Blackburn GP flagged to NHS fraud team is cleared at medical tribunal - here's what happened

Dr Mohammed Raouf Alam completed his GP training in December 2016 after which he took up a salaried position at the Umar Medical Centre in Lime Street, Blackburn, which has 8,000 patients. Not long after he joined the practice he became a managing partner and held that position for 11 months.

What happened?

Dr Alam was called before a Medical Practitioners Tribunal Service (MPTS) hearing this year over concerns related to irregularities in information provided by the practice in respect of the QOF scheme. The QOF scheme is for the management of patients with chronic diseases such as asthma and diabetes, with targets set for all GP practices to carry out an annual review of those patients.

The QOF scheme allows two types of exception reporting. The first is where a patient has either expressed the desire not to participate in attending, or has failed to respond to three invitations to do so. The second is when a patient is coded as unsuitable, for example where they have received a terminal prognosis, are on chemotherapy.

Audit

A visit to the Umar Medical Centre was arranged by the local Clinical Commissioning Group after a high level of exception reporting was recorded in 2017/18. A subsequent audit identified that 192 of the patients that were exception reported during that period were were not seen by the practice and did not have an appointment. The report also identified that towards the end of the 2017/2018 financial year, there had been seven retrospective entries to patients’ notes by Dr Alam, and another 44 made by two other members of staff.

On each of the entries, verbal invites had been retrospectively added to the patients’ medical records and in many instances these patients were exception reported outside of the normal practice hours. The recommendation was that a full investigation should be carried out and the CCG referred the matter to NHS England Counter Fraud.

Tribunal findings

It was proved that Dr Alam had made retrospective entries in the notes of four patients without indicating that they were retrospective entries. In respect of two of those patients he had neither informed the other two clinicians concerned that he had done so, nor had he seen those two patients. Dr Alam admitted that he had not made it clear that his entries were made retrospectively and in some cases had been made by him, and that the information entered was misleading.

It was the GMC’s case that in carrying out the above, Dr Alam’s actions were dishonest. Dr Alam denied this and the tribunal panel found it unproven.

In his witness statement and in the course of his oral evidence, Dr Alam explained that it was his first job since GP training, had a lack of experience, and that the pratice was “dysfunctional” at the time, with staff that were unhappy with their rates of pay and looking for other jobs. One experienced member of staff was on long-term sick and other valuable clinical staff had left the practice. A report states: “He explained their struggle to offer enough appointments to meet the demands of their large list of patients with complex needs and chronic medical problems, and the difficulties they had trying to recruit more doctors.”

Struggled to cope

Dr Alam had to take on additional administrative work, which he was unsure how to code properly. The report says: “Dr Alam explained that he struggled to cope with the additional stresses placed on him but despite feeling overwhelmed he felt he had no choice but to just keep going.”

He relied on an “efficient” and experienced health care assistant to verbally invite patients to reviews, and the tribunal found he had genuinely believed that the correct number of valid invites had been issued and was entitled to rely on those invites when exemption reporting the patients on the list he had been given. The Tribunal also heard that Dr Alam had been told by a colleague that it was acceptable to make retrospective entries to patient notes where there was evidence of three invites being given.

There was no suggestion that Dr Alam carried out this exercise for financial gain and the panel members concluded he was a “competent physician who cares about his patients”.

Conclusion

A report states: “The Tribunal considered that the conduct of Dr Alam fell below, but not seriously below, the standards expected of a competent GP. The Tribunal determined that Dr Alam’s conduct although misconduct did not meet the threshold for serious misconduct.”

The tribunal was not required to consider whether his fitness to practise was impaired and no warnings were given.

In October 2018 Dr Alam he left the practice and now works part-time as a locum GP elsewhere. The pracrice has now been taken over by a new partnership and renamed.