On Wednesday 25 March 2015 the Care Standards Tribunal unanimously dismissed a GP’s appeal against suspension of his registration with CQC. This is the first time CQC has used this enforcement action against a GP.
The test applied by the Tribunal in reaching its decision involved asking whether the Tribunal had reasonable cause to believe that, at the date of the decision, any person would or might have been exposed to the risk of harm. The test of the reasonable belief is whether a reasonable person aware of the law and the relevant information, would believe such a risk to exist.
Despite the GP’s Counsel highlighting that the practice had run for a very long time without incident and very few complaints (and the Tribunal accepting that this was true), the Tribunal concluded that in its view this could not convince the hypothetical reasonable person that the practice had been running without risk. Therefore a good track record may not protect providers from such decisions if there is evidence to suggest that people were put at risk.
CQC’s case included the submission that the GP had relied on the CQC for guidance as a substitute for his lack of management. The Tribunal agreed with this submission by stating that the evidence before it was indicative of the GP’s “carelessness, passive and reactive approach to the management of his practice.” Concerns highlighted by CQC included the lack of access to emergency medicines, the lack of adequate induction procedures for new locum doctors, the absence of appropriate checks such as DBS, hepatitis status and references, the lack of child protection and adult safeguarding policies and no adequate staff fire training.
The Tribunal stated that the decision was due to the “obvious risks arising from the appellant’s casual approach to the management of his practice, which, as a result, was ill-equipped to deal with an emergency such as a fire or an anaphylactic reaction. The checks which Dr Khan had admittedly failed to carry out are provided for the purpose of protecting patients from risk. The conclusion that…persons, patients and staff and doctors, were exposed to the risk of harm was inescapable. That risk would have continued without action on the part of the CQC.”
The Tribunal concluded that the GP’s “failure to appreciate that the regulations had an important purpose and that he had a duty to comply with at least the spirit of the law, if the letter of the law were beyond his grasp as a non-technical person, persuaded the Tribunal that the imposition of conditions would have been ineffective and that to protect from the risk of harm envisaged by s.31, there was no practical alternative to the suspension of his registration.”
The decision highlights the need for GPs, and indeed all providers regulated by CQC, to ensure that they know their legal obligations, act in accordance with them and can demonstrate that they comply with the law. In line with the new CQC inspection regime, in particular the ‘well-led’ question, CQC are looking for proactive and engaged management and will not tolerate what could be perceived as passive and reactive management.