case. He directed the Tribunal’s attention to the evidence that Dr Abbasi has a 25-year career as an excellent hardworking clinician who cared about his patients. He submitted that the public interest was also met by ensuring members of the public have access to a good, competent clinician. 11. Mr Storey quoted some of the feedback on Dr Abbasi, submitting that it would assist this Tribunal in its determination: “Honest and exceptional doctor”

“Excellent clinical and diagnostic skills”



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“Very caring and conscientious, goes the extra mile to help colleagues and patients”

12. Mr Storey also reminded the Tribunal of the oral evidence from Miss K who, like Miss D, was also a young, female receptionist. From her close working relationship with Dr Abbasi, she described him as: “one of the best GPs I have ever worked with” 13. Mr Storey highlighted the mitigating factors that he asserted the Tribunal should take into consideration including:

▪ The incident was isolated and very brief, there was no injury to Miss D, it was impulsive and out of character;

▪ The matter was never the subject of criminal proceedings, and if it had been it would have been at the lowest level, namely common assault;

▪ There was a very low level of force with no intent to harm Miss D;

▪ Personal and professional difficulties Dr Abbasi was facing at the time

including:

o Dr Abbasi was suffering emotionally because he could not work at his practice, colleagues were taking sides at work, and he was initially prevented from coming in to the building;

o He had lost his livelihood and his status, in circumstances which were later found not to be serious misconduct; and

o Dr Abbasi acted impulsively, albeit wrongly.

▪ The incident was isolated and limited in time, and this was not a pattern of misconduct;

▪ This was a single aberration in context of long and successful career;

▪ There is a lot of evidence attesting to his character, showing a very caring and competent doctor, who is polite; and

▪ Dr Abbasi respects the Tribunal’s finding of impairment.

14. Mr Storey submitted that Dr Abbasi has been facing these damaging allegations against him for several years, all of which were found to be not proved or not serious misconduct, with the exception of the incident with Miss D. He submitted



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that this has had an extremely significant impact on him and that the punitive sanctions of suspension or erasure would serve as a hammer blow to such a man. 15. Mr Storey went further to submit that Dr Abbasi accepts and understands the determinations of the Tribunal. He observed that Dr Abbasi has engaged fully with the GMC and the MPTS. 16. Mr Storey submitted that it would be sufficient to impose a period of conditions on Dr Abbasi’s registration, which would send a message to Dr Abbasi, members of the public and the profession that such behaviour is unbefitting of a medical professional. He submitted that, if the Tribunal determines that a period of suspension is necessary, it should be of a shorter duration and that anything more punitive would be disproportionate and deprive the public of an otherwise excellent and valuable clinician. Mr Storey submitted that there are no patient safety concerns in this case and that erasure would be wholly disproportionate; whilst the misconduct was serious, it was not incompatible with continued registration. The Tribunal’s Approach 17. The decision as to the appropriate sanction to impose, if any, is a matter for this Tribunal exercising its own judgement. The Tribunal considered the sanctions available, starting with the least restrictive. 18. In reaching its decision, the Tribunal has taken account of the SG and GMP. It has borne in mind that the purpose of a sanction is not to be punitive, but to protect patients and the wider public interest, although it may have a punitive effect. 19. Throughout its deliberations, the Tribunal applied the principle of proportionality, balancing Dr Abbasi’s interests with the public interest. It has taken account of the statutory overarching objective, which includes the protection of the public, the maintenance of public confidence in the profession, and the promoting and maintaining of proper professional standards and conduct for members of the profession. 20. The Tribunal has already given detailed determinations on facts and impairment and has taken those matters into account during its deliberations on sanction. Mitigating and Aggravating Factors 21. In reaching a decision as to the appropriateness of any sanction in this case the Tribunal considered the mitigating and aggravating factors.



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22. The Tribunal first identified the mitigating factors in this case. The Tribunal identified numerous factors as set out in SG 24-49 including:

• Dr Abbasi’s previous good character and career history;

• The considerable volume of positive testimonials and character references;

• Evidence that Dr Abbasi is a competent, well-respected clinician;

• He has demonstrated some steps towards remediation, as set out in his

appraisal report;

• Dr Abbasi has otherwise complied with GMP since the incident;

• Dr Abbasi has worked in appropriate areas of practice since the incident;

• There is no evidence that Dr Abbasi has not complied with the interim order

on his registration;

• The specific personal and professional difficulties faced by Dr Abbasi in 2017;

and

• The lapse of time since the incident. 23. Turning to the aggravating factors, the Tribunal considered the following relevant:

• The imbalance in the respective positions of him and Miss D; and • As indicated, Dr Abbasi had not demonstrated a timely development of insight

(SG 52c). The Tribunal’s Determination on Sanction 24. Having considered the mitigating and aggravating factors in this case, the Tribunal went on to consider what sanction, if any, to impose on Dr Abbasi’s registration. In doing so, it considered each of the sanctions available starting with the least restrictive. The Tribunal also had regard to the statutory overarching objective. This states that the main reason for imposing sanctions is to protect the public, which includes to (i) protect and promote the health, safety and wellbeing of the public, (ii) promote and maintain public confidence in the medical profession and (iii) promote and maintain proper professional standards and conduct for the members of the profession. No action 25. In reaching its decision as to the appropriate sanction, if any, to impose in Dr Abbasi’s case, the Tribunal first considered whether to conclude the case by taking no action. Taking no action following a finding of impaired fitness to practise would only be appropriate in exceptional circumstances.



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26. The Tribunal determined that there were no exceptional circumstances in this case and that it would therefore not be in the public interest to conclude this case by taking no action. Conditions 27. The Tribunal next considered whether it would be appropriate and sufficient to impose conditions on Dr Abbasi’s registration. It bore in mind that any conditions imposed should be appropriate, proportionate, workable and measurable. 28. The Tribunal considered that it was not possible to formulate conditions to address misconduct of this nature. In any case, the Tribunal determined that conditions would not be sufficient to maintain confidence in the medical profession, uphold professional standards, nor to mark the unacceptability of Dr Abbasi’s misconduct. Suspension 29. The Tribunal considered the factors outlined in the SG which indicate when suspension may be appropriate. In particular, it had regard to the following paragraphs:

“91. 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 doctor. Suspension from the medical 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 suspension, although this is not its intention.

92. Suspension will be an appropriate response to misconduct that is so

serious that action must be taken to protect members of the public and maintain public confidence in the profession. A period of suspension will be appropriate for conduct that is serious but falls short of being fundamentally incompatible with continued registration (ie for which erasure is more likely to be the appropriate sanction because the tribunal considers that the doctor should not practise again either for public safety reasons or to protect the reputation of the profession).”

30. It also had regard to paragraph 97, which indicates that suspension may be appropriate if the following factors are present:

“a A serious breach of Good medical practice, but where the doctor’s misconduct is not fundamentally incompatible with their continued registration, therefore complete removal from the medical register would not be in the public interest. However, the breach is serious enough that any



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sanction lower than a suspension would not be sufficient to protect the public or maintain confidence in doctors. …

e No evidence that demonstrates remediation is unlikely to be successful, eg because of previous unsuccessful attempts or a doctor’s unwillingness to engage.

f No evidence of repetition of similar behaviour since incident. g The tribunal is satisfied the doctor has insight and does not pose a significant risk of repeating behaviour.”

31. The Tribunal acknowledged that suspension has a deterrent effect and can be used as a signal to the doctor, the profession and the public about what is regarded as behaviour unbefitting of a registered doctor. It also acknowledged that suspension is an appropriate response to misconduct which is sufficiently serious that action is required in order to maintain public confidence in the profession. 32. The Tribunal paid careful regard to the numerous mitigating factors in this case when considering whether a period of suspension may be necessary or in the public interest. In particular, the Tribunal acknowledged the highly positive testimonials and character references in relation to Dr Abbasi. These include, but are not limited to:

• A former colleague described Dr Abbasi as “a thorough professional, an

excellent colleague, and man of principles and integrity. He was very popular amongst patients and other colleagues. I found him honest, exceptional and an expert in his field of work.” ; and

• The example given by a grandmother about her baby grandson who had been repeatedly misdiagnosed by hospital clinicians before Dr Abbasi identified his epilepsy.

33. The Tribunal determined that the appropriate sanction in this case would be one of suspension. It determined that Dr Abbasi’s conduct represented a departure from proper standards of conduct and behaviour and would have a damaging effect on public confidence in the profession. Against that background, the Tribunal considered that a period of suspension would have a deterrent effect and would send out a suitable signal. A period of suspension is appropriate in this case because it has involved conduct on Dr Abbasi’s part that is serious but falls short of being fundamentally incompatible with continued medical registration (SG 97a).



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34. Having determined that a period of suspension was necessary, the Tribunal was not required to consider the sanction of erasure. Nevertheless, it took the view that this would be disproportionate and, as detailed above, Dr Abbasi’s misconduct falls short of being fundamentally incompatible with continued medical registration. The Tribunal accepted that the incident with Miss D was isolated in time, limited in scope and very much out of character. Further, it determined that the public interest includes the return of a highly regarded doctor to medical practice in the future. 35. The Tribunal went on to consider the length of suspension, taking into account the SG in that regard. 36. Given the seriousness of the misconduct and Dr Abbasi’s current level of insight and remediation, the appropriate period of suspension was determined to be four months. This would allow sufficient time for Dr Abbasi to address his impairment, to develop insight and to demonstrate further remediation. Review hearing directed 37. The Tribunal considered whether it would be appropriate to direct a review hearing in Dr Abbasi’s case. It has borne in mind that no doctor should be allowed to resume unrestricted practice following a period of suspension unless the Tribunal considers that they are safe to do so. The Tribunal had regard to paragraph 163 of the SG which states:

“163. It is important that no doctor is allowed to resume unrestricted practice following a period of conditional registration or suspension unless the tribunal considers that they are safe to do so.”

The Tribunal determined to direct a review hearing because there are ongoing concerns about Dr Abbasi’s insight and remediation that need to be resolved, before he can return to unrestricted practice. 38. Having determined to direct a review hearing in this case, the Tribunal wished to clarify that, at the review hearing, the onus will be on Dr Abbasi to demonstrate how he has developed his insight into, reflected upon and remediated his misconduct. 39. A reviewing Tribunal might be assisted by:

(a) A reflective statement to address the findings made by this Tribunal; (b) Any further evidence of remediation, in relation to the findings of this Tribunal; (c) Evidence that Dr Abbasi has kept his clinical skills and knowledge up-to-date; and



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(d) Any other information that Dr Abbasi believes will assist a reviewing Tribunal.

Determination on Immediate Order - 12/12/2019 1. Having determined that Dr Abbasi’s registration be made subject to suspension, the Tribunal has now considered in accordance with Rule 17(2)(o) of the Rules, as amended, whether to impose an immediate order on his registration. Submissions 2. Mr Rigby submitted that the Tribunal should revoke the interim order of conditions currently in place on Dr Abbasi’s registration and impose an immediate order of suspension. He stated that in the particular circumstances of this case, and considering the Tribunal’s determinations on the facts, impairment and sanction, the public would be surprised if Dr Abbasi was allowed to practise unrestricted. 3. On behalf of Dr Abbasi, Mr Storey submitted that it is not necessary to impose an immediate order on Dr Abbasi’s registration. He submitted that there are no patient safety issues in this case and that the public interest is met by the imposition of the substantive period of suspension. Mr Storey also highlighted the difficulties this would cause with pre-arranged professional commitments but recognised paragraph 175 of SG was against him. The Tribunal’s Decision 4. In reaching its decision, the Tribunal has exercised its own judgement, and balanced the interests of the doctor with those of the public. The Tribunal has borne in mind that it may impose an immediate order where it is satisfied that it is in the public interest, or is in the best interests of the practitioner. It has also borne in mind the guidance given in the relevant paragraphs of the SG, specifically 172, 173, 175, 177 and 178. The Tribunal did not give any weight to the submission on behalf of Dr Abbasi regarding the difficulties caused with his future professional commitments when making its decision. 5. The Tribunal noted that there have been no concerns raised regarding Dr Abbasi since the incident. 6. The Tribunal determined that in light of its findings during the facts, impairment and sanction stages, and considering the particular circumstances of this case, an immediate order of suspension is not appropriate and not necessary. It determined that there are no patient safety concerns in this case, that the public interest is met by the



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imposition of the substantive period of suspension, and that the sanction marks the seriousness of the misconduct. 7. The effect of the foregoing direction is that, unless Dr Abbasi exercises his right of appeal, his registration will be suspended 28 days from the date on which written notice of this decision is deemed to have been served upon him. 8. The Interim Order currently imposed on Dr Abbasi’s registration will be revoked with immediate effect. 9. That concludes this case. Confirmed Date 12 December 2019 Mr Rob Ward, Legally Qualified Chair



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ANNEX A – 04/06/2019

Application to admit evidence

Submissions 1. On behalf of the GMC, Mr Rigby submitted under Rule 34(1) of the General Medical Council’s (Fitness to Practise) Rules 2004, as amended, (the Rules) that a supplementary GMC expert report from Dr M should not be adduced as evidence to the Tribunal. He submitted that the GMC did not give instructions to her to undertake the assessment of the practice computer system and that Dr M is not an IT expert, therefore it would not be relying on this evidence to support its case. 2. Mr Rigby observed that, following due process and procedure and maintaining transparency, the report was provided to Dr Abbasi’s representatives in the Rule 7 correspondence, but that the GMC did not intend to introduce this evidence on the basis that Dr M is an expert in relation to medical issues and not in relation to how computerised appointment systems work. 3. On behalf of Dr Abbasi, Mr Storey submitted that the supplementary GMC expert report from Dr M should be adduced to the Tribunal in its entirety. He submitted that both expert reports from Dr M are the opinions of an instructed GMC expert and that Dr M had made it clear in her second report that she had experience of the operations of practice computer systems. He submitted that the opinions of a GP familiar with the practice computer system are highly relevant to this Tribunal’s determinations and that Dr M addressed matters relating to the use and operation of the system. Mr Storey referred the Tribunal to Dr M’s report where she states: “in my experience of EMIS“. He submitted that it would be both fair and appropriate to admit the report into evidence. Tribunal decision 4. The Tribunal considered Rule 34(1) of the Rules:

“The Committee or a Tribunal may admit any evidence they consider fair and relevant to the case before them, whether or not such evidence would be admissible in a court of law.”

5. In reaching its decision, the Tribunal has borne in mind the principle of

fairness to both parties.

6. The Tribunal first considered whether the supplementary expert report was relevant to the matters before it, and determined that in relation to paragraph 2 of the Allegation, understanding the operation and application of the practice computer system was relevant to its decision making and its determinations.



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7. The Tribunal next considered whether it would be fair to admit the document in evidence. It bore in mind that Dr M is a GP who is apparently familiar with the system utilised by Dr Abbasi and the practice. The Tribunal considered that Dr M is an experienced GP and was in a position to assist the Tribunal in understanding the use of the practice computer system. 8. The Tribunal can exercise its own judgement and it can assess what weight, if any, it might seek to attach to the report. It noted that it would not be in the interest of justice to include one report from the GMC expert and not include the other. Further, it noted that Dr M may not have been completely clear regarding her instruction from the GMC and has sought to assist the Tribunal by drafting the supplementary report. 9. Accordingly, the Tribunal has determined to allow the supplementary report from Dr M to be admissible. ANNEX B – 04/06/2019

Application to amend the Allegation Submissions 1. On behalf of the GMC, Mr Rigby made an application, under Rule 17(6) of the General Medical Council’s (Fitness to Practise) Rules 2004, as amended, (the Rules), to delete the entries relating to patients E and H from Schedule 1 of the Allegation. He submitted that these entries were incorrect and not necessary. He submitted that there would be no injustice to grant the application and that it adds clarity to the schedule and Allegation. 2. On behalf of Dr Abbasi, Mr Storey endorsed the application made by Mr Rigby. The Tribunal’s decision 3. The Tribunal noted paragraph 17(6) of the Rules which states:

‘17(6) Where, at any time, it appears to the Medical Practitioners Tribunal that— (a) the allegation or the facts upon which it is based and of which the practitioner has been notified under rule 15, should be amended; and (b) the amendment can be made without injustice,



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it may, after hearing the parties, amend the allegation in appropriate terms.’

4. The Tribunal determined that the amendment could be made without injustice and therefore it considered it appropriate to exercise its power under Rule 17(6) of the Rules and grant the application to delete the entries from Schedule 1 accordingly. ANNEX C – 06/06/2019

Application to amend the Allegation Submissions 1. On behalf of Dr Abbasi, Mr Storey made an application, under Rule 17(6) of the General Medical Council’s (Fitness to Practise) Rules 2004, as amended, (the Rules), to delete the entry for 17 April 2015 at 16.42 from Schedule 1 of the Allegation. Dr Abbasi had already formally admitted paragraph 2 of the Allegation, including the information contained within Schedule 1. However the evidence heard so far had revealed that the content of the entry was erroneous. He submitted that there would be no injustice to grant the application and that it adds clarity to the schedule and Allegation. 2. On behalf of the GMC, Mr Rigby did not oppose the application. The Tribunal’s decision 3. The Tribunal noted paragraph 17(6) of the Rules which states:

‘17(6) Where, at any time, it appears to the Medical Practitioners Tribunal that— (a) the allegation or the facts upon which it is based and of which the practitioner has been notified under rule 15, should be amended; and (b) the amendment can be made without injustice, it may, after hearing the parties, amend the allegation in appropriate terms.’

4. The Tribunal determined that the amendment could be made without injustice and therefore it considered it appropriate to exercise its power under Rule 17(6) of the Rules and grant the application to delete the entry from Schedule 1 accordingly.



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Schedule 1

Patient Date Time Actions carried out

D 17 April 2015 07.46 Added to appointment list

Unknown Made an entry in medical records

F 30 April 2015 12.31 -Added to appointment list -Updated appointment status to: (1) arrived; (2) send in; (3) left.


G 11 May 2015 07.59 -Added to appointment list -Updated appointment status to: (1) arrived; (2) send in; (3) left.

12.33 -Added to appointment list -Updated appointment status to: (1) arrived; (2) send in; (3) left.


I 19 May 2015 07.57 -Added to appointment list -Updated appointment status to: (1) arrived; (2) send in;



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(3) left.


J 21 May 2015 08.07 -Added to appointment list -Updated appointment status to: (1) arrived; (2) send in; (3) left.


PUBLIC RECORD - MPTS · 2020-03-05 · Record of Determinations – Medical Practitioners Tribunal...

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