Imran Khan

Background

1. The Registrant is a Chiropodist who was employed by Walsall Health Care NHS Trust (the Trust) between 12 August 2019 and October 2020.

2. Concerns into the Registrant’s conduct first arose following an episode of ill health in September 2019 which meant that he was not permitted to drive for six months. In the following months, the Registrant was seen on multiple occasions by his colleagues driving to and from work. Following this, he was spoken to about it on multiple occasions by his Team Leader, CH, and his manager, MK, the Clinical Lead Podiatrist.

3. During the course of the Registrant’s employment, several other concerns were identified which involved his inadequate treatment of patients. In February 2020 there were two incidents where it is said that the Registrant provided inadequate care to patients. On one occasion the Registrant was attending to a patient (Patient O) and provided inadequate care, with this patient subsequently requiring a partial amputation of his toes. On another occasion during a routine appointment, it is said that the Registrant provided inadequate care to another patient (Patient P) who, following this, required nail surgery to rectify the Registrant’s actions.

4. Additional concerns arising throughout the remainder of 2019 and early 2020 surrounded his record-keeping.

5. Following a period of sick leave in March 2020, the Registrant was taken off clinical duties due to the concerns raised with his patient care and instead he was due to be placed on the wards at the hospital as a Clinical Support Worker (CSW) to assist with the COVID-19 pandemic. During his two-day health and safety training day at the hospital to prepare him for this role, the Registrant was witnessed introducing himself as a doctor. Following this, the Registrant was placed in an office environment to work until the end of his contract with the Trust.

6. A referral was made to the HCPC on 17 March 2020 by MK.

7. At its meeting on 9 June 2021, a panel of the HCPC Investigating Committee determined that there was a case to answer in relation to the allegation of impairment of the Registrant’s fitness to practise.

8. At the outset of the hearing, the Registrant unequivocally admitted the facts of Particulars 1, 2a – 2n, and 6 in relation to Particular 1. The remaining factual particulars were denied.

Decision on Facts

Live evidence heard

9. The Panel heard live evidence from five witnesses:

• CH, Team Leader Podiatrist at the Trust;
• MK, Clinical Lead Podiatrist / Manager;
• AM, Interim Clinical Lead Podiatrist;
• MP, lay witness and Practice Education facilitator; and
• SM, e-Learning Developer at the Trust.

10. The Panel also received the witness statements of CB, a Legal Assistant at Kingsley Napley LLP, dated 21 June 2022, and SH, a General Medical Council Information Manager.

11. The Panel also had sight of a number of documentary exhibits which included, but were not limited to:

• The Fitness to Practise Referral Form dated 17 March 2020;
• Various emails and other correspondence from the Registrant’s employer to the Registrant;
• Patient O’s treatment records;
• Patient P’s treatment records;
• Various policy documents, including “Care Pathway for Foot Care in Diabetes”; “Putting Feet First Pathway Update”; “Management of Diabetic foot infections”; “Equality Impact Assessment Form”; “Foot care in Diabetes Policy” and “Ulcerated Diabetic Patient Flowchart”.

12. The Panel also heard oral evidence from the Registrant. It also considered the documentation provided by the Registrant, which included an 11-page bundle including email correspondence, a Podiatry Musculoskeletal Assessment form, and two guidance documents drafted by the Registrant. The Registrant also provided one testimonial from PM, dated 17 May 2021.

Submission of no case to answer

13. At the conclusion of the HCPC case, Mr James, on behalf of the Registrant, made a submission of no case to answer in relation to Particulars 3a, 3b, and 4.

14. In relation to Particular 3b, Mr James submitted that the evidence supporting this sub-particular was contained in the second half of paragraph 28 of MK’s witness statement. MK came to the conclusion from looking at Patient O’s podiatry treatment record that she could not see any evidence that a full vascular assessment occurred. Indeed, MK was asked, in oral evidence, the following:

Question: “From that page, you can’t tell us whether or not one was done?”

Answer: “No – it would have been a referral to the ABPI [Ankle Brachial Pressure Index] or a referral to the MDT but that didn’t happen.”

15. Therefore, he submitted that the evidence presented by the HCPC was inconclusive as to whether an adequate vascular assessment was carried out. An absence of a record of such an assessment is wholly different from first-hand evidence of Patient O himself, or indeed anyone present at the consultation, that no assessment took place. He submitted that the HCPC’s evidence was nothing more than an assertion based on what was not written in Patient O’s notes.

16. Furthermore, he submitted that there also appeared to be significant confusion as to what the HCPC defined as an “adequate vascular assessment”:

a. MK’s witness statement suggested that “a vascular assessment entails taking an [ABPI]” [Mr James’ emphasis] … The Panel is invited to note the use of the word “a” and not “adequate””.

b. During questioning from the Panel, MK suggested that the following would amount to a “full vascular assessment”:

• First, feeling for a pulse with one’s fingers;
• Then the use of a small ultrasonic machine;
• Further assessment would be a brachial pressure index in both the arm and the leg and, if there was a difference, it would indicate that it was not quite right and then, depending on the results, if there was anything monophasic, that would be sent on for further investigation;
• They did in-house ABPIs but often that was always when the diabetic was sent to the multidisciplinary team (MDT) team as they have a Vascular Consultant who could do it straight away.

c. MK seemed to suggest there needed to be a referral to the ABPI. This contradicted the idea that the Registrant could have carried this out himself.

d. There also appeared to be a written policy on what constituted a vascular assessment. This suggested that one should check:

• Dorsalis pedis and posterior tibial pulses;
• If not palpable, assess skin colour and capillary refill;
• If pulses were absent, consider cardiovascular risk factor management.

17. Mr James therefore submitted that it was entirely unclear what the Registrant was expected to have done, whether that was to follow the policy, to have done an assessment himself, or to refer Patient O to another practitioner.

18. Accordingly, there was no evidence that the Registrant did not conduct an adequate vascular assessment. Furthermore, he submitted that the evidence on what is an adequate vascular assessment was tenuous in character due to vagueness and inconsistency with other evidence.

19. In relation to Particular 3a, Mr James submitted that the HCPC had no direct evidence of what actually occurred during this consultation. This could have taken the form of evidence from Patient O or from someone else in the room. Therefore, the HCPC was reliant on Patient O’s exhibited podiatry treatment record. Within that document, he submitted that there was no evidence of the Registrant making a referral to the Multidisciplinary Diabetic Foot Team. Equally, there was no evidence of his not doing so.

20. Accordingly, Mr James submitted that the HCPC had no evidence in support of this sub-particular.

21. In relation to Particular 4, Mr James submitted that the HCPC had provided no evidence that the Registrant cut Patient P’s nails too severely.

22. The entirety of the evidence for this particular was contained in AM’s witness statement. There were two exhibits:

• a treatment continuation sheet dated 5 February 2020; and
• a nail surgery operation record dated 5 March 2020.

23. Mr James submitted that there was no mention in AM’s witness statement of the Registrant cutting the nails of Patient P too severely, nor was there mention of this in the exhibits. Indeed, in AM’s oral evidence of this, she stated:

Question: Looking at Patient P’s podiatry treatment record: “Does this document say that the nails were cut too severely?”

Answer: “No not really. He treated both first toenails. He put down that both were ingrown but the patient did not make any comment about pain.”

Question: “You had a conversation with Patient P?”

Answer: “I did at nail surgery.”

Question: “That’s the next month.”

Answer: “It is yeah.”

Question: “What was said?”

24. Following private discussions with Mr Jotangia and the Legal Assessor, no further questions were asked about Patient P.

25. Mr James submitted that AM’s answer at 16b above, namely “no not really”, demonstrated that there was nothing in the exhibits from which it could be concluded that the Registrant cut Patient P’s nails too severely.

26. Accordingly, as the HCPC had advanced no evidence to support this particular, it was submitted that there was no case for the Registrant to answer in respect of Particular 4.

HCPC submissions

27. Mr Jotangia, on behalf of the HCPC, opposed the application.

28. He submitted that the facts in question should fall to be determined by the Panel having heard from the Registrant. The allegations related to procedural policies that should have been adopted but were not.

29. He submitted that the evidence of MK presented to the Panel was such that it could conclude that it would have been reasonable for the Registrant to have performed a vascular assessment and to have referred Patient O to an MDT.

30. So far as Particular 4 was concerned, Mr Jotangia invited the Panel to rely on the evidence of AM. Beyond that, he had no further submissions to make.

The Panel’s decision

31. In considering these submissions, the Panel considered all of the evidence it had received and heard, and accepted the advice of the Legal Assessor. It applied to the regulatory nature of these proceedings the test as set out in the case of R v Galbraith [1981] 1 WLR 1039, namely:

“(1) If there is no evidence that the crime alleged has been committed by the defendant, there is no difficulty. The judge will of course stop the case.

(2) The difficulty arises where there is some evidence but it is of a tenuous character, for example because of inherent weakness or vagueness or because it is inconsistent with other evidence.

(a) Where the judge comes to the conclusion that the prosecution evidence, taken at its highest, is such that a jury properly directed could not properly convict upon it, it is his duty, upon a submission being made, to stop the case.

(b) Where however the prosecution evidence is such that its strength or weakness depends on the view to be taken of a witness's reliability or other matters which are generally speaking within the province of the jury and where on one possible view of the facts there is evidence upon which a jury could properly come to the conclusion that the defendant is guilty, then the judge should allow the matter to be tried by the jury … There will of course, as always in this branch of the law, be borderline cases. They can safely be left to the discretion of the judge.”

Particular 3a

3. On or around 11 February 2020 you did not provide adequate care to Patient O, in that:

a. You did not make a referral to the Multidisciplinary Diabetic Foot Team.

32. In relation to Particular 3a, the Panel had regard to the evidence of MK. She was unequivocal that the policies in force at the time, of which the Registrant had been informed, indicated that, as Patient O had a history of diabetes, had previously had a foot amputated, and had an ulcer, a rapid referral to an MDT was required.

33. In the circumstances, the Panel found that there was sufficient evidence which, if accepted, could enable a properly directed panel to find the facts proved. That determination could only be made at the conclusion of the facts stage when an assessment of the credibility and reliability of MK’s evidence could be made in relation to this particular. The Panel therefore refused Mr James’ application and found that there was a case to answer in respect of Particular 3a.

Particular 3b

3. On or around 11 February 2020 you did not provide adequate care to Patient O, in that:

b. You did not conduct an adequate vascular assessment.

34. In relation to Particular 3b, the Panel considered the adequacy of the evidence that the Registrant did not conduct an adequate vascular assessment.

35. The Panel carefully considered the contents of Patient O’s treatment record. Having done so, it noted that the Registrant had undertaken palpation and assessed the pulse phases with an ultrasound Doppler machine. The evidence before the Panel did not indicate whether the Registrant had access to the equipment that would have allowed him to undertake an ABPI assessment or whether that would have to be undertaken by the MDT. The Panel noted that the evidence of MK suggested a referral to an MDT would be required for an ABPI.

36. As such, the Panel concluded that the evidence in relation to this particular was inherently weak and tenuous, such that the second limb of the Galbraith test was not met.

37. In the circumstances, the Panel found that there was insufficient evidence which, even if accepted, could enable a properly directed panel to find that the Registrant acted as alleged. The Panel therefore granted Mr James’ application and found that there was not a case to answer in respect of Particular 3b.

Particular 4

4. In or around February 2020 during a routine appointment you did not provide adequate care for Patient P in that you cut his nails too severely.

38. In relation to Particular 4, the Panel noted the evidence of AM, noting that the patient’s nails were long so the Registrant cut them. She subsequently stated that a partial nail avulsion was required to remove an ingrowing nail, which can be caused by cutting nails too short.

39. The Panel noted that Patient P’s records indicated that the nails were already ingrown when the Registrant cut them. Whilst the Panel had regard to the fact that a nail avulsion can result from nails being cut too short, the evidence before the Panel did not demonstrate that the Registrant’s actions in this particular case were the cause of the need for a nail avulsion. The Panel also had regard to the fact that there was no explicit evidence that it was the Registrant who cut Patient O’s nails too severely.

40. As such, the Panel concluded that the evidence in relation to this particular was inherently weak and tenuous, such that the second limb of the Galbraith test was not met.

41. In the circumstances, the Panel found that there was insufficient evidence which, even if accepted, could enable a properly directed panel to find that the Registrant acted as alleged. The Panel therefore granted Mr James’ application and found that there was not a case to answer in respect of Particular 4.

Decision on Facts

Panel’s Approach

42. The Panel was aware that the burden of proving the facts was on the HCPC. The Registrant did not have to prove anything and the individual particulars of the Allegation could only be found proved if the Panel was satisfied that this was the case on the balance of probabilities.

43. In reaching its decision the Panel took into account the oral evidence of the HCPC witnesses, together with all of the documentary evidence provided to it, including the Registrant’s evidence, documents submitted by him, and the oral submissions made by Mr Jotangia on behalf of the HCPC and by Mr James on behalf of the Registrant.

44. The Panel also accepted the advice of the Legal Assessor, which was a matter of record.

Particular 1 – Proved

1. Between September and November 2019 you were seen driving to and from work, on multiple occasions, despite having informed your employer that you were not driving and/or suspended from driving.

45. The Panel found the facts of Particular 1 proved for the following reasons.

46. The Panel accepted the evidence of CH, which it found to be credible and reliable in relation to this particular given the Registrant’s admission to the facts alleged.

47. CH stated that during the Registrant’s induction, the Registrant had informed her that he had not been feeling well. He subsequently took time off work and, on his return, told her that he was unable to drive for six months. CH referred the Registrant to Occupational Health.

48. CH stated that she met with the Registrant on 21 October 2019. She had been told by colleagues that he had been seen driving to and from work. She addressed the driving concerns in the meeting. She stated that the Registrant assured her that his wife was picking him up and dropping him off at work. When CH asked if his wife was dropping him off and picking him up when it had been observed that his car was then left in the Trust car park all day, she stated that the Registrant made no comment or eye contact.

49. After the meeting, CH stated that from her office, she clearly saw the Registrant leave the building, get into his car (which had a personalised number plate), and drive off. She subsequently wrote to the Registrant informing him of what she saw.

50. The Panel also accepted the evidence of MK in relation to this particular. Much of MK’s evidence was consistent with that of CH and with the Registrant’s admissions. The Panel therefore concluded that MK’s evidence was credible and reliable.

51. MK stated that, having been informed by a colleague that the Registrant was unwell, she spoke to the Registrant and sent him home, following which he was off work for a period of time.

52. MK stated that TH, an Occupational Health Advisor who saw the Registrant on 11 October 2019, told her that the Registrant had informed her that he had informed the DVLA and that he was unable to drive for six months.

53. MK stated that she spoke to the Registrant about this and he stated that he had informed the DVLA. She said that the Registrant informed her that he was not driving to and from work, but rather his wife was dropping him off and picking him up. To explain why the car was then left on the premises all day, he informed MK that his wife would sometimes leave the car in the car park whilst she went shopping. However, following this conversation, MK stated that she was still receiving reports that the Registrant was seen driving.

54. In addition the Panel accepted the evidence of AM, who gave credible evidence that on 30 October 2019, she saw the Registrant driving off from the Trust premises.

55. The Panel also took into account that the Registrant admitted the facts alleged. In admitting the factual particular, the Registrant stated that he only drove his car on three or four occasions. This happened when his wife assured him that she would drive him to work but then let him down at the last minute. He stated that he did not take public transport because of the time and cost involved, and that his motivation was to ensure that he could get to work in time to ensure that he could complete his clinical list without disruption to colleagues or patients. He stated that he recognised the risk his actions had posed both to himself and others.

56. In all the circumstances, the Panel therefore found the facts of Particular 1 proved.

Particulars 2a-2n – Proved

2. Between 09 September 019 and 24 February 2020 you did not make any and/or adequate notes for:

a. Patient A
b. Patient B
c. Patient C
d. Patient D
e. Patient E
f. Patient F
g. Patient G
h. Patient H
i. Patient I
j. Patient J
k. Patient K
l. Patient L
m. Patient M
n. Patient N

57. The Panel found the facts of Particulars 2a – 2n proved for the following reasons.

58. The Panel accepted the evidence of CH, which it found to be credible and reliable in relation to this particular given the Registrant’s admission to the facts alleged.

59. CH stated that she became aware of concerns regarding the Registrant’s record-keeping. She stated that notes would be handwritten rather than made electronically.

60. CH stated that the information on the electronic booking system consists of the date of the appointment and who conducted the appointment. There is also space to insert the outcome of the appointment, which would include how many weeks it is until the clinician wants to see the patient again. In every appointment, whomever conducted the appointment should edit their name into the outcome section of the system. MK’s name is the automatic default name that appears for all appointments. However, whomever inputs the data outcome would have been the treating clinician so they can be certain of who undertook the appointment. In addition, MK does not do planned routine clinics, only very occasional specialist clinics, and therefore did not conduct any of the appointments.

61. CH stated that she randomly selected some of the Registrant’s files for one week and, having conducted a visual audit, concluded that the Registrant was not filling out the written notes, which would not be picked up until the next patient appointment.

62. CH exhibited the relevant patient notes and identified the following concerns, which can be summarised as follows:

Patient A

63. Patient A was booked in to see the Registrant on 20 December 2019. However, there was a gap in the written notes. There was an entry of 5 November 2019 and the next one was 6 March 2020. Therefore, the Registrant’s appointment notes from 20 December 2020 were never written down.

64. There were also appointments from the electronic booking system for 8 November 2019, 25 November 2019, and 27 January 2020 which did not appear in the note system. This was because the appointment on 8 November 2019 was carried out at a separate clinic rather than their premises, so the patient notes would not be stored with them. The appointments on 25 November 2019 and 27 January 2020 were for other services under the Trust separate to podiatry, and therefore CH did not have the notes from these appointments. CH stated that their NHS booking system had a record of all patient appointments across the Trust, and therefore they would get to see any appointment that a patient had been to.

Patient B

65. An appointment was conducted by the Registrant on 28 October 2019. However, there was a gap in the written notes as there was an entry on 29 July 2019 and the next one was 3 March 2020. Therefore, the Registrant never made any written notes of the appointment. There also appeared to be an appointment on the electronic booking system for 20 January 2020, which was also not in the patient notes. This was because this was an appointment for a different service under the Trust.

Patient C

66. The Registrant had an appointment with this patient on 25 September 2019. The written notes showed that there was an entry on 24 June 2019 and then the next appointment notes were on 12 December 2019. Therefore, the Registrant never made any written notes of the appointment on 25 September 2019. There also appeared to be appointments evidenced on the electronic system for 2 October 2019, 24 September 2019, 3 September 2019, and 31 July 2019 which did not appear in the written notes. This, CH stated, was because these appointments were for a different service under the Trust.

Patient D

67. The Registrant conducted an appointment on 23 October 2019. However, the notes only evidenced an appointment on 27 August 2019 and then the next one on 16 December 2019. Therefore, the Registrant never made any written notes of the appointment on 23 October 2019. There also appeared to be an appointment on the electronic booking system for 18 December 2019 which also did not appear in the written notes. This was because these appointments were for a different service under the Trust.

Patient E

68. The Registrant conducted an appointment on 2 January 2020. The written notes evidenced an appointment on 26 September 2019 and then the next written notes were from an appointment conducted on 13 March 2020. Therefore, the Registrant never made any written notes of the appointment he had on 2 January 2020.

Patient F

69. The Registrant had an appointment with this patient on 24 February 2020. There were notes from an appointment on 4 December 2019. It would seem, on the following page, that there was evidence of the Registrant’s written notes from his appointment as CH recognised his handwriting. However, there was no date and time provided next to the notes which were made.

Patient G

70. The Registrant had appointments with this patient on 28 November 2019 and 24 February 2020. The Registrant wrote notes for the appointment on 28 November 2019, which were correct, and then inadequately completed the notes for the appointment on 24 February 2020. He wrote the notes directly under the previous appointment without providing the date and time of the appointment. It was clear that these notes were for a second appointment rather than a continuation of the notes from the appointment conducted on 28 November 2019 because of the use of the word “SOAP” (Subjective Objective Action Plan) twice, and the entry had two stickers, which were for the instrument packs used for each appointment. There was an appointment on the electronic booking system for 27 September 2019 which did not appear on the written notes. This was not only an appointment conducted at a different location but by another colleague, who noted in the record that she made a device for the patient during this time rather than attending to them face-to-face.

Patient H

71. The Registrant had an appointment with this patient on 23 October 2019. However, in the written notes CH wrote ‘NO OUTCOME RECORDED’ as the notes jumped from an appointment on 13 August 2019 to the next appointment on 10 January 2020. Therefore, the Registrant never made any written notes of the appointment on 23 October 2019. In addition, the ‘seen by’ section listed MK. The system always defaults to MK unless the clinician manually changes the ‘seen by’ name to their own name. All clinicians are informed of this when they are first introduced to the Trust’s systems and therefore the Registrant would have known that he needed to change this to his own name.

Patient I

72. The Registrant had an appointment with this patient on 28 October 2019. However, in the written notes CH stated that she made an entry for 28 October 2019 where she wrote ‘NO NOTES WRITTEN UP’, as the notes jumped from an appointment on 3 July 2019 to 18 March 2020. Therefore, the Registrant never made any written notes of the appointment on 28 October 2019.

Patient J

73. The Registrant had an appointment with this patient on 28 October 2019. However, in the written notes, on the third page, CH made an entry for 28 October 2019 and wrote ‘NO OUTCOME - MISSING’ as the notes jumped from an appointment in September 2019 to 20 December 2019. Therefore, the Registrant never made any written notes of the appointment on 28 October 2019.

Patient K

74. The Registrant saw this patient on 23 November 2019. The written notes show an appointment on 28 October 2019 and the next notes were on 13 February 2020. Therefore, no notes were recorded for the appointment on 23 November 2019.

Patient L

75. An appointment was conducted by the Registrant on 22 October 2019. CH stated that she made an entry for 22 October 2019 and noted ‘OUTCOME MISSING’ as there was no record kept of this appointment.

Patient M

76. The Registrant conducted an appointment on 22 October 2019. There were written notes for an appointment that occurred on 24 September 2019 and the next notes were for an appointment on 10 December 2019. In her handwritten note, CH stated ‘MISSING OUTCOME’ as the Registrant never made any written notes of the appointment on 22 October 2019.

Patient N

77. An appointment was conducted by the Registrant on 22 October 2019. Written notes were made of an appointment that occurred on 27 August 2019 and the next notes of an appointment were on 17 December 2019. CH stated that she made handwritten notes stating ‘OUTCOME MISSING’ for 22 October 2019 as the Registrant never made any written notes of the appointment he had with this patient on 22 October 2019.

78. CH stated that the potential consequences of a clinician taking inadequate notes or not recording notes at all is that there is a risk of liability to the Trust. If a patient decided to sue the Trust, accusing it of negligence, the Trust would have either no notes or inadequate notes to prove otherwise. It is a high risk, not only for the Trust but also for the Registrant. There is also the risk that the next Podiatrist a patient is seen by will not have a full overview of the patient history and would not be aware of any treatment plan being followed. This is not only inconvenient for the Podiatrist but also puts the patient at risk. It also looks unprofessional if the Podiatrist has to ask the patient questions which they have already previously answered.

79. CH also made reference to exhibited Trust policies regarding record-keeping, requiring clinicians to take adequate notes of any appointment.

80. The Panel also took into account that the Registrant admitted the facts alleged. The Registrant recognised that his record-keeping was inadequate but explained that he had difficulty adjusting to the practice at the Trust in keeping handwritten notes when the practice at his former post in Oxford was to maintain records electronically. This, coupled with time constraints, meant that he was unable to maintain adequate patient notes, although he stated that he had made some separate handwritten notes but these were not kept with the patients’ records. However, he emphasised that he understood the importance of accurate record-keeping. He stated that he has since undertaken a Continuing Professional Development (CPD) course in record-keeping to “better myself”.

81. In light of the admitted facts, the Panel concluded that the Registrant did not keep any / adequate notes as alleged. The Panel therefore found the facts of Particulars 2a – 2n proved.

Particular 3a – Proved

3. On or around 11 February 2020 you did not provide adequate care to Patient O, in that:

a. You did not make a referral to the Multidisciplinary Diabetic Foot Team.

82. The Panel found the facts of Particular 3a proved for the following reasons.

83. CH stated that the Registrant was fully informed of the processes that had to be followed whenever a diabetic patient came into the clinic with an ulcer. She stated that the Registrant was provided with the following policies, which should have enabled him to know what procedure to follow when faced with this particular patient, namely:

• “Care Pathway for Foot Care in Diabetes”.
• “Putting Feet First Pathway Update”, which further outlines that if the clinician has a patient who has an ulceration, there needs to be “rapid referral” (within one working day) to the Multidisciplinary Diabetic Foot Team.
• “Management of Diabetic foot infections”, which states: “These ulcers need to be reviewed and managed by a multi-disciplinary team of Diabetologist, vascular surgeon, podiatrist and microbiologist who are interested in management of the diabetic foot”.
• “Equality Impact Assessment Form”
• “Foot Care in Diabetes Policy”
• “Ulcerated Diabetic Patient Flowchart”

84. She stated that the above policies confirmed that, because of Patient O’s health condition, he should have been referred to the MDT.

85. The Registrant accepted in evidence that he was made aware of the above policies and further accepted that it would not have been a “bad thing” if Patient O had been referred to an MDT given the patient’s medical history and presentation, in that he suffered from diabetes, had previously had toes amputated, and presented with an ulcer. However, the Registrant stated that he was unable to state with any certainty whether he did refer Patient O to an MDT.

86. The Panel had regard to the fact that Patient O’s notes as completed by the Registrant did not state that he referred Patient O to an MDT, despite the fact that the Registrant wrote that the patient should be reviewed a week later.

87. The Panel also took into account the contents of MK’s letter to Patient O’s granddaughter, who wrote to the Trust with her concerns regarding the Registrant’s care of her grandfather. In her response, MK wrote:

“The pathway for a patient similar to your Grandfather is to send them to our Multidisciplinary Diabetic Foot team at the Manor Hospital within 48 hours for their assessment. We would also give written and verbal advice regarding any changes to the toe and the need to contact us if there is an emergency. This unfortunately did not happen in this case.”

88. In all the circumstances, the Panel concluded that it was more likely than not that the Registrant did not refer Patient O to an MDT.

89. The Panel then went on to consider whether, by not referring Patient O to an MDT, he did not provide adequate care to Patient O.

90. The Panel noted that the Registrant had provided appropriate treatment to Patient O, in that he had undertaken palpation and assessed the pulse phases with an ultrasound Doppler machine. However, the Panel concluded that for effective care to be given, Patient O should have been referred to an MDT in accordance with the applicable guidance. For the avoidance of doubt, the “Care pathway for Foot Care in Diabetes” flowchart unequivocally makes clear that a referral to an MDT was required in Patient O’s circumstances.

91. In the absence of such a referral, notwithstanding the treatment provided by the Registrant, the Panel concluded that the Registrant had therefore not provided adequate care.

92. The Panel therefore found the facts of Particular 3a proved.

Particular 5 – Proved

5. On or around 5 May 2020 you told colleagues that you were a doctor when this was not the case.

93. The Panel found the facts of Particular 5 proved for the following reasons.

94. It was not disputed that the Registrant is not a qualified medical doctor and is not registered with the General Medical Council (GMC).

95. AM stated that, following concerns being raised about the Registrant, a decision was taken for the Registrant to be taken away from a clinical role pending the outcome of an internal investigation. A decision was taken that the Registrant should work as a CSW, where he would not have one-to-one contact with patients but would assist nursing staff. It was agreed that the Registrant would take part in the week of CSW training.

96. MP stated that on 5 May 2020, colleagues from the Learning and Development team, SM and JE, informed her that the Registrant had attended the training session but he had caused some confusion by informing the group that he was a doctor who specialised in foot and ankle surgery.

97. MP stated that she then spoke to the Registrant with SM. She stated that she asked the Registrant to tell her which department he worked in within the Trust. He informed her that he worked in Podiatric Medicine and his line manager was MK, whom MP knew was on secondment at the time. The Registrant went on to say that he had been asked to go on the wards as there were no elective surgeries occurring at the moment, so he was to be redeployed. MP stated that she asked the Registrant what he meant by elective surgeries, and he responded to say foot and ankle surgeries. She asked him to confirm his role at the Trust prior to the COVID-19 pandemic and he informed her it was carrying out foot and ankle surgeries. She did not ask any further questions about his current role as she recalled being shocked by what he was saying. He then named a particular member of staff at the Trust with whom he worked in surgery. Being a podiatrist herself and previously working at the Trust, MP was aware that this member of staff did not conduct foot and ankle surgery, so she challenged the Registrant on this information. He insisted that this member of staff did conduct foot and ankle surgery and he then proceeded to name another member of staff at the Trust whom MP knew did work in Podiatric Surgery.

98. MP then asked the Registrant to confirm whether he was a podiatrist or a doctor, to which he responded that he was both, that he had completed his medical degree and his podiatry degree, and that he was registered with the HCPC and GMC.

99. SM, in his evidence, also stated that the Registrant, whom he spoke to as the Registrant was not on his list of training attendees, had also stated to SM that he was a doctor.

100. The Panel also considered the hearsay statements of JE, a Clinical Academic Link Tutor, and TH, a Principal Audiologist, who both made a contemporaneous statement of their dealings with the Registrant on 6 and 7 May 2020 respectively.

101. In her statement, JE stated that:

“I met [the Registrant] in reception and asked what his job was and he told me he was a Paediatric Surgeon who due to elective surgery being cancelled and that he had returned from being off sick, he was due a refresher as requested by HR. I called [ML] as I believed he was due for a doctor’s induction but [ML] didn’t know who he was. A few minutes later [EB] from Recruitment came down and addressed him as the Podiatrist she knew about … I was bit confused as he told me he was a Doctor and not a Podiatrist … I accompanied both [MP] and [the Registrant] into Room 2 within the MLCC. At this point [MP] asked [the Registrant] if he held dual registrations with GMC and Allied Health Profession Register (unable to remember the anacronym). [The Registrant] confirmed that he held both registrations and that he had studied Paediatric Medicine and Podiatry and that he currently did surgery on foot and ankle.”

102. In her statement, TH stated that:

“I performed Fit Masking Testing on this person on Tuesday May 2020.

As part of the test procedure, I asked [the Registrant] to talk to me for one minute, and he chose to talk about his work.

He said that he worked in Podiatric medicine, and that he had been brushing up on his Respiratory medicine in case he was redeployed on ICU with ventilated patients. I am certain that he said that it had been a while since he had covered this in medical school.

I cannot recall any more of his conversation, but the impression he gave was that he was a doctor rather than a Podiatrist.”

103. AM stated that she was informed by MP that the Registrant was referring to himself as a doctor. AM subsequently met with the Registrant, who denied that he had referred to himself as a doctor.

104. The Registrant denied that he had said he was a doctor and said that he had no motive for doing so.

105. The Panel weighed up all the evidence and balanced the Registrant’s denial with the HCPC witnesses’ evidence, noting that some of it was hearsay evidence. The Panel also took into account the undoubted confusion given the similarity between the words ‘paediatric’ and ‘podiatric’. However, given the consistency between the accounts of the HCPC witnesses, the Panel concluded that it was more likely than not that the Registrant said he was a doctor, necessitating questions to be asked about possible GMC registration. The Panel did not consider it credible that questions would have been asked about his GMC registration in the absence of the Registrant stating that he was a doctor.

106. The Panel therefore found the facts of Particular 5 proved.

Particular 6

6. Your conduct in relation to particulars 1 and 5 was dishonest.

107. In considering whether the Registrant acted dishonestly, the Panel applied the test for dishonesty as set out in Ivey v Genting Casinos (UK) Ltd t/a Crockfords [2017] UKSC 67:

“When dishonesty is in question the fact-finding tribunal must first ascertain subjectively the actual state of the individual’s knowledge or belief as to the facts. The reasonableness or otherwise of his belief is a matter of evidence (often in practice determinative) going to whether he held the belief, but it is not an additional requirement that his belief must be reasonable; the question is whether it is genuinely held. When 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 has done is, by those standards, dishonest.”

108. It also took into account the Registrant’s good character, in accordance with the advice received from the Legal Assessor.

Dishonesty in relation to Particular 1 – Proved

109. The Panel found the facts of Particular 6 proved in respect of Particular 1 for the following reasons.

110. The Panel, having found the facts of Particular 1 proved, then considered whether the Registrant’s conduct was dishonest.

111. In light of the Registrant’s admission and the Panel’s determination in respect of Particular 1, the Panel found that the Registrant was driving to and from work despite having informed his employer that he was not driving and/or suspended from driving as a result of his health. The Panel was therefore satisfied that the Registrant knew that what he had told his employers was untrue and that he continued to drive when he stated that he was not doing so.

112. The Panel considered that ordinary members of the public would find that knowingly falsely stating to his employer that he was not driving to and from work when he was would be considered dishonest.

113. The Panel also took into account the Registrant’s admission of dishonesty in respect of this particular.

114. The Panel therefore concluded that in relation to this particular, the Registrant acted dishonestly. The Panel therefore found Particular 6 proved in respect of Particular 1.

Dishonesty in relation to Particular 5 – Proved

115. The Panel, having found the facts of Particular 5 proved, then considered whether the Registrant’s conduct was dishonest.

116. The Panel concluded in respect of this particular that the Registrant stated that he was a doctor when he knew that he was not. The Panel considered that ordinary members of the public would find that knowingly falsely stating that he was a doctor when he was not would be considered dishonest.

117. The Panel therefore concluded that in relation to this particular, the Registrant acted dishonestly. The Panel therefore also found Particular 6 proved in respect of Particular 5.
Decision on Grounds and Impairment

HCPC submissions

118. Mr Jotangia, relying on his submissions made in his case summary, submitted that the Registrant’s conduct marked a serious departure from the standards expected of a registered Podiatrist / Chiropodist and was sufficiently serious to amount to misconduct.

119. In relation to impairment, Mr Jotangia invited the Panel to consider his representations as set out in the case summary, highlighting the seriousness of the Registrant’s failings, an alleged ongoing risk to patients, and a lack of insight into his failings. He submitted that, given the seriousness of the Registrant’s failings, a failure to make a finding of impairment would undermine confidence in the profession and the regulatory process.

120. He invited the Panel to conclude that the Registrant had breached standards 1, 2, 6, 7, 9, and 10 of the HCPC “Standards of Conduct, Performance and Ethics” (2016):

1: Promote and protect the interests of service users and carers
2: Communicate appropriately and effectively
6: Manage risk: Identify and minimise risk
7: Report concerns about safety
9: Be honest and trustworthy;
9.1: You must make sure that your conduct justifies the public’s trust and confidence in you and your profession;
10.1: You must keep full, clear, and accurate records for everyone you care for, treat, or provide other services to.

121. He also invited the Panel to conclude that the Registrant had breached standards 1, 3, 4, 10, 12, 13, 14, and 15 of the HCPC “Standards of Proficiency for Chiropodists/Podiatrists” (September 2013):

1: be able to practise safely and effectively within their scope of practice
3: be able to maintain their fitness to practise
4: be able to practise as an autonomous professional, exercising their own professional judgement
10: be able to maintain records appropriately
12: be able to assure the quality of their practice
13: understand the key concepts of the knowledge base relevant to their profession
14: be able to draw on appropriate knowledge and skills to inform practice
15: understand the need to establish and maintain a safe practice environment

Registrant’s submissions

122. In advance of making any submissions Mr James provided the Panel with the Registrant’s written reflective statement, together with evidence of a CPD course in record-keeping undertaken in February 2022.

123. In his reflective statement, the Registrant stated in relation to Particular 1:

“I realise on reflection that there were other options such as public transport which I should have taken regardless of the cost that it incurred to me … I just want the panel to know I am extremely regretful and remorseful about this entire situation which could have been avoided entirely.

… I was not only putting my life at risk but the lives of other road users, I am so very sorry about this and I am grateful to God that nothing ever happened.

I am also deeply ashamed about not telling those whom asked me about the driving situation when asked at the time, I realise now on reflection that honesty with colleagues is the core foundation of team work as there needs to be a level of trust and integrity between colleagues so we are able to support one another and work effectively in a team. I believe it was my internal faulty thinking which led me to conceal this from them at the time, I felt attacked at the time and I just hid, for this I’m sorry.

Reflecting on this I would do everything differently I would make choices that do not risk me or others I would have sought help from work and colleagues … so that I could have been offered the support that I needed.”

124. In relation to Particular 2, he stated:

“Record-keeping is of paramount importance, not only are the notes and records you make legal documents, they are necessary in knowing what exactly occurred or happened in any given contact between a practitioner and patient.

The impact of poor record-keeping affects patients, and their safety is put at risk if the records are not thoroughly taken and kept, this leads to problems and potentially catastrophic consequences, especially when it comes to consequential errors from the poor record-keeping in the first instance. The local intervention helped significantly I.e. the use of templates for structuring notes that are complete and coherent … after this my record-keeping improved as I was helped and made aware of my shortcomings and how I could rectify them, I only wish that I had asked for this help and intervention sooner as to avoid this problem in the first place. Also if I had to do handwritten notes again, I would utilise the structural templates I have to my disposal and also ask colleagues and others to review and audit notes to ensure they are lucid, coherent and accurate.

I have since completed CPD courses from the college of Podiatry specifically in relation to record-keeping.”

125. In relation to Particular 3, he stated:

“I realise now on reflection that it is better always for the patient to be referred in every situation regardless of how minor or superficial a wound may be as it is our duty of care to ensure all patients receive an excellent quality of care and not let the perceived severity affect my clinical actions towards patients.”

126. In relation to Particular 5, he stated:

“In the future I will make sure that I only use the names podiatry or chiropody as to make sure that no one is confused, as Podiatric Medicine can lead to confusion.

I understand that it is problematic to claim you're a doctor when you’re not. On reflection the impact this would have on patients and colleagues would be serious as they would not fully understand your job role or your remit and this could lead to a number of problems and issues for both patients and colleagues, for example if a patient thought their podiatrist was a doctor they may think that the podiatrist should and could prescribe medication for them and if denied by the podiatrist this could escalate into an extremely dangerous situation for both patient and practitioner, similarly with colleagues they may think you are able to for example request imaging or take IV bloods this would all end badly for all parties concerned.

I also understand the impact on my profession, this would have; as members of the public would lose faith in podiatry and put the profession into disrepute as they may generalise all podiatrists in this way, this is not something I wish to do, therefore I have made sure this will not happen again, by only referring to the profession as podiatry or chiropody as to avoid confusion in the future.”

127. Mr James submitted that this was not a case where the Panel should make a finding of a lack of competence. He referred the Panel to the principle derived from the case of Calheam v GMC [2007] EWHC 2606 (Admin) and submitted that the matters found proved at Particular 3a did not represent a fair sample of the Registrant’s work. He submitted that the concerns related to 14 patients out of approximately 300 available patient notes. He reminded the Panel of CH’s evidence that, after record-keeping concerns were raised, there were no further concerns about the Registrant’s practice.

128. He also reminded the Panel that the Registrant does not have an adverse regulatory history with the HCPC.

129. So far as misconduct is concerned, Mr James conceded that Particulars 1 and 5 constituted misconduct.

130. As for Particular 2, he submitted that the Panel should carefully consider whether the Registrant’s failings fell seriously short of the expected standard as to amount to misconduct.

131. As for Particular 3a, Mr James submitted that, in the absence of evidence about the seriousness of Patient O’s ulcer, it could not be said that the Registrant failing to refer Patient O to an MDT amounted to a serious falling short of the standard expected of him. The Registrant, he submitted, provided appropriate treatment, in that he had undertaken palpation and assessed the pulse phases with an ultrasound Doppler machine.

132. So far as impairment was concerned, Mr James referred to the personal and public components of impairment as referred to in the HCPTS Practice Note on “Fitness to Practise Impairment”.

133. He submitted that in the Registrant’s oral evidence and in his reflective statement, he expressed an understanding that his behaviour fell below the standard expected. In relation to Particular 2, he stated that the Registrant accepted full responsibility for his actions. He invited the Panel to take into account the circumstances for the Registrant’s record-keeping being inadequate, referred to earlier in this determination.

134. So far as Particular 3a was concerned, Mr James submitted that the Registrant now accepted that he should have referred Patient O to an MDT.

135. Addressing the issue of protecting service users, Mr James submitted that in relation to inadequate record-keeping, service users had not been exposed to any actual harm. Whilst Patient O may have been subjected to a risk of harm, he submitted that this single error did not make the Registrant an unsafe practitioner.

136. As regards Particular 5, Mr James submitted that the Registrant was not seeking to mislead patients and that therefore the risk of harm to service users was minimised.

137. Addressing public interests concerns, Mr James invited the Panel to take into account:

• the Registrant’s admissions to Particulars 1, 2, and 6;
• the limited scope of the dishonesty found proved;
• the lack of any actual harm to service users;
• the insight the Registrant had shown into the issues, including those particulars which he denied;
• the reasons the Registrant had given for taking the admittedly foolish decision to drive when he should not have, including his desire to fulfil his obligations as a podiatrist;
• the glowing reference provided by PM and the Registrant’s previous fitness to practise history;
• the evidence of the Registrant being a tenacious worker who actively sought to improve processes in his workplaces for the benefit of himself and others; and
• what the underlying motivation was in Particular 5; the Panel might conclude that the Registrant was foolishly trying to inflate his importance, rather than anything more.

138. In the circumstances, Mr James invited the Panel not to find any lack of competence and, as regards impairment, not to make a finding on either public protection or public interest grounds.

Decision on Grounds

139. On the basis of the facts found proved, the Panel went on to consider whether the Registrant’s conduct amounted to misconduct and/or a lack of competence. It took into account all the evidence, including the additional documentation received together with the submissions made by Mr Jotangia on behalf of the HCPC and those made by Mr James on behalf of the Registrant.

140. In considering this matter, the Panel exercised its own judgement. The Panel also took into account the public interest, which includes protection of the public, maintenance of public confidence in the profession, and the declaring and upholding of proper standards of conduct and behaviour.

141. When considering whether the facts found proved amounted to misconduct, the Panel noted that not all breaches of the HCPC “Standards of Performance, Conduct and Ethics” need amount to a finding of misconduct.

142. The Panel heard and accepted the advice of the Legal Assessor, which included but was not limited to reference to the cases of: Calhaem v GMC [2007] EWHC 2606 (Admin); Council for Healthcare Regulatory Excellence v (1) Nursing and Midwifery Council (2) Grant [2011] EWHC 927 (Admin); Cohen v GMC [2008] EWHC 581; Remedy UK v GMC [2010] EWHC 1245; PSA v HCPC & Ghaffar [2014] EWHC 2723 (Admin); and Chaudhary v GMC [2017] EWHC 2561 (Admin).

143. The Legal Assessor also reminded the Panel of the meaning prescribed to misconduct in the case of Roylance v General Medical Council (No 2) [2000] 1 A.C. 311, in which it was said:

“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 … practitioner in the particular circumstances. The misconduct is qualified in two respects. First, it is qualified by the word ‘professional’ which links the misconduct to the profession ... Secondly, the misconduct is qualified by the word ‘serious’. It is not any professional misconduct which will qualify. The professional misconduct must be serious.”

144. In Nandi v GMC [2004] EWHC 2317 (Admin), the Court referred to Roylance where the Court described misconduct as “a falling short by omission or commission of the standards of conduct expected among medical practitioners, and such falling short must be serious” such that it would be “regarded as deplorable by fellow practitioners”.

145. The Panel adopted a two-step process in its consideration. Firstly, the Panel considered whether the facts found proved amounted to misconduct or a lack of competence. Secondly, and only if the facts proved were found to amount to misconduct or a lack of competence, the Panel would go on to consider whether the Registrant’s fitness to practise is currently impaired as a result of that misconduct or lack of competence.

146. Given the Panel’s findings in relation to the facts found proved, it concluded that the Registrant breached standards 1, 6, 9, and 10 of the HCPC “Standards of Conduct, Performance and Ethics”, and, in relation to Particular 2, standards 1 and 10 of the HCPC “Standards of Proficiency for Chiropodists/Podiatrists”.

147. However, the Panel was mindful that a finding of misconduct / lack of competence did not necessarily follow as a result.

148. The Panel carefully considered the seriousness of the Registrant’s failings. In doing so, it identified that:

• the Registrant repeatedly knowingly made false statements, as found proved in relation to Particular 6, in relation to his driving and in relation to stating that he was a doctor. Honesty is a fundamental core quality of what it means to be a professional and the public should rightly be entitled to assume that registered HCPC professionals are honest and trustworthy;

• by driving when he should not have done so, the Registrant put himself and others at risk of serious harm;

• in relation to the Registrant’s record-keeping, CH took a random sample of 14 files and identified that 75% had missing notes. The Panel concluded that this did represent a fair sample of the Registrant’s work;

• the Registrant appreciated the importance of accurate record-keeping to ensure effective patient care;

• in relation to Particular 3a, whilst the Registrant did not follow all guidelines, he nevertheless otherwise appropriately treated Patient O. There was no evidence before the Panel that this shortcoming was anything other than an isolated incident. His failure to refer Patient O was not motivated by malice or a deliberate disregard for Patient O’s care, noting that he had treated Patient O and noted on his patient record that he informed Patient O that he should return to the clinic a week later, or earlier in an emergency.

149. For the reasons set out above, the Panel concluded that the matters found proved in relation to Particulars 1, 5, and 6, and subsequent breaches of the HCPC “Standards of Conduct, Performance and Ethics”, were both individually and collectively sufficiently serious departures from the standards expected of a Chiropodist / Podiatrist as to amount to misconduct.

150. Having carefully considered the advice received from the Legal Assessor, the Panel therefore found that the Registrant’s conduct in relation to Particulars 1, 5, and 6 amounted to misconduct.

151. In relation to Particular 2, the Panel concluded that the inadequate notes did represent a fair sample of the Registrant’s work. The Panel also found that his failing to keep adequate patient records arose from his failure / inability to adapt to a handwritten record-keeping system, particularly when working under pressure of time. The Registrant’s failings in this regard extended to a large number of patients, with the risk to ongoing patient care as identified by CH and recognised by the Registrant.

152. In the circumstances, the Panel concluded that the Registrant’s failings in relation to Particular 2 could properly be categorised as amounting to a lack of competence.

153. In relation to Particular 3a, noting the Panel’s observations at paragraph 149 above, the Panel concluded that whilst the Registrant failed to refer Patient O in compliance with prevailing protocols, the Registrant’s failing did not fall so far short of the standard expected so as to amount to misconduct, because:

• the Registrant did provide an appropriate level of treatment;

• the Registrant requested the patient return to clinic a week later for review;

• the Panel accepted the Registrant’s evidence that Patient O’s ulcer was “superficial”; and

• this was an isolated incident.

154. In all the circumstances the Panel concluded that, whilst not condoning the Registrant’s failing, the Registrant’s failure with regard to Particular 3a was not sufficiently serious to justify a finding of misconduct.

Decision on Impairment

155. The Panel went on to decide whether, as a result of his misconduct and lack of competence, the Registrant’s fitness to practise is currently impaired.

156. The Panel had regard to all of the evidence presented in this case, including the submissions of Mr Jotangia and Mr James. The Panel also heard and accepted the advice of the Legal Assessor and took into account the HCPTS Practice Note on “Fitness to Practise Impairment”.

157. In reaching its decision on impairment, the Panel was mindful that it does not necessarily follow that a finding of current impairment follows from a finding of dishonesty. However, any instance of dishonesty is likely to impair a registrant’s fitness to practise and it will be an unusual case where this is not found to be so.

158. Chiropodists / Podiatrists are expected at all times to act in a professional manner. They must make sure that their conduct at all times justifies both service users’ and the public’s trust in the profession. In this regard, in reaching its decision the Panel considered the judgement of Mrs Justice Cox in the case of Council for Healthcare Regulatory Excellence v (1) Nursing and Midwifery Council (2) Grant [2011] EWHC 927 (Admin). In paragraph 74, she said:

“In determining whether a practitioner’s fitness to practise is impaired by reason of misconduct, the relevant panel should generally consider not only whether the practitioner continues to present a risk to members of the public in his or her current role, but also whether the need to uphold proper professional standards and public confidence in the profession would be undermined if a finding of impairment were not made in the particular circumstances.”

159. Mrs Justice Cox went on to say in paragraph 76:

“Do our findings of fact in respect of the doctor’s misconduct, deficient professional performance, adverse health, conviction, caution or determination show that his/her fitness to practise is impaired in the sense that s/he:

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; and/or

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

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

d. has in the past acted dishonestly and/or is liable to act dishonestly in the future”.

160. Given its findings regarding ‘seriousness’, the Panel considered that limbs a, b, c, and d were all engaged by the Registrant’s past actions. The Panel had regard to the fact that honesty is a core value of the Chiropody / Podiatry profession which the Registrant had repeatedly breached in two separate and distinct circumstances.

161. In relation to the Registrant’s record-keeping, in assessing future risk the Panel noted that whilst the Registrant had reflected on the importance of accurate record-keeping and had attended a relevant course in February 2022, he had not meaningfully demonstrated what he had learned from that course. In addition, because the Registrant has not been working in a clinical post in the interim since he left the Trust, the Panel was not satisfied that the Registrant had demonstrated there were no longer any ongoing concerns and that he now fully complied with his professional obligations within a clinical setting. As such, the Panel concluded that it was not satisfied that the Registrant had, in practice, remediated his failing in this regard. In the circumstances, it concluded that there remained an ongoing risk of repetition of his lack of competence.

162. As such, in relation to the Registrant’s lack of competence, the Panel determined that the Registrant’s fitness to practise is impaired on the personal component.

163. In relation to dishonesty, the Panel recognised that dishonesty is difficult to remediate. The Panel carefully considered the Registrant’s reflective statement and was satisfied that the Registrant had demonstrated some insight into his dishonesty. Whilst recognising that he would not now lie about driving or state that he was a doctor, the Panel concluded that his insight was limited because it was not satisfied that he had meaningfully reflected and demonstrated insight into the impact of dishonesty on the reputation of the profession generally.

164. The Panel also took into account that the matters found proved reflected repeated acts of dishonesty over a six-month period in relation to separate and distinct events. Given the Panel’s finding that the Registrant’s insight was limited, it concluded that there remained an ongoing risk of dishonest behaviour, albeit that it may not be in relation to the exact same circumstances as arose in this case.

165. As such, in relation to the Registrant’s misconduct, the Panel determined that the Registrant’s fitness to practise is also impaired on the personal component.

166. The Panel also took into account the overarching objectives of the HCPC to protect, promote, and maintain the health, safety, and wellbeing of the public and patients, and to uphold and protect the wider public interest, which includes promoting and maintaining public confidence in the Chiropodist / Podiatrist profession and upholding proper professional standards for members of the profession. The Panel therefore considered that, given the serious nature of the dishonesty found proved and the Registrant’s lack of competence that had yet to be fully remediated, public confidence in the profession would be undermined if a finding of impairment were not made in all the circumstances.

167. Having regard to all of the above the Panel found that, by reason of his misconduct and lack of competence, the Registrant’s fitness to practise is also currently impaired on the public component of impairment.

Decision on Sanction

HCPC submissions

168. Mr Jotangia did not make any specific submissions regarding sanction but reminded the Panel that it was a matter for it exercising its judgement, taking into account any aggravating and mitigating factors.

Registrant’s submissions

169. Mr James referred the Panel to the HCPC Sanctions Policy, highlighting those factors that should be taken into account in respect of each available sanction. He submitted that the following mitigating factors were present:

• The Registrant’s admissions to Particulars 1, 2, and 6;
• The lack of actual harm caused to service users;
• The contextual factors, including the use of handwritten notes at the time of the allegations;
• The glowing reference provided by PM, and the Registrant’s previous fitness to practise history;
• The remediation undertaken;
• The Registrant’s insight and remorse, which showed a genuine recognition of the concerns raised and an understanding of the impact of it on service users, colleagues, and the public more widely.

170. Mr James submitted that in relation to the Panel’s finding of dishonesty, the Panel should take into account that neither instance of dishonesty was long-term. He further submitted that there was only evidence of two instances of driving. Similarly, the conduct in relation to Particular 5 all took place on the same day. He invited the Panel to take into account the mitigating factors which contributed to the Registrant’s driving.

171. Mr James conceded that the Panel was unlikely to conclude that taking no action was appropriate, nor was this a case where mediation would be an appropriate outcome.

172. So far as conditions of practice were concerned, Mr James submitted that the Registrant had shown insight, even for the particulars which were denied. Record-keeping concerns were capable of being remedied and had been to some extent. He submitted that the Registrant had fully engaged with proceedings throughout and was keen to return to the workplace, and would not jeopardise this by failing to comply with any conditions imposed. Finally, the clinical concerns were not such as to put patients at a real risk of harm, and any concern could be effectively mitigated through conditions.

173. As for suspension, Mr James submitted that the Panel may feel that many of the factors identified in the HCPC Sanctions Policy applied in this case. Although the misconduct was serious, he submitted that the Registrant had shown insight, was unlikely to behave that way again, and had already demonstrated a willingness and ability to resolve his failings. Dishonesty was more difficult to remediate, but it was not impossible.

174. Mr James submitted that a Suspension Order also had the benefit of a review and the Panel could direct what it required of the Registrant at that review, whether in the form of a further reflective statement, additional remediation, or whatever else was deemed appropriate. This would give the Registrant the chance to fully understand the Panel’s decision on the facts and the seriousness of his past conduct. With guidance from both this Panel and his legal representatives, the Registrant could go a long way to remediating the current issues and return to fulfilling a crucial role in an already stretched NHS.

175. So far as striking off was concerned, Mr James submitted that this was a sanction of last resort which should be reserved for the most serious cases of dishonesty which, he submitted, was not the case here.

176. He further submitted that any public protection concerns arising from the Registrant’s lack of competence were insufficient to justify a Striking Off Order. There was no evidence of actual harm to patients and the Registrant had shown improvement in his record-keeping, not least with his remediation. The risk posed to the public through Particular 1 was mitigated through the Registrant’s admission and reflection on the seriousness of this conduct. Mr James reminded the Panel that it had concluded “that there remained an ongoing risk of dishonest behaviour, albeit that it may not be in relation to the exact same circumstances as arose in this case.” The risk to the public from driving was therefore not such that the only appropriate sanction was a Striking Off Order, as the risk of repetition of that particular conduct was lower than that of dishonest conduct generally.

177. As regards public confidence, Mr James submitted that a well-informed member of the public would consider a Suspension Order to be sufficient. It would mark the seriousness with which the HCPC treats allegations of dishonesty. Furthermore, it would provide the Registrant with the ability to build on the insight he has already shown to ensure there is no repetition of this conduct, the likelihood of which is already reduced by dint of the experience of this regulatory process.

Panel’s Decision

178. The Panel accepted the advice of the Legal Assessor, who referred it to the HCPC Sanctions Policy. He reminded the Panel that it should consider any sanction in ascending order, and to apply the least restrictive sanction necessary to protect the public and the public interest. It should also consider any aggravating and mitigating factors and bear in mind proportionality. He reminded the Panel that the primary purpose of imposing a sanction was protection of the public and the public interest and that there was a need to balance those interests with the interests of the Registrant.

179. In reaching its decision on whether to impose a sanction, and if so, which one, the Panel reminded itself of its conclusions in relation to the seriousness of the Registrant’s misconduct and lack of competence as set out in its determination on impairment. The Panel concluded that the Registrant continues to pose an ongoing risk to the public and that there remains a risk of repetition of his misconduct. As such, any sanction should reflect the need to uphold the public interest and mark the seriousness of the misconduct found proved. In that regard, the Panel had due regard to paragraphs 56-58 of the HCPC Sanctions Policy, noting the impact of dishonesty on public confidence.

180. The Panel considered all of the information before it. In doing so, the Panel identified the following aggravating factors:

• That the Registrant behaved dishonestly in relation to two separate issues over a six-month period;

• That the Registrant drove on at least three or four occasions when he should not have done so, thereby repeatedly putting himself and others at risk.

181. The Panel identified the following mitigating factors:

• The Registrant engaged in the regulatory process and made early admissions to a number of particulars, including one allegation of dishonesty, at the outset of the hearing;

• The Registrant had difficult health and personal circumstances at the time which impacted on his performance.

• The Registrant provided a positive testimonial attesting to his character and professionalism. However, the Panel attached less weight to that reference than might otherwise have been the case, given that the author had not worked with the Registrant since 2017 and had only done so for approximately five months. The Panel also noted that the referee made no comment on the current allegations or that he was aware of them.

182. In identifying mitigating factors, the Panel considered that it was incumbent on the Registrant to familiarise himself with the Trust’s procedures, particularly handwriting patient notes, and therefore attached little weight to Mr James’ submission in this regard.

183. Similarly, whilst the Panel noted that the Registrant has undertaken a record-keeping course, the Panel considered that the Registrant has not meaningfully demonstrated what he took from the course nor demonstrated how he has effectively put his learning into practice.

184. Considering all of the circumstances in the round, the Panel considered the Registrant’s dishonesty to be towards the centre of the spectrum of dishonesty.

185. The Panel approached the issue of sanction starting with the least restrictive first, bearing in mind the need for proportionality and to take into account the Registrant’s interests. Having done so, it concluded that taking no further action would not reflect the nature and gravity of the misconduct. The Panel concluded that taking no action would not be adequate to protect the public or the wider public interest of maintaining confidence in both the profession and the regulatory process. Such an outcome was therefore neither appropriate nor proportionate in the circumstances.

186. The Panel next considered mediation but, having had due regard to the circumstances of this case, such an outcome was inappropriate to address the issues of inadequate record-keeping and dishonesty. It therefore concluded that this was not an appropriate outcome.

187. The Panel then considered whether to impose a Caution Order and had regard to paragraphs 99-102 of the HCPC Sanctions Policy. The Panel concluded that this was also not an appropriate outcome because:

• For the reasons set out in its determination on misconduct in relation to dishonesty and impairment, the Panel did not consider the Registrant’s misconduct to be minor in nature;

• The Registrant has demonstrated limited insight;

• The Panel considered that there remained an ongoing risk of repetition given the lack of effective remediation of his failings.

188. The Panel next considered whether a Conditions of Practice Order was appropriate. It had regard to paragraphs 105-109 of the SP. Notwithstanding that such an outcome might be considered appropriate for the Registrant’s lack of competence alone, it concluded that such a sanction would neither be appropriate nor proportionate to address the public interest concerns identified. The Panel concluded that workable and appropriate conditions could not be formulated that would meaningfully address the dishonesty concerns identified.

189. In the circumstances, the Panel concluded that imposing a Conditions of Practice Order was not the appropriate sanction to impose.

190. The Panel next considered the sanction of suspension. The Panel bore in mind that this would be an appropriate sanction to impose where, even though the allegation is serious, the conduct was not fundamentally incompatible with the Registrant remaining on the Register and hence, a Striking Off Order would not be merited.

191. The Panel considered that this was the appropriate sanction to impose because:

• The matters found proved, as set out in the Panel’s determination on misconduct, represented serious breaches of the HCPC “Standards of Conduct Performance and Ethics”;

• The Registrant demonstrated some insight into his failings, particularly in relation to Particular 1;

• The Panel was mindful that a Striking Off Order was appropriate for the most serious cases of dishonesty. It considered that the Registrant's failings were not so serious that they were fundamentally incompatible with remaining on the Register. In reaching that conclusion, it had regard to paragraph 121 of the HCPC Sanctions Policy, which states that a Suspension Order may be appropriate where “there is evidence to suggest that the Registrant is likely to be able to resolve or remedy their failings”. The Panel noted, as set out in the Panel’s determination on impairment, that the Registrant had developed some insight into his dishonest behaviour even though that process was not as yet complete.

192. To satisfy itself that a Suspension Order was the appropriate and proportionate sanction to impose, the Panel considered whether a Striking Off Order was justified. It had regard to paragraph 130 of the SP, which states that, “A striking off order is a sanction of last resort for serious, persistent, deliberate or reckless acts” whilst setting out a non-exhaustive list of applicable circumstances. The Panel was satisfied that the facts of this case were not of such gravity as to merit such a restrictive sanction. It concluded that the public protection and the public interest concerns could be adequately met by the imposition of a Suspension Order, which would restrict the Registrant’s ability to practise as a Chiropodist / Podiatrist until such time as a reviewing panel determined that he was fit to do so.

193. The Panel therefore imposed a Suspension Order for a period of four months. The Panel concluded that this was an appropriate and proportionate period of time to enable the Registrant to reflect on the nature and gravity of the misconduct found proved and to allow him an adequate period of time to reflect on and address his failings.

194. So far as any future review is concerned, the Panel considered a future reviewing panel would be assisted by:

• Further evidence of remediation in relation to record-keeping;

• Evidence of reflection by the Registrant on his conduct, demonstrating meaningful insight into the impact of his dishonest behaviour on the wider profession and the public;

• Up-to-date references / testimonials in relation to any work undertaken by the Registrant, whether paid or unpaid;

• Evidence that the Registrant has kept his skills and knowledge up to date;

• Any other evidence the Registrant considers would assist him to demonstrate that he is suitable to return to unrestricted practice.

That the Registrar is directed to suspend the registration of Mr Imran Khan for a period of 4 months from the date this order comes into effect.

This order will be reviewed again before its expiry.

Interim Order

1. Mr Jotangia applied for an Interim Suspension Order in light of the Panel’s findings, on the grounds that it was necessary for the protection of the public and otherwise in the public interest to cover the appeal period.

2. Mr James stated that an interim order was not necessary to protect the public given that the Registrant had gone some way to remediate his failings with record-keeping.

3. The Panel was mindful that when a substantive sanction is imposed, a registrant’s entitlement to practise is unrestricted whilst their appeal rights against the substantive sanction remain outstanding. The Panel concluded that in view of its determination that a substantive Suspension Order should be imposed, it would not be appropriate for the Registrant to return to unrestricted practice given the Registrant’s incomplete insight and lack of demonstrable remediation, including in relation to his lack of competence, and the ongoing risk of repetition of his misconduct as identified.

4. The Panel therefore decided to impose an interim order under Article 31(2) of the Health Professions Order 2001, it being necessary to protect members of the public and being otherwise in the public interest, which outweighs the Registrant’s personal and professional interests.

5. It first considered an Interim Conditions of Practice Order. The Panel concluded that such an interim order would not be appropriate given its rationale for its earlier determination on sanction. It considered that in light of that determination, an Interim Suspension Order is necessary for protection of the public and is also in the public interest. It would be wholly incompatible with the Panel’s findings and its decision as to sanction not to impose an Interim Suspension Order.

6. The Panel concluded that the appropriate length of the Interim Suspension Order should be 18 months, as the interim order would continue to be required pending the resolution of an appeal in the event that the Registrant submits a Notice of Appeal within the 28-day period. This Interim Suspension Order will expire: (if no appeal is made against the Panel’s decision and Order) upon the expiry of the period during which such an appeal could be made; (if an appeal is made against the Panel’s decision and Order) on the final determination of that appeal, subject to a maximum period of 18 months.

 

History of Hearings for Imran Khan

Date	Panel	Hearing type	Outcomes / Status
22/08/2023	Conduct and Competence Committee	Review Hearing	Suspended
17/04/2023	Conduct and Competence Committee	Final Hearing	Suspended