Mr Andrea Franchini

Preliminary Matters
Service
1. The Panel was provided with a copy of the Notice sent by email to the Registrant’s registered email address on 14 September 2022, setting out the time, date and remote nature of this review hearing and inviting the Registrant to attend the virtual hearing. The Notice also explained the possibility of the Panel proceeding without the Registrant in the event that he did not attend. There was an email delivery receipt and also a signed declaration from the Scheduling Officer who sent the email, confirming that the email had been sent. The Panel was thus satisfied with service in this case.

Application for part of the hearing to be heard in private
2. Before making an application to proceed in the absence of the Registrant, Ms Welsh made an application that part of the hearing be heard in private. This was as a consequence of the Registrant’s written submissions, in which there was such a request because references would be made to the Registrant’s health during the hearing and as a reason for his non-attendance today.

3. The Panel considered the application with care, taking into account what was said within the Registrant’s written submissions. The Panel also accepted the Legal Assessor’s advice that whilst the default position is that the hearing should be in public, there was provision within the Rules for the hearing to be heard in private when dealing with issues such as the health of the Registrant. This was to protect the private life of the Registrant. The Panel therefore agreed that where matters pertaining to the health of the Registrant were raised they would be dealt with in private.

Proceeding in the absence of the Registrant
4. The Registrant did not attend the review hearing, nor did those representing him. However, written representations were provided by his representative, in which it was stated that no disrespect was intended by their non-attendance and that the Registrant was content for the hearing to proceed in his absence, provided the written submissions were provided to, and considered by, the Panel.

5. Ms Welsh, on behalf of the HCPC, made an application to proceed in the Registrant’s absence.

6. When deciding whether to proceed in the absence of the Registrant, the Panel took into account the submissions made by Ms Welsh and the written submissions received on behalf of the Registrant.

7. The Registrant’s representative added that the Registrant recognises that the conditions of practice are subject to mandatory review before their expiry and that the Registrant was not making any application to adjourn or postpone this hearing and he was content for the hearing to proceed in his absence.

8. The Panel heard and accepted the advice of the Legal Assessor. It bore in mind that, although it had a discretion to proceed in the absence of the Registrant, this discretion should be exercised with the utmost care and caution. The Panel was cognisant of the fact that its purpose was to undertake a statutory review of a Conditions of Practice Order before the date on which it was due to expire.

9. The Panel noted that the Registrant had the benefit of legal representation and, in light of the unambiguous written submissions received on behalf of the Registrant, the Panel was satisfied that he had voluntarily absented himself from this review hearing and thereby waived his right to be present. No request had been made for an adjournment, only that the written submissions be taken into account. The Panel indicated that it would take those written submissions into account when reaching its decisions on the review of the current Order.

10. The Panel considered there was a clear public interest in the matter proceeding and it was also in the Registrant’s own interests that the Order be reviewed.

11. In all the circumstances, the Panel decided to proceed in the absence of the Registrant.

Background
12. The Registrant is a registered Physiotherapist. At the time of the events detailed in the allegation he was working at the Great Health Clinic (“the Clinic”) in Islington.

13. Service User B attended the Clinic in relation to a thumb injury sustained following a bicycle accident. She first saw the Registrant at the Clinic on or about 20 May 2016, and no complaint was made about that session. Service User B returned to the Clinic and again saw the Registrant on 31 May 2016, when it was alleged that the events described in particulars 2(a) to 2(e) took place. By particular 3 it was alleged that the particular 2(a) to (e) actions were without clinical justification, and by particular 4 it was alleged that they were sexually motivated.

14. In relation to the contentions advanced by particulars 2(a) to (e), the final hearing panel found them all to be proven. So far as those actions being without clinical justification (i.e. particular 3) was concerned, it found that only those in 2(a) to (c) inclusive were done without clinical justification. With regard to particulars 2(d) and 2(e) the final hearing panel found that the technique was clinically justified. The final hearing panel also found particular 4 (sexual motivation) to be not proved with regard to the proved particulars relating to Service User B.

15. Service User A attended the Clinic on 10 August 2016 and was seen by the Registrant. The HCPC maintained that the actions alleged in particulars 1(a) to (k) inclusive occurred on that occasion. It was also alleged with regard to Service User A that the actions were not clinically justified (particular 3) and that they were sexually motivated (particular 4).

16. The final hearing panel found particulars 1(b), 1(c), 1(d), 1(e), 1(f),1(g), 1(h), 1(j) and 1(k) to be proved. It found particulars 1(a) and 1(i) to be not proved. When it turned to consider whether those particulars it had found to be proved had been actions without clinical justification, the final hearing panel found particular 3 to be proved with regard to particulars 1(b), 1(c), 1(g), 1(h) and 1(j), but not in relation to the other actions it had found to have occurred (namely, 1(d), 1(e), 1(f), 1(j) and 1(k). It also found that it had not been proved that the Registrant had been sexually motivated with regard to his actions with regard to Service User A (particular 4).

17. When it addressed the statutory ground of misconduct, the final hearing panel decided that misconduct was established only in relation to particulars 1(b), 1(c), 1(g) and 2(a). The final hearing panel’s view that misconduct was not made out in relation to particulars 1(d), 1(e), 1(f), 1(h), 1(j), 2(b), 2(c), 2(d) and 2(e) and those elements of particular 3 which it had found proved, was challenged by the PSA on appeal. By consent, that finding was quashed and substituted with a finding that misconduct was made out in relation to them (clauses 1(a) and 2 respectively of the Consent Order).

18. Another aspect of the final hearing panel’s decision that was quashed were the findings relating to the risk of repetition. The final hearing panel’s findings that the risk of repetition of inappropriate touching and failure to obtain informed consent were low, were replaced by findings that the risk of repetition of inappropriate touching and failure to obtain informed consent is present (clauses 1(b) and 3 of the Consent Order).

19. In summary, the starting point of the panel’s decision on sanction was to accept the following:
· With regard to Service User A, that the actions alleged by particulars 1(b), 1(c), 1(d), 1(e), 1(f), 1(h), 1(j) and 1(k) took place, and that there was no clinical justification for 1(b), 1(c), 1(g), 1(h) and 1(j).
· With regard to Service User B, that the actions alleged by particulars 2(a), 2(b) and 2(c) took place, and that there was no clinical justification for any of them.
· That misconduct was established on the wider basis that has been stated above.
· That the risk of inappropriate touching and failure to obtain informed consent is present.
· That it was not proved that the Registrant had been sexually motivated in acting as he did.

20. In reaching its decision on sanction the panel in October 2021 stated:
“The Panel commenced by considering the factors that could fairly be described as aggravating and those that could properly be taken into account in favour of the Registrant.

In the judgement of the Panel, the on-going distress felt by the two service users concerned was an aggravating factor, as was the lack of understanding of the impact of his actions on the part of the Registrant and the present risk of repetition substituted by the Consent Order.

In favour of the Registrant were the references and testimonials he produced, although the Panel was alive to the need to remember that though they were positive, they were subject to the original panel’s finding that his fitness to practise was impaired and the on-going risk of repetition substituted by the Consent Order. The Panel also accepted that it could properly consider the fact that there had been a pre-final hearing interim order that had been complied with and that the Registrant had already been subject to a sanction following the conclusion of the final hearing.

The Panel also had very much in mind that sexual motivation had not been established. However, it is important to record that inappropriate touching, even when it is not done for an improper motive but because of inadequate communication and failure to explain, can be very distressing for service users, as the reactions of the two service users in this case only serve to demonstrate.

It was agreed by the parties, and endorsed by the Legal Assessor, that the task for the present Panel was to decide on what sanction is required at the present time, October 2021. In reaching that decision the Panel was aware that findings made in 2019 and the substituted decisions ordered by the High Court in 2020 were to be accepted. In this regard the fact that the Panel received no information about the Registrant’s activities since the final hearing was relevant to the extent that it was found that there was a lack of understanding on his part and a present risk of repetition. There was no current information on which the Panel could conclude that there had been further progress made by the Registrant. The Panel considered the information provided by the Registrant at the 2019 final hearing both orally and in his “Clinic Reflections”. The Panel was concerned that his reflections showed little appreciation of the distress caused to Service User A and Service User B, and concentrated more on physiotherapy practice rather than addressing his poor communication and apparent lack of empathy.

Applying these various factors to the first question of whether any sanction is required, the Panel came to the clear conclusion that a sanction is required. The circumstances are too serious properly to result in no further action.

The Panel then considered whether a caution order would be appropriate, and in that context considered paragraph 101 of the Sanctions Guidance. The conclusion of the Panel was that it was not possible to bring the present case within the suggested factors in paragraph 101 for the following reasons:

• It might be argued that the issue was limited as there were two incidents that occurred in a short period of time. However, the issue could not be described as relatively minor in nature.

• Consistent with the terms of the Consent Order, it could not be said that the risk of repetition is low.

• It is fair to record that the Registrant has shown some insight, but in the judgement of the Panel it could not be said to be “good” for the reasons explained … above.

• Some steps have been taken towards remediation, but for the reasons explained in the same paragraph, the assumption made by the Panel is that remediation has not been fully achieved.

The Panel therefore rejected a caution order as an appropriate disposal and next considered conditions of practice.

When the Panel considered the factors suggested in paragraph 106 of the Sanctions Guidance, it concluded that it could properly be said that they were met in the present case. In particular:

• Although the Registrant’s insight is not complete, at the same time it is not wholly lacking.

• The deficiencies identified by this case are capable of being remedied.

• There are no persistent or general failings which would prevent the Registrant from remediating.

• Conditions can be formulated that are appropriate, proportionate, realistic and verifiable.

• The Panel is confident that as an honest and committed professional, the Registrant will comply with conditions imposed on his registration.

• With appropriate information provided to it, a reviewing panel will be able to determine whether the conditions have been met, and, importantly, whether the risk of repetition has been addressed.

• The Registrant does not pose a risk of harm by being in restricted practice.

The Panel tested the last of these factors (“the registrant does not pose a risk of harm by being in restricted practice”) by considering whether the circumstances of the present case require the imposition of a suspension order. The conclusion of the Panel was that a suspension order is not required in order to provide the degree of protection the public is entitled to expect. That being so, a suspension order would be unfair and disproportionate.

As to the Conditions to be imposed by the Conditions of Practice Order, the Panel does not propose to set them out verbatim in the body of this determination as they appear in the Order below. However, it is necessary to explain why they are both necessary and sufficient. Conditions 8, 9 and 10 are standard conditions. Condition 8 requires the Registrant to inform the HCPC of the name of any employer. Condition 9 requires notification of any disciplinary proceedings, and condition 10 requires various parties to be informed of the existence of the Order. Conditions 1 to 7 inclusive are all designed to ensure that the Registrant prepares and completes in conjunction with a supervisor a Professional Development Plan to address the shortcomings in the three identified areas (namely, reflective practice, communication with patients and the obtaining of informed consent). Condition 7 requires the Registrant to prepare periodic reflective pieces. The Conditions require the Registrant to submit information to be made available to a reviewing Panel when the Conditions of Practice Order is reviewed.

It has already been stated that the Panel does not have any information about the Registrant’s professional activities since the final hearing concluded, and that includes the present time. Accordingly, the conditions are prefaced by the words, “To the extent that you undertake professional work for which your HCPC registration is required”. In the view of the Panel, with the focus provided by the Professional Development Plan, the Registrant should be able to address his remaining shortcomings within 12 months, and that is the reason for the duration of the Order imposed. However, if it proves to be the case that the conditions will not be applicable for some time, there is clearly a prospect that the conditions will be renewed on a review of the Order imposed today.”

21. The conditions imposed were as follows:
(1) You must place yourself and remain under the supervision of a supervisor (who can, but need not, be a workplace supervisor) who is a Physiotherapist registered by the HCPC, and you must supply details of your supervisor to the HCPC within 21 days. Without prejudice to the specific requirements of paragraphs 2 and 4 of this Order below, you must attend upon that supervisor as required and follow their advice and recommendations.
(2) You must work with your supervisor to formulate a Personal Development Plan (“PDP”) designed to address your deficiencies in the following areas of your practice:
(i) reflective practice;
(ii) communication with patients;
(iii) obtaining of informed consent.

(3) Within three months of the commencement of your work with your supervisor to formulate a PDP you must forward a copy of the PDP to the HCPC.
(4) You must meet with your supervisor on a monthly basis to consider your progress towards achieving the aims set out in your PDP.
(5) Three months after the forwarding to the HCPC of a copy of your PDP, you must request your supervisor to provide a written report on your progress towards achieving the aims set out in your PDP, and thereafter you must request such reports every three months. You must forward copies of the written reports to the HCPC as when they are received by you from your supervisor.
(6) You must allow your supervisor to provide information to the HCPC about your progress towards achieving the aims set out in your PDP.
(7) You must maintain a reflective practice profile detailing occasions of, when and how you have used your communication skills to aid in the delivery of the effective physiotherapy treatments given particular focus in relation to informed consent and patient reassurance. You must provide a copy of that profile to the HCPC on a three- monthly basis.
(8) In relation to any professional activities undertaken by you for which your HCPC registration is required, you must promptly inform the HCPC of any employer by whom you are employed or details of any self-employed work you undertake. If the details change at any time while this Order is in force you must notify the HCPC forthwith of such change.
(9) You must promptly inform the HCPC of any disciplinary proceedings taken against you by your employer.
(10) You must inform the following parties that your registration is subject to these conditions:
(i)any organisation or person employing or contracting with you to undertake professional work;
(ii)any agency you are registered with or apply to be registered with (at the time of application); and,
(iii)any prospective employer (at the time of your application).

22. These conditions have yet to come into effect as the panel in October 2021 made an Interim Suspension Order at the conclusion of that hearing. The reason that panel made an Interim Suspension Order rather than an Interim Conditions of Practice Order was because it had been made aware that the Registrant was, at that time, already subject to an Interim Suspension Order in connection with another matter.

23. That other matter was heard between 28 February 2022 and 4 March 2022. The panel at that substantive hearing did not have sufficient time to conclude the matter and thus adjourned part-heard, having found most of the facts alleged proved and that they amounted to misconduct. The question of current fitness to practice and sanction have yet to be dealt with. Matters were due to be concluded in September 2022, but that hearing was postponed due to the Registrant’s poor health. It is now not expected to conclude until April 2023.

24. The matters found proved at that hearing were as follows:
As a registered Physiotherapist (PH105028) your fitness to practise is impaired by reason of misconduct. In that when you were treating Service User 1:

1) On or around 12 September 2019, you:

a) not proved;

b) not proved;

c) Confirmed to Service User 1 that she needed to remove her bra for treatment and/or allowed Service User 1 to remove her bra for treatment when there was no clinical justification for treatment being given that necessitated Service User 1 removing her bra.

d) Placed your hands on Service User 1’s breasts without clinical justification and/or communication;

e) Allowed Service User 1’s breasts to be exposed when asking her to turn over on the treatment table;

f) Allowed Service User 1’s breasts to become exposed during treatment when she was lying supine, and did not take any action to remediate and/or prevent this;

g) When conducting an exercise which involved you sitting behind Service User 1, with your arms clasped around her chest, you allowed Service User 1’s breasts to be exposed, and did not take any action to remediate and/or prevent this;

h) when conducting the exercise referred to at particular 1(g) above, you pressed your arm against Service User 1’s breast and/or nipple

2) On or around 19 September 2019, you:

a) not proved;
b) Massaged Service User 1’s chest, without clinical justification and/or communication;

c) When performing exercises on Service User 1’s chest, you performed them in a manner which allowed Service User 1’s breasts to become exposed;

d) Confirmed to Service User 1 that she needed to remove her bra for treatment and/or allowed Service User 1 to remove her bra for treatment when there was no clinical justification for treatment being given that necessitated Service User 1 removing her bra;

e) When conducting an exercise which involved you sitting behind Service User 1, with your arms clasped around her chest, you allowed Service User 1’s breasts to be exposed, and did not take any action to remediate and/or prevent this.

3) On or around 26 September 2019, you:

a) Confirmed to Service User 1 that she needed to remove her bra for treatment and/or allowed Service User 1 to remove her bra for treatment when there was no clinical justification for treatment being given that necessitated Service User 1 removing her bra;

b) Touched Service User 1’s breasts without clinical justification and/or communication;

c) When conducting an exercise which involved you sitting behind Service User 1, with your arms clasped around her chest, you allowed Service User 1’s breasts to be exposed, and did not take any action to remediate and/or prevent this;.

4) On or around 10 October 2019, when massaging:

a) Confirmed to Service User 1 that she needed to remove her bra for treatment and/or allowed Service User 1 to remove her bra for treatment when there was no clinical justification for treatment being given that necessitated Service User 1 removing her bra;

b) You brushed your groin against Service User 1’s hand.

c) When your groin brushed against Service User 1’s hand as described in 4a, your penis was ‘semi-stimulated’;

5) During treatment of Service User 1 on each of the above dates, you did not obtain informed consent from Service User 1.
6) Your assessment and/or clinical notes for the treatment of Service User 1 on 12 September 2019 were inadequate in that:

a) You did not obtain and/or record an adequate subjective history including:

(i)Details of easing or aggravating movements and postures;

(ii) Details of previous treatment.

b) You did not undertake and/or record an adequate objective examination including:

(i)Details of the movements that cause pain and/or those movements that were more limited;

(ii) Details of the location of tenderness between the shoulder blades;

(iii) Details of the testing method for establishing the tenderness between the shoulder blades;

c) You did not record any specific anatomical structures or pathology to aid your diagnosis;

d) You did not record the following items in your clinical records adequately and/or at all:

(i)The nature and/or purpose of the massage given;

(ii) The structures treated utilising muscle energy techniques or trigger point therapy;

(iii) The direction or amplitude of mobilisation used;

(iv) The levels of the spine that were treated;

(v) The breathing exercises used

7. Your assessment and/or clinical notes for the treatment of Service User 1 on 19 September 2019 and/or 26 September 2019 and/or 10 October 2019 were inadequate in that:

a) not proved;

b) You did not obtain and/or record the direction and/or degrees of Service User 1’s movement.
8. You copied and pasted sections of your clinical notes from previous clinical entries at follow up appointments with Service User 1 on 19 September 2019 and/or 26 September 2019 and/or 10 October 2019;

9) At the time your actions in paragraphs 1-4 above were carried out, you believed you were the subject of a Caution Order placed on your registration by a Panel of Conduct and Competence Committee on 29 July 2019 (although such order was later quashed by consent order of the High court on 08 September 2020 and replaced by a Conditions of Practice Order).
10) Your conduct in paragraphs 1 – 4 were sexually motivated.

11) The matters set out in paragraphs 1– 10 constitute misconduct.

Submissions
25. Ms Welsh, on behalf of the HCPC, detailed the background to the case and submitted that the Registrant’s fitness to practice remained impaired. She highlighted the most recent findings of a panel of the Conduct and Competence Committee in March 2022, which involved very similar allegations of inappropriate touching of a service user in September 2019. She said the majority of those allegations were found proved and were found to have been sexually motivated. She reminded the Panel that the question of current impairment and sanction had yet to be dealt with and the reasons for the delay.

26. Ms Welsh submitted that in light of this most recent case there had been a material change in circumstances and that a Conditions of Practice Order was no longer appropriate or proportionate. She said that no conditions could now be formulated to provide the necessary degree of protection to the public and she invited the Panel to consider striking the Registrant off the Register today, or, in the alternative, to make a Suspension Order for 12 months.

27. In the written representations provided on behalf of the Registrant the Panel was invited to consider extending the Conditions of Practice Order.

Decision
28. The Panel considered with care the documentation provided by both parties, together with the oral submissions made by Ms Welsh. The Panel accepted the advice of the Legal Assessor and in reaching its decisions referred to the HCPTS’s Practice Note on ‘Finding Fitness to Practise is Impaired’. The Panel carried out a comprehensive review of the current order in light of the circumstances as they existed today.

29. The Panel first considered the issue of current impairment. The Panel took account of the principle set out in Abrahaem v GMC [2008] EWHC 183 (Admin) that there is, in practical terms, a persuasive burden at a review hearing for the Registrant to demonstrate that he has “fully acknowledged why past performance was deficient and through insight, application, education, supervision or other achievement sufficiently addressed the past impairments.”

30. The Panel noted that the Registrant had yet to be able to comply with the conditions because he has been suspended from practice since the Order was made in October 2021. He had not, therefore, addressed the concerns raised by that panel. However, he could, in this Panel’s view, have taken steps to reassure the Panel that his fitness to practise was no longer impaired, even whilst suspended. For example he could have written a reflective piece to demonstrate insight into the impact of his conduct upon the two service users in 2016. It was clear that they were still being impacted upon by his behaviour three years later at the hearing in 2019 and yet there was nothing from the Registrant expressing remorse for his actions and acknowledging the feelings of Service Users A and B. The Registrant had attended some online courses but had not said what he had learned from those courses or how it would affect the way in which he would treat service users when he resumed his practice.

31. As the Registrant had done none of this the Panel could not be satisfied that he would not repeat such behaviour and consequently he continues to represent a risk to the public. This conclusion was significantly reinforced by his subsequent behaviour which demonstrated in the clearest of ways that there was a real risk of repetition, since within weeks of the panel’s findings in July 2019 the Registrant went on to touch another service user inappropriately. The extent of that inappropriate touching can be seen in detail in the proved facts referred to above and which that panel found to be sexually motivated.

32. Notwithstanding the significant number of positive testimonials provided, the Panel was satisfied that the Registrant continued to represent a real risk of harm to service users and that a finding of current impairment was called for on public protection grounds.

33. The Panel was also satisfied that the Registrant’s current fitness to practise was impaired on public interest grounds. This was because members of the public would be rightly concerned to know that a physiotherapist registered with the HCPC, who had been found to have inappropriately touched two female service users, had subsequently shown no insight, no remorse, negligible remediation and, most significantly, had gone on to touch another female service user within weeks of the findings made against him. Even more concerning was that the subsequent touching had been found to be sexually motivated. The Panel was in no doubt that public confidence in the profession would be undermined if a finding of current impairment were not made in such circumstances.

34. The Panel thus went on to consider what sanction to impose and in doing so was guided by the Sanctions Policy issued by the HCPC. Having identified a risk to the public, the Panel considered it would not be appropriate to take no further action or to make a Caution Order.

35. The Panel then considered whether to extend the current Order of conditions, as suggested by those representing the Registrant. However, given the almost complete lack of steps taken by the Registrant thus far to demonstrate insight and remediation, the Panel did not consider such an extension to be appropriate. Furthermore, in light of his subsequent offending behaviour in relation to Service User 1, the Panel did not consider such a sanction to be proportionate. The Panel rejected the submission made by those representing the Registrant that the two cases were discrete and should be treated as such. Whilst acknowledging that no sexual motivation was found in relation to Service Users A and B, those cases still involved inappropriate touching. The case concerning Service User 1 also involved inappropriate touching, just of a more serious kind since it was found to be sexually motivated. It would be wrong of the Panel not to take that clearly aggravating factor into account.

36. Having determined a Conditions of Practice Order was no longer appropriate, the Panel next considered whether a Suspension Order should be made. The Sanction Policy states that, “A suspension order is likely to be appropriate where there are serious concerns which cannot be reasonably addressed by a conditions of practice order, but which do not require the registrant to be struck off the Register. These types of cases will typically exhibit the following factors:
• the concerns represent a serious breach of the Standards of conduct, performance and ethics;
• the registrant has insight;
• the issues are unlikely to be repeated; and
• there is evidence to suggest the registrant is likely to be able to resolve or remedy their failings.”

37. There was no doubting the concerns represented a serious breach of the Standards of conduct, performance and ethics. However, the Registrant had not shown any real degree of insight, the issues were likely to be repeated (and indeed had been) and there was no cogent evidence before the Panel to suggest the Registrant was likely to be able to resolve his failings.

38. The Panel did take into account what had been said about the Registrant’s health and also the fact that he had been suspended from practice on an interim basis since the substantive order had been made in October 2021. However, as stated above, in the Panel’s view there was still much that the Registrant could have done to demonstrate insight and remediation and this he had singularly failed to do.

39. The Panel therefore looked at what the guidance said about a Striking Off Order. The Sanctions Policy states that a Striking Off Order is a sanction of last resort for serious, persistent, deliberate or reckless acts involving, amongst other things, sexual misconduct. The guidance states that sexual misconduct is a very serious matter which has a significant impact on the public and public confidence in the profession. It includes, but is not limited to, sexual harassment, sexual assault, and any other conduct of a sexual nature that is without consent, or has the effect of threatening or intimidating someone. The Panel was cognisant of the fact that the matters found proved in July 2019 did not include sexual misconduct and it was very careful not to allow the subsequent findings in March 2022 to taint those findings. However, there was no escaping the fact that within weeks of findings of inappropriately touching two female serve users, the Registrant was inappropriately touching a third. On any view this portrayed a concerning pattern of behaviour.

40. The guidance goes on to state that, “A striking off order is likely to be appropriate where the nature and gravity of the concerns are such that any lesser sanction would be insufficient to protect the public, public confidence in the profession, and public confidence in the regulatory process. In particular where the registrant:
• lacks insight;
• continues to repeat the misconduct; or
• is unwilling to resolve matters.”

41. In this case the Panel has found that the Registrant lacks insight, he repeated misconduct of a very similar nature and he appears unwilling to resolve matters.

42. The Panel fully recognised the draconian nature of a Striking Off Order and the severe impact of such an Order on a Registrant. However, given the lack of insight, the repeated behaviour and the seriousness of the misconduct the Panel concluded that a Striking Off Order was now the only appropriate and proportionate sanction in this case.

is served on you.

The Registrar is directed to, on the expiry of the current Conditions of Practice Order, strike the Registrant off the Register.

The Order imposed today will apply from 16 November 2022.

Right of Appeal
You may appeal to the High Court in England and Wales against the Panel’s decision and the order it has made against you.

Under Articles 30(10) and 38 of the Health Professions Order 2001, any appeal must be made to the court not more than 28 days after the date when this notice is served on you.

History of Hearings for Mr Andrea Franchini