No, not of itself.

Dr K’s case concerned the treatment of 14 patients, he admitted 29 allegations and there were a further 42 allegations which were to be determined by the Tribunal.

Dr K had over 20 years of experience and ran a busy practice on his own.  His practice was in a deprived area, he and his family faced threats of serious violence and he was unable to recruit a second GP for his practice.  He had an unblemished record up to the point of the incidents that were alleged to have occurred during 2017 and 2018.

The case included expert evidence from two expert GPs, one instructed by the GMC the other by Dr K.  They disagreed on various points, they each wrote their own report and both contributed to a joint report.  The joint report had agreement in relation to only one patient. The experts agreed the treatment in this isolated case fell seriously below expected standards.  The MPTS correctly noted that where there is a conflict between experts the burden is on the GMC to prove its case and the issue should be resolved in favour of the doctor.

To monumentally oversimplify a more than 50 page judgement; a large number of the allegations concerned a dispute over whether treatment had been provided and the fact that there was no record of the treatment and/or advice.  Dr K’s defence was mostly that he had provided the treatment and advice but due to the pressures of working as a single-handed GP the pressure meant his records lapsed.  There were a good few instances of not recording safety netting advice and time and again on his evidence Dr K stated that it was his usual practice to provide safety netting advice and findings were made by the Tribunal accordingly.  It was not the case there were no records and neither was it the case there had not been thorough examinations.  For example, Dr K had completed a ‘frailty index score’ but not recorded further advice, or there was not a record of a question about iron deficiency when facts indicated it was required. There was also a self-prescribing breach over the period of just over a year but this was not dishonest and there was no deception.

The Tribunal meticulously examined each of the allegations and referred itself to Cohen v GMC [2008] stating that the sequential approach to considering allegations means that not every finding of misconduct will result in a determination of impaired FTP.  The Tribunal therefore found the self-prescribing was not serious misconduct.  As there was only one medical failing in respect of one patient neither did that cross the line.  It should be pointed out even in that instance the patient was asked to return in one week and was given safety netting advice.  The Tribunal recognised the difficult circumstances Dr K worked in and determined it was not misconduct.  Interestingly it also asked itself the question that even if it looked at all the allegations cumulatively would it make a general finding of misconduct.  Its answer was no.

We are most certainly not advising that it would be acceptable henceforth to simply abandon all record keeping, that is not the conclusion to draw from this case.  Quite the reverse.  No two cases are the same and we can provide advice if you face allegations regarding your record keeping.  Domain 1 of GMP includes provision at sections 19 to 21 spelling out the requirement for clear accurate and legible clinical records which contain findings, decisions, patient advice, any prescribed drugs or treatment and you should identify yourself.