Dr William Bratby
Your fitness to practise as a Clinical Psychologist is impaired by reason of your health.
1. As this is a health case the Panel took into account the HCPC Practice Note – Conducting Hearings in Private. The Panel was satisfied that there was no need for a formal application and determined that the entire review hearing should be conducted in private to protect Dr Bratby’s private life, in accordance with rule 10 of The Health and Care Professions Council (Health Committee) (Procedure) Rules 2003.
2. Dr Bratby was employed by Cambridgeshire and Peterborough NHS Foundation Trust (the Trust) as a Clinical Psychologist. In 2012, the Trust investigated concerns relating to his record keeping. Dr Bratby admitted that he had failed to keep accurate and timely records over a two-year period. However he was suffering from health problems and therefore this case was referred to the HCPC Health Committee.
3. The original panel found Dr Bratby’s fitness to practise was impaired by reason of his health
4. Dr Bratby ceased working at the Trust on 6 August 2014. He sent an email to the HCPC, dated 17 November 2014, stating that he wished to return to practise but was “not yet at the stage of resuming work”. He did not attend the final Health Committee hearing in January 2014, for health reasons and at that hearing an 18 month Conditions of Practice Order was imposed.
5. Dr Bratby did not attend the first review of the Conditions of Practice Order, which took place on 7 July 2015, nor was he represented. In reaching its decision on impairment the previous panel noted that:
“…the Registrant has not provided the information which the original Panel stated may have assisted the Panel today or indeed, any recent information. In the absence of any new information to the contrary, the Panel is satisfied that the Registrant’s fitness to practise remains impaired by reason of his health and therefore the risk to the public remains.”
6. At the sanctions stage the previous review Panel concluded that the Conditions of Practice Order should be replaced with a 9 month Suspension Order, in part because Dr Bratby had breached the Conditions of Practice Order by not informing the HCPC that he had ceased employment and the panel considered that the Order could not be monitored without his engagement.
7. Ms Kavanagh, on behalf of the HCPC, opened the case by outlining the history of these proceedings. She referred the Panel to the findings of the original Health Committee and the first review panel. In her closing submissions, Ms Kavanagh, invited the Panel to conclude that Dr Bratby remains impaired by reason of his health, but adopted a neutral stance as to the sanction that should be imposed.
8. Dr Bratby gave oral evidence to the Panel. He apologised for his lack of communication following the original Health Committee hearing. Dr Bratby explained the difficulties he had experienced whilst working at the Trust, the steps he had taken to improve his record keeping and manage his health, and he outlined his plans for the returning to practice. He submitted that self-employment as a psychologist in private practice would offer him an opportunity to manage his caseload. He had an office at home which he could use as a clinic room. He submitted a period of being involved in supervision, or group discussions with other practitioners, and/or shadowing a colleague who works in a private clinic would help him to prepare for a return to work. He stated he had considered applying for a position as a high intensity therapist but had not taken this further. He also stated that apart from a period of time when he was self-employed building and selling computers, he had not been in employment since April 2014. He invited the Panel to revoke the current Suspension Order and replace it with a Conditions of Practice Order. He submitted the previous conditions imposed were wholly appropriate and would have been helpful if he had had the opportunity to put them into practice.
The Panel’s Approach
9. In undertaking this review, the Panel took into account the documentary evidence, the oral evidence of Dr Bratby, and the submissions from both parties. The Panel accepted and applied the advice it received from the Legal Assessor as to the proper approach it should adopt. In particular that:
• The purpose of the review is to consider the issue of impairment based on the previous panel’s findings of fact, the extent to which Dr Bratby has engaged with the regulatory process, the scope and level of his insight, whether his previous misconduct has been sufficiently and appropriately remedied and the risk of repetition.
• In terms of remediation, relevant factors include whether Dr Bratby:
(i) fully appreciates the gravity of the previous panel’s finding of impairment;
(ii) has maintained his skills and knowledge;
(iii) is likely to place patients at risk if he were to return to unrestricted practise.
• The Panel should have regard to the HCPC Practice Note: Finding that Fitness to Practice is impaired.
• It is only if the Panel determines that Dr Bratby’s fitness to practise remains impaired, that the Panel should go on to consider sanction by applying the guidance as set out in the HCPC Indicative Sanctions Policy, and the principles of proportionality which require Dr Bratby’s interests to be balanced against the interests of the public.
10. The Panel’s decision and brief reasons were announced on 10 March 2016. However, due to insufficient hearing time both parties were informed that full written reasons would follow shortly.
11. The Panel first considered whether Dr Bratby’s fitness to practise remains impaired by reason of his health. In particular the Panel took into account the risk to patient safety, the risk that the concerns identified when he was employed at the Trust would re-occur and the wider public interest which includes upholding public trust and confidence.
12. The Panel noted that despite the Conditions of Practice Order and the observations made by the previous review panel, Dr Bratby did not submit any medical evidence to demonstrate that he is fit to return to practise either with or without restrictions. As a consequence the Panel could not be satisfied that there had been any material change with regard to Dr Bratby’s state of health and the management of his health condition. Therefore the Panel concluded that his fitness to practise remains impaired.
13. The Panel then went on to consider what, if any, sanction it should impose. The Panel first considered whether to take no further action and to allow the current Suspension Order to lapse. The Panel concluded that this would not be sufficient to protect the public or maintain trust and confidence in the profession and would therefore be wholly inappropriate. Similarly, the Panel was of the view that a Caution would not be appropriate as it would not address the concerns regarding Dr Bratby’s health.
14. The Panel next considered a Conditions of Practice Order. The Panel noted that the HCPC did not submit that there had been any breach of the previous Conditions of Practice Order.
15. The Panel noted that Dr Bratby has not worked as a clinical psychologist for a significant period of time. Dr Bratby informed the Panel that his suspension provided him with an opportunity to ‘step away from the situation and reflect’. He stated that having reflected on the matter he is thinking of returning to practice as a self-employed psychologist, as this would provide him with an opportunity to manage his workload and build it up slowly. Dr Bratby also explained that he has taken practical steps to improve his organisational skills and that those close to him are willing to assist him by acting as a ‘double checker’ with regard to his paperwork. Alternatively, Dr Bratby indicated that he would consider employment as a newly qualified psychologist (a level below his previous level and where he would expect to receive more support).
16. The Panel appreciated Dr Bratby’s attendance and his willingness to engage with the regulatory process. The Panel was satisfied that Dr Bratby demonstrated some insight with regard to his health and the impact it was likely to have on his ability to practise. However, in the absence of up to date medical evidence the Panel was unable to formulate appropriate and workable conditions. In particular, there was no independent verifiable evidence before the Panel that Dr Bratby was fit to return to work as a clinical psychologist and if so, whether this should be with or without restrictions. As a consequence, the Panel could not be satisfied that the risks previously identified could be adequately addressed by the imposition of conditions or that the risk of repetition had been reduced.
17. The Panel then went on to consider whether to extend the Suspension Order. The Panel viewed Dr Bratby’s attendance as a positive indication that he is willing to work towards remediation. The Panel was satisfied that in the interests of fairness the current order should be extended for a period of 3 months to provide Dr Bratby with a further opportunity to demonstrate that he is fit to return to practise with or without restriction. In deciding on a period of 3 months the Panel took into account the length of time Dr Bratby may need to reflect on how to convince the review panel.
18. The Panel cannot bind any future panel. However, the Panel took the view that when the extended Suspension Order is reviewed shortly before expiry the panel conducting that review may be assisted by the following:
(i) Medical reports:
• Medical condition(s);
• Ability to return to work;
• If he is able to return to work, any restrictions, limitations or adjustments that may be appropriate or necessary.
(ii) Evidence of appropriate Continuing Professional Development or evidence of how his skills and knowledge have been kept up to date.
(iii) Evidence of how he would return to practise as a Clinical Psychologist (either in private practice or employed) and details of any support he would have available to him.
(iv) Evidence from anyone willing to offer relevant work or work shadowing experience.
(v) Any other evidence relevant to the issue of fitness to return to practise with or without restriction.
The order imposed today will apply from 7 April 2016.
This order will be reviewed again before its expiry on 7 July 2016.
History of Hearings for Dr William Bratby
|Date||Panel||Hearing type||Outcomes / Status|
|05/12/2017||Health Committee||Review Hearing||Conditions of Practice|
|09/06/2017||Conduct and Competence Committee||Review Hearing||Suspended|
|07/06/2016||Health Committee||Review Hearing||Suspended|
|10/03/2016||Health Committee||Review Hearing||Suspended|
|07/07/2015||Health Committee||Review Hearing||Suspended|
|10/01/2014||Health Committee||Final Hearing||Conditions of Practice|