Fitness to Practice
I thought it would be reasonable to advise that the conditions of registration which were imposed by the General Medical Council on my practice on November 2007 for 3 years ended November 2010. These conditions were of an administrative nature and the General Medical Council did not seek to influence the conductance of my medical practice, which I hope has continued to provide a useful service towards the diagnosis and management for patients with hypothyroidism.
The General Medical Council have convened a Hearing for the 28th and 29th July (probably Manchester). This Hearing will examine if I have successfully fulfilled my conditions of registration which were set for 3 years from November 2007 to November 2010. I have requested that this Hearing be public.
June 29th 2011
I have now been advised that the Hearing is to continue for 5 days in Manchester at the GMC premises as before and beginning on 28th July.
This would not be the place to delve into the details of this Hearing. Suffice to say, that the conditions between November 2007 and 2010 asked that I transmit to the GMC the referral letter from the referring practioner, my clinical notes and my return letter to the referring practioner. I have fulfilled these conditions with dilligence and no significant problems have been drawn to my attention at 6 monthly review during these three years; addtionally, there are no cases under review by the GMC or any further allegations vis-a-vis my medical Practice. The focus of the investigation during five days of expensive court proceedings is therefore something of a mystery.
These proceedings are public and you are welcome to attend any part of these proceedings. I would of course appreciate any support and encouragement during these proceedings.
July 4th 2011
The Medical Protection Society would welcome the support from any of the patients that have seen Dr. Skinner and if you wish to send a note to Dr. Stewart, Medical Protection Society, 33 Cavendish Square, London, W1G 0PS; it is very important to send a copy to Louise Lorne Clinic, 22 Alcester Road, Moseley, Birmingham, B13 8BE. Thank you.
October 14th 2011
I will be attending a further GMC hearing on 14-11-2011 to 19-11-2011 Manchester at the GMC premises. This hearing will examine my compliance with my conditions of registration which were set in November 2007. I have failthfully conformed to these conditions and I am now very hopeful that I will be reinstated to my full medical registration.
November 25th 2011
I am delighted to inform you that at the recent GMC hearing the panel decided to lift my conditions of registration and I am free to practice without restriction. As a gesture of good faith I will to continue to see new patients who have been referred from a medical practitioner registered within Europe.
I very much hope that the termination of my conditions will encourage a more flexible strategy among Endocrinologists and Family Practitioners on the diagnosis of hypothyroidism. As you know I have been trying for some 15 years to establish a formal clinical trial to investigate the pivotality of thyroid chemistry in the diagnosis and manangement of this condition; and secondly a formal trial to compare the relevant efficacy of the synthetic hormone preparations and the dessicated extract preparation.
This is more critical than ever as a number of Practitioners continue to adhere to a proposition advanced by the Assocation of Clinical Biochemists and two Royal Colleges that hypothyroidism should not be diagnosed unless the TSH value is more than 10 miu/L. I believe that this is a seriously flawed position; it is statistically wayward given the average TSH value and the standard error of this average and thus a TSH value of 10 miu/L will be an unacceptably high number of standard errors from the average value; secondly it is hardly commensurate with clinical experience culled over many years of clinical practice where few Practitioners will not have encountered unequivocally hypothyroid patients who had a TSH level of, say 7 miu/L, who have returned to optimal health on thyroid replacement therapy.
We will continue to press for these important clinical trials and would of course welcome any suggestions towards possible funding sources to conduct these trials.
January 25th 2012
As the dust settles - or fails to settle as it so seems - I thought it worth advising that a new issue has arisen with respect to complaints from Family Practitioners on my work. I would add that none of the Practitioners have made contact with me prior to firing off a complaint to the General Medical Council.
This would not be the place to discuss the nature of these complaints save to advise that the patients who are involved have not made any complaint(s) and, as far as I can judge and indeed as reported by two of the four GP complainants they have returned to good health. I am sure that you are anxiously awaiting publication of my new book “Essential Statistics” and there is an interesting practical application of Poissonian theory to this matter.
Poissonian distribution describes the frequency of independent events for example goals at football matches, number of letters arriving per day to a house, accidents in a given day in a city. Poisson teaches a remarkable linkup between mathematics and biology; if we know the average number of goals in a football match we can predict the probability of no goals or five goals or eleven goals. Thus it may be with the frequency of complaints about a given medical practitioner.
Anybody still listening ?
The average number of complaints from Family Practitioners over a decade has been 1.5 per year. Thus if complaints are random events, then the probability of receiving four complaints at two weekly intervals is P <0.0001 or in other words less than one in 10,000 chance if complaints were randomly distributed which is the point. This suggests that some other factor has motivated this plague of complaints. The only event which might have distorted the randomness would be my recent FTP but this would be contrary as the General Medical Council exonerated my position and removed restrictive conditions which were of only an administrative nature and were never intended to influence the strategy of management of patients with hypothyroidism.
The recent and inexplicable frequency of these complaints is certainly a worry in that while the complaints contain no specific allegation of shortfall in my care, the accumulative effect of a number of silly solicitations masquerading as complaints may encourage the erroneous concept that there cannot be smoke without fire etc.
In these circumstances it is my intension to seek a meeting with the General Medical Council and the Medical Protection Society.
February 17th 2012
It never rains but it pours. I returned from Europe today to learn that I have been summoned to an Interim Orders Procedure at the General Medical Council at 9.30am on Wednesday 22nd February 2012 at the GMC Offices at St james's Buildings, 79 Oxford Street, Manchester, M1 6 FQ.
This IOP has arisen following five complaints to the GMC from Family Practitioners in the recent past. This would not be the place to debate these complaints but suffice to say that I do not believe that I have placed any patient in harm from my ministrations.
I have formally requested that the Hearing on Wednesday be open to the public and that adequate facility will be available; I realise that you must be extremely worried at this latest turn of events particularly perhaps those of you for whom I provide prescription for thyroid medication. I am working closely with the Medical Protection Society to try to finally put these allegations of shortfall in patient care to rest.
March 9th 2012
And still they come. I am afraid there are now 8 complaints from Family Practitioners in the last three monthsnotwithstanding the paucity of any complaints during the last 15 years of this work and notwithstanding any significant change in management strategy. As stated previously this would not be an appropriate Forum to provide detailed information on these complaints but I owe it to my professional reputation and ongoing relationship with my patients to earnestly advise that to my knowledge none of my patients have come to harm from my ministrations and again to my best knowledge the patients have returned to good health; I do not therefore believe that there has been any shortfall in care to these patients.
I recently was advised by a patient from the USA that my statistical analysis (vide supra) was a bunch of baloney. This was at least a refreshing change from the incomprehensible reiteration from complainants that there was a shortfall in my monitoring system for patients - I suspect this is usually 'lifted' from my erstwhile Conditions of Registration - in spite of there being clear arrangements in place which have been examined by the appropriate regulatory authority.
To return to the bunch of baloney allegation.
The probability (p) of 8 events (x) in 3 months where the average number of events (z) is 0.25 in 3 months (in this example a complaint is considered an event and an unpleasant one at that) is given by the beautiful Poissonian formula namely
p = Z / e X x!, where e is a fairly incomprehemsible concept but is the base
of natural logrithms and the day is saved by using its approximate value of 2.71 which we will bung into the equation and thus
p = 0.25 / 2.71 X 8!
p = < 0.0000000003 or a 1 in 10,000 0000 chance if these were random events.
Thus we must conclude that the congestion of complaints during the last three months are not random events. I leave you to draw any conclusions from this analysis.
I am in discussions with the MPS on this matter.
June 26th 2012
On the 24th of May there was a further Interim Orders Procedure following a complaint to the General Medical Council (GMC). Although the determination stated that there were no findings against me, the Panel reimposed Conditions of registration and added to the conditions that my work was to be supervised on a fortnightly basis by a Consultant Endocrinologist; unfortunately, following solicitation to a number of endocrinologists, I have been unable to secure an endocrinologist who would carry out this supervision. I did in fact have the agreement of an endocrinologist who finally withdrew from the role. One of the main difficulties is that is is an almost impossible task for a colleague in full time employment to undertake this commitment and secondly, the number of endocrinologists have asked that their solicitation be brokered directly from the GMC.
I personally believe that this was a disproportionate decision by the Panel at the GMC and I am in discussion with the Medical Protection Society towards the possibility of an Appeal to the High Court. If the news is bad, then we need to consider the future management strategy for patients who receive their prescriptions from my surgery and I will keep you abreast of any developments.
September 21st 2012
We contacted at least 300 Endocrinologists and I am grateful to the 3 colleagues who agreed to supervise my work. I am now working with one of these colleagues who has been asked by the GMC to prepare a report at approximately the end of November 2012. I should also let you know that I have been exonerated from 5 of my 8 cases so I am afraid 3 are still ongoing; suffice to say that I do not believe that there has been any shortfall in my care and will robustly defend my position.
October 12th 2012
In addition to the cases outlined above (September 21st 2012), a Family Practioner has expressed the view to the General Medical Council that she is unsure if I am following my conditions of registration. I will be rigorously opposing this complaint at a Hearing scheduled for Friday November 9th 2012 at 9.30am at the GMC Offices in Manchester. I would of course appreciate your support at this public meeting.
December 18th 2012
The IOP held on November 9th 2012 had a disappointing outcome in that the panel decided that my Conditions of Registration should remain in place and I must continue to be supervised by a Consultant Endocrinologist; This latter condition is not particularly onerous and in fact I have found it most helpful to discuss difficult cases with this supervisor who is continuing his supervisory role for the forseeable future.I understand that the General Medical Council are comissioning two further experts one of whom will be revisiting the ongoing complaints and the other will be providing an academic opinion on (I think) the pivotality of thyroid chemistry in the diagnosis of hypothyroidism; I assume that these reports will generate yet another review/IOP/FTP early next year. I will keep you abreast of developments.
February 11th 2013
We have had a period of relative quiet no doubt the lull before the storm which is pleasing enough in remembrance of the mulitplicity of complaints from Family Practioners following my exoneration in November 2011 - a curious matter.
I understand that the GMC are seeking a further expert report for reasons that are unclear and raises the question of whether a next (possibly) adverse expert report will transcend or be given a greater weighting that the previous expert report on the same case; conversely, how many known adverse reports are required to preclude a further trawl for an adverse report - honi soit qui mal y pense indeed.
The sad thing is that I do not believe I have behaved irresponsibly in the care of any of my patients and that in essence a difference in academic opinion has beeen transmuted into disciplinary issues.
I will adivse on any further developments
April 24th 2013
I thought I should let you know that I have been asked to attend a further Interim Orders Procedure on 26th April; regrettably, I have received too little notice to cancel a Clinic on that day and I cannot therefore attend but Afshan will be there to represent me.
There is a considerable problem as IOPs to my understanding would normally review compliance with my conditions of registration. However, I have been unable to establish if material from a new Rule 7 will be addressed at this hearing. This latter is a fourth revisitation to three cases which have been addressed at previous hearings and have already been the subject of two Advisory Reports. As advised in the above February 11th note, The GMC have commissioned a third report which may be incorporated into this forthcoming hearing. This is a catastrophe in the making as I have not had time to prepare and submit a considered rebuttal to these reports and I will thus be in a somewhat invidious position; Additionally, these reports will be considered at a later date irrespective of IOP findings by GMC case examiners.
En passant, the promised academic report (vide supra) has either not been comissioned or has been comissioned and has not been made available which is disappointing and I am seeking clarification on this matter.
We can but solidier on.
June 7th 2013
The Panel at the Interim Orders Procedure (as above; 26th April 2013) decided to continue my conditions of registration but did not clarify whether the report by the expert examiner was the promised academic report or a further standard expert report; you will recall that the GMC had indicated that they were commissioning two reports.
There has followed a rather astonishing development. The GMC has requested a further report from the last expert for reasons that are unclear but it would be surprising indeed if the next offering is not a further condemnation of my work.
I would like to sincerely thank the 25 patients who attended the last GMC hearing and all the patients whose support during the last 15 years, travelling near and far to GMC hearings has meant a great deal to me. I would also of course like to thank my collagues at the Louise Lorne Clinic and the legal staff of Radcliffe le Brasseur.
I will let you know what goes forward.
August 1st 2013
There are three new developments two of which are distinctively bad news. There have been two new complaints to the GMC. While it is not appropriate to discuss these complaints on a public domain, I do think that it is fair to advise present and (perhaps) future patients the views of colleagues on my work.
1. The Pharmacist at a retail outlet received a prescription from me for low dose thyroxine replacement He considered this inappropriate and, astonishingly complained to the GMC who, equally astonishingly, have embraced the complaint and galvanised Rule 7 Procedures.
2. A Medical Director of an NHS hospital has complained to the GMC to assert that he has 'crossed paths' with me before (he is 'afraid') and that he is not clear if I have broken my Conditions of my Conditional Registration following what is described as an episode; the episode appears to consist of my providing advice to a patient and colleagues that in my opinion her thryoid status was satisfactory for her to undergo surgery. It is asserted by this Medical Director and that of involved colleagues that my advice 'is at best poor' and 'at worst dangerous to the patient.'
I do not agree with these comments but it is important that patients are aware of contrary views. I have asked that the matter be thoroughly explored at my next Fitness to Practice hearing.
3. As outlined in my June 7th update (above), the third revamped report is now available and is being considered by the Medical Protection Society.
I will let you know how it goes....
September 27th 2013
This is to confirm that there will be a public IOP hearing 07-10-2013 in Manchester at the GMC offices. Four "cases" will be investigated; two of these cases have been investigated on four previous occasions and the two other cases refer to above are mysterious to say the least in that I am unaware of any shortfall in care and have received no precise notification of the putative allegations from the GMC.
We can but soldier on!