Pratiksha Venkatesh Patil

Preliminary Matters

Service and Proceeding in Absence

1. The Panel found that notice of this hearing had been properly served on 11 March 2025 on the Registrant at her registered email address with the HCPC in terms of the rules of the Health and Care Professions Council (Conduct and Competence Committee) (Procedure) Rules 2003 (“the Rules”).

2. The Panel next considered Ms Collins’ application to proceed in the Registrant’s absence. She referred to the Rules, the HCPTS Practice Note on Proceeding in the Absence of the Registrant, and to the relevant case law. She pointed out that reminder emails about this hearing were also sent by the HCPTS to the Registrant on 29 May and 12 June 2025. There had been no response to either the notice or the later emails. She submitted that the Registrant had not requested an adjournment or indicated that she would attend, and there was a public interest in proceeding and witnesses were in attendance. The last contact with the Registrant was by telephone on 3 November 2023. She submitted that it appeared that the Registrant had chosen not to attend.

3. The Panel was aware that its discretion to proceed in absence is one which should be exercised with care. The Legal Assessor gave advice to the Panel and referred it to the HCPTS Practice Note and to the guidance in GMC v Adeogba [2016] EWCA Civ 162. This case makes clear that the first question the Panel should ask is whether all reasonable efforts have been taken to serve the Registrant with Notice. Thereafter, if the Panel is satisfied on Notice, the discretion whether or not to proceed must be exercised having regard to all the circumstances of which the Panel is aware, with fairness to the Registrant being a prime consideration but with fairness to the HCPC and the interests of the public also considered. Adeogba was clear that, “where there is good reason not to proceed, the case should be adjourned; where there is not, however, it is only right that it should proceed”.

4. The Panel agreed to proceed in the Registrant’s absence as it is satisfied that it is fair and in the public interest to do so. In reaching this decision, the Panel noted that the Registrant has not responded to the Notice and she has not asked for an adjournment. It concluded that she has chosen to absent herself and she has waived her right to attend. The Panel balanced fairness to the Registrant with fairness to the HCPC and the public interest in proceeding. In all the circumstances, the Panel was satisfied that it was appropriate and fair to proceed in the Registrant’s absence.

 

Background

5. The Registrant was employed by HCRG Care Group as a Band 5 Physiotherapist. She began this role on 23 January 2023. Her probationary period was extended due to concerns about her competence, and her contract was subsequently terminated on 30 June 2023.

6. HCRG Care Group referred the Registrant to the HCPC on 7 July 2023, citing concerns in relation to her performance whilst she was in their employment. The referral raised a number of concerns, including the Registrant’s ability to carry out basic physiotherapy assessments.

7. Additionally, concerns were raised about the Registrant’s knowledge and ability in risk assessing patients’ conditions, using appropriate outcome measures, and her clinical reasoning. The referral raised further concerns about the Registrant’s knowledge and ability in formulating individualized goal sheets and exercise plans relevant to patient conditions, documenting assessments, and copying information from previous patient assessments into current records. Further concerns were raised that the Registrant did not seek advice or assistance when unsure about a procedure and did not ask for support.

8. Documentation supplied to the HCPC by HCRG Care Group suggested that the Registrant had probationary review meetings with her manager in February, March and May 2023, when deficits in her performance were identified, including concerns about basic and fundamental areas of practice, such as communication, clinical reasoning, appropriate assessments, and documentation. She was given the opportunity to improve with her statutory probation period extended, but on 23 June 2023 HCRG Care Group terminated her employment on the grounds that they considered the Registrant was not safe to practice independently.

9. It is the HCPC case that the evidence indicates a fair sample of the Registrant’s practice and shows that it fell below an acceptable standard and that amounts to a lack of competence. The HCPC also submit that the Registrant’s fitness to practise is currently impaired.

10. The Panel heard from four HCPC witnesses:

• SB – Colleague & Occupational Therapist;

• RM – Colleague, Physiotherapist and the clinical lead involved in the supervision of the Registrant;

• DB – Colleague & Physiotherapist;

• JO – Colleague & Physiotherapist.

Witness 1 – Ms SB

11. SB is a registered Occupational Therapist. She adopted and referred to her witness statement and explained her role. She worked at times with the Registrant and she told the Panel about the alleged incident on 11 May 2023 with Service User H. The Registrant was the lead clinician in the assessment.

12. SB told the Panel that the Registrant did not ask the patient any questions about her social environment or her personal care. She had intervened to ask these questions. When they returned to the office following this visit, she had asked the Registrant to write up the notes for the visit as she had led the visit. After the Registrant had drafted the notes, she had asked to check the notes and noticed that the Registrant had included false and inaccurate information in the notes, and she sat down with the Registrant and talked through some of the inaccuracies. SB said that despite these discussions with the Registrant the notes remained unclear and inaccurate. She exhibited the notes.

13. SB said that she felt the Registrant had not met the required standards and the service user suffered more pain than had been necessary and was placed at risk of further injury. SB had intervened when the service user experienced pain. SB said that had she not been present, the service user would have been placed at even more risk as the necessary questions were not asked by the Registrant. SB said that the service user had reported that they had fallen during the “step transfer” from the bed, but SB had added to the notes that no injuries had occurred.

14. SB also told the Panel about her concerns with a visit on 16 May 2023 to Service User I. Again, the Registrant was the lead clinician in the assessment. SB was asked by the manager RM, to shadow the Registrant doing an assessment and was instructed not to get involved unless necessary. The Registrant was aware of this arrangement. SB had concerns that the Registrant did not properly assess the patient, particularly around balance tests, and had recorded results in the notes for assessments that had not been conducted.

15. SB said she considered that there had been a lack of questioning of the patient by the Registrant, and it was all a bit “slap dash”. The Registrant had recommended equipment, a four wheeled walker, that was not suitable as the patient had multiple steps outside his house. SB had later asked the Registrant to consider her clinical reasoning but recalled that the Registrant was generally “very dismissive” in discussions and she did not seem interested in listening to or accepting advice. Over five to ten visits with the Registrant, SB said there was a continued lack of engagement by the Registrant, and she saw no improvement in the Registrant’s practice in that time. SB raised her concerns with the manager, RM.

Witness 2 – RM

16. RM is a registered Physiotherapist and she assisted in the supervision and management of the Registrant. She formally adopted her extensive and detailed written witness statement in which she set out thoroughly her concerns about the Registrant’s interactions with each of the service users A – O, all as set out in the 15 parts of the allegation. RM stated that at times patients were placed at risk by the Registrant’s lack of explanation and actions.

17. RM explained her role and her supervision of the Registrant which involved regular meetings to review the objectives agreed with the Registrant. The Registrant's probation had been extended, which was unusual, and had not happened before under her supervision or in this service. RM confirmed that a registered physiotherapist would be expected to be able to set out their clinical reasoning, that was a “given”. She said that the Registrant, despite training in respect of outcome measures was not competent at the end of her probationary period in June 2023. She referred to the extended probationary report dated 24 May 2023, and said that by the end of June 2023 the Registrant had not met any of the 11 HCPC Standards of Proficiency detailed therein. RM stated that the Registrant also tended to record assessments in the patient notes that she had not carried out or discussed with patients.

18. The Registrant’s probationary contract was terminated on 30 June 2025 following discussions with HR. RM said she felt the Registrant had been well supported and she did not think there was more that could have been done. The Registrant never requested any further guidance. RM said that the Registrant was “very far off” all the HCPC standards and would place patients at risk if she were to practice. RM confirmed that the Registrant was never unsupervised and she had a good overview of the totality of the Registrant’s practice. She said that the Registrant had tried really hard and had some difficult personal circumstances.

Witness 3 – DB

19. DB is a registered Physiotherapist and she attended a number of patient visits with the Registrant. She adopted her written witness statement.

20. DB visited Service User J with the Registrant on 22 May 2023. DB said that the Registrant should have, but did not, check SU J’s oxygen saturation level. She recalled this as the Registrant did not have her oximeter with her to check the oxygen levels. DB said that the Registrant also had not conducted proper assessments of the service user who was not in an appropriate position for assessing the range of movement or strength tests. DB said that the Registrant had not correctly completed the patient notes, and she referred to the exhibited patient notes which she had been required to amend and add further information so that they were a correct clinical record.

21. DB also visited Service User M with the Registrant on 6 June 2023. She told the Panel that the Registrant had decided to remove a knee brace from the service user without checking it was safe to do so. She stated that the Registrant had not obtained or read the service user’s hospital discharge summary. DB said she had to intervene to prevent removal of the brace to avoid the risk of damaging the service user’s knee. When she raised this with the Registrant, the Registrant did not understand DB’s concerns or accept her feedback.

22. DB said she had concerns about the Registrant’s practice having worked with her with 10 to 15 patients over 2-3 months, and she raised this with RM. DB said that she saw no improvement in the Registrant's practice over the period she worked with her, and she did not think the Registrant was functioning at the level of a Band 5 Physiotherapist.

Witness 4 – JO

23. JO is a registered Physiotherapist. She formally adopted her written witness statement. She told the Panel about the five visits to patients that she undertook with the Registrant over about two months, She said she had concerns about the Registrant’s practice in four of those visits where she was asked to supervise the Registrant.

24. On one visit on 31 March 2023 with Service User D, concerns raised by the patient were not discussed or referred to by the Registrant. JO intervened and asked follow up questions to avoid a risk of harm to the patient. The Registrant was prompted by JO about “red flag” issues but she did not know them or what to do, even when prompted. JO said she would have expected the Registrant as a band 5 Physiotherapist to know about red flags.

25. JO also told the Panel about the supervised visits to Service User K on 30 May 2023. A multi-factorial risk assessment was required (MFRA) and the Registrant was asked to complete it, but she said to JO that she did not know how to do so. The Registrant had observed this assessment but did not know what to do, despite guidance being available both as a paper version and online on the iPad. Further, JO said that the Registrant was unable to identify muscle tightness, restricted movement or contractures. The Registrant did not ask questions of the patient to assess these issues. JO said that the risk is that the patient can deteriorate further. JO said that the Registrant was also unable to assess sciatica in the patient and, when asked, she said she was not aware of the tests required, which JO then undertook. She said she would have expected the Registrant to know the basic practice around that issue.

26. JO said the Registrants’ information gathering improved, but the Registrant had continued to record assessments that had not been conducted and tended to “gloss over” assessments and use exactly the same phrases in difference cases. JO reported her concerns about the Registrant’s practice to RM.

Submissions on Facts

27. Ms Collins submitted a detailed written closing submission. She submitted that the evidence of the four witnesses was credible and reliable and was such that the Panel should find the entire allegation proved. She reminded the Panel of the burden and standard of proof.

 

Decision on Facts

28. The Legal Assessor reminded the Panel that the onus of proof rested on the HCPC and that the standard of proof was the balance of probabilities. The Registrant need prove nothing.

29. The Panel was mindful of the burden and standard of proof. The Panel noted that the Registrant has not responded to the allegation and she has offered no explanations or challenged any of the evidence. There is no evidence from her to contradict the evidence of any of the witnesses or the documentary evidence.

Allegation 1a, b and c

1. On or around 21 February 2023 you:

a. Did not adequately tailor the physiotherapy assessment to Service User A’s presenting complaint;

b. Prescribed breathing exercises for Service User A, when Service User A did not have any breathing issues;

c. Recorded in Service User A’s notes that Service User A had breathing issues, when this was not the case.

30. 1a – The Panel had regard to the evidence of RM whose evidence it found to be clear, cogent and credible. She was fair and objective and her live evidence was consistent with her detailed witness statement. She told the Panel that the Registrant had not assessed the patient adequately and did not focus on Outcome Measures or ask relevant questions in respect of the symptoms and complaints presented. 1b – RM said that the Registrant has prescribed various breathing exercises despite the patient confirming they did not have breathing issues. RM said that she had been required to intervene to ask the patient relevant questions about the presenting symptoms. 1c – RM said that the Registrant did not adequately identify presenting symptoms and recorded breathing issues in the notes when that was not the case. This is supported and consistent with the documentation exhibited by RM and the Panel found this proved.

Allegation 2a, b, c and d

2. On or around 22 March 2023 when attending Service User B:

a. When carrying out a Timed Unsupported Stand (TUSS) assessment, you did not ensure that the environment was safe for Service User B and/or that Service User B had something to hold onto if needed;

b. You did not correctly take Service User B through the required steps for a TUSS assessment;

c. When carrying out a Romberg Test, you did not correctly take Service User B through the required steps for a Romberg Test; and/or

d. When Service User B began to sway whilst standing with their eyes closed, you tapped them on the shoulder, which was unnecessary and/or unsafe.

31. 2a – The Panel had regard to the evidence of RM. She told the Panel that the Registrant had not correctly conducted the TUSS assessment despite her having discussed the matter with her in advance. The Registrant did not ensure the environment was safe and that the patient had something to support them. The Registrant required prompting by RM to check the environment. 2b and 2c – RM was clear that the Registrant had muddled the two tests, TUSS and Romberg, and did not conduct the tests properly or safely. RM had been required to intervene. She said that the Registrant was not giving the patient the correct instructions required for the Romberg assessment. 2d – RM described the Registrant “nudging” the service user and that this tap on the shoulder was not required and was unsafe as the patient was off-balance. This evidence from RM was clear and consistent and the Panel accepted it, and found this proved.

Allegation 3

3. On or around 22 March 2023, when attending to Service User C, you were unable to demonstrate competence in assessing Service User C for a walking aid.

32. The Panel had regard to the clear evidence of RM. She told the Panel that the Registrant was unsure what to do and did not assess the patient’s ability to stand up from a sitting position and to walk without a walking aid. The Registrant did not check lower limb strength or range of movement. RM said that the Registrant clearly did not know what to ask, what she should be observing and how to assess the patient. She required significant support from RM. This evidence is consistent with the notes made at the time and the Panel found this proved.

Allegation 4a and 4b

4. On or around 31 March 2023, when Service User D told you that they had chronic lower back pain and had experienced some new trouble with their bladder:

a. you did not ask follow up questions; and/or

b. you did not identify this as a potential ‘red flag’ which required further investigation.

33. JO attended the patient with the Registrant. She told the Panel that the Registrant failed to recognise the clinical relevance of a service user with lower back pain reporting that they had experienced new bladder related symptoms. JO said that the Registrant did not notice this new symptom as being a “red flag”, possibly indicative of serious pathology and did not ask further clinically required questions. JO was required to intervene and follow up with the patient on these red flags which she said were “alarming points that required addressing”.

34. The Panel found that JO was clear and consistent in her evidence and that she was fair, noting that the Registrant would not necessarily have a detailed knowledge of the conditions. However, JO was clear that the Registrant did not seem to understand, notice or act upon the red flags raised by the patient. This evidence was consistent with the notes at the time, and it was credible and cogent. The Panel found this proved.

Allegation 5a, b, and c

5. On or around 18 April 2024 when attending Service User E, who required a falls risk assessment and a standard physiotherapy assessment, you:

a. Did not adequately complete the main components of the TUSS assessment;

b. When completing outcome measures relating to balance, you did not ensure that the environment was safe for Service User E and/or that Service User E had something to hold onto if needed;

c. Did not adequately carry out a walking stick check and/or a walking stick adjustment.

35. 5a – RM told the Panel that the Registrant failed to give clear instruction to lead the service user through the four stages of the TUSS assessment. RM said that the Registrant failed to complete the main components of the TUSS and had to be prompted throughout the assessment. The Panel noted that this took place three months into the role and the evidence from RM was that the Registrant was not able to conduct this basic assessment. 5b – RM said the patient was put at risk until RM intervened as the Registrant had not placed the patient in a safe environment to conduct the assessment. 5c – RM said that the Registrant did not check or measure the patient’s walking stick which she said was “one of the most basic checks” she would expect any Physiotherapist to check and there was a risk to the patient as a result. The Registrant was unable to assess the height of the walking stick and RM had to readjust it. This evidence was consistent with the notes made by RM at the time. Her evidence was clear, credible and cogent and the Panel found this proved.

Allegation 6a and 6b

6. On or around 19 April 2023 you:

a. Conducted outcome measures with Service User F which related to balance, which were not relevant to Service User F’s presenting complaint; and/or

b. Discussed with Service User F balance exercises which were not relevant to Service User F’s presenting complaint.

36. RM said in her witness statement that as part of a falls risk assessment the Registrant had carried out measures relating to balance and then discussed some balance exercises with the patient which she stated were also not relevant. However, in her live evidence RM, when questioned, accepted that the balance assessment may have relevantly formed part of a falls risk assessment. The Panel was mindful of the words used in the allegation, notably “relevant”. As such, the Panel was of the view that it was not sufficiently clear from the evidence that what the Registrant did was not relevant and it therefore found this allegation not proved.

Allegation 7

7. On or around 24 April 2023, you prescribed breathing exercises for Service User G which were inappropriate for Service User G’s presenting complaint of balance issues.

37. RM said that the Registrant had prescribed breathing exercises that were not appropriate. However, RM accepted when questioned that breathing exercises may be appropriate for a patient with a rib fracture injury. The Panel noted in the exhibit supporting this allegation that what is illustrated are not breathing exercises. In these circumstances the Panel was not satisfied that there was sufficient evidence to prove this allegation as to the exercises being “inappropriate” as alleged. The Panel found this not proved.

Allegation 8a, b, c, & d

8. On or around 11 May 2023:

a. You inaccurately recorded in Service User H’s notes that Service User H had attended hospital, which was incorrect;

b. You inaccurately recorded in Service User H’s notes that Service User H had fallen out of bed, which was incorrect;

c. You did not record in Service User H’s notes information about how Service User H was completing transfers between care calls; and/or

d. You did not record in Service User H’s notes that Service User H was unsuitable for a rehabilitation programme at that time due to Service User H’s high pain levels

38. 8a – SB spoke in her evidence about this allegation. She was clear, open and credible. She said she noticed that the Registrant had included “false and inaccurate information in the notes” including a reference to the patient being discharged from hospital when they had not been to hospital. She had discussed these issues with the Registrant who had then amended the notes, but despite that SB had been required to further amend the notes to correct the inaccuracies. This is consistent with the annotations to the notes made by SB at the time. The Panel accepted that evidence as credible and consistent and found this proved.

39. 8b – SB accepted in her oral evidence that the patient had said they had “slipped off” the bed, and she had amended the notes to record no injuries. The Panel was mindful of the words in the allegation, “inaccurately recorded” and “incorrect.” Given those words and the live evidence of SB, the Panel therefore found the record in the notes made by the Registrant was not inaccurate and incorrect and it found this allegation not proved.

40. 8c and 8d are supported by the evidence of SB. She said that the Registrant did not ask the patient any questions about her social environment or her personal care. The Registrant also did not set out in the notes if the patient was suitable for rehabilitation or the plan going forward given the patient had high pain levels. SB said these were important issues and she had been required to annotate the patient notes to reflect them. This evidence is supported by and is consistent with documentary evidence of the notes showing the annotations made by SB. The Panel found this evidence credible and consistent, and it found this proved.

Allegation 9

9. On or around 16 May 2023, you advised that Service User I should have a four wheeled walker to walk outside, when this was impractical and/or unsafe because Service User I would not be able to manoeuvre this up and down the steps outside their home.

41. SB said that the assessment conducted by the Registrant was inadequate. The Registrant took the lead, and she had not taken account of the steps at the patient’s property and had recommended a four wheeled walker to the patient. SB said that the use of this type of walking aid was both impractical and unsafe, and when she later discussed the clinical reasoning for this the Registrant had said that she had not considered the number of steps at the patient’s door. SB’s live evidence was clear and cogent and consistent with her notes made at the time. The Panel found this proved as to both impractical and unsafe.

Allegation 10a, b, c, d (i) – (v)

10. On or around 22 May 2023, when assessing Service User J, who used an oxygen tank and a wheelchair, you:

a. Transferred Service User J to bed without checking his oxygen levels;

b. Completed range of movement and strength testing with Service User J whilst they were in a crooked position, when these tests should have been carried out whilst they were lying flat;

c. Although Service User J said that he could walk with his frame, you did not conduct a mobility assessment;

42. 10a, b and c – DB told the Panel about this incident. She explained the importance of oxygen saturation levels and that the Registrant transferred the patient to bed when she had not checked these levels prior to transfer. DB further stated that the patient was in a “crooked” position when the Registrant conducted the movement and strength testing when the patient should have been lying flat and so could not have recorded accurate test results. She also told the Panel that the Registrant did not observe the patient walking when conducting a mobility assessment, and DB required to conduct that test and she observed the patient walking 20 metres with a frame. DB was clear and cogent in her live evidence, and it was consistent with her witness statement and with the notes made at the time. The Panel found this proved.

10d. Did not make accurate and/or complete records for Service User J, in that:

i. You recorded that Service User J lived with his grandson, when he lived alone;

ii. You recorded that Service User J was admitted to hospital on Christmas evening, when he was admitted on 13 December;

iii. You recorded that Service User J was discharged from hospital in February, when he was discharged on 25 December;

iv. You recorded that Service User J suffered with COPD, when he did not have COPD; and/or

v. You recorded that Service User J used a 6 litre oxygen supply whilst walking, when he used a 4-5 litre oxygen supply.

43. 10 di, ii, iii, iv and v – DB stated that the Registrant then completed both inaccurate and incomplete records of the visit to the patient including simple factual errors such as the dates as alleged, and that the patient lived with his grandson when in fact he lived alone. DB explained to the Panel how she had required to discuss the notes with the Registrant and had been required to annotate them to correct them. DB also explained the importance of accurate notes as they are used as a basis for further assessments and plans.

44. The Panel considered that evidence and the notes exhibited by DB showing her amendments in respect of each allegation. Those notes and the changes made by her were fully consistent with DB’s live evidence which the Panel found was clear and credible. The Panel found that the records made by the Registrant were not accurate, clear or complete in each respect alleged and found this proved.

Allegation 11a and b

11. On or around 30 May 2023, when attending Service User K, you:

a. Did not know and/or did not demonstrate knowledge of how to conduct a falls risk assessment;

b. When Service User K reported that they were unable to fully straighten their knees, you did not identify that they may have contractures and/or;

c. When Service User K reported lower back pain radiating into their leg, you did not adequately carry out a straight leg raise test.

45. 11a – JO gave clear and cogent evidence about this visit. She attended the patient with the Registrant and said that, despite her prompting, the Registrant did not know how to conduct the falls risk assessment. JO said that as the Registrant could not do so, she had to conduct the test. The clinical records are consistent with that evidence and the Panel found this proved.

46. 11b – JO said that when the patient said they could not straighten their leg, JO considered the patient may have had contractures. She had then asked the Registrant about the possibility of contractures and said in her evidence that the Registrant had not identified this possibility. 11c – In addition, JO stated that although the patient had identified lower back pain radiating into their leg, a symptom of sciatica, the Registrant did not test for this. This test is the Straight Leg Raise Test, which is used to identify nerve or muscle related pain. JO said that when questioned the Registrant did not know about this test. This evidence was clear, and it was supported and consistent with the patient notes made by JO at the time. The Panel found this proved.

Allegation 12

12. On or around 5 June 2023, when attending Service User L, who had knee and ankle complaints, you did not conduct any joint-related tests.

47. RM stated in her evidence that the Registrant did not carry out “any joint-related tests” on the patient and conducted no tests relevant to the patient’s complaints. RM had been required to intervene. This is consistent with the patient notes made at the time stating the Registrant had “…no knowledge of ankle/knee joint specific tests.” The Panel found this proved.

Allegation 13a and b

13. On or around 6 June 2023, when attending to Service User M, who had recently been discharged from hospital:

a. You did not ask to see Service User M’s hospital discharge summary; and/or

b. You removed or went to remove Service User M’s knee brace without first consulting their doctor.

48. The evidence from DB was clear. She said that the Registrant did not check the patient’s discharge summary, and then “went to” or attempted to remove the patient’s knee brace. The evidence was not that the brace was removed, as this was prevented by DB. Her evidence about the discharge summary was supported by her notes made at the time. She said that removing a brace without medical information from a doctor or medical notes was “dangerous” and that a Physiotherapist “should never remove or change stings of a patient’s brace without guidance from a doctor”. She was clear and consistent in her statement and live evidence and said that this conduct had created a risk of harm to the patient and she had been required to intervene. The Panel found 13a proved, and with regard to 13b, found it proved as to “went to remove” the brace.

Allegation 14 a & b

14. On or around 9 June 2023, you did not make accurate and/or complete records following an assessment of Service User N, in that you recorded that they had bilateral strength of 5/5 when:

a. You had not tested Service User N’s strength during the assessment; and/or

b. This was in contradiction to your record that Service User N had limited hip flex on the right side due to pain

49. RM in her evidence was clear and consistent. She said that the Registrant had completed inaccurate and incomplete notes indicating assessments that had not been conducted, in particular the incorrect recording of a bilateral strength test at 5/5 which the Registrant had not conducted. This is reflected in the notes made at the time. That was in contradiction to the record made by the Registrant that the same patient was “in pain on the side”. This is clear from the notes exhibited.

50. RM said that she had discussed this with the Registrant and had then corrected the clinical record which the Panel found was consistent with RM’s evidence. The Panel found this proved.

Allegation 15a, b, c, and d

15. On a date between 23 January 2023 and 30 June 2023:

a. When attending to Service User O, who had Oedema, you did not conduct palpation until prompted to do so;

b. When completing notes of your visit with Service User O, you included results from a Godet’s sign test conducted with a previous patient and/or recorded results which were not accurate for Service User;

c. When completing notes of your visit with Service User O you did not record the results of the palpation; and/or

d. When completing notes of your visit with Service User O you recorded that Service User O had limited range of movement due to swelling when Service User O had no limitation of movement.

51. 15a – RM described this clearly to the Panel in her witness statement. She said that the Registrant needed prompting to conduct a palpation test, did not understand it and then did not record the results in the patient’s notes. She said that “it was clear she did not know what she was looking for.” RM annotated the notes to deal with inaccuracies in the Registrant’s notes. The Panel found this proved.

52. 15b – RM confirmed that the Godet test from a previous patient appeared in the notes for this patient. The Registrant had copied over the results to another patient. The Panel found those notes, made at the time, were consistent with this evidence. The Panel found this proved as to both the test from a previous patient and the lack of accuracy.

53. 15c and d – Further, she confirmed that the Registrant had not recorded the results of the palpation and had recorded limited movement when RM indicated there was “no limitation”. The written records exhibited are consistent with RM’s evidence, which was clear. The Panel found this proved.

Submissions on Grounds and Impairment

54. Ms Collins provided the Panel with written submissions. She submitted that the facts proved amount to a lack of competence and she referred to the relevant case law. She further submitted that a finding of impairment on both the personal and public aspects of impairment was appropriate.

 

Decision on Grounds

Lack of Competence

55. The Legal Assessor referred the Panel to the guidance on lack of competence in Holton v General Medical Council [2006] EWHC 2960 which stated “that the standard to be applied was that applicable to the post to which the registrant has been appointed and the work she was carrying out. The public was entitled to expect that the work of a registrant who performed in any speciality was at the standard applicable to that post in that speciality.” In Calhaem v GMC [2007] EWHC 2606 the court stated as to lack of competence that it “connotes a standard of professional performance which is unacceptably low and which (save in exceptional circumstances) has been demonstrated by reference to a fair sample of the doctor's work.

56. The Panel has made significant findings of fact which include findings in respect of failures to conduct adequate and effective assessments, to conduct appropriate questioning of patients and a failure to recognise clinical “red flags”. This has been coupled with a repeated and persistent lack of proper, accurate and complete record and note keeping. The evidence showed that the Registrant repeatedly placed patients at risk of harm, caused pain to one patient and risked causing serious harm to the patient with the knee brace.

57. RM oversaw the Registrant’s whole probation period and said that the Registrant was never unsupervised. The evidence is that the Registrant was unable to practise safely or effectively, and she did not improve her practice over the extended probation period of some five months.

58. The Panel found that the Registrant was well supported by her senior colleagues, four of whom gave clear and cogent evidence. They all explained clearly that the Registrant consistently and repeatedly failed to meet the standard of competence to be expected of a band 5 Physiotherapist. She was unable to recognise the importance of presenting symptoms, unable to conduct or understand basic assessments, and she was unable to provide clinical reasoning or make accurate records. Despite support, supervision and prompting from her colleagues over an extended period, the Registrant’s practice continued to raise serious concerns and she could not practise autonomously.

59. The Panel was satisfied that it had before it clear and cogent evidence of a fair sample of the Registrant’s practice. The Panel was satisfied that the findings of fact make clear that the Registrant could not practice autonomously, safely or effectively and that she failed to meet the standard reasonably to be expected of a Band 5 Physiotherapist.

60. Further, the Panel considered the HCPC Standards of Proficiency for Physiotherapists, applicable at the time. It concluded that the Registrant did not meet the following standards:

1 Be able to practise safely and effectively within their scope of practice

1.2 Recognise the need to manage their own workload and resources effectively and be able to practise accordingly

3 Be able to maintain fitness to practise

3.3 Understand both the need to keep skills and knowledge up to date and the importance of career-long learning

4 Be able to practise as an autonomous professional, exercising their own professional judgement

8 Be able to communicate effectively

9 Be able to work appropriately with others

10 Be able to maintain records appropriately

11 Be able to reflect on and review practice

12 Be able to assure the quality of their practice

12.6 Be able to evaluate intervention plans using recognised outcome measures and revise the plans as necessary in
conjunction with the service user

13 Understand the key concepts of the knowledge base relevant to their profession

13.4 Understand the structure and function of the human body, together with knowledge of health, disease, disorder and dysfunction, relevant to their profession

13.5 Understand the theoretical basis of, and the variety of approaches to, assessment and intervention

13.6 Understand the following aspects of biological science: – normal human anatomy and physiology, including the dynamic relationships of human structure and function as related to the neuromuscular, musculoskeletal, cardio-vascular and respiratory systems – patterns of human growth and development across the lifespan – factors influencing individual variations in human ability and health status – how the application of physiotherapy can cause physiological and structural change

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.

61. The Panel, having considered all the evidence, concluded that despite support and an extended probation period, the Registrant lacked the competence reasonably to be expected of a Band 5 Physiotherapist. Her performance was consistently and repeatedly unacceptably low and she placed several patients at a real risk of harm. The Panel decided that the facts proved amounted to a lack of competence.

 

Decision on Impairment

62. The Legal Assessor referred the Panel to the HCPC guidance on impairment of fitness to practise, and to the guidance in case law, in particular in CHRE v NMC and Grant [2011] EWHC 927 (Admin). This stresses the importance of considering insight, remediation and the wider public interest.

63. Whilst the Panel considered that the deficiencies are remediable, there is no evidence before the Panel of any steps taken by the Registrant to reflect on her practice, and no evidence of any further work as a Physiotherapist. The Panel has no evidence of insight or any remediation by the Registrant. The evidence the Panel has heard indicates that the Registrant did not engage positively with the support and supervision she received and that is indicative of a lack of insight and reflection by the Registrant. The Panel has no information about the Registrant’s current circumstances. There is no evidence of any training or professional development having been undertaken, and there are no references or testimonials.

64. With the tests suggested in the Grant case in mind, the Panel decided that in these circumstances there is a real risk of repetition of the lack of competence. It concluded that the Registrant is liable in the future to place patients at real risk of harm, and she is liable in the future to breach fundamental tenets of the profession, namely that she is unable to practice safely, effectively or autonomously. The Panel concluded that the Registrant’s current fitness to practise is impaired on the personal component.

65. The Panel next considered the wider public interest in maintaining confidence in the profession and upholding proper professional standards. The Panel decided that, in light of its serious findings, that a member of the public would be greatly concerned were the Registrant to be permitted to practice on an unrestricted basis given she placed patients at real risk of harm due to her lack of competence. The Registrant’s lack of competence is therefore liable to bring the profession into disrepute.

66. The Panel decided that not to find the Registrant’s fitness to practise currently impaired would undermine public confidence in Physiotherapists. Furthermore, it would fail to uphold and declare proper professional standards. It would also undermine public confidence in the regulator.

67. The Panel decided that the Registrant’s fitness to practise is therefore currently impaired on both the personal and public components following HCPC guidance.

Decision on Sanction

68. Ms Collins provided a written submission on sanction. She referred to the HCPC Sanctions Guidance and remained neutral as to the sanction to be imposed. She advised that the Registrant has been subject to an interim suspension order since 4 December 2023. She confirmed that the last contact with the Registrant was on 3 November 2023.

69. The Legal Assessor referred the Panel to the HCPC Sanctions Guidance and reminded it of the importance of proportionality and protecting the public. He advised the Panel that a Striking Off Order was not available to it as this is a lack of competence case and there has not been a continuous period of restriction on the Registrant in the two years immediately preceding this decision, as is required by Fitness to Practise Rule 29(6).

70. The Panel was mindful of the Sanctions Policy and the need for proportionality. It first considered whether there were any mitigating or aggravating factors. The Panel found the following mitigating factors:

• Some evidence of difficult personal circumstances during this employment, having trained abroad and moved to the UK to take up this role;

• No evidence of any previous fitness to practise proceedings.

71. The Panel found the following aggravating factors:

• Repeated deficiencies despite support over a sustained period;

• Actual harm caused to a patient;

• Lack of insight or any remediation;

• Lack of engagement with the hearing process.

72. The Panel first considered mediation, taking no action or a caution order. The findings in this case are serious. The Registrant caused harm and there was a repeated risk of harm to numerous patients over a sustained period of support and supervision. The Panel was mindful of paragraph 101 regarding the use of a caution order in the Sanctions Policy:

“A caution order is likely to be an appropriate sanction for cases in which:

• the issue is isolated, limited, or relatively minor in nature;

• there is a low risk of repetition;

• the registrant has shown good insight; and

• the registrant has undertaken appropriate remediation”

73. The Panel found that none of these factors were engaged in this case. Given the nature and gravity of the findings, the Panel decided that this case was too serious to impose any of these sanctions. None of these would place any restriction on the Registrant’s practice and would fail to protect the public or address the wider public interest.

74. The Panel next considered imposing conditions of practice and was mindful of paragraph 106 of the Sanctions Policy:

“A conditions of practice order is likely to be appropriate in cases where:

• the registrant has insight;

• the failure or deficiency is capable of being remedied;

• there are no persistent or general failures which would prevent the registrant from remediating;

• appropriate, proportionate, realistic and verifiable conditions can be formulated;

• the panel is confident the registrant will comply with the conditions;

• a reviewing panel will be able to determine whether or not those conditions have or are being met; and

• the registrant does not pose a risk of harm by being in restricted practice.”

75. The Panel has found there was a lack of progress by the Registrant in the role despite support and constant supervision. The Panel has found persistent, general and serious failures in professional standards over a sustained period of support. These failures were wide ranging across core professional skills – clinical assessment and reasoning, communication and record keeping. As a result, there was harm caused and a risk of harm to patients. Furthermore, the Registrant has not engaged to any meaningful extent in this process. There is no evidence of insight or remediation.

76. As a result, the Panel decided that it could have no confidence that the Registrant would be willing or able to comply with any conditions of practice that may be imposed. She did not progress or respond positively to the supervision and support she received over five months in the role. Mindful of the lack of evidence of any insight, remediation or engagement, the Panel decided that conditions would not be effective, realistic or workable and would fail to properly reflect the seriousness and depth of the lack of competence found.

77. The Panel decided that a Suspension Order was the proportionate and appropriate sanction. That sanction would reflect the seriousness of the findings. The Panel was mindful of paragraph 121 which states that suspension may be appropriate where:

• 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.

78. Whilst there is no evidence of insight by the Registrant and the Panel has found there is a likelihood of repetition, the Panel was of the view that the findings represent a serious breach of the professional standards set out in the decision above. These standards are core professional standards and represent essential professional proficiencies that the Registrant breached repeatedly and so placed patients at risk of harm.

79. In all the circumstances of this case, the Panel accordingly decided that a Suspension Order for 12 months is the proportionate sanction. That period will proportionately and properly mark and reflect the gravity of the findings.

80. The Panel was mindful that it is not in a position to impose a Striking Off Order at this time.

81. A future reviewing Panel would likely be assisted by:

• Written reflections on her clinical practice with the employer, and on her lack of engagement with the regulator;

• Any relevant references, testimonials, training or personal development undertaken;

• An up to date CV identifying any further physiotherapy related work and CPD.

ORDER: That the Registrar is directed to suspend the registration of Miss Pratiksha Venkatesh Patil for a period of 12 months from the date this order comes into effect.

Interim Order

1. In light of its findings on Sanction, the Panel next considered an application by Ms Collins for an Interim Suspension Order to cover the appeal period before the Sanction becomes operative.

2. The Panel accepted the advice of the Legal Assessor who referred it to the HCPTS Practice Note on Interim Orders. He reminded the Panel that an Interim Order must be necessary to protect the public, or be otherwise in the public interest. The Panel must act proportionately and balance the interests of the Registrant with the need to protect the public.

3. The Panel was mindful of its earlier findings and concluded that an Interim Order is necessary to protect the public during the appeal period. The Panel decided that it would be wholly incompatible with its earlier findings and with the Suspension Order imposed to conclude that an Interim Suspension Order is not necessary in the meantime for the protection of the public or otherwise in the public interest. Accordingly, the Panel concluded that an Interim Suspension Order should be imposed on both public protection and public interest grounds.

4. The Panel decided that it is appropriate for that Interim Suspension Order to be imposed for a period of 18 months to cover the appeal period. When the appeal period expires, this Interim Order will come to an end unless there has been an application to appeal. If there is no appeal the Suspension Order shall apply when the appeal period expires.

History of Hearings for Pratiksha Venkatesh Patil

Date	Panel	Hearing type	Outcomes / Status
16/06/2025	Conduct and Competence Committee	Final Hearing	Suspended
07/02/2025	Conduct and Competence Committee	Interim Order Review	Hearing has not yet been held
01/11/2024	Conduct and Competence Committee	Interim Order Review	Interim Suspension
07/06/2024	Investigating Committee	Interim Order Review	Interim Suspension
04/12/2023	Investigating Committee	Interim Order Application	Interim Suspension