Dr John Owen

: Practitioner psychologist

: PYL17989

: Final Hearing

Date and Time of hearing:10:00 18/10/2017 End: 17:00 27/10/2017

: Health and Care Professions Council, 405 Kennington Road, London, SE11 4PT

: Conduct and Competence Committee
: Caution

Allegation

Allegation (as amended at the Final Hearing):


During the course of your employment as a Practitioner Psychologist at Bolton Hospitals NHS Foundation Trust, between June 2013 and February 2014, you:

1. Did not keep adequate patient records in relation to Patient 1, namely:


a. In relation to an appointment on 19 July 2013, you:


i. Recorded the date of the appointment as 19 March 2013.
ii. Did not time the initial page of your notes.
iii. Did not date and/or time the continuation page of your notes.


b. In relation to an appointment on 23 August 2013, you:


i. Did not time the initial page of your notes.
ii. Did not date and/or time the continuation page of your notes.


c. In relation to an appointment on 6 September 2013, you:


i. Did not time your notes.
ii. Did not sign your notes.


d. In relation to an appointment on 27 September 2013, you:


i. Did not time your notes.
ii. Did not sign your notes.
iii. Did not record the patient's name and/or RMC number on your notes.


e. In relation to a telephone call on 18 October 2013, you did not time your notes.


f. In relation to an appointment on 15 November 2013, you:


i. Did not date and/or time the continuation page of your notes.
ii. Did not record the patient's name and/or RMC number on the continuation page of your notes.


g. In relation to an appointment on 17 January 2014, you:


i. Did not date and/or time the continuation page of your notes.
ii. Did not record the patient's name and/or RMC number on the continuation page of your notes.


h. In relation to an appointment on 21 February 2014, you:


i. Recorded the date of the appointment as 28 February 2014.
ii. Did not record the patient's name on your notes.


2. Did not progress treatment in a timely manner in relation to Patient 1, in that you:


a. Did not make a referral to the Pain Management Programme following the appointment on 21 February 2014:


i. Until you were prompted by your supervisor.
ii. Until 28 February 2014.


3. Your actions in paragraph 2 above could have delayed Patient 1's access to the Pain Management Programme.


4. Did not keep adequate patient records in relation to Patient 2, namely:

a. In relation to an appointment on 2 August 2013 you did not date and/or time your notes.


b. In relation to an appointment on 30 August 2013 you did not time your notes.


c. In relation to an appointment on 25 October 2013 you did not make any notes of the appointment.


d. In relation to an appointment on 6 December 2013, you:


i. Did not time the initial page of your notes.
ii. Did not date and/or time the continuation page of your notes.
iii. Did not record the patient's name and/or RMC number on the continuation page of your notes.


e. In relation to an appointment on 31 January 2014 you did not record the patients name and/or RMC number on your notes.


f. In relation to an appointment on 7 February 2014, you:


i. Recorded the date of your appointment as 7 January 2014.
ii. Did not date and/or time the continuation page of your notes.
iii. Did not record the patient's name and/or RMC number on the continuation page of your notes.


g. In relation to an appointment on 14 February 2014, you recorded the date of your appointment as 14 July 2014.


h. In relation to an appointment on 21 February 2014, you:


i. Recorded the date of the appointment as 21 January 2014.
ii. Did not time your notes.


5. Did not progress treatment in relation to Patient 2, in that you, following an appointment with Patient 2 on 30 August 2013, did not communicate the plan of therapy to other professionals until 28 February 2014.


6. Did not keep adequate patient records in relation to Patient 3, namely:


a. In relation to an appointment on 22 November 2013, you did not time your notes.


b. In relation to an appointment on 6 December 2013, you:


i. Recorded the date of the appointment as 6 November 2013.
ii. Did not date and/or time the continuation page of your notes.


c. In a letter date 28 February 2014 to the Gastroenterologist, you referred to Patient 3 by the incorrect name.


7. Did not keep adequate patient records in relation to Patient 4, namely:


a. In relation to an appointment on 30 August 2013, you did not time your notes.


b. In relation to an appointment on 13 September 2013, you did not time your notes.


c. In relation to an appointment on 27 September 2013, you:


i. Did not time your notes.
ii. Did not sign your notes.

d. In relation to an appointment on 4 October 2013, you:


i. Did not time your notes.
ii. Did not record the patient's name and/or RMC number on your notes.


e. In relation to an appointment on 11 October 2013, you did not time your notes.


f. In relation to an appointment on 18 October 2013, you did not time your notes.


g. In relation to a telephone call on 1 November 2013, you did not time your notes.


h. In relation to an appointment on 8 November 2013, you:


i. Did not time your notes.
ii. Did not record the patient’s name and/or RMC number on your notes.


i. In relation to an appointment on 6 December 2013, you:


i. Recorded the date of the appointment as 6 November 2013.
ii. Did not time your notes.
j. In relation to an appointment on 13 December 2013, you:
i. Did not date and/or time the continuation page of your notes.
ii. Did not record the patient's name and/or RMC number on the continuation page of your notes.


k. Authorised a letter on 10 February 2014 to be sent to an alternative service provider without the letter containing the patient’s details.


l. In relation to an appointment on 17 January 2014, you:


i. Did not date and/or time the continuation page of your notes.
ii. Did not record the patient's name and/or RMC number on the continuation page of your notes.
m. In relation to an appointment on 31 January 2014, you did not time the initial page of your notes.


n. In relation to an appointment on 7 February 2014, you:


i. Recorded the date of the appointment as 7 January 2014.
ii. Did not date and/or time the continuation page of your notes
iii. Did not record the patient's name and/or RMC number on the continuation page of your notes.


o. In relation to an appointment on 28 February 2014, you did not record the patient's name and/or RMC number on your notes.


8. Your actions in paragraph 7.k above delayed Patient 4's referral.


9. Did not keep adequate patient records in relation to Patient 5, namely:


a. In relation to an appointment on 14 June 2013, you


i. Did not time the initial page of your notes.
ii. Did not date and/or time the continuation page of your notes.


b. In relation to an appointment on 28 June 2013, you:
i. Did not time your notes.
ii. Did not sign your notes.


c. In relation to an appointment on 30 August 2013, you


i. Did not time your notes.
ii. Did not record the patient's name and/or RMC number on your notes.


10. Did not conclude treatment in a timely manner in relation to Patient 5, in that you:


a. Following an appointment on 30 August 2013 you:


i. Did not send a discharge letter to Patient 5 until 23 December 2013.
ii. Did not send a discharge letter to the referrer until 28 February 2014.


11. Did not keep adequate patient records in relation to Patient 6, namely:


a. In relation to an appointment on 12 July 2013, you:


i. Put your own name on the initial page of your notes instead of the patient's.
ii. Did not date and/or time the continuation page of your notes.
iii. Did not record the patient's name and/or RMC number on the continuation page of your notes.

b. Did not record the date and/or time of a telephone conversation made after an appointment on 12 July 2013.


12. Did not keep adequate patient records in relation to Patient 7, namely:


a. In relation to an appointment on 11 October 2013, you:


i. Did not record the patient's name and/or RMC number on your notes.
ii. Did not time your notes.


13. Did not keep adequate patient records in relation to Patient 8, namely:


a. In relation to an appointment on 14 June 2013, you:


i. Did not time the initial page of your notes.
ii. Did not date and/or time the continuation page of your notes.
iii. Did not sign your notes.

b. In relation to an appointment on 28 June 2013, you:


i. Recorded the date of the appointment as 27 June 2013.
ii. Did not time your notes.
iii. Did not sign your notes.


c. In relation to an appointment on 19 July 2013, you:


i. Did not time the initial page of your notes.
ii. Did not date and/or time the continuation page of your notes.
iii. Did not sign your notes.


d. In relation to an appointment on 26 July 2013, you:


i. Did not time the initial page of your notes.
ii. Did not date and/or time the continuation page of your notes.


e. In relation to an appointment on 2 August 2013, you did not sign your notes.


f. In relation to an appointment on 9 August 2013, you:


i. Did not time your notes.
ii. Did not sign your notes.


g. In relation to an appointment on 16 August 2013, you:


i. Did not time the initial page of your notes.
ii. Did not date and/or time the continuation page of your notes.
iii. Did not record the patient’s name and/or RMC number on the continuation page of your notes.
iv. Did not sign your notes.


h. In relation to an appointment on 23 August 2013, you did not time your notes.


i. In relation to an appointment on 30 August 2013, you did not time your notes.
j. In relation to an appointment on 13 September 2013, you did not time your notes.


k. In relation to an appointment on 20 September 2013, you:


i. Did not time the initial page of your notes.
ii. Did not date and/or time the continuation page of your notes.
iii. Did not record the patient’s name and/or RMC number on the continuation page of your notes.

l. In relation to an appointment on 27 September 2013, you:


i. Recorded on the continuation page the date of the appointment as 26 September 2013.
ii. Did not time your notes.
iii. Did not sign your notes.


m. In relation to an appointment on 11 October 2013, you did not time your notes.


n. In relation to an appointment on 1 November 2013, you did not record the patient's name and/or RMC number on your notes.


o. In relation to an appointment on 15 November 2013, you:


i. Did not time the initial page of your notes.
ii. Did not date and/or time the continuation page of your notes.


p. In relation to an appointment on 29 November 2013, you:


i. Did not time the initial page of your notes.
ii. Did not date and/or time the continuation page of your notes.
iii. Did not record the patient's name and/or RMC number on the continuation page of your notes.


14. Did not keep adequate patient records in relation to Patient 9, namely:


a. In relation to an appointment on 22 November 2013, you:


i. Did not time the initial page of your notes.
ii. Did not date and/or time the continuation page of your notes.
iii. Did not record the patient's name and/or RMC number on the continuation page of your notes.


15. Did not keep adequate patient records in relation to Patient 10, namely:


a. In relation to an appointment on 27 June 2013, you:


i. Did not time the initial page of your notes.
ii. Did not date and/or time the continuation page of your notes.
iii. Did not record the patient's name and/or RMC number on the continuation page of your notes.
iv. Did not sign your notes.


b. In relation to an appointment on 19 July 2013, you:


i. Did not record the patient's name and/or RMC number on your notes.
ii. Did not date and/or time the continuation page of your notes.


c. In relation to an appointment on 26 July 2013, you:


i. Did not time your notes.
ii. Did not sign your notes.


d. In relation to an appointment on 2 August 2013, you:


i. Did not time the initial page of your notes.
ii. Did not record the patient’s name and/or RMC number on your notes.
iii. Did not date and/or time the continuation page of your notes.
iv. Did not sign your notes.


e. In relation to an appointment on 23 August 2013, you:
i. Did not time your notes
ii. Did not sign your notes.


f. In relation to an appointment on 6 September 2013, you did not time your notes.


g. In relation to a telephone call on 15 November 2013, you did not time your notes.


h. In relation to an appointment on 22 November 2013, you:


i. Did not time your notes.
ii. Did not record the patient’s name and/or RMC number on your notes.


16. Did not progress treatment in a timely manner in relation to Patient 10, in that you, following an appointment on 6 September 2013 did not send a letter to the Consultant Clinical Oncologist until 21 October 2013.


17. Did not keep adequate patient records in relation to Patient 11, namely:


a. In relation to an appointment on 27 September 2013, you:


i. Did not time your notes.
ii. Did not make satisfactory notes of your initial screening assessment.


18. Did not keep adequate patient records in relation to Patient 12, namely:


a. In relation to an appointment on 13 September 2013, you:


i. Did not time your notes.
ii. Did not record the patient's name and/or RMC number on the continuation page of your notes.


19. Did not conclude treatment in a timely manner in relation to Patient 12, in that you did not send a discharge letter to the Heart Failure Specialist until 28 February 2014.


20. Did not keep adequate patient records in relation to Patient 13, namely:


a. In relation to an appointment on 28 February 2014, you did not record the patient's name and/or RMC number on your notes.


21. Did not progress treatment in a timely manner in relation to Patient 13, in that you did not reinstate assessment sessions as requested by your supervisor on 21 January 2014.


22. Your actions at paragraph 21 above had the potential to delay Patient 13's Treatment and/or referral to mental health services.


23. Did not keep adequate patient records in relation to Patient 14, namely:


a. In relation to an appointment on 29 November 2013, you:
i. Did not record the patient's name and/or RMC number on your notes.
ii. Did not time your notes.


b. In relation to an appointment on 6 December 2013, you did not time your notes.


c. In relation to an appointment on 13 December 2013, you:


i. Recorded the date of the appointment as 13 February 2013.
ii. Did not time the initial page of your notes.
iii. Did not record the patient's name and/or RMC number on your continuation page of your notes.
iv. Did not date and/or time the continuation page of your notes.


d. In relation to an appointment on 31 January 2014, you:


i. Did not record the patient's name and/or RMC number on your continuation page of your notes.
ii. Did not date and/or time the continuation page of your notes.


e. In relation to the entry in the notes confirming the patient's discharge you, did not:


i. Date this entry.
ii. Time this entry.
iii. Record the patient's name and/or RMC number on this page of your notes.


24. On 28 February 2014, you referred Patient 14 to the Pain Management Programme despite the patient awaiting the results of an investigation.


25. Did not keep adequate patient records in relation to Patient 15, namely:


a. In relation to an appointment on 26 July 2013, you did not time your notes.


b. In relation to an appointment on 16 August 2013, you did not time your notes.


c. In relation to your notes made on 3 November 2013, following supervision, you did not time your notes.


d. In relation to an appointment on 6 December 2013, you did not time your notes.


e. In relation to an appointment on 31 January 2014, you did not record the patient's name and/or RMC number on your notes.


f. In relation to an appointment on 28 February 2014, you:


i. Did not record the patient's name and/or RMC number on your continuation page of your notes.
ii. Did not date and/or time the continuation page of your notes.


26. The matters set out in paragraphs 1 – 25 constitute misconduct and/or lack of competence.

27. By reason of your misconduct and/or lack of competence your fitness to practise is impaired.

Finding

Preliminary matters

Application to amend the allegation

1. At the beginning of the hearing Mr Dite on behalf of the HCPC applied to amend the allegation by correcting typographical errors in Particular 17(a)(ii) changing "satisfactorily" to "satisfactory", in Particular 18(a)(i) changing "you notes" to “your notes", in Particular 18(a)(ii) inserting  “of” so it reads "of your notes" and in Particular 23(a)(ii) - changing "you notes" to “your notes". Mr Dite also applied to amend Particular 13(l)(i) by changing "26 June 2013" to "26 September 2013" to better reflect the evidence. He said that no injustice would be caused by those amendments. There was no objection to the proposed amendments from the Registrant or his representative. The Legal Assessor advised that the allegation could be amended provided that the Panel was satisfied that no injustice was thereby caused. The Panel allowed the application for amendment of all of the particulars asked for, considering that there was no injustice caused and accepting that the amendments helped to ensure clarity in the allegation but did not change the nature of it or make it more serious for the Registrant. 


Background


2. The Registrant was employed as a bank member of staff by Bolton Hospitals NHS Foundation Trust in the clinical health psychology service between June 2013 and February 2014. He worked one day a week on Fridays. Concerns were raised initially by secretarial support staff as to the Registrant’s organisational skills. This led to an investigation of his clinical notes. The investigation identified concerns with poor record keeping, communication with referrers, organisational skills and communication with patients. The concerns identified could have impacted on patient care. On 22 May 2014 the matter was reported to the HCPC. 
3. The allegation was read out. The Registrant admitted a number of the particulars which were put into a schedule or matrix of admissions and denials. The Panel acknowledged the fact that those admissions had been made and bore the admissions in mind when considering whether the particular it was considering had been proved or not. The Panel bore in mind the burden and standard of proof and considered each particular separately.

4. The Panel first considered the witnesses who had given evidence. The HCPC called 2 witnesses, Witness 1, and Witness 2.  The Registrant gave evidence. The Panel also noted the admissions made by the Registrant at the start of the hearing.

• Witness 1 – Overall the Panel found this witness to be credible. She was the Registrant’s line manager. She gave evidence about the entries made by the Registrant in the patient records. She explained why the Registrant’s errors were more serious than others. The witness was unclear when explaining continuation pages, the way they should be kept and what should be recorded on them. She was considered by the Panel to be honest and conceded where appropriate.  She displayed no ill will to the Registrant and she stated that the Registrant was clinically competent.

• Witness 2 – The Panel found her to be a very good witness. She was able to explain her reasoning and was able to cross reference her answers with the documentation. Overall the Panel found her to be honest and consistent in her evidence. The witness was challenged and held up her consistency.

• The Registrant – The Panel took into account the nervousness he faced from being a Registrant giving evidence. He appeared to be evasive in answering questions, particularly in cross examination. The Registrant had to be prompted to answer questions in relation to simple matters and guidelines. This had the effect of undermining his credibility on occasions.

5. The Panel also considered all of the documents produced and made its determination on facts bearing in mind all of the evidence that it had heard and read.

Decision on Facts


Particulars relating to progression of patient care


6. In its finding on facts the Panel divided up the allegations and dealt first with matters dealing with the progression of patient care.


Particular 2(a)(i) and (ii)Proved


7. The Registrant denied this Particular. He claimed that he intended to make the referral. The Registrant made the referral on the next working day that he attended. The referral was made after a prompt by Witness 2 in a meeting. The Panel accept the evidence of Witness 2 that he was prompted and find this Particular proved in its entirety.

Particular 3Proved


8. The Registrant denied this Particular, but given the finding in Particular 2(a)(i), the Panel finds there was a potential for a delay to access the Pain Management Programme and therefore finds this Particular proved.


Particular 5Not Proved


9. The Registrant denied this Particular. The Panel considered the notes and the entries made by the Registrant. The Registrant denied that he did not progress treatment in relation to Patient 2. He accepted that he did not communicate the plan to other professionals until 28 February 2014. The Panel have considered all of the evidence including the Registrant’s analysis of the case notes. The entries in the case notes of 30 August 2013, 31 January 2014, 7 January 2014 and 21 February show that the assessment of Patient 2 was continuing and treatment had not begun. Therefore although there was no communication of the plan to other professionals the panel finds this Particular not proved.


Particular 7(k)Not Proved


10. The Registrant denies this Particular.  There is no evidence produced by the HCPC of the original letter. The strongest evidence comes from Witness 2 who stated that she had been told by MC, the secretary, of the original letter’s existence. Witness 2 confirmed that she did not bring the letter to the Registrant’s attention at the time. MC was not called to give evidence or provide a witness statement. Accordingly, the Panel considered that the HCPC has not proved this Particular.


Particular 8Not Proved


11. Because of its finding on Particular 7(k) the Panel also finds this Particular not proved.


Particular 10(a)(i)Not Proved

Particular 10(a)(ii)Proved 


12. The Panel dealt with this Particular in its entirety. The Registrant denied this Particular. In relation to Particular 10(a)(i), he maintained in his evidence in chief that the letter of 23 December 2013 was not a discharge letter. The Registrant in cross examination agreed that sending a letter to Patient 5 until 23 December was not timely and was later than planned. The document is a letter but is not a discharge letter so Particular 10(a)(i) is found not proved. In relation to Particular 10(a)(ii), the letter of the 28 February 2014 is a discharge letter and is accepted as such by the Registrant. Witness 1 stated that the discharge letter should have been sent within 2 weeks of 17 January 2014. There are no written guidelines as to when discharge letters should be sent. But the custom and practise of the Trust was that discharge letters are to be sent within 2 weeks of the final appointment. The Registrant did not challenge this practise. Although the Registrant only worked one day a week, he had 5 working days to send the letter and therefore it was not timely. The Panel finds this Particular proved.

Particular 16Proved 


13. The Registrant denied this Particular. In his evidence he accepted that he sent a letter on 21 October 2013. He said the letter was possibly later than it should have been but he did not make it a priority to send it earlier. The Panel noted that there was a letter sent on the same date to the patient stating that the Registrant was still awaiting a response from the consultant. However, the Registrant only sent the letter to the consultant on the same date that he had written to the patient. The Panel considers that a six week delay was not timely and finds this Particular proved.

Particular 17(a)(ii)Not Proved


14. The Registrant denied 17(a)(ii) but admitted the rest of this Particular. The Registrant entered notes and wrote a letter on the same date of 27 September 2013. The Registrant’s case was that they both amounted to an initial screening assessment and should be read together. Witness 1 in evidence accepted that the letter was detailed and could with the notes amount to an initial screening assessment. The letter and the notes form part of the patient record. The Panel therefore found this Particular not proved.


Particular 19Proved

15. The Registrant denied this Particular. The Registrant said that he ‘de-prioritised’ this letter in order to make space in his workload. Witness 1 said that the letter should have been sent by 10 January or on the Registrant’s next working day, which was 17 January 2014. Allowing for the two week rule the latest date on which the letter should have been sent was 24 January 2014. The Registrant failed to do this. In evidence the Registrant accepted that it was not sent in a timely manner. The Panel therefore finds this Particular proved.

Particular 21 and 22Not Proved


16. The Registrant denied these Particulars. In his evidence he accepted that he did not reinstate assessment sessions. Witness 2 said she emailed the Registrant on 21 January 2014 to request that he reinstate the sessions. He did not do so.  In his evidence the Registrant accepted that he received the request but that he had spoken to Witness 2 and told her that he would not be offering the patient further assessments as they were not necessary and not his responsibility. He considered that the patient was Witness 2’s. In his evidence he said that he had been asked to do a depression assessment which he did and there was nothing left to assess. In the case notes he undertook an assessment of the patient on 12 December 2013. Weighing up all of the evidence and the case notes the Panel is not satisfied that there is sufficient evidence to conclude that the Registrant’s actions caused the treatment to not progress in a timely manner and had the potential to delay the patient’s referral to Mental Health Services. The Panel therefore finds these 2 Particulars not proved.


Particular 24Not Proved


17. The Registrant denied this Particular. In his evidence he accepted that he made the referral and did so in good faith, but he cannot recall that he had been made aware that he should have awaited the results of an investigation. He also said that he was not made aware that the patient was awaiting the results of investigations (of scanning or x-ray). The case notes of the patient do not clearly indicate investigations were awaited at the time of the referral. The Panel cannot find clear evidence that the patient was awaiting the results of an investigation when the Registrant made the referral to the Pain Management Programme. The Panel therefore finds this Particular not proved.


Particular 4(c)Not Proved


18. The Registrant denied this Particular. The Registrant stated in his evidence that he was off sick on the date of the appointment and that he had telephoned his workplace on the morning of 25 October 2013 to say that he would be absent. There is an entry on this patient’s electronic Appointments Booking and Reporting System (LE2) on the date of 25 October 2013 where the clinician is recorded as Witness 2 and not the Registrant. Witness 1 was asked if the Registrant was off sick on that date and she could not recall his absence. The Panel considers that there is insufficient evidence to prove this Particular and finds it not proved.


Particulars relating to the use of continuation pages


19. The record keeping Particulars faced by the Registrant involved the use of continuation pages in patient records and individual record keeping entries in patient records.


20. In respect of the continuation page Particulars these fall into two categories: the use of a continuation page which is double sided and the use of a separate new continuation page.


21. The HCPC submitted that there is no formal reference to ‘continuation pages’ in the Getting Started in Physical Health Service document, the Record keeping audit proforma, or in the Health record-keeping standards. There is reference to ‘continuation sheets’ in the Registrant’s Supervision Review on 13 December 2013. Witness 1 and Witness 2 referred to both ‘continuation sheets’ and ‘continuation pages’ interchangeably. The Panel therefore formed the view that they are the same. Their purpose is for documenting continuous entries on patient records.


22. It was accepted that there were two versions of a continuation page in existence during the Registrant’s employment, one with a date and time column and one with only a date column. The HCPC witnesses contended that the reverse side of a sheet in the records constituted a continuation page and therefore there was a requirement for the Registrant to sign, date and time each entry, and have the patient’s name and case number at the top of every page. This was challenged by the Registrant who maintained there was no necessity to duplicate the same details on the reverse side.

23. It was further contended by the HCPC witnesses that when using a separate new continuation page, the Registrant was required to sign, date and time each entry and have the patient’s name and case number at the top of each page. This was particularly important in the event that the sheet became detached from the main file as there would otherwise be no way of reconciling the case notes with the patient.


24. Having considered both arguments the Panel concludes that continuing an entry on the reverse side of a page does not require duplication of date, time and patient details. However, the Panel does consider that new appointments on that page would still require a date, time and signature. 


Particular 1(a)(iii)Proved


25. The continuation page is a new sheet and for the reasons given above the Registrant should have noted the date and time. The Panel finds this Particular proved.


Particular 1(b)(ii)Proved


26. This is the reverse of a new separate continuation page. It is a continuing entry which had been dated but not timed. The Registrant should have timed the entry. The Panel finds this Particular proved in relation to the time element alone.


Particular 1(f)(i)Not Proved


27. This is the reverse of a new separate continuation page. It is a continuing entry which had been dated and timed on the front page. The Panel finds this Particular not proved.

Particular 1(f)(ii)Not Proved

28. This is the reverse of a new separate continuation page. It is a continuing entry which had been dated and timed on the front page. The Panel finds this Particular not proved.


Particular 1(g)(i)Not Proved


29. This is the reverse of a new separate continuation page. It is a continuing entry which had been dated and timed on the front page. The Panel finds this Particular not proved.


Particular 1(g)(ii)Not Proved

30. This is the reverse of a new separate continuation page. It is a continuing entry which had been dated and timed on the front page. The Panel finds this Particular not proved.


Particular 4(d)(ii) – Proved


31. This is the reverse of a new separate continuation page. It is a continuing entry which had been dated but not timed. The Registrant should have timed the entry. The Panel finds this Particular proved in relation to the time element alone.


Particular 4(d)(iii) Not Proved


32. This is the reverse of a new separate continuation page. It is a continuing entry where the patient’s name and RMC number is noted on the front page. The Panel finds this Particular not proved.


Particular 4(f)(ii)Not Proved  


33. This is the reverse of a new separate continuation page. It is a continuing entry which had been dated and timed on the front page. The Panel finds this Particular not proved.


Particular 4(f)(iii)Proved 


34. The appointment of 7 February 2014 begins on a separate continuation page. Neither this page nor the reverse contains the patient’s name and/or RMC number. Therefore, the Panel finds this Particular proved.


Particular 6(b)(ii)Proved


35. This is the reverse of a new separate continuation page. It is a continuing entry which had been dated but not timed on the front page. The Registrant should have timed the entry. The Panel finds this Particular proved in relation to the time element alone.


Particular 7(j)(i)  – Not Proved

36. This is the reverse of a new separate continuation page. It is a continuing entry which had been dated and timed on the front page. The Panel finds this Particular not proved.


Particular 7(j)(ii)Not Proved 


37. This is the reverse of a new separate continuation page. It is a continuing entry which had been dated and timed and contained the patient's name and RMC number on the front page. The Panel finds this Particular not proved.


Particular 7(l)(i)Not Proved


38. This is the reverse of a new separate continuation page. It is a continuing entry which had been dated and timed on the front page. The Panel finds this Particular not proved.


Particular 7(l)(ii)Not Proved

39. This is the reverse of a new separate continuation page. It is a continuing entry which had been dated and timed and contained the patient's name and RMC number on the front page. The Panel finds this Particular not proved.


Particular 7(n)(ii)Not Proved


40. This is the reverse of a new separate continuation page. It is a continuing entry which had been dated and timed on the front page. The Panel finds this Particular not proved.


Particular 7(n)(iii)Not Proved 


41. This is the reverse of a new separate continuation page. It is a continuing entry which had been dated and timed and contained the patient's name and RMC number on the front page. The Panel finds this Particular not proved.


Particular 9(a)(ii)Proved


42. This is the reverse of a new separate continuation page. It is a continuing entry which had been dated but not timed on the front page. The Registrant should have timed the entry. The Panel finds this Particular proved in relation to the time element alone.


Particular 11(a)(ii)Not Proved


43. This is the reverse of a new separate continuation page. It is a continuing entry which had been dated and timed on the front page. The Panel finds this Particular not proved.


Particular 11(a)(iii)Proved 


44. This is the reverse of a new separate continuation page. It is a continuing entry which had been dated and timed. It did not contain the patient's name but did contain the RMC number. The Panel finds this Particular proved in relation to the patient’s name only.


Particular 13(a)(ii)Proved


45. This is the reverse of a new separate continuation page. It is a continuing entry which had been dated but not timed on the front page. The Registrant should have timed the entry. The Panel finds this Particular proved in relation to the time element alone.


Particular 13(c)(ii)Proved


46. The continuation page is a new sheet and for the reasons given above the Registrant should have noted the date and time. The Panel finds this Particular proved.


Particular 13(d)(ii)Proved


47. This is the reverse of a new separate continuation page. It is a continuing entry which had been dated but not timed on the front page. The Registrant should have timed the entry. The Panel finds this Particular proved in relation to the time element alone.


Particular 13(g)(ii)Proved


48. This is the reverse of a new separate continuation page. It is a continuing entry which had been dated but not timed on the front page. The Registrant should have timed the entry. The Panel finds this Particular proved in relation to the time element alone.


Particular 13(g)(iii)Not Proved


49. This is the reverse of a new separate continuation page. It is a continuing entry which had been dated and timed on the front page. It did contain the patient's name and RMC number. The Panel finds this Particular not proved.


Particular 13(k)(ii) Proved


50. This is the reverse of a new separate continuation page. It is a continuing entry which had been dated but not timed on the front page. The Registrant should have timed the entry. The Panel finds this Particular proved in relation to the time element alone.


Particular 13(k)(iii)Not Proved

51. This is the reverse of a new separate continuation page. It is a continuing entry which had been dated and timed on the front page. It did contain the patient's name and RMC number. The Panel finds this Particular not proved.


Particular 13(o)(ii)Proved


52. The continuation page is a new sheet and for the reasons given above the Registrant should have noted the date and time. The Panel finds this Particular proved.


Particular 13(p)(ii) – Proved


53. This is the reverse of a new separate continuation page. It is a continuing entry which had been dated but not timed on the front page. The Registrant should have timed the entry. The Panel finds this Particular proved in relation to the time element alone.


Particular 13(p)(iii)Not Proved

54. This is the reverse of a new separate continuation page. It is a continuing entry which had been dated and timed on the front page. It did contain the patient's name and RMC number. The Panel finds this Particular not proved.


Particular 14(a)(ii)Proved


55. This is the reverse of a new separate continuation page. It is a continuing entry which had been dated but not timed on the front page. The Registrant should have timed the entry. The Panel finds this Particular proved in relation to the time element alone.


Particular 14(a)(iii)Not Proved


56. This is the reverse of a new separate continuation page. It is a continuing entry which had been dated and timed on the front page. It did contain the patient's name and RMC number. The Panel finds this Particular not proved.


Particular 15(a)(ii) and (iii)Proved


57. This is the reverse of a new separate continuation page. It is a continuing entry which had been dated but not timed on the front page. The Registrant should have timed the entry. The Panel finds this Particular proved in relation to the time element alone.


58. The appointment of 27 June 2013 begins on a separate continuation page. Neither this page nor the reverse contains the patient’s name and/or RMC number. Therefore, the Panel finds this Particular proved.


Particular 15(b)(ii)Not Proved


59. This is the reverse of a new separate continuation page. It is a continuing entry which had been dated and timed on the front page. The Panel finds this Particular not proved.


Particular 15(d)(ii) and (iii)Proved


60. This a new separate continuation page. It did not contain the patient's name nor the RMC number. The Panel finds this Particular proved.


61. This is the reverse of a new separate continuation page. It is a continuing entry which had been dated but not timed on the front page. The Registrant should have timed the entry. The Panel finds this Particular proved in relation to the time element alone.


Particular 18 (a)(ii)Not Proved


62. This is the reverse of a new separate continuation page. It is a continuing entry which had been dated and timed on the front page. It did contain the patient's name and RMC number. The Panel finds this Particular not proved.


Particular 23(c)(iii)Not Proved


63. This is the reverse of a new separate continuation page. It is a continuing entry which had been dated and timed on the front page. It did contain the patient's name and RMC number. The Panel finds this Particular not proved.


Particular 23(c)(iv)Proved


64. This is the reverse of a new separate continuation page. It is a continuing entry which had been dated but not timed on the front page. The Registrant should have timed the entry. The Panel finds this Particular proved in relation to the time element alone.


Particular 23(d)(i)Not Proved


65. This is the reverse of a new separate continuation page. It is a continuing entry which contained the patient’s name and RMC number on the front page. The Panel finds this Particular not proved.


Particular 23(d)(ii)Not Proved

66. This is the reverse of a new separate continuation page. It is a continuing entry which had been dated and timed on the front page. The Panel finds this Particular not proved.


Particular 25(f)(i) and (ii)Not Proved


67. This is the reverse of a new separate continuation page. It is a continuing entry which had been dated and timed on the front page. It did contain the patient's name and RMC number. The Panel finds this Particular not proved.


68. This is the reverse of a new separate continuation page. It is a continuing entry which had been dated and timed on the front page. The Panel finds this Particular not proved.


Particulars relating to record keeping


69. The Panel then turned to the remaining record keeping particulars.


Particular 1(a)(i)Proved

70. The Registrant admitted this and it was confirmed by the patient’s records. The Panel found this Particular proved.


Particular 1(a)(ii)Proved


71. The Registrant admitted this and it was confirmed by the patient’s records. The Panel found this Particular proved.


Particular 1(b)(i)Proved


72. The Registrant admitted this and it was confirmed by the patient’s records. The Panel found this Particular proved.


Particular 1(c)(i) and (ii)Proved


73. The Registrant admitted Particular 1(c)(i) and it was confirmed by the patient’s records. The Panel found this Particular proved.


74. In relation to Particular 1(c)(ii), the Registrant admitted this and it was confirmed by the patient’s records. The Panel found this Particular proved.


Particular 1(d)(i)Proved


75. The Registrant admitted this and it was confirmed by the patient’s records. The Panel found this Particular proved.


Particular 1(d(ii) – Proved


76. The Registrant admitted this and it was confirmed by the patient’s records. The Panel found this Particular proved.


Particular 1(d)(iii)Not Proved


77. The Registrant did not admit this. It is clear the patient’s records for this date does not show the patient’s name or RMC number, however the Panel considers this is a reverse page of a new separate continuation page and the details are contained on the first page so there is no necessity to repeat them. The Panel found this Particular not proved.


Particular 1(e)Proved


78. The Registrant did admit this. The patient record shows an entry for a telephone conversation but this is not timed. Therefore, the Panel find this Particular proved.


Particular 1(h)(i)Proved


79. The Registrant admits this. The patient record shows an incorrect date recorded. The Panel finds this Particular proved.


Particular 1(h)(ii)Proved


80. The Registrant did not admit this. The patient’s notes show a record of the patient’s RMC Number but not the patient’s name. The Panel find this Particular proved.


Particular 4(a)Proved


81. The Registrant admitted this and it was confirmed by the patient’s records. The Panel found this Particular proved.


Particular 4(b)Proved


82. The Registrant admitted this and it was confirmed by the patient’s records. The Panel found this Particular proved.


Particular 4(d)(i)Proved


83. The Registrant admitted this and it was confirmed by the patient’s records. The Panel found this Particular proved.


Particular 4(e)Proved


84. The Registrant admitted this and it was confirmed by the patient’s records. The Panel found this Particular proved.


Particular 4(f)(i)Proved


85. The Registrant admitted this and it was confirmed by the patient’s records. The Panel found this Particular proved.


Particular 4(g)Proved


86. The Registrant admitted this and it was confirmed by the patient’s records. The Panel found this Particular proved.


Particular 4(h)(i)Proved


87. The Registrant admitted this and it was confirmed by the patient’s records. The Panel found this Particular proved.


Particular 4(h)(ii)Proved


88. The Registrant admitted this and it was confirmed by the patient’s records. The Panel found this Particular proved.


Particular 6(a)Proved


89. The Registrant admitted this and it was confirmed by the patient’s records. The Panel found this Particular proved.


Particular 6(b)(i)Proved


90. The Registrant admitted this and it was confirmed by the patient’s records. The Panel found this Particular proved.

Particular 6(c)Proved


91. The Registrant admitted this. The patient’s name was redacted so the Panel relies totally on the admission made by the Registrant and finds this Particular proved.


Particular 7(a)Proved


92. The Registrant admitted this and it was confirmed by the patient’s records. The Panel found this Particular proved.


Particular 7(b)Not Proved


93. The Registrant did not admit this. No time was recorded on the patient notes produced by the HCPC. The Registrant also produced notes for this patient’s appointment where there was a time recorded. The Registrant’s notes were not challenged by the HCPC, therefore the Panel found this Particular not proved.


Particular 7(c)(i)Not Proved


94. The Registrant did not admit this. No time was recorded on the patient notes produced by the HCPC. The Registrant also produced notes for this patient’s appointment where there was a time recorded. The Registrant’s notes were not challenged by the HCPC, therefore the Panel found this Particular not proved.

Particular 7(c)(ii)Proved

95. The Registrant admitted this and it was confirmed by the patient’s records. The Panel found this Particular proved.


Particular 7(d)(i)Proved


96. The Registrant admitted this and it was confirmed by the patient’s records. The Panel found this Particular proved.


Particular 7 (d)(ii)Not Proved

97. This is the reverse of a new separate continuation page. It is a continuing entry which had been dated and timed on the front page. It did contain the patient's name and RMC number. The Panel finds this Particular not proved.


Particular 7(e)Proved


98. The Registrant admitted this and it was confirmed by the patient’s records. The Panel found this Particular proved.


Particular 7(f)Not Proved


99. The Registrant did not admit this. No time was recorded on the patient notes produced by the HCPC. The Registrant also produced notes for this patient’s appointment where there was a time recorded. The Registrant’s notes were not challenged by the HCPC, therefore the Panel found this Particular not proved.


Particular 7(g)Not Proved


100. The Registrant did not admit this. No time was recorded on the patient notes produced by the HCPC. The Registrant also produced notes for this patient’s appointment where there was a time recorded. The Registrant’s notes were not challenged by the HCPC, therefore the Panel found this Particular not proved.


Particular 7(h)(i)Not Proved


101. The Registrant did not admit this. No time was recorded on the patient notes produced by the HCPC. The Registrant also produced notes for this patient’s appointment where there was a time recorded. The Registrant’s notes were not challenged by the HCPC, therefore the Panel found this Particular not proved.


Particular 7(h)(ii)Not Proved


102. This is the reverse of a new separate continuation page. It is a continuing entry which had been dated and timed on the front page. It did contain the patient's name and RMC number. The Panel finds this Particular not proved.


Particular 7(i)(i)Proved


103. The Registrant admitted this and it was confirmed by the patient’s records. The Panel found this Particular proved.


Particular 7(i)(ii)Not Proved


104. The Registrant did not admit this. No time was recorded on the patient notes produced by the HCPC. The Registrant also produced notes for this patient’s appointment where there was a time recorded. The Registrant’s notes were not challenged by the HCPC, therefore the Panel found this Particular not proved.


Particular 7(m)Proved


105. The Registrant admitted this and it was confirmed by the patient’s records. The Panel found this Particular proved.


Particular 7(n)(i)Proved


106. The Registrant admitted this and it was confirmed by the patient’s records. The Panel found this Particular proved.


Particular 7(o)Not Proved


107. This is the reverse of a new separate continuation page where the patient’s name and RMC number had been recorded on the front page. It is a continuing entry. The Panel found this Particular not proved.


Particular 9(a)(i)Proved


108. The Registrant admitted this and it was confirmed by the patient’s records. The Panel found this Particular proved.


Particular 9(b)(i)Proved


109. The Registrant admitted this and it was confirmed by the patient’s records. The Panel found this Particular proved.


Particular 9(b)(ii)Proved


110. The Registrant admitted this and it was confirmed by the patient’s records. The Panel found this Particular proved.


Particular 9(c)(i)Proved


111. The Registrant admitted this and it was confirmed by the patient’s records. The Panel found this Particular proved.


Particular 9(c)(ii)Not Proved


112. This is the reverse of a new separate continuation page. It did contain the patient's name and RMC number on the front page. The Panel found this Particular not proved.


Particular 11(a)(i)Proved


113. The Registrant admitted this and it was confirmed by the patient’s records. The Panel found this Particular proved.


Particular 11(b)Proved


114. The Registrant admitted this and it was confirmed by the patient’s records. The Panel found this Particular proved.


Particular 12(a)(i)Proved


115. The Registrant admitted this and it was confirmed by the patient’s records. The Panel found this Particular proved.


Particular 12(a)(ii)Proved


116. The Registrant admitted this and it was confirmed by the patient’s records. The Panel found this Particular proved.


Particular 13(a)(i)Proved


117. The Registrant admitted this and it was confirmed by the patient’s records. The Panel found this Particular proved.


Particular 13(a)(iii)Proved


118. The Registrant admitted this and it was confirmed by the patient’s records. The Panel found this Particular proved.


Particular 13(b)(i)Proved

119. The Registrant admitted this and it was confirmed by the patient’s records. The Panel found this Particular proved.


Particular 13(b)(ii)Proved


120. The Registrant admitted this and it was confirmed by the patient’s records. The Panel found this Particular proved.


Particular 13(b)(iii)Proved


121. The Registrant admitted this and it was confirmed by the patient’s records. The Panel found this Particular proved.


Particular 13(c)(i)Proved


122. The Registrant admitted this and it was confirmed by the patient’s records. The Panel found this Particular proved.


Particular 13(c)(iii)Proved

123. The Registrant admitted this and it was confirmed by the patient’s records. The Panel found this Particular proved.


Particular 13(d)(i)Proved


124. The Registrant admitted this and it was confirmed by the patient’s records. The Panel found this Particular proved.


Particular 13(e) – Proved


125. The Registrant admitted this and it was confirmed by the patient’s records. The Panel found this Particular proved.


Particular 13(f)(i)Proved


126. The Registrant admitted this and it was confirmed by the patient’s records. The Panel found this Particular proved.


Particular 13(f)(ii)Proved


127. The Registrant admitted this and it was confirmed by the patient’s records. The Panel found this Particular proved.


Particular 13(g)(i)Proved


128. The Registrant admitted this and it was confirmed by the patient’s records. The Panel found this Particular proved.


Particular 13(g)(iv)Proved

 
129. The Registrant admitted this and it was confirmed by the patient’s records. The Panel found this Particular proved.


Particular 13(h)Proved


130. The Registrant admitted this and it was confirmed by the patient’s records. The Panel found this Particular proved.


Particular 13(i)Proved


131. The Registrant admitted this and it was confirmed by the patient’s records. The Panel found this Particular proved.


Particular 13(j)Proved

132. The Registrant admitted this and it was confirmed by the patient’s records. The Panel found this Particular proved.


Particular 13(k)(i)Proved


133. The Registrant admitted this and it was confirmed by the patient’s records. The Panel found this Particular proved.


Particular 13(l)(i)Proved

 
134. The Registrant did not admit this Particular. It is clear however from the patient’s records that the date was recorded as 26 September 2013 instead of 27 September 2013. The Panel therefore finds this Particular proved.


Particular 13(l)(ii)Proved

135. The Registrant did not admit this Particular. It is clear however from the patient’s records that no time was recorded. The Panel therefore found this Particular proved.


Particular 13(l)(iii)Proved


136. The Registrant admitted this and it was confirmed by the patient’s records. The Panel found this Particular proved.


Particular 13(m)Proved


137. The Registrant admitted this and it was confirmed by the patient’s records. The Panel found this Particular proved.


Particular 13(n)Not Proved


138. This is the reverse of a new separate continuation page. It did contain the patient's name and RMC number on the front page. The Panel found this Particular not proved.


Particular 13(o)(i)Proved


139. The Registrant admitted this and it was confirmed by the patient’s records. The Panel found this Particular proved.


Particular 13(p)(i)Proved


140. The Registrant admitted this and it was confirmed by the patient’s records. The Panel found this Particular proved.

Particular 14(a)(i)Proved


141. The Registrant admitted this and it was confirmed by the patient’s records. The Panel found this Particular proved.


Particular 15(a)(i)Proved


142. The Registrant admitted this and it was confirmed by the patient’s records. The Panel found this Particular proved.


Particular 15(a)(iv)Proved


143. The Registrant admitted this and it was confirmed by the patient’s records. The Panel found this Particular proved.


Particular 15(b)(i)Proved

144. The Registrant admitted this and it was confirmed by the patient’s records. The Panel found this Particular proved.

Particular 15(c)(i)Proved


145. The Registrant admitted this and it was confirmed by the patient’s records. The Panel found this Particular proved.


Particular 15(c)(ii)Proved


146. The Registrant admitted this and it was confirmed by the patient’s records. The Panel found this Particular proved.


Particular 15(d)(i)Proved


147. The Registrant admitted this and it was confirmed by the patient’s records. The Panel found this Particular proved.


Particular 15(d)(ii)Proved


148. The Registrant admitted this and it was confirmed by the patient’s records. The Panel found this Particular proved.


Particular 15(d)(iv)Proved


149. The Registrant admitted this and it was confirmed by the patient’s records. The Panel found this Particular proved.

Particular 15(e)(i)Proved


150. The Registrant admitted this and it was confirmed by the patient’s records. The Panel found this Particular proved.


Particular 15(e)(ii)Proved


151. The Registrant admitted this and it was confirmed by the patient’s records. The Panel found this Particular proved.


Particular 15(f)Proved


152. The Registrant admitted this and it was confirmed by the patient’s records. The Panel found this Particular proved.


Particular 15(g)Proved


153. The Registrant admitted this and it was confirmed by the patient’s records. The Panel found this Particular proved.


Particular 15(h)(i)Proved


154. The Registrant admitted this and it was confirmed by the patient’s records. The Panel found this Particular proved.


Particular 15(h)(ii)Not Proved


155. The Registrant accepted this Particular but the entry is recorded on the reverse of a new separate continuation page, which contains the patient’s name and RMC number on the front page. Therefore the Panel found this Particular not proved.

Particular 17(a)(i)Proved


156. The Registrant admitted this and it was confirmed by the patient’s records. The Panel found this Particular proved.


Particular 18(a)(i)Proved


157. The Registrant admitted this and it was confirmed by the patient’s records. The Panel found this Particular proved.

Particular 20(a)Not Proved

158. The Registrant accepted this Particular but the entry is recorded on the reverse of a new separate continuation page, which contains the patient’s name and RMC number on the front page. Therefore the Panel found this Particular not proved.

Particular 23(a)(i)Not Proved


159. The Registrant did not accept this Particular. The entry is recorded on the reverse of a new separate continuation page, which contains the patient’s name and RMC number on the front page. Therefore the Panel found this Particular not proved.


Particular 23(a)(ii)Not Proved

160. The Registrant did not accept this Particular. The Panel’s attention was drawn to a record showing a timed entry for this appointment, therefore the Panel found this Particular not proved.
Particular 23(b)Not Proved


161. The Registrant did not accept this Particular. The Panel’s attention was drawn to a record showing a timed entry for this appointment, therefore the Panel found this Particular not proved.

Particular 23(c)(i)Proved

162. The Registrant admitted this and it was confirmed by the patient’s records. The Panel found this Particular proved.


Particular 23(c)(ii)Not Proved


163. The Registrant did not accept this Particular. The Panel’s attention was drawn to a record showing a timed entry for this appointment, therefore the Panel found this Particular not proved.
Particular 23(e)(i)Proved

164. The Registrant admitted this and it was confirmed by the patient’s records. The Panel found this Particular proved.


Particular 23(e)(ii)Proved


165. The Registrant admitted this and it was confirmed by the patient’s records. The Panel found this Particular proved.


Particular 23(e)(iii)Not Proved


166. The Registrant did not accept this Particular. The entry is recorded on the reverse of a new separate continuation page, which contains the patient’s name and RMC number on the front page. Therefore the Panel found this Particular not proved.


Particular 25(a) – Proved

167. The Registrant admitted this and it was confirmed by the patient’s records. The Panel found this Particular proved.


Particular 25(b)Proved


168. The Registrant admitted this and it was confirmed by the patient’s records. The Panel found this Particular proved.


Particular 25(c)Proved


169. The Registrant admitted this and it was confirmed by the patient’s records. The Panel found this Particular proved.


Particular 25(d)Proved


170. The Registrant admitted this and it was confirmed by the patient’s records. The Panel found this Particular proved.


Particular 25(e)Not Proved


171. The Registrant did not accept this Particular. The entry is recorded on the reverse of a new separate continuation page, which contains the patient’s name and RMC number on the front page. Therefore the Panel found this Particular not proved.


Decision on Grounds


172. Having found some of the Particulars proved, the Panel went on to consider whether they amounted to misconduct and/or lack of competence. The Panel first considered whether the facts found proved amounted to lack of competence. The Panel accepted the definition given by Mr Justice Jackson in the case of (R v Calhaem v GMC [2007] EWHC 2606 (Admin) para 39) for deficient professional performance and accepted that the definition was applicable to lack of competence.

“"Deficient professional performance" within the meaning of 35C(2)(b) is conceptually separate both from negligence and from misconduct. 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.”


173. The Panel also considered whether the Particulars found proved in relation amounted to misconduct. It bore in mind the misconduct was alleged to have taken place in a clinical setting and accepted the definition as given in the case of Calhaem:


“Mere negligence does not constitute "misconduct" within the meaning of section 35C(2)(a) of the Medical Act 1983. Nevertheless, and depending upon the circumstances, negligent acts or omissions which are particularly serious may amount to "misconduct".”


174. And also the case Remedy UK Ltd V GMC [2010] EWHC 1245 (Admin) (para 37):

“it may involve sufficiently serious misconduct in the exercise of professional practice such that it could properly be described as misconduct going to fitness to practise.”


175. The Panel first considered failures in record keeping, which it divided into two main categories:


• Failure to note the patient name and RMC number.


• Failure to date, time and sign appointment entries.

 
176. The first category related to the Registrant’s failures to identify the patient records by name or RMC number. This was a serious failing which may have had consequences in relation to the welfare and treatment of patients. If an unidentified loose sheet became detached from the main patient record it would be difficult to reconcile the notes with the correct patient file. A follow on clinician would therefore not have a complete set of patient notes.

177. The second category related to failures by the Registrant to time, date and sign the patient’s records. The Panel reasoned that, should another clinician require access to the information, it could be retrieved from the LE2. This would show the date and time of the patient’s appointment and the name of the clinician seeing the patient. In relation to these failures therefore the Panel concluded that it was a falling short by the Registrant and amounted to a standard of performance that was unacceptably low.


178. The Registrant had been made aware of the importance of record keeping. During the Registrant’s induction with the Trust he had been provided with a copy of ‘Getting Started in Physical Health Service’ guidance. This detailed the expectations of patient note keeping. Although in the course of their evidence the witnesses from the HCPC admitted that they had omitted similar details from their notes on occasion, the audits of the Registrant’s records revealed that he had a much higher level of non-compliance in his patient notes. When determining this the Panel took into account that the records produced are the totality of the patients that the Registrant saw during his employment at the Trust in this role.  


179. The standards expected of the Registrant in relation to record keeping were brought to his attention during three supervision sessions in October, November and December of 2013. There was some improvement in his record entries as was noted in an email from Witness 1 sent to the Registrant on 10 January 2014:

“Dear John – I confirmed that since last audit you have maintained your notes as required by trust guidelines”


180. However as is shown by the Panel’s findings of facts the Registrant’s standards lapsed after 10 January 2014 and there was a repetition of the same failures. The failures found proved are basic and not complex. Despite having supervision sessions during which the failures were brought to his attention the Registrant appeared unable to follow professional guidelines or management directions.


181. The Panel considers that the actions found proved with respect to record keeping breached the following standards of the HCPC’s Standards of conduct, performance and ethics (2012) which applied at the time:


1     You must act in the best interests of service users.


10    You must keep accurate records.


182. The Registrant also breached the following standards of Standards of proficiency Practitioner psychologists (2010):


2b.5     be able to maintain records appropriately


2c.2     be able to audit, reflect on and review practice


183. The Registrant was provided with opportunities to rectify his failures but after a short period of improvement he again lapsed. The facts found proved demonstrate a pattern of behaviour by the Registrant which is unacceptably low. None of the individual particulars found proved, however, were sufficiently serious to have amounted to misconduct. The Panel therefore considers that this amounted to a lack of competence.

184. The Panel considered the matters found proved in Particulars 2 and 3. Both matters related to the timeliness of the Registrant’s actions. He did not progress the patient’s referral to the Pain Management Programme until he was prompted by Witness 2. The Registrant’s inactions, had he not been prompted, were clearly not in the patient’s best interests.


185. In relation to the matters found proved in Particular 10, the Registrant delayed sending a discharge letter. There was a significant delay. The patient’s referring clinician would not have been aware of the patient’s intended or planned discharge and would have assumed the patient was still being treated by the Registrant. This was clearly not in the patient’s best interests.

 
186. In relation to Particular 16, the Registrant delayed sending a letter to the Consultant Clinical Oncologist for six weeks. However, the Registrant had written to the patient stating that he had not received a response to his letter from the Consultant Oncologist, when in fact he had not yet sent the letter. The Panel considered that this was misleading and that the Registrant was not acting in the best interests of the patient.

187. In relation to Particular 19, the Registrant delayed sending a discharge letter to the referring clinician. The referring clinician would have been under the assumption that the patient was receiving psychological intervention under the care of the Registrant when this was not the case. The Registrant in evidence maintained that he had ‘de-prioritised’ the sending of the letter. The Panel found the Registrant therefore made an informed decision which given all the circumstances was not in the patient’s best interests.


188. The Panel considers that the case progression particulars found proved showed that the Registrant breached the following standards of the HCPC’s Standards of conduct, performance and ethics (2012) which applied at the time:


7     You must communicate properly and effectively with service users and other practitioners.


189. He also breached the following standards of Standards of proficiency Practitioner psychologists (2010):


1a.7      recognise the need for effective self-    management of  workload and resources and be able to practise accordingly.


1b.4      understand the need for effective communication throughout the care of the service user.


190. The Panel considered that the failings identified in relation to delay and timeliness, although clearly not in the patients’ best interests, were not of such a serious nature that they would have been regarded as deplorable by fellow practitioners. They do however demonstrate a pattern of professional behaviour which was unacceptably low. The Panel therefore does not find that these failings amounted to misconduct but found that they did amount to a lack of competence.
Decision on Impairment 


191. Having found the matters proved amounted to lack of competence, the Panel went on to consider whether the Registrant’s fitness to practise is currently impaired. It bore in mind the evidence given by the Registrant, the submissions made by Mr Dite and Mr Bown, the advice of the Legal Assessor and the HCPTS practice note of ‘Finding that Fitness to Practise is impaired’.


192. The Panel then considered the two component parts relating to impairment, the personal component and the public component. It first considered the personal component, whether the conduct was remediable, whether it had been remedied and whether it was likely to be repeated.

 
193. The Panel considered that its findings on facts and subsequent findings that they amounted to a lack of competence could be divided into two categories, ‘record keeping’ and ‘timeliness’. The Panel first considered the level of insight shown by the Registrant in relation to each category.


194. In relation to the category of ‘record keeping’, the Panel considers that the Registrant had demonstrated some insight. He has acknowledged his failures over record keeping. He had a number of supervision sessions during his employment and made a number of admissions of his failings during the course of this hearing.


195. In relation to the category of ‘timeliness’, the Panel considers that the Registrant has not given any adequate explanation regarding his failures to adequately progress matters for patients in a timely manner. Although no patients suffered or were actually placed at risk of harm because of the Registrant’s actions, some were put in a position where they could have potentially been denied a service that they were entitled to. His failures were clearly not in the patients’ best interests. The Registrant’s employment at the Trust ceased on 28 February 2014. At that time matters concerning his patients were still outstanding. One patient in particular was potentially at risk of not being able to access the Pain Management Clinic on 3 March 2014. This was because their case was only reviewed on the Registrant’s last day of employment. Had the case not been reviewed on this date the patient would have missed out on being referred to the clinic.


196. The Panel has seen no evidence to show that if the Registrant had continued in his employment at the Trust that these delays would have been identified. When the Registrant was asked about the consequences of his lack of ‘timeliness’, he was keen to say that no harm had been caused to patients as a result.


197. The potential harm was considered by the Panel to be that, where, firstly, when a patient was considered to be suffering from a medical condition and remains in that position rather than being referred to a service which may help the medical management of that condition, and secondly where psychological intervention had been concluded and it would have been important to communicate these to the initial referrer who may need to review the patient further for interventions and considerations of their care.


198. The Registrant was reluctant to acknowledge the potential for risk of harm even after he had heard the evidence of witnesses 1 and 2 who emphasised the potential harm. The Panel considers that the Registrant has not yet demonstrated that he has full insight into the potential consequences of his actions in regard to ‘timeliness’.


199. In relation to the category of ‘record keeping’, the Panel considers that the errors are remediable. No allegations have come to the regulators attention since these matters were referred. There is no evidence of any concerns since these matters. The Registrant has given evidence of his record keeping being satisfactory although the Panel has seen no independent evidence of this. He said that he is undertaking medico-legal work and a solicitor at a firm which instructs him has commented that the quality of his work is up to the required professional standards. The Panel has not been given any independent assurance of this. The Registrant appears to be relying on his own resources to remedy his failings. He has not produced any independent external evidence, such as peer reviews or audits of his records. Further, he has not provided the Panel evidence of having taken any course or training in relation to record keeping and time management. The Panel acknowledges that there had been some improvement in the Registrant’s record keeping as was shown by the email Witness 1 sent to the Registrant on 10 January 2014:

“Dear John – I confirmed that since last audit you have maintained your notes as required by trust guidelines”.


200. However, the Registrant lapsed after this and there were further errors although the Panel does acknowledge that the Particulars found proved after this email were not as significant as the ones proved before. The Panel considers that the Registrant’s failures have not been fully remediated. Should the Registrant move into a role that uses a fully electronic automated record keeping system, the risk of repetition becomes very low. If, however, the Registrant remains working in private practice where there is not a fully automated record keeping system, then there is still a risk of repetition as this will rely on manual entries. The Panel does acknowledge that at present this is mitigated by the evidence given by the Registrant that he only sees approximately eight patients a week and therefore has the ‘luxury’ of time to make good quality entries into the patient records. This has the effect of reducing the risk of repetition.


201. In relation to the category of ‘timeliness’, the Panel has heard no evidence from the Registrant’s current or previous employers concerning any remediation of these concerns. The Panel has found that the Registrant has not demonstrated full insight into the risks or potential risks of the timeliness concerns. Although the matters identified are remediable the Panel does not consider that the Registrant has done anything to remedy them. He has shown no appreciation of the impact that his actions of delay may have had upon his patients. They were placed at risk of harm because of the delays and the subsequent potential denial of services and treatment that they required.


202. Witnesses 1 and 2 confirmed in their evidence that the Registrant was clinically competent and that the concerns related to his record keeping and lack of organisation in his professional practise. For the reason given above the Panel considers that these concerns, although remediable, have not been remedied and there is a risk of repetition.


203. The Panel therefore finds that the Registrant’s fitness to practise is impaired on the basis of the ‘personal’ component of impairment.


204. The Panel is aware that it must also look to the public component of impairment. It notes the passage in the practice note of ‘Finding that Fitness to Practise is impaired’ that it is important for Panels to recognise the need to address the “critically important public policy issues” identified in Cohen -v- GMC [2008] EWHC 581 (Admin) to protect service users, declare and uphold proper standards of behaviour and maintain public confidence in the profession. This means that they cannot adopt a simplistic view and conclude that fitness to practise is not impaired simply on the basis that, since the allegation arose, the registrant has corrected matters or “learned his or her lesson”.

205. The Panel noted the test formulated by Dame Janet Smith in her Fifth Report from Shipman, referred to in the case of: Council for Healthcare Regulatory Excellence -v- Nursing and Midwifery Council and Paula Grant [2011] EWHC 927 (Admin)


“Do our findings of fact in respect of the doctor’s ……., deficient professional performance, …… show that his fitness to practise is impaired in the sense that 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;”

206. The Panel considers that the Registrant has breached the first of these matters in the past, although it accepts that he is unlikely to do so in the future. The Panel further considered the judgement of Mrs Justice Cox in the case of Paula Grant:

74. “I agree with that analysis and would add this. 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.”


207. The Panel does not consider that public confidence in the profession would be undermined if a finding of impairment were not made in this particular case. It therefore finds that the Registrant’s fitness to practise is not impaired on the basis of the ‘public’ component. Therefore, the Panel’s finding is that the Registrant’s fitness to practise is currently impaired solely on the ‘personal’ component.


Decision on Sanction


208. Having found that the Registrant’s fitness to practise is currently impaired by reason of his lack of competence, the Panel went on to consider the question of sanction. It heard evidence from the Registrant, who produced two references, and submissions from Mr Dite and Mr Bown.


209. In his evidence on oath the Registrant gave the Panel information as to his current places and methods of employment. This was backed up and supported by the two references, one from each of the places of employment at which the Registrant was currently working. The Panel is satisfied that the Registrant has significantly changed and improved his working practices. His work has been regularly audited. The Panel particularly noted the passages in the letter dated 27 October 2017 from one of his employers, Med-Cop:

“During his time with us, Dr Owen has added tremendous value to our agency. His work ethic, time efficiency consistency and quality of work have always been to an extremely high standard.

We are a company that regularly audits our consultants work rigidly and Dr Owen has always surpassed our set standards. Our corresponding law firms, insurers, senior psychologist and patients have always deemed Dr Owen’s work as exemplary. We take pride in the fact that our consultants go above and beyond above the line of duty and Dr Owen is no exception to this.


………His ability to effectively communicate with his colleagues and our patients on the phone, via letters and email is always done in a professional and timely manner. We can confirm we have never received any complaints of his work during his time with our company.”


210. The Panel also noted the passages contained within the letter dated 27 October 2017 from the Registrant’s other employer, Verax Solicitors:

“Our firm does not deal with the clients, having Road Traffic Accidents (RTA), so we work to the strict deadlines of the County and Family Courts in the family matters, Immigration Tribunals, Upper Tribunals, Administrative Courts for administrative and immigration matters, and Home Office for the applications involve leave to remain in the United Kingdom. We submit/file the Clinical Psychological Assessments Reports to the Courts and/or to the Home Office.


We have not received any complaint either from our clients or from the Courts/Home Office on the professional behaviour of Dr John Owen and the quality of his work has never been challenged.
Our record shows that Dr John Owen meets the strict deadline to undertake and complete instructed work from our firm. We are in the professional opinion that Dr John Owen is an honest and reliable professional with high integrity.”


211. The Panel is satisfied by the evidence given by the Registrant and corroborated by the two independent testimonials that the Registrant has done much to remedy his failures in relation to the record keeping Particulars. He has been working without complaint from his employers since 2013. The letter from Med-Cop has referred to the fact that his record indicates that the Registrant has produced over 1,000 medico-legal reports as a Psychologist. He has also carried out psychological treatment on patients. All of these matters require that the Registrant keeps adequate and satisfactory records, which the letters confirm.


212. The Panel is also satisfied that in his evidence the Registrant has fully acknowledged his previous lack of insight. He has recognised it now, although late and possibly as a result of his reading of the Panel’s decision on impairment and hearing the live evidence. The Registrant explained that during the course of the hearing the accumulative effect of his actions as explained by Witnesses 1 and 2 made him recognise the gravity of the Allegation and the extent of insight that was expected of him. The Panel accepts that this late development of insight amounts to genuine insight.


213. The Registrant has articulated his understanding of the consequences of lack of timeliness on the welfare and possible delays of treatment to patients. He has been working in a private capacity for several years. This work is different from the work he undertook in the Trust which led to these fitness to practise proceedings. Regarding his current role the Registrant was able to detail specific time requirements for case progression and delivery of reports. The Registrant has recognised the importance of accurate record keeping and timeliness and he adjusts his work load to accommodate these matters. The Panel considers that there is now a very low risk of repetition.

214. The Panel then considered the question of Sanction. It bore in mind all of the evidence it has heard and read in this hearing. Before reaching its decision, the Panel considered the HCPC’s Indicative Sanctions Policy and accepted the advice of the Legal Assessor.


215. The Panel considered the gravity of the matters found proved and identified the following aggravating and mitigating factors.


216. The aggravating factors:


• The identified failures of record keeping were basic and persistent;
• Although the Registrant was provided opportunities to remedy the failings they recurred.

 
217. The mitigating factors:


• The Registrant continued to work in his four day a week role at the Trust up to July 2016 and thereafter as a sole practitioner without incident; 
• The Registrant made early admissions where appropriate;
• The Registrant produced insightful and relevant references from the two law firms that instruct him to produce medico-legal reports;
•  He has fully engaged throughout the regulatory process.


218. The Panel is satisfied that the Registrant now has insight into his failings.


219. The Panel is aware of the risk of recurrence from which the public need to be protected and the Panel is now satisfied that this risk is low. This is because the Registrant works as a sole practitioner in a private capacity. He stated that he is able to adjust his workload in order to allow sufficient time to keep proper and accurate records and ensure that letters of referral to colleagues in relation to case progression are sent in a timely manner.


220. The risk of repetition of previous conduct is further reduced because, should the Registrant’s work falls short of the standards expected he would not receive further referrals from the firms that instruct him. One of these firms has been instructing the Registrant since 2013 and the other has been for at least 1 ½ years. The two references state that the Registrant’s work has been of a consistent high standard.


221. In deciding what sanction, if any, to impose, the Panel has reminded itself that the purpose of sanction is not to be punitive but to protect service users and the public interest, although a sanction may have a punitive effect. The Panel has taken into account the principle of proportionality, balancing the interests of the public with those of the Registrant.


222. There is a need to demonstrate to the public and to Practitioner Psychologists the importance of adhering to the fundamental requirement of keeping high standards of personal conduct by declaring and upholding proper standards of professional behaviour and adhering to the essential core practices of the profession.


223. There is also a need to maintain public confidence in the profession and the regulatory process.


224. Accordingly, the seriousness of this case meant that taking no action was not an option. Mediation has not been offered by either side in this case and is therefore not appropriate.


225. The Panel next considered whether to impose a Caution Order. Such an Order is suitable for cases that can be regarded as being slightly more serious than those for which no action or mediation is appropriate.


226. This is a case in which the Panel considers that the Registrant has fully understood the effect that his failures have had on the public and patients. The Registrant had practiced without incident before and the Panel considers that this Allegation occurred during a limited period between 2013 and early 2014 in an otherwise unblemished career. 


227. The Panel has therefore decided to impose a Caution Order.


228. The Panel considered the sanction above, a Conditions of Practice Order, but concluded that this would be disproportionate given that the failings of record keeping and timeliness of case progression had been remedied and this was confirmed by the two references.

 
229. A Caution Order will maintain confidence in the regulatory process as members of the public will be reassured by the fact that cases such as this are taken seriously and departures from fundamental and core duties are not tolerated. This will also ensure the continued professional practise of a useful and now competent practitioner. The period of the order will be for three years in order to act as a warning to the Registrant whilst not interfering with his continuing professional practice.

Order

Order: That the Registrar is directed to annotate the register entry Dr John Owen with a caution which is to remain on the register for a period of 3 years from the date this order comes into effect.  

Notes

The order imposed today will apply from 24 November 2017. 

Hearing history

History of Hearings for Dr John Owen

Date Panel Hearing type Outcomes / Status
18/10/2017 Conduct and Competence Committee Final Hearing Caution
15/02/2017 Conduct and Competence Committee Final Hearing Adjourned
20/06/2016 Conduct and Competence Committee Final Hearing Adjourned