Chapter 6: The General Medical Council
The GMC investigation: third Interim Orders Committee and the Preliminary Proceedings Committee
The local restrictions agreed in February 2002 were due to be reconsidered in light of the findings of the IOC hearing.
Dr Barton’s solicitors wrote to Dr Peter Old, Director of Public Health for Portsmouth and South East Hampshire, on 26 March 2002 asking the Health Authority to reconsider the voluntary restriction in light of the decision of the IOC (DOH603360). The documents show that Dr Old replied on 28 March (DOH603361). However, the Panel has not seen Dr Old’s response. On 2 April, Dr Barton’s solicitors wrote to Dr Old, saying Dr Barton was “content voluntary prescribing restriction is lifted but restriction on medical care at GWMH should continue and be reviewed monthly” (DOH701884, p2; DOH702154).
On 11 July, the GMC wrote to Dr Barton, informing her “that the Council has received from Hampshire Constabulary information which appears to raise a question whether, as a registered medical practitioner, you have committed serious professional misconduct within the meaning of section 36(1) of the Medical Act 1983” (GMC101057, pp777–80). The information related to allegations of inappropriate prescribing and management in relation to Mrs Page, Mrs Wilkie, Mr Cunningham, Mr Wilson and Mrs Richards. The information had been considered by a Medical Screener and had been referred to the GMC’s Preliminary Proceedings Committee (PPC). The available documents suggest that the GMC notified the Hampshire and Isle of Wight Strategic Health Authority on 5 August (DOH701884, p2).
On 27 August, the Primary Care Trust (PCT) met and decided that no local action needed to be taken against Dr Barton (DOH701884, p2). The available documents suggest that the PCT’s rationale was that suspension was not justified because the GMC had decided to take no action in March 2002. There were continuing concerns in relation to her role as a clinical assistant at the hospital, where she no longer worked, but not in relation to her role as a GP. The suspension of a senior GP would be a strain on resources. The PCT discussed ‘lines to take’ relating to different possible outcomes of the forthcoming PPC (DOH701884, p2).
The Trust did not tell the GMC of this meeting, nor of the reasons for its decision.
On 29 August, the PPC considered the papers provided by the GMC and a letter from Dr Barton’s solicitors, setting out her response to the allegations (GMC101057, pp774–6, pp1507–15).
The PPC decided that “the matter unequivocally needs to be tested by the Professional Conduct Committee” (GMC100941, pp416–19). The PPC did not refer Dr Barton back to an Interim Orders Committee. On 12 September, the GMC decided that, because the status of the case had changed and it had been referred to the PCC, a further application should be made for an interim order (GMC100941, p469).
The PPC’s determination also referred to a Dr Althea Lord, consultant geriatrician at the hospital:
“The Committee noted that Dr Barton’s post was supervised by a consultant, Dr Lord, who must therefore assume some responsibility for the events … The Committee considered that the case of Dr Lord should be screened if it hasn’t already been. It further suggested that if the allegations against Dr Lord have already been screened, we might now have more information than the screener had at the time, and it may need to be re-screened.” (GMC000187, p2)
The Panel has seen no documentation to suggest that the GMC did re-screen Dr Lord or otherwise follow up on this part of its determination.
The GMC became aware of the Commission for Health Improvement (CHI) report, which had been published in July 2002, and attended the CHI offices where it examined files it considered to be of use. The GMC wrote to the Trust to ask for information about the complaints listed in the report (GMC101057, p985). The GMC’s letter, of 21 August 2002, was addressed to Dr Richard Ian Reid, the Medical Director, one of the consultants who was responsible for monitoring and supervising care on the wards.
In a further development, on 12 September, Sir Liam Donaldson, the Chief Medical Officer, sent an email to the Trust, saying that he thought the “ban on prescribing opiates should be re-instated immediately” (DOH701884, p3).
On 13 September, the Trust held a meeting with Dr Barton. It was agreed that a review of the prescribing restriction would take place when she returned to work from sick leave (DOH701884, p3).
The GMC was not told of this intervention by the Chief Medical Officer at this time nor of the meeting between the Trust and Dr Barton.
On the morning of 19 September, before the third IOC hearing that day, Dr Simon Tanner, Director of Public Health, Hampshire and Isle of Wight Strategic Health Authority, spoke to the GMC. He told them about the 1991 nurses’ dossier that had been provided (see Chapter 4). During that call, Dr Tanner told the GMC that the Chief Medical Officer had indicated that his view was that voluntary restrictions on prescribing should be reinstated. Dr Tanner said Dr Barton was currently on sick leave. He told the GMC that the voluntary undertaking had ceased following the last decision of the IOC to make no order.
The documents suggest that this was the first time the GMC was made aware that the voluntary undertaking had not continued in the intervening period (GMC100088, pp77–8).
The IOC was not informed that a telephone call had been received from the Trust before the hearing, stating there was no local voluntary restriction in place on prescribing.
Counsel for the GMC argued that the relevant change in circumstances was that the CPS was reconsidering the original decision not to pursue criminal charges. However, she said she was sure that Dr Barton’s solicitor:
“… will tell you, the defence have been in contact with the officer in the case who is happy with the original decision that was taken by the Crown Prosecution Service not to proceed with the criminal proceedings. But Of course, it is not a decision which is taken by the police. It is a decision which is taken by the Crown Prosecution Service whether to institute or discontinue proceedings.”
Counsel for the GMC then added: “I think, to be fair to Dr Barton, there has been a degree of pressure brought upon the Crown in this case to reconsider the matter” (GMC101057, p795).
The Panel has found no documents showing that any such pressure was applied to the CPS.
The solicitor for Dr Barton made submissions that his colleague (who was present at the hearing) had spoken to Detective Chief Superintendent (Det Ch Supt) Steven Watts and he summarised an attendance note of a telephone conversation between them (the note was not provided):
“The understanding that [his colleague] got from the conversation was that this was a case of back-covering – I can use that expression – by the police. The police were perfectly satisfied. They had no concerns. Because of concerns raised by family members, they thought ‘We will get the CPS to check’ and that is the basis upon which papers have been sent to the CPS. There is no new evidence.” (GMC101057, p796)
The Panel has found that on the day of the IOC hearing Det Ch Supt Watts telephoned the CPS to inform it of a major development in the form of the receipt of papers referred to as the nurses’ dossier, that the Trust had appointed two senior officials to investigate these matters, and that the police were taking steps to establish the provenance of the papers and why they had not come to their attention before now (CPS000932). The GMC had not been given this information by the police and the IOC hearing proceeded without this knowledge. Counsel for the GMC made no representations about the submission which had been made by Dr Barton’s solicitor and did not ask for time to confirm its accuracy.
The legal assessor invited Dr Barton’s solicitor to make comments about “the propriety – not the power, but the propriety” of the IOC considering the case again “without any fresh evidence at all” (GMC101057, p796).
Dr Barton’s solicitor said that Dr Barton “does not routinely prescribe benzodiazepines or opiates”. He made submissions that the only real change was that the condition she had made with the Health Authority not to prescribe opioids or benzodiazepines had lapsed at the end of March “and the Health Authority did not see fit to invite her to renew that undertaking” (GMC101057, p797).
The legal assessor advised the IOC “in light of the fact that there was no new evidence before them it would be unfair to the doctor for the Committee to consider the matter any further”. The IOC’s determination was “there is no new material in this case since the previous hearing of the Interim Orders Committee”. No order was made (GMC101057, pp798–9).