PUBLIC RECORD...GMC Representative: Mr Gavin McBride, Counsel, 8-11 April 2019, 3-4 February 2020 Ms Rebecca Vanstone, Counsel 5-8 August 2019, 13-17 July 2020 Attendance of Press

Record of Determinations –

Medical Practitioners Tribunal

MPT: Dr AKRAM 1

PUBLIC RECORD Dates: 08/04/2019 to 11/04/2019, 05/08/2019 to 08/08/2019, 03/02/2020 to 04/02/2020, 13/07/2020 to 17/07/2020

Medical Practitioner’s name: Dr Shazia AKRAM

GMC reference number: 7094045

Primary medical qualification: Lekarz 2010 Warszawski Uniwersytet Medyczny

Type of case Outcome on impairment New - Misconduct Impaired

Review - Misconduct Impaired

XXX XXX

Summary of outcome

Erasure

Tribunal:

Legally Qualified Chair Mr Robin Ince

Lay Tribunal Member: Miss Susan Hurds

Medical Tribunal Member: Dr Jill Edwards

Tribunal Clerks: Ms Samantha Montgomery 8 April 2019 Ms Lauren Culkin 9-11 April 2019 Ms Angela Carney 5-8 August 2019; 3-4 February 2020; and 13-17 July 2020

Attendance and Representation:

Medical Practitioner: Not present and not represented 8-11 April 2019 Present and not represented 5-8 August 2019 Present and represented 3-4 February 2020 Present and represented 13-17 July

2020



MPT: Dr AKRAM 2

Medical Practitioner’s Representative: Mr Lee Hughes, Counsel, instructed by Olliers Solicitors

GMC Representative: Mr Gavin McBride, Counsel, 8-11 April

2019, 3-4 February 2020 Ms Rebecca Vanstone, Counsel 5-8 August 2019, 13-17 July 2020

Attendance of Press / Public In accordance with Rule 41 of the General Medical Council (Fitness to Practise) Rules 2004 the hearing was held partly in public and partly in private. Overarching Objective Throughout the decision making process the tribunal has borne in mind the statutory

overarching objective as set out in s1 Medical Act 1983 (the 1983 Act) to protect, promote and maintain the health, safety and well-being of the public, to promote and maintain public confidence in the medical profession, and to promote and maintain proper professional standards and conduct for members of that profession. Determination on Facts - 06/08/2019 1. At the hearing in April 2019 the GMC was represented by Mr McBride,

counsel. At this reconvened hearing the GMC is represented by Ms Vanstone, counsel. Background 2. Dr Akram qualified in 2010 in Warsaw, Poland. She undertook her foundation training at Sunderland Royal Hospital on a less than full-time basis. Her Foundation Year One (‘FY1’) training started in August 2010 and was completed in August 2013. Her Foundation Year Two (‘FY2’) commenced in August 2013 and continued until October 2014 but was not completed. In addition to this, Dr Akram undertook locum work at

four different hospitals from January 2013 to August 2014. 3. At the time of the events giving rise to the Allegation, Dr Akram was not practising or in employment as a doctor; however, she stated that, in January 2018, she had undertaken some Continuing Professional Development (‘CPD’) courses. 4. The allegation that has led to Dr Akram’s hearing can be summarised as: on 2 February 2018, whilst suspended from the List of Registered Medical Practitioners following a decision of a Medical Practitioners Tribunal dated 1 February 2017, Dr Akram

submitted an application to work with NHS Professionals. NHS Professionals is an



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organisation owned by the Department of Health, which specialises in providing temporary Health care staff to NHS Trusts, Further, that Dr Akram failed to disclose that she had been and still was suspended by the MPT and knew this at the time of submitting the application. It is alleged that in so doing, Dr Akram’s actions were dishonest.

5. The concerns in relation to the Allegation were raised with the GMC on 6 February 2018 by Dr B, Medical Director (‘MD’) and Responsible Officer (‘RO’) of NHS Professionals. This referral to the GMC was subsequent to a GMC investigation which had resulted in Dr Akram’s suspension from the Medical Register by the MPTS, in relation to allegations that had arisen during her FY2. The Outcome of Applications Made during the Facts Stage 6. Dr Akram was neither present nor represented at the hearing in April 2019.

The Tribunal was satisfied that notice of hearing had been properly served on Dr Akram, and determined to proceed in her absence. The Tribunal’s full reasoning to do so is set out in Annex A. 7. At the hearing in April 2019 Mr McBride made an application, made pursuant to Rule 34(1) of the Rules, to admit further evidence. The Tribunal’s full decision on this application is included at Annex B. 8. At the hearing in April 2019, due to insufficient time the Tribunal determined

to adjourn the hearing under Rule 29(2). The Tribunal also noted that Dr Akram’s current suspension was due to expire on 11 May 2019, therefore it determined to exercise its power under section 35D(5)(a) of the Medical Act 1983 to extend the order of suspension. The Tribunal’s full decision is included at Annex C. 9. At this resumed hearing Dr Akram made an application, made pursuant to Rule 34(1) of the Rules, to be allowed to give oral evidence and to admit further documentary evidence. The Tribunal’s full decision on the application is included at Annex D.

10. Having initially made admissions to paragraphs 1, 2a and 2b (but not 2c, 3 or 4) of the Allegation Dr Akram subsequently indicated that she had been mistaken and wished to withdraw these admissions, notwithstanding that the Tribunal had already announced that it found those allegations proved under Rule 17(1)(e). 11. The LQC advised that, although there was no specific provision in the Rules which allowed a Tribunal to reverse its decision on facts, it had inherent jurisdiction to correct procedural errors. Having taken instructions, Ms Vanstone indicated that the GMC did not object to Dr Akram withdrawing her previous admissions and to the

Tribunal reversing its decision. The Tribunal therefore retired to consider its position.



MPT: Dr AKRAM 4

12. In so doing, it asked itself whether sufficient reasons had been given by Dr Akram as to why she had made those admissions. She had explained that she had become confused and had simply made an error, which she only realised when being asked whether she admitted allegation 2c, which she had denied on the basis that she had not made an ‘application’ (to which the stem of paragraph 2 referred).

She had denied allegation 3 on the same basis. The Tribunal accepted this explanation taking account of the fact that Dr Akram was unrepresented, had just commenced giving evidence and had indicated that she was under some stress. 13. The Tribunal next considered whether any significant prejudice would be caused to the GMC if allowed Dr Akram to withdraw her admissions and reverse its decision. It noted that Ms Vanstone had indicated that the GMC did not object to the application and therefore it concluded that this was the clearest evidence that no prejudice would result.

14. The Tribunal therefore determined to allow Dr Akram to withdraw her admissions to paragraphs 1, 2a and 2b. In turn it reversed its finding under Rule 17(1)(e). The Allegation and the Doctor’s Response 15. The Allegation made against Dr Akram is as follows:

That being registered under the Medical Act 1983 (as amended):

1. On 2 February 2018, whilst you were suspended from the List of Registered Medical Practitioners following a decision of a Medical Practitioners Tribunal (‘MPT’), you submitted an application to work with NHS Professionals (‘the Application’). To be determined

2. Within the Application you:

a. referred to your GMC registration number;

To be determined but admitted as a fact

b. stated on one or more occasion that you were registered with the GMC;


c. failed to disclose that you:

i. had been suspended by the MPT;




MPT: Dr AKRAM 5

ii. were still suspended. To be determined but admitted as a fact

3. At the time of submitting the Application you knew that you:

a. had been suspended by the MPT; To be determined but admitted as a fact

b. were still suspended. To be determined but admitted as a fact

4. Your actions as set out at paragraph 2 were dishonest by reason of paragraph 3. To be determined

The Facts to be Determined 16. Dr Akram made no formal response to the Allegation against her when the matter came before the Tribunal in April 2019. However, as she was present at this hearing in August 2019, the Tribunal took the opportunity to ascertain whether she admitted any of the allegations against her. Ultimately, Dr Akram denied all the allegations. However, she indicated that her denials of allegations 2 and 3 were based on the fact that she did not admit that she had made an ‘application to work’ as alleged in allegation 1 and therefore could not admit the stems of allegations 2

and 3. However, she did admit paragraphs 2a, 2b, 2c, 3a and 3b as being factually correct. The Tribunal therefore determined that, if it found that Dr Akram had made an application to work, it would find these paragraphs proved by way of admission. 17. The parties therefore agreed that there remained to be determined by the Tribunal two questions, the first being whether the doctor had made an application to work as claimed in paragraph 1. Ms Vanstone accepted on behalf of the GMC that if the Tribunal did not find this allegation proved that the remainder of the paragraphs fell away. However, the parties agreed that, if the Tribunal found paragraph 1 proved then the second decision it had to make was whether Dr

Akram’s actions in paragraph 2 were dishonest by reason of paragraph 3. 18. The Tribunal should also record that prior to Dr Akram giving evidence, both Ms Vanstone and Dr Akram listened to part of the transcript of the previous hearing in April 2019 (in particular, Mr McBride’s closing submissions). Factual Witness Evidence 19. The Tribunal received evidence on behalf of the GMC from the following

witness, Dr B, MD and RO of NHS Professionals, via telephone link; and also in the form of her written statement, dated 13 June 2018.



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20. Dr Akram gave oral evidence.

Documentary Evidence

21. The Tribunal had regard to the documentary evidence provided by the parties. This evidence included, but was not limited to:

• Dr Akram’s letter submitted by email, dated 7 April 2019 • Dr Akram’s reference letter from another agency ‘Locum People’, dated 6 April

2018 • Dr Akram’s record of applications she has submitted, dated between 13 and

27 March 2019

• Dr Akram’s list of various training courses • Previous MPTS determination record, conclusion date 1 February 2017 • Various letters from MPTS and GMC to Dr Akram, between 2 February to 6

March 2017 • Dr Akram’s e-mail to NHS Professionals, including cover letter and CV

attached, dated 2 February 2018

• Various internal and external e-mail exchanges between Dr B, with potential employer Dr A; and GMC contacts, dated 5 and 6 February 2018

• Fitness to Practise Referral Form completed by Dr B, dated 13 April 2018 • Timeline of events internal NHS Professionals e-mail, dated 22 May 2018 • E-mail from Dr Akram in response to the Allegation, dated 24 July 2018 • Various correspondence e-mails between GMC and Dr Akram, between

12 April 2018 to 26 February 2019; the latter being Dr Akram’s request to adjourn the hearing.

• Learning and Review document- Heart failure • Learning and Review document – Rheumatoid arthritis • Letter from Dr Akram dated 30 July 2019 • Letter dated 29 May 2019 to Mr C from Dr E • Emails to Dr Akram from Mr D, Locum People recruitment agency

The Tribunal’s Approach 22. In reaching its decision on facts, the Tribunal has borne in mind that the burden of proof rests on the GMC and it is for the GMC to prove the Allegation. Dr Akram does not need to prove anything. The standard of proof is that applicable to civil proceedings, namely the balance of probabilities, i.e. whether it is more likely than not that the events occurred.

23. The Tribunal reminded itself of the factors to be taken into account when assessing the probability of an event occurring, and considered this in the case of In Re H & Ors (minors), Re [1995] UKHL 16 (05 April 2000), which states:



MPT: Dr AKRAM 7

‘74. Although the result is much the same, this does not mean that where a serious allegation is in issue the standard of proof required is higher. It means only that the inherent probability or improbability of an event is itself a matter to be taken into account when weighing the probabilities and deciding whether, on balance, the event occurred.’

This provides that, in general, the more serious the allegation, it generally being accepted that dishonesty is a particularly serious allegation, the more cogent the evidence is required for the matter to be found proven. Neither the seriousness of the allegation nor the seriousness of the consequences, however, makes any difference to the standard of proof to be applied. 24. Furthermore, on considering the issue of dishonesty, the Tribunal took account of the principles set out in the case of Ivey v Genting Casinos UK Ltd (t/a Crockfords Club) [2017] UKSC 67, in which Lord Hughes set out the correct test for

dishonesty, which is as follows:

’74. When dishonesty is in question the fact-finding tribunal must first ascertain (subjectively) the actual state of the individual’s knowledge or belief as to the facts. … When once his actual state of mind as to knowledge or belief as to facts is established, the question whether his conduct was honest or dishonest is to be determined by the fact-finder by applying the (objective) standards of ordinary decent people.’

The Tribunal’s Analysis of the Evidence and Findings The context and background of the Allegation 25. The Tribunal considered all the evidence presented to it, in which the background of the alleged events is as follows: 26. Between 16 January and 1 February 2017, Dr Akram was subject to a MPT hearing which she did not attend. Amongst the allegations proved against her on that occasion were that Dr Akram had: undertaken locum work at Blackpool Victoria

and Airedale Hospitals for remuneration when she knew that she did not have permission from her primary employer (the City Hospitals Sunderland NHS Foundation Trust (‘the Trust’)) to do so; denied this when asked at a Trust meeting; minimised such locum work in a subsequent letter; and had been dishonest as a consequence. That Tribunal determined to suspend Dr Akram’s registration for a period of 12 months; it also imposed an immediate order of suspension for the appeal period and directed that a review take place. The substantive sanction of suspension for 12 months therefore took effect from 6 March 2017 until 5 March 2018.



MPT: Dr AKRAM 8

The Allegation 27. The Tribunal has considered each outstanding paragraph of the Allegation separately and has evaluated the evidence in order to make its findings on the facts, as follows:

Paragraph 1 28. The Tribunal found that there was no dispute that on 2 February 2018 at 20:26, whilst under suspension, Dr Akram e-mailed NHS Professionals stating:

‘Subject: RE. looking for work Good evening I’m looking for FY2 training/ clinical post/ long-term fixed positions. I attach my resume for your attention. regards <Health application.pdf>’

This email was accompanied by Dr Akram’s resume and a generic letter dated January 2018 which stated:

‘…I am fully qualified medical physician registered with the GMC…’ and ‘Despite not working in the health field, for a couple of years, I reassure you I have kept up to date with the changes in the [NICE] guidelines and am ready for work. I have completed the following courses to ensure that I am clinically competent and up to date with current practices. Please note these are documented in my resume… I would appreciate if you could consider me for the role for which I have applied. I am available for an interview immediately…’ 29. The Tribunal noted Dr Akram’s oral evidence on this point. In particular, it noted that Dr Akram maintained that what she sent on 2 February 2018 was not an application to work with NHS Professionals, as she was not looking for work, but was more of an enquiry. She had been out of the UK until the end of 2017 and wanted to see whether she could obtain a clinical observation position as a preliminary to returning to work as a doctor if and/or when the MPT lifted her suspension. She had said that she had drafted her generic letter in January 2018. The purpose in sending

the email to NHS Professionals on 2 February 2018 was to establish contact with someone there following which she intended to make full disclosure in relation to her



MPT: Dr AKRAM 9

GMC registration status. She had prepared an additional document also in January 2018 which went into further details about her suspension and what she had learned from it. However, she had not sent this document with her email on 2 February 2018. She explained that she had not made full disclosure about her GMC registration because she knew from past experience that if she did so she would not

receive any response. She was adamant that she was not making a job application – she was not responding to a job advertisement and had not completed any application form. She was in any event only seeking a clinical observer post. 30. As confirmed by the parties, the Tribunal first needed to consider whether this communication would be regarded as Dr Akram submitting an ‘application’. 31. The Tribunal noted the advice of the Legally Qualified Chair that the online Oxford Dictionary definition for an ‘application’ was ‘a formal request to an authority for something’, with the synonyms of ‘request’ being ‘petition’, ‘entreaty, ‘plea’, ‘enquiry’, ‘approach’. 32. Furthermore, the Tribunal noted the suggestion that, ordinarily, some ‘formality’ would have to be involved in order to class a communication as an ‘application’, for instance by completing an application form. However, it noted Mr McBride’s submission that the GMC put its case on the basis that even if the Doctor had not made a ‘formal’ application, as she had commenced the process of submitting an application for work, this was encompassed by the word 'application’ in the Allegation. He argued that the Tribunal was to take account of Dr B’s evidence

that 20% of doctor registrations with NHS Professionals were commenced by those doctors simply sending in a CV. Moreover, he submitted that Dr Akram’s covering email was headed ‘Looking for work’ and the wording of her generic letter indicated that she was applying to see if a post was available (in particular her request that she be considered ‘for the role for which I have applied’). 33. The Tribunal also noted that, regardless as to whether Dr Akram’s e-mail was generic, it contained words or phrases which suggested that she was making a job application, such as:

“Subject: RE. looking for work; I’m looking for FY2 training/ clinical post/ long-term fixed positions.’ “Health application…”

34. In addition, Dr Akram’s generic cover letter attached to the e-mail stated: “… I would appreciate if you could consider me for the role for which I have

applied. I am available for an interview immediately. …”



MPT: Dr AKRAM 10

35. The Tribunal had regard to Dr B’s further evidence that this contact by Dr Akram started the recruitment process when the e-mail was brought to Dr B’s attention on 6 February 2018 by a Recruitment Officer colleague. This in turn, caused Dr B to contact Mr A, the Medical Director at City Hospitals Sunderland, where Dr Akram had previously worked, in which Dr B stated in her e-mail on 6

February 2018 (sent at 10.36pm): “The above named doctor has applied to join NHSP locum bank.” This suggests to the Tribunal that Dr Akram’s email sent on 2 February 2018 was in fact treated as an application to work in accordance with the practice of NHS Professionals. 36. Having considered all of the above evidence the Tribunal reached the following conclusions. It was satisfied that the GMC had proved on balance that

Dr Akram submitted an application to work with NHS Professionals when she emailed that organisation on 2 February 2018. The Tribunal notes, in particular, that the subject heading of her email stated ’Looking for work’. The email also stated that she was looking for ‘FY2 training/clinical post/long term fixed positions’. The accompanying generic letter refers to her being ‘ready for work’ and asking that she be considered ‘for the role for which I have applied’. It is therefore clear to the Tribunal that, on the face of it, this was an application seeking work through this locum agency.

37. The Tribunal also notes Ms Vanstone’s submission that there were two ways of interpreting Dr Akram’s oral evidence, namely that either the doctor did not make an application to work but was simply making an enquiry or that she was making an application but only for a clinical observer post. The Tribunal agrees with Ms Vanstone that neither explanation ‘holds water’. Nowhere in either the email, the generic letter or her resume was there any mention of the doctor seeking a clinical observer post. 38. Had Dr Akram merely sent the email without the accompanying documents the Tribunal may have accepted that she was simply making a general enquiry.

However, the Tribunal considers that Dr Akram went further and introduced a significant element of formality by including not only her resume but also the generic letter. Even though the doctor was not responding to any job advertisement or did not complete an application form, taken together, these documents, in the Tribunal’s opinion, constituted an application to work with NHS Professionals. 39. Therefore, the Tribunal found paragraph 1 proved. 40. Having found paragraph 1 proved, the Tribunal took account of Dr Akram’s

factual admissions to the sub-paragraphs of the Allegation set out in paragraphs 2 and 3. Having noted that the stems of each paragraph were now proved, the



MPT: Dr AKRAM 11

Tribunal determined to find the remainder of those paragraphs and sub-paragraphs proved by way of admission. 41. The Tribunal therefore found paragraphs 2a, 2b, 2c(i), 2c(ii), 3a and 3b proved by way of admission.

Paragraph 4 42. The Tribunal next considered the second question, namely whether Dr Akram’s actions, in the application, by referring to her GMC registration number, stating on one or more occasions that she was registered with the GMC, but failing to disclose that she had been suspended by the MPT and was still suspended, were dishonest because at the time of submitting the application she knew that she had been suspended and was still suspended.

43. In considering this question, the Tribunal had regard to the following paragraphs of the current edition of Good Medical Practice (2013) (‘GMP’), as follows (The Tribunal has emphasised by underlining the relevant words): ‘Act with honesty and integrity Honesty 66. You must always be honest about your experience, qualifications and current role. … Communicating information 68 You must be honest and trustworthy in all your communication with patients and colleagues. This means you must make clear the limits of your knowledge and make reasonable checks to make sure any information you give is accurate. … 71 You must be honest and trustworthy when writing reports, and when completing or signing forms, reports and other documents. You must make sure that any documents you write or sign are not false or misleading. a. You must take reasonable steps to check the information is correct. b. You must not deliberately leave out relevant information.’



MPT: Dr AKRAM 12

44. The Tribunal considered that in accordance with GMP, it would have been Dr Akram’s duty to disclose such information and that she was aware, as a registered doctor, albeit suspended, of such a duty. 45. The Tribunal noted Dr Akram’s evidence on why she had omitted reference to

the previous GMC proceedings and suspension. It noted that she candidly stated that she had deliberately withheld full disclosure in relation to her GMC registration because she anticipated that she once again would not receive any response. The Tribunal also notes that she justified this omission by maintaining that she ‘had not told a lie’ and had she received a response she would have made full disclosure once the primary purpose of her communication (to develop a relationship) had been achieved. She did not accept that what she had done was dishonest because of this underlying intention. 46. In deciding the question of dishonesty the Tribunal had regard to the LQC’s

advice. It therefore first considered what was in Dr Akram’s mind at the time that she sent her email on 2 February 2018 at 20.26pm. The Tribunal has found that: Dr Akram was aware that her GMC registration was suspended; she had made an application for employment as a doctor; she was aware of her GMP duty to make full disclosure of all relevant matters and to be truthful at all times; and, most persuasively, had admitted to deliberately withholding such information. On the face of it, therefore, the Tribunal considers that there is cogent evidence before it that Dr Akram was deliberately concealing the fact of her GMC suspension.

47. The Tribunal therefore moved on to consider whether what Dr Akram did was dishonest by the objective standards of ordinary decent people. The Tribunal noted that Dr Akram had deliberately concealed the fact of her GMC suspension. Whilst it may be arguable that some people might deliberately withhold information from their resumes that place them in a poor light and therefore without full information might not consider this to be dishonest, the Tribunal considers that most ordinary decent people would have little hesitation in concluding that such actions are dishonest. 48. Consequently, the Tribunal was satisfied that, although she had opportunity

to indicate that she was suspended and moreover a duty to do so, in withholding information of her suspension from an organisation that had the potential to find her employment, Dr Akram’s actions were dishonest. 49. Therefore, the Tribunal found paragraph 4 proved. The Tribunal’s Overall Determination on the Facts 50. The Tribunal has determined the facts as follows:



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That being registered under the Medical Act 1983 (as amended):

1. On 2 February 2018, whilst you were suspended from the List of Registered Medical Practitioners following a decision of a Medical Practitioners Tribunal (‘MPT’), you submitted an application to work

with NHS Professionals (‘the Application’). Determined and found proved

2. Within the Application you:

a. referred to your GMC registration number; Determined and found proved

b. stated on one or more occasion that you were registered with the GMC;

Determined and found proved

c. failed to disclose that you:

i. had been suspended by the MPT; Determined and found proved

ii. were still suspended. Determined and found proved

3. At the time of submitting the Application you knew that you:

a. had been suspended by the MPT; Determined and found proved

b. were still suspended. Determined and found proved

4. Your actions as set out at paragraph 2 were dishonest by reason

of paragraph 3. Determined and found proved

Determination on Impairment - 15/07/2020 1. This determination will be read in private. However, as this case also concerns Dr Akram’s misconduct a redacted version will be published at the conclusion of the hearing with matters that are confidential redacted.



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2. The Tribunal now has to decide in accordance with Rule 17(2)(l) of the Rules whether, on the basis of the facts which it has found proved as set out before, Dr Akram’s fitness to practise is impaired by reason of misconduct. 3. The Tribunal was informed that in conjunction with the new misconduct

matter, it was to review a previous finding of impaired fitness to practise by reason of misconduct XXX. 4. The Tribunal has considered both the new and review matters in Dr Akram’s case, in accordance with Rule 21A of the Rules. Background to the New Elements of the Case 5. The Tribunal found proved that on 2 February 2018, whilst Dr Akram was suspended from the List of Registered Medical Practitioners (LRMP) following a

decision by a Medical Practitioners Tribunal in 2017, she submitted an application to work with NHS Professionals. The Tribunal also found proved that in that application Dr Akram referred to her GMC registration number and stated on a number of occasions that she was registered with the GMC. The Tribunal further found that at the time of submitting the application Dr Akram knew that she had been and remained suspended but failed to disclose this information and in failing to do so her actions were dishonest. Background to the Review Elements of the Case

6. The Tribunal has been informed of the background to Dr Akram’s review case and of her fitness to practise history. The details of Dr Akram’s previous hearings remain a matter of record and the Tribunal does not propose to rehearse them here, beyond the following summary. The 2017 Hearing 7. Dr Akram’s case was first considered in 2017 (‘the 2017 Tribunal’) by a Medical Practitioners Tribunal, which found the following proved:

• Between 3 November 2014 and 6 February 2015 and whilst working for the

City Hospitals Sunderland NHS Foundation Trust (‘the Trust’), Dr Akram undertook locum work for 10 Hospitals, when she knew she had been XXX excluded from doing so and that she was required to have permission to work elsewhere. It was found that Dr Akram did not have permission to carry out secondary employment, and knew that she should not carry out locum work as she had been so informed by representatives of the Trust;

• Dr Akram was in receipt of sick pay from the Trust between 3 November 2014

and 24 August 2015 and had stated on both 19 February and 22 October



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2014 that she felt unable to increase her working hours. It was also found that Dr Akram worked at Blackpool Victoria Hospital on 7 November 2014 whilst in receipt of sick pay from the Trust;

• Dr Akram had failed to inform locum agencies, through which she had

completed work, that she had been deemed unfit to work by XXX the Trust on 14 November 2014;

• On 11 December 2014 Dr Akram sent an inappropriate email to a colleague

which breached the Trust’s intranet and email Policy;

• On 1 January 2015 Dr Akram had attended a meeting at the Trust in which she stated that she had not been working elsewhere as a locum when she

knew this to be untrue;

• In a letter dated 1 February 2015 Dr Akram stated she had ‘done little more than a few shifts here and there’, which she knew was untrue;

• XXX.

8. The 2017 Tribunal found that Dr Akram’s behaviour in respect of knowingly

needing permission from the Trust, and not having that requisite permission to carry out secondary or locum employment was dishonest. It also found that Dr Akram’s failure to inform agencies of her being deemed unfit to work, her denial of working as a locum externally to the Trust, and her claim that she had ‘done little more than a few shifts here and there’ amounted to both misleading conduct and dishonesty. 9. Notwithstanding that the 2017 Tribunal found a number of matters had been proved against her, it determined that only in relation to the allegations of dishonesty (that (i) she deliberately undertook locum work when she knew that she

should not; and (ii) she lied to representatives of the Trust about the extent of her locum working on two occasions, once in a meeting and once in a letter, in a deliberate attempt to minimise the extent of her locum working) was it found that her actions amounted to misconduct. It found that Dr Akram had breached a fundamental tenet in Good Medical Practice 2013 which was failing to act with honesty and integrity at all times, conduct which would be regarded as deplorable by fellow practitioners. The 2017 Tribunal found that Dr Akram was impaired by reason of her misconduct and XXX and determined to suspend her registration for a period of 12 months.

The May 2018 Review Hearing 10. Dr Akram’s case was reviewed on 12 February, 16 March and 9 May 2018 (‘the 2018 Review Hearing’), having gone part-heard twice. That Tribunal determined that, whilst there was a lot of improvement with regard to Dr Akram’s



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insight and remediation, concerns remained as to her understanding of her misconduct. XXX. 11. The May 2018 Tribunal concluded Dr Akram’s fitness to practise remained impaired by reason of her misconduct and XXX. That Tribunal suspended Dr Akram’s

registration for a further period of four months and directed a review hearing. The October 2018 Review Hearing 12. Dr Akram’s case was reviewed on 22 October 2018. XXX 13. XXX

Misconduct 14. The October 2018 Tribunal considered that there was an evidential burden on Dr Akram to demonstrate that she had addressed and remediated her misconduct. It noted that, although at times Dr Akram had engaged with the GMC, she did not provide any information or documentation to demonstrate that she had developed insight or remediated her misconduct since the May 2018 Review Hearing. XXX. 15. The October 2018 Tribunal concluded that it had no new evidence before it that Dr

Akram had gained insight or remediated her misconduct. It therefore determined that Dr Akram’s fitness to practise was impaired by reason of her misconduct. The October 2018 Tribunal imposed a six-month suspension on Dr Akram’s registration and directed a review, stating that the reviewing Tribunal may be assisted by the following:

• XXX;

• Evidence in the form of a reflective piece that she has reflected on her dishonesty, fully appreciates its gravity and the impact dishonesty has on the public’s confidence in the profession, and that she has fully developed her insight;

• Evidence that she has kept her knowledge up to date during the periods of suspension, which may include evidence of her attendance at CPD programmes; and • Any other information that Dr Akram considers will assist the Tribunal.

16. The October 2018 Tribunal also noted that Dr Akram may have found it helpful to have a mentor; however, this was not a necessary requirement in her development of insight and remediation.



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The April 2019 Tribunal 17. In April 2019 this Tribunal convened to hear a new allegation of misconduct against Dr Akram, who did not attend the hearing. The tribunal determined to proceed in her absence. However, the hearing adjourned part-heard whilst the tribunal was in

camera prior to the facts determination being finalised due to insufficient time. The Tribunal was informed that there were review matters to consider (but not about the substance of the review matters) and that Dr Akram’s suspension concerning the review matters was due to expire on 11 May 2019. It extended the suspension for a further period of four months, until 10 September 2019, determining that such an extension was necessary, proportionate and in the public interest in order to ensure that appropriate safeguards were in place to cover the intervening period before it could reconvene and conclude its deliberations. The April 2019 Tribunal did not consider that it would be appropriate for the order of suspension to lapse.

The August 2019 Tribunal 18. In August 2019 this Tribunal reconvened to conclude its deliberations on the new allegation of misconduct against Dr Akram. On this occasion Dr Akram attended in person but was not legally represented. Notwithstanding that this Tribunal had adjourned the April 2019 hearing whilst in camera considering its decision on facts, it allowed Dr Akram to give evidence and to make submissions. This hearing adjourned due to insufficient time to conclude, the Tribunal having determined the facts relating to the new allegation of misconduct against Dr Akram. The Tribunal noted that Dr Akram’s

suspension was due to expire on 10 September 2019 and determined to extend the order of suspension for a period of six months. The Tribunal was satisfied that it would not have been appropriate to allow the suspension to lapse, given that the outstanding review matters had not been addressed. The Tribunal determined that an extension was necessary, proportionate and in the public interest in order to ensure that appropriate safeguards were in place to cover the intervening period before it could reconvene and conclude its deliberations. The February 2020 Tribunal

19. In February 2020 this Tribunal reconvened (i) to conclude its deliberations on the new allegation of misconduct (by considering the impairment and, if appropriate, the sanction stages) and (ii) to review the substantive order arising from the determinatio n of the February 2017 Tribunal which has last been reviewed in October 2018. However, although Dr Akram attended the hearing in person and was legally represented by her current representatives, that hearing was adjourned XXX. This Tribunal XXX again extended the current suspension of Dr Akram for a further six months, it now being due to expire on 8 September 2020.



MPT: Dr AKRAM 18

20. This Tribunal accordingly reconvened in July 2020 once again to conclude its deliberations on the new allegation of misconduct and to review the substantive order arising from the decision in February 2017. The evidence considered for the review hearing

21. The Tribunal has taken into account all the evidence received during the facts stage of the April and August 2019 hearings, both oral and documentary. In addition, the Tribunal received further evidence as follows.

• GMC review bundle dated February 2020 • GMC review bundle dated July 2020 • XXX

• XXX • XXX • XXX • XXX

22. XXX

23. Dr Akram provided her own witness statement dated 11 July 2020 and a reflection dated 12 July 2020. Dr Akram did not give any oral evidence. 24. The Tribunal also received the following documents from Dr Akram:

• Duty of candour course 16 May 2019 including a reflective statement on the course

• Letters dated 17 April 2019 and 1 July 2019 from Dr Akram regarding courses

upon which she had enrolled, had completed and the CPD points they would attract

• Letter dated 8 July 2019 from Dr Akram to the Tribunal with a reflection statement and declaration of what, behaviourally, can be expected from Dr Akram in the future

• A duty of candour course programme from the Medical Defence Union, certificate of attendance for Dr Akram, and a learning and reflection statement on the duty of candour

• CPD Certificates for courses attended by Dr Akram between April and June 2019

• Royal College of Physicians of Edinburgh course programme for acute and general internal medicine, a certificate of attendance for Dr Akram, and a list of participants (which includes Dr Akram)

• Resuscitation Council (UK) Advanced Life Support Course Script-safe prescribing course for physicians

• Statement of supporting information on NHS jobs website, dated March 2019 • Letter dated 6 April 2018 from Mr D regarding Dr Akram



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confirming that Akram is seeking clinical attachments and declared her suspension status

• Letter dated 10 January 2020 from Ms J to Dr Akram confirming a clinical attachment in medicine at Pinderfields and Dewsbury Hospital, commencing on 14 January 2020 and ending on 13 March 2020 and

write-ups of observations during the clinical attachment • Dr Akram’s statement, February 2020 • Certificate of attendance and the course content for a probity and ethics

course • Email from Dr Akram to Dr K regarding supervision, dated 12 July 2020 • Certificates of online CPD courses

25. XXX 26. XXX 27. XXX

28. XXX 29. XXX

30. XXX 31. XXX 32. XXX 33. XXX

34. XXX 35. The Tribunal noted Dr Akram’s reflective statement dated 8 July 2019 in which she stated:

‘In light of my determination and love of medicine I request humbly that I'm allowed to practice. Furthermore, I would like to please ask for permission so that I may apply for LAS/Fixed term or Trust doctor posts. Please don't think this is about me trying to make money, it's about finding a way to get my foot back in through the door so that I may begin to practice again. With my current fitness to practice situation, and being out of work for so long it is extremely difficult for me to gain a clinical observership let alone a job locally. By applying for the above named positions I can adhere to the GMC orders and complete my foundation programme proficiencies all under



MPT: Dr AKRAM 20

the supervision of the GMC. I do realise that in my previous orders I was prohibited to work as a locum, however under these circumstances the jobs I apply for will allow me to gain exposure and start to work again. I have and will again accept my mistake- my dishonest actions were inexcusable. But it has been many years now, I have matured, accepted the responsibility of my ways and have taken steps to better myself in the professional field. I have taken steps to enhance learning, to better understand my mistakes and have developed insight. Without repeating much of what I have written in the learning and reflection document for probity I can assure you this has been a very difficult life lesson. I have continued looking to gain a clinical observership post but to no avail. I have kept up to date with my professional development. I feel that I have worked very hard to be in the position I am today. I only hope that I will be given the opportunity to show that I am a doctor the GMC will be happy with. Whilst my colleagues and patients will respect and trust. What the GMC can expect from me: 1. Openness, honesty and full disclosure 2. Keep the GMC up to date with current employer details and point of contact 3. Be open and honest with my employer about my fitness to practice and probity concerns 4. Ensure I have a Clinical or Educational supervisor as a point of contact with the GMC and that he/she can supervise my work and keep the GMC informed of progress 5. Ensure any changes in employment are given in writing/email to the GMC so that the GMC is always aware of my movements 6. Complete my FY1/FY2 proficiencies and have these signed off - Inform the GMC of this on completion 7. Continue with my Professional development - Keep the GMC updated 8. Inform the GMC if I move abroad to work as a physician 9. Complete and adhere to any other orders the GMC has mentioned 10. Meet to review progression with the GMC as required. 11. Always keep the GMC in the loop irrespective of minor changes



MPT: Dr AKRAM 21

12. To use this opportunity wisely and never place myself in a situation whereby my integrity and morals are placed under question. I can only ask for an opportunity to remedy my mistake. I hope that I can be forgiven and that my development and progression is more obvious now, as is my insight into my wrong ways and poor decision making. I humbly took forward to your review and judgement at the tribunal’

36. The Tribunal noted Dr Akram’s statement dated 11 July 2020:

‘2. [XXX] 3. [XXX] 4. [XXX] 5. On the 4th July I completed a professional ethics course entitled Probity and Ethics course. This accounted for 5 hours CPD. 6. I have made various attempts to obtain a consultant mentor and have approached two individuals who are confirming their position with their respective hospitals. 7. Prior to the last MPTS hearing I had arranged a clinical observership and was attending at Pinderfields Hospital with [Dr M] in the acute medical admissions unit and Ambulatory care department.’

37. Further, in a separate twenty-three page long reflection dated 12 July 2020 Dr Akram went on to say:

‘Conclusion – what else could you have done? When looking back at the progress I have made I feel I have had ample time to learn and reflect. Understanding and acknowledging my mistakes has not only broadened my capacity to understand what I did wrong but what was expected of me as a clinical physician. To summarise I know what I did was wrong, it was selfish, stupid and reckless. Had I understood the further implications of my actions I feel in no circumstances would I have taken the actions that I did or made the decisions I made irrespective of the pressures placed on me. Learning and reflecting has allowed me to develop insight which I did not possess at the start of the hearing process. Despite taking much time, I feel I have developed sufficient insight to realise my actions were not only unprofessional but also did not act with probity. They not only compromised me as a doctor but the trust placed within the medical



MPT: Dr AKRAM 22

profession by patients and the general public. This could have an adverse affect on patients' trust and thereby our ability to manage their care optimally. As a doctor I know that my primary responsibility is to my patient and my profession. Maintaining and developing trust is an integral part to allow us to keep our patients safe. As a doctor I have high standards and moral ethics to which I should adhere to at all times. It is important to be always open and honest, particularly when mistakes are made. One should accept and take responsibility for his/her actions and take the onus onto themselves to learn and better themselves so that such mistakes don’t happen again. Having good ethics is equipotent to having good behaviours which is equivocal for the development of the characteristics needed to be a doctor. Action Plan – what will you do next time? Ask for help early. If I'm unsure of something, seek advice sooner rather than later. If a mistake was to happen, accept responsibility and inform the necessary people. Take accountability. Take responsibility. Take measures so this does not happen again. Do not lie. Be open and honest. Always act with probity. Learn to manage stress better- [XXX]. Think calmly of consequences and outcomes before acting. If angry, wait till [XXX] and more calm before taking action. Never place my reputation and integrity on the line again. Remember the pain and suffering I have endured, the pain and humiliation caused to my family- this should be more than enough for me to make a sound judgement. If I am unhappy about something, formulate measures in a calm, concise professional manner via the proper channels. Emotional decision making is risky and potentially could result in poor decision making Continue learning and reflecting during clinical practice and ethics - How can I better myself Always remember the consequences my actions will have on peers, patients, the general public and the GMC. Read, learn and develop insight as part of professional development. Review the GMC guidelines more frequently as a source of review. Never abuse the trust placed in me as a doctor and always put my patients safety first. Continued development of insight.’

Submissions 38. Both parties provided the Tribunal with written and oral submissions. The following is a summary of those submissions.

39. On behalf of the GMC, Ms Vanstone suggested that, when determining whether Dr Akram’s fitness to practise remains impaired for the purposes of this review hearing, the



MPT: Dr AKRAM 23

Tribunal had also to take into account its findings of fact in respect of the new allegations. The GMC invited the Tribunal to find that Dr Akram’s fitness to practise is currently impaired.

40. XXX

41. Ms Vanstone reminded the Tribunal of the two misconduct matters arising from the allegations heard in 2017 and those heard in 2019. She stated that the dishonesty allegations found proved in 2017 were found to amount to misconduct. She submitted that the later allegations also amounted to misconduct.

42. Ms Vanstone submitted that Dr Akram has breached paragraphs 65, 66, 68 and 71 of Good Medical Practice (2103), which state:

‘65. You must make sure that your conduct justifies your patients’ trust in you and the public’s trust in the profession. 66. You must always be honest about your experience, qualifications and current role. 68. You must be honest and trustworthy in all your communication with patients and colleagues. This means you must make clear the limits of your knowledge and make reasonable checks to make sure any information you give is accurate. 70. When advertising your services, you must make sure the information you publish is factual and can be checked, and does not exploit patients’ vulnerability or lack of medical knowledge.’

43. She reminded the Tribunal that Dr Akram’s dishonest actions in the second misconduct matter occurred when she was already on a substantive order of suspension for the first matter of dishonesty. Moreover, her actions giving rise to the second matter took place some ten days before the review hearing in relation to the first matter, which was scheduled for hearing on 12 February 2018.

44. Ms Vanstone submitted that Dr Akram’s fitness to practise remains impaired by virtue of the allegations heard in 2017, and is also impaired by virtue of the findings made by this Tribunal last summer. 45. Ms Vanstone referred the Tribunal to the case of CHRE v NMC and Grant [2011] EWHC 927 (Admin) which refers to the importance of the wider public interest being taken into account at this stage, when determining impairment by reason of misconduct.

46. Ms Vanstone stated that Dr Akram has made some efforts to obtain work and some efforts to develop insight, but submitted that, although they were perhaps



MPT: Dr AKRAM 24

more than cursory they did not go far enough. She submitted that the previous Tribunal had been generous in concluding that the first matter was a ‘one-off’ with no ‘significant’ risk of repetition. She stated that Dr Akram has repeated the dishonest conduct.

47. Ms Vanstone referred the Tribunal to the case of Abrahaem v GMC [2008] EWHC 183 (Admin) which states that the reviewing Tribunal must consider whether all of the concerns raised have been addressed. She stated that there is a persuasive burden on the doctor to evidence that past impairments have been sufficiently addressed. 48. Ms Vanstone referred the Tribunal to paragraph 164 of the Sanctions Guidance on factors applicable at review hearings, and submitted that, in particular, ‘Re-offending’ (set out at (b)) is relevant in this case.

49. In relation to remediation Ms Vanstone referred the tribunal to the case of Cohen v GMC [2008] EWHC 581. She submitted that Dr Akram’s dishonest conduct is attitudinally notoriously difficult to remedy, that it has not been remedied and was not highly unlikely to recur. Ms Vanstone gave a number of examples as to why Dr Akram’s misconduct has not been remedied. 50. XXX 51. Mr Hughes XXX. He submitted that, although Dr Akram accepted that the new

matters found proved amounted to misconduct, her fitness to practise was not currently impaired by reason of misconduct. He reminded the Tribunal that even the most recent allegation was two and half years old and that Dr Akram has now been suspended for three years and five months. 52. He submitted that XXX, and there was evidence of CPD. He reminded the Tribunal that Dr Akram has undertaken a clinical observership which was unfortunately cut short due to the pandemic. 53. He submitted that Dr Akram’s reflective statements demonstrate an evolution of

thinking which goes far enough to show that she has demonstrated insight. Mr Hughes reminded the Tribunal that the May 2018 Tribunal was previously impressed with her developing insight. He conceded that Dr Akram has in the past ‘buried her head in the sand’ and has at times failed to engage fully with the GMC. However, he stated that Dr Akram recognises the seriousness of the situation but has continued to build on that insight as demonstrated by her remediation. He submitted that there has been an improvement of Dr Akram’s insight and reflection. 54. He reminded the Tribunal that Dr Akram has struggled with XXX and familial

responsibilities, which is no excuse or defence, but must have had an impact on her decision making.



MPT: Dr AKRAM 25

55. Mr Hughes stated here has been no repetition of the misconduct in the two and a half years since Dr Akram sent the email on 2 February 2018 and said that there have never been any clinical concerns about her practice. He submitted that Dr Akram has demonstrated regret and remorse.

56. In relation to Dr Akram’s reflective pieces Mr Hughes reminded the Tribunal that she is not a lawyer and therefore should not be expected to draft her statements like one, but it was clear that she was addressing both occasions of misconduct. 57. XXX The Relevant Legal Principles 58. The Tribunal reminded itself that at this stage of proceedings, there is no burden

or standard of proof and the decision of impairment is a matter for the Tribunal’s judgement alone. 59. In approaching the decision, the Tribunal was mindful of the two-stage process to be adopted: first whether the facts as found proved amounted to misconduct and that the misconduct was serious and then whether the finding of that misconduct which was serious could lead to a finding of impairment. 60. The Tribunal must determine whether Dr Akram’s fitness to practise is impaired

today, taking into account her conduct at the time of the events and any relevant factors since then such as whether the matters are remediable, have been remedied and any likelihood of repetition. 61. The Tribunal took account of the cases of Roylance v GMC (2) [2000] 1AC 311 and Nandi v GMC [2004] EWHC 2317 (Admin). In summary:

• in Roylance v GMC (2) [2000]1AC 311 it was said that misconduct is a word of general effect involving some act or omission which falls short of what would be proper in the circumstances. The standard of propriety may often be found by reference to the rules and standards ordinarily required to be followed by a medical practitioner in the particular circumstances.

• in Nandi v GMC [2004] EWHC 2317 (Admin) emphasised the need to give the

adjective ‘serious’ proper weight and observation that in other contexts, misconduct has been referred to as ‘conduct which would be regarded as deplorable by fellow practitioners’.

Misconduct – new (2019) matters 62. In determining whether Dr Akram’s fitness to practise is currently impaired by

reason of misconduct, the Tribunal first considered whether the new facts found proved



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in August 2019 amount to misconduct. This Tribunal found that whilst suspended (by reason of the decision of the MPT on 1 February 2017), Dr Akram: (i) on 2 February 2018 submitted an application to work with NHS Professionals;

(ii) referred in that application that she was registered with the GMC and to her GMC registration number; (paragraphs 2a and 2b) (iii) failed to disclose that she had been, and still was, suspended by the MPT (paragraphs 2c(i) and 2c(ii)) (iv) knew that she had been and remained suspended (paragraphs 3a and 3b)

(v) acted dishonestly in relation to matters (ii) and (iii) above. (paragraph 4) 63. The Tribunal was satisfied that the findings of dishonesty only applied to paragraph 2c in its entirety and paragraph 3 also in its entirety and did not apply to paragraphs 2a and 2b. 64. The Tribunal noted its decision on facts that, Dr Akram, in omitting information, namely that she was suspended from practice, on an application that was relevant to her work, was dishonest. Accordingly, Dr Akram, by omission, gave the impression that

she was fit to practise without restriction, which was an impression that she knew she was not entitled to give and therefore was acting dishonestly when she did so. 65. The Tribunal also considered whether Dr Akram’s misconduct constitutes a serious departure from GMP. The Tribunal identified that paragraphs 65, 66, 68 and 71 of Good Medical Practice (as above) are relevant. The Tribunal considered that Dr Akram’s dishonest actions were significant departures from GMP. It has also borne in mind that dishonesty is regarded as a particularly serious matter, as indicated in the Sanctions Guidance. Further Dr Akram has breached a fundamental tenet of the profession with her dishonest behaviour which has brought the profession into disrepute.

66. The Tribunal therefore concluded that Dr Akram’s dishonesty was serious and her conduct fell so far short of the standards of conduct reasonably to be expected of a doctor as to amount to misconduct. Misconduct – review (2017) matters 67. The Tribunal accepted the Legally Qualified chair’s advice that it is entitled initially to presume impairment in relation to Dr Akram’s misconduct found in

February 2017 and to see whether anything has changed in the interim.



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Impairment by reason of misconduct – current assessment 68. The Tribunal noted the allegations found proved in February 2017 were that Dr Akram:

(i) deliberately undertook locum work when she knew that she should not have done so; (ii) failed to inform locum agencies that the Trust’s XXX had found her unfit to work; and (iii) lied to representatives of the Trust about the extent of her locum working on two occasions, once in a meeting and once in a letter, in a deliberate attempt to minimise the extent of her locum working.

69. The Tribunal noted that the May 2018 Tribunal found that Dr Akram had attained some insight into her misconduct and considered that she had begun to realise that what she had done was wrong. The Tribunal has, however, borne in mind that, at the time, Dr Akram was under investigation for the February 2018 matters, which the May 2018 Tribunal was not aware of. 70. The Tribunal must determine whether Dr Akram’s fitness to practise is currently impaired by reason of misconduct and/or XXX, taking into account her conduct at the time of the events and any relevant factors such as whether the

matters are remediable, have been remedied, any development of insight and the likelihood of repetition. 71. The Tribunal noted that whilst there is no statutory definition of impairment, it is assisted by the guidance set down by Dame Janet Smith in the Fifth Shipman Report and the more recent approach in CHRE v NMC and Paula Grant , both of which recognise that when determining whether a doctor is fit to practise today it must take account of past actions or failures to act. In particular, the relevant considerations as to whether Dr Akram’s Fitness to Practise is impaired are whether she:

‘a. Has in the past acted and/or is liable in the future to act so as to put a patient or patients at unwarranted risk of harm; and/or

b. Has in the past or is liable in the future to bring the medical profession into disrepute; and/or

c. Has in the past breached or is liable to breach in the future one of the fundamental tenets of the medical profession […]’



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72. In the case of CHRE v. NMC and Grant [2011] EWHC 927 (Admin) in which Mrs Justice Cox states that the relevant panel 'should generally consider … whether the need to uphold proper professional standards and public confidence in the profession would be undermined if a finding of impairment were not made in the particular circumstances.’ 73. The Tribunal took into account the guidance given by Cranston J. In the case of

Cheatle v GMC [2009] EWHC 645 (Admin) as follows: ‘In my judgment this means that the context of the doctor’s behaviour must be

examined. In circumstances where there is misconduct at a particular time, the issue becomes whether that misconduct, in the context of the doctor’s behaviour both before the misconduct and to the present time, is such as to mean that his or her fitness to practise is impaired. The doctor’s misconduct at a particular time may be so egregious that, looking forward, a panel is persuaded that the doctor is simply not fit to practise medicine without restrictions, or maybe at all. On the other hand, the doctor’s misconduct may be such that, seen within the context of an otherwise unblemished record, a Fitness to Practise Panel could conclude that, looking forward, his or her fitness to practise is not impaired, despite the misconduct.’

74. The Tribunal next considered the test of impairment as stated in the case of Cohen v. GMC [2008] EWHC 581 (Admin):

‘It must be highly relevant in determining if a doctor’s fitness to practise is impaired that first his or her conduct which led to the charge is easily remediable, second that it has been remedied and third that it is highly unlikely to be repeated.’

75. Further, the Tribunal reminded itself that it had to ask whether Dr Akram has had exhibited remorse and had demonstrated insight into her failings. 76. Having found that Dr Akram’s actions amounted to misconduct which was serious, the Tribunal went on to consider whether, as a result, her fitness to practise is currently

impaired by reason of her misconduct. 77. In determining whether a finding of current impairment of fitness to practise is necessary, the Tribunal first of all looked for evidence of insight and remediation and the likelihood of repetition balanced against the three elements of the statutory overarching objective. 78. The Tribunal noted another passage in Dr Akram’s reflection, dated 12 July 2020:

‘Insight to my understanding is that all about recognising one's mistake, understanding and acknowledging that what they did was wrong. It is about



MPT: Dr AKRAM 29

accepting responsibility for one's actions. It deals with how we respond to and handle a situation should this arise in the future. I cannot move on from this section without mentioning the job application via email I made. Can I please first state that I had come prepared to manage discussions regarding the first aspect of my case and upon questioning, I was greatly confused. I couldn't recall the email in question and in kind responded with what I only could remember. Around that time I was genuinely looking for clinical observership posts, in addition to that a hearing was due and I was expecting the outcome to be favourable to allow me to practice with conditions or supervision. The truth of the matter is I made two mistakes. Firstly, I should have clarified my situation in the email about the fact I was suspended and that I was hoping to be cleared for work following the upcoming hearing. This is something I have to develop further. My second mistake was that I was ill prepared for the hearing regarding the email. I cannot recall receiving the bundle as I was abroad and as such when questioned I struggled to remember what this was about and was not able to explain myself further. Therefore when questioned my responses may have appeared to be vague and avoiding what needed to be addressed. What this has taught me is to ensure I am prepared to face the tribunal, make sure I am ready to attend to and manage the matter at hand. Secondly, when I am looking for clinical observership posts make sure I clarify my situation. Thirdly, If I am to apply for a job, hoping that my situation is resolved I need to provide the full details. I did not intend to be dishonest, however I can appreciate why the panel found me to be dishonest and I do not disagree with that finding.’

79. The Tribunal considered that in this particular reflection Dr Akram failed to

acknowledge that what she did in February 2018 was dishonest. The Tribunal noted in her oral evidence in August 2019 that Dr Akram admitted that she deliberately concealed that she was suspended and said that when she disclosed that she was suspended she would not receive a response to her emails. The Tribunal had concluded that in sending the February 2018 application, Dr Akram’s strategy was, by her own admission, to withhold the information that she was suspended in the hope of making a contact to build a relationship, which when a relationship was established, she would then inform them about her suspension. This finding and the evidence which led to it does not square with her now saying ‘I did not intend to be dishonest’. Essentially, the Tribunal considered that Dr Akram has difficulty in recognising what constitutes dishonesty. In the February 2018 matter her dishonesty



MPT: Dr AKRAM 30

was deliberately ‘by omission’ which is as serious as deliberately telling lies. On the evidence currently before it, the Tribunal considered that Dr Akram does not appreciate this distinction. 80. Further, the Tribunal does not accept that Dr Akram was ‘confused’ at the

hearing in August 2019 when answering questions about the February 2018 email. The Tribunal has reviewed the transcript of that hearing and was satisfied that Dr Akram fully understood what was in her mind at the time and, as observed in its determination on facts above, candidly admitted deliberately omitting reference to her suspension when sending the email. The Tribunal considered that her responses to being asked about that incident were anything but ‘vague’ as she suggests. 81. Moreover, although Dr Akram accepts that she should have ‘clarified’ that she was suspended, she maintains that its omission was simply a ‘mistake’, notwithstanding that the Tribunal found that it was calculated and deliberate

dishonesty. In addition, Dr Akram fails to acknowledge or appreciate that such omission was a repetition of dishonest conduct of the same nature as some of her previous dishonesty (when she failed to inform locum agencies that XXX the Trust had deemed her XXX unfit to work). 82. The Tribunal noted some developing insight when Dr Akram appeared to realise that she had been ‘putting her head in the sand’. The Tribunal considered that, essentially, Dr Akram has provided copious evidence that she had completed steps towards remediation in respect of the 2017 Tribunal’s finding of misconduct but very

little evidence in regard to this Tribunal’s finding of misconduct in August 2019 and its implications with regard to her repetitive behaviour. 83. The Tribunal accepts that Dr Akram’s July 2020 reflections seem to indicate that she realises that she should have disclosed her fitness to practise history and suspended status at that time of her application to work with NHS Professionals. However, the Tribunal is of the opinion that no matter how much Dr Akram says she has reflected on her actions in February 2018, she has still failed to articulate how they were dishonest and why she repeated her dishonest behaviour. Accordingly, the Tribunal was not satisfied that Dr Akram recognises that by her omissions her actions were dishonest.

84. Moreover, the Tribunal took account of Dr Akram’s email dated 12 July 2020 to Dr K, in which she states:

‘So all in all a few poorly made decisions have resulted in the mess I am in. My license remains suspended. The GMC is looking for me to 1) complete a professional ethics course (Which I have done so) 2) get a consultant supervisor 3) continue my professional development.’

85. The Tribunal agrees with Ms Vanstone that this email is a further example of Dr Akram’s apparent failure to fully disclose her dishonest conduct. Dr Akram refers



MPT: Dr AKRAM 31

to the misconduct as a ‘breach of contract’ and ‘mistakes’ but fails to mention her dishonesty. The Tribunal considered this email was a prime opportunity for Dr Akram to demonstrate that she has gained full insight into her dishonesty, but again it would appear that she has a tendency not to be fully open to third parties about her background. The Tribunal therefore considered that Dr Akram ‘played down’ her

culpability to her proposed mentor Dr K when she had the opportunity to fully disclose her fitness to practise history. 86. The Tribunal considered that Dr Akram has gained has some insight into her misconduct and has started to consider her dishonesty and its impact of the reputation of the profession. It noted that Dr Akram has done some remediation by attending two ethics courses but considered that she has failed to properly apply her learning to her own dishonest actions both in 2017 and 2018, particularly in how they were connected. The Tribunal considered that whilst Dr Akram may have a better understanding on what she did and where she went wrong, she has failed to provide any real reflection on why

she repeated her actions. 87. In conclusion, the Tribunal is of the opinion that Dr Akram appears to have failed to recognise that withholding or playing down information in any communication is wrong. Further, Dr Akram appears to have failed to recognise that her behaviour was a repetition of the dishonesty found by the February 2017 Tribunal. 88. In the light of the Tribunal’s findings with regard to the seriousness of Dr

Akram’s misconduct, its concerns over the lack of evidence before it of sufficient remediation on her part, and its concerns with her limited insight, the Tribunal was not satisfied that Dr Akram would not repeat her misconduct in the future. It therefore concluded that she has not personally remediated her dishonest actions in accordance with the Cohen test. 89. In addition, taking account of all the circumstances, the Tribunal determined that a finding of impairment is necessary to protect and promote the health, safety and wellbeing of the public, to promote and maintain public confidence in the medical profession, and to promote and maintain proper professional standards and conduct for

members of the profession. 90. The Tribunal considered that that Dr Akram’s misconduct damaged public trust in the profession. It considered that a member of the public, fully informed of the circumstances, would be shocked if a finding of impairment was not made and her actions would be considered deplorable by fellow practitioners and the wider public. It has borne in mind the need to uphold proper professional standards and public confidence in the profession which would be undermined if a finding of impairment were not made in the particular circumstances.



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91. Accordingly, the Tribunal determined that Dr Akram’s fitness to practise is impaired by reason of her misconduct. XXX

92. XXX

93. XXX

94. XXX. 95. XXX. Determination on Sanction - 17/07/2020 1. This determination will be read in private. However, as this case also concerns Dr Akram’s misconduct a redacted version will be published at the conclusion of the hearing with matters that are confidential redacted. 2. Having determined that Dr Akram’s fitness to practise is impaired by reason of misconduct XXX, the Tribunal now has to decide in accordance with Rule 17(2)(n) of the Rules on the appropriate sanction, if any, to impose.

The Evidence 3. The Tribunal has taken into account evidence received during the earlier stages of the hearing where relevant to reaching a decision on sanction. Submissions 4. On behalf of the GMC, Ms Vanstone highlighted the aggravating factors in this case and referred the Tribunal to paragraph 50 of the Sanctions Guidance (November 2019) (the SG):

‘50 It is important for tribunals to consider insight, or lack of, when determining sanctions…’ 5. She reminded the Tribunal of the previous finding of impairment and maintained that it is an aggravating factor. She stated that Dr Akram has been suspended for over three years and despite previous Tribunals guiding her, she has been unable to demonstrate full insight and remediation. Ms Vanstone questioned whether this was a case where full insight and remediation could ever be demonstrated. She stated that Dr

Akram failed to acknowledge that she has repeated her misconduct and cannot recognise what constitutes dishonesty.



MPT: Dr AKRAM 33

6. Ms Vanstone referred the Tribunal to paragraphs 120-128 in the SG relating to dishonesty, in particular paragraphs 120, 124, 125 and 128:

‘120 Good medical practice states that registered doctors must be honest and trustworthy, and must make sure that their conduct justifies their patients’ trust in them and the public’s trust in the profession. 124 Although it may not result in direct harm to patients, dishonesty related to matters outside the doctor’s clinical responsibility (eg providing false statements or fraudulent claims for monies) is particularly serious. This is because it can undermine the trust the public place in the medical profession. Health authorities should be able to trust the integrity of doctors, and where a doctor undermines that trust there is a risk to public confidence in the profession. Evidence of clinical competence cannot mitigate serious and/or persistent dishonesty. 125 Examples of dishonesty in professional practice could include: a … b … c … d … e failing to take reasonable steps to make sure that statements made in formal documents are accurate. 128 Dishonesty, if persistent and/or covered up, is likely to result in erasure

7. Ms Vanstone stated that the facts found proved in February 2017 represent misconduct spanning fourteen months to which was to be added the misconduct in relation to the February 2018 allegation, which is clearly persistent dishonesty. She stated, in addition, that the email to Dr K on 12 July 2020 (which omitted any reference to the February 2018 application) clearly demonstrated an unwillingness for Dr Akram to take responsibility for her actions, even though it was a prime opportunity for her to demonstrate full insight.



MPT: Dr AKRAM 34

8. Ms Vanstone submitted that the Tribunal may consider that Dr Akram’s registration is fundamentally incompatible with continued registration and referred the tribunal to paragraphs 108 and 109 of the SG:

‘108 Erasure may be appropriate even where the doctor does not present a risk to patient safety, but where this action is necessary to maintain public confidence in the profession. For example, if a doctor has shown a blatant disregard for the safeguards designed to protect members of the public and maintain high standards within the profession that is incompatible with continued registration as a doctor. 109 Any of the following factors being present may indicate erasure is appropriate (this list is not exhaustive).

a A particularly serious departure from the principles set out in Good medical practice where the behaviour is fundamentally incompatible with being a doctor. … h Dishonesty, especially where persistent and/or covered up (see guidance below at paragraphs 120–128). … j Persistent lack of insight into the seriousness of their actions or the consequences.

9. Ms Vanstone invited the Tribunal, in all of the circumstances of this case, to determine that that Dr Akram’s name should be erased from the medical register. 10. On behalf of Dr Akram, Mr Hughes submitted that erasure is disproportionate in the circumstances given, not least, the passage of time since the misconduct and the efforts Dr Akram has made to remediate her position. He invited the Tribunal to err on

the side of caution, given that XXX. He advised the Tribunal that Dr Akram had chosen not to give oral evidence at this stage (because of XXX) but that she had heard ‘loud and clear’ what the Tribunal had said about her current impairment and that she ‘implores the Tribunal’ for another opportunity to demonstrate that she could develop insight. Accordingly, he stated that the Tribunal may feel that hearing oral evidence from Dr Akram at a future Review Hearing may be preferable to reaching a final decision on sanction now. XXX

11. XXX.



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12. Mr Hughes reminded the Tribunal that it must consider and balance any mitigating factors presented by the doctor against the central aim of sanctions and invited it to take into account the following mitigation:

a. Dr Akram’s engagement with the proceedings, which has improved in recent months; b. The age of the misconduct (over four years ago for the locum matter and two and half years ago for the email matter); c. No evidence of concern with respect to Dr Akram’s clinical abilities; d. No evidence that any patients came to harm as a result of Dr Akram’s actions;

e. Obtained an observership (as recommended by the Tribunal); f. XXX; g. XXX; h. Evidence that Dr Akram is adhering to important principles of good practice (e.g. keeping up to date with her skills and CPD);

i. The stage of Dr Akram’s career (she was a relatively inexperienced FY2 trainee at the time of the first misconduct and is capable of contributing to the profession in the future); j. The circumstances leading up to the incidents (the Trust’s “heavy handed” approach to Dr Akram, XXX at the time of the locum matter and her personal difficulties, including XXX at the time of the email matter); k. Dr Akram’s remorse and regret, progressing from some remorse in 2017 (page

35 of the Review Hearing Bundle, paragraph 9), to her being “sincerely sorry” in March 2018 (Page 51 of the Review Hearing Bundle) to the expression of remorse and regret in Dr Akram’s most recent reflective statement (page 95 of Dr Akram’s bundle); and l. Dr Akram’s commitment to the profession and her role being plain from her reflective statements.

13. He reminded the Tribunal that it has previously accepted mitigation incorporating

some of these points. He submitted that none of the aggravating factors in the SG



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apply in this case, save for the Tribunal having to consider two dishonesty matters, which of course is serious. 14. Mr Hughes XXX. He told the Tribunal that in light of its impairment determination, Dr Akram recognises that the possibility of practising with conditions attached to her

registration is remote and indeed an unrealistic aim and does not seek to be allowed to practise with conditions at this time but hopes that such practice is a possibility in the future. 15. Mr Hughes invited the Tribunal to suspend Dr Akram. He referred the Tribunal to paragraph 93 of the SG:

‘93 Suspension may be appropriate, for example, where there may have been acknowledgement of fault and where the tribunal is satisfied that the behaviour or incident is unlikely to be repeated. The tribunal may wish to see evidence that the doctor has taken steps to mitigate their actions (see paragraphs 24–49).’

16. Mr Hughes submitted that there is certainly an acknowledgement of fault by Dr Akram and she accepted that the email matter amounted to misconduct. He to ld the Tribunal that Dr Akram acknowledges that she has further work to do in respect of the email matter and her appreciation of her wrongdoing, as set out in the its determination.

17. In respect of the possibility of repetition, Mr Hughes stated that the Tribunal may ask itself, ‘Would Dr Akram put herself through this process again?’ He submitted that she would not XXX. He stated that at a Review Hearing in the future, XXX, she hopes to XXX give oral evidence. He stated that the Tribunal may consider it important to hear oral evidence from Dr Akram before making a determination as final as erasure. 18. Mr Hughes submitted that a suspension of 12 months, added to the current period of suspension, would elapse on 8 September 2021. He said that this would represent suspension for a period of 4 years, 7 months and 7 days and noted that such a period is only just shorter than the five-year period after which a doctor can apply for restoration

following erasure. 19. Mr Hughes submitted that erasure would be disproportionate in the circumstances as it is punitive and not in the public interest in this case. He submitted that erasure is not the only means by which the interests of the public can be protected, which is a requirement for erasure to take place. 20. Mr Hughes referred the Tribunal to the SG which states that dishonesty ‘if persistent and/or covered up, is likely to result in erasure’ but submitted that this does

not require that Dr Akram’s registration be erased, nor suggest certainty in what must happen where there has been dishonesty. He submitted that it allows for the possibility ,



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in some cases, of a Tribunal exercising its discretion not to erase where there has been dishonesty. Mr Hughes submitted that, given Dr Akram’s XXX and personal background, suspension would be appropriate, particularly given how long it has taken to arrive at this point.

21. Mr Hughes reminded the Tribunal that Dr Akram has expressed at length the long-held ambition she had to become a doctor XXX. However, given the passage of time and the considerable effort that Dr Akram has put into remediation (acknowledging that more work is required), he submitted that she has adequately demonstrated the potential to rehabilitate fully. 22. Mr Hughes reiterated that erasure is disproportionate in this matter and a further period of suspension would permit Dr Akram the opportunity to do what work remains to be done to adequately demonstrate rehabilitation in the future. He stated that at a review Dr Akram would have the opportunity to demonstrate in person what she has

learned and articulate, perhaps better than she has done in writing, the learnings of her work from the beginning of 2018 onwards. The Tribunal’s Approach 23. The decision as to the appropriate sanction to impose, if any, in this case is a matter for this Tribunal exercising its own judgement. In reaching its decision, the Tribunal has taken account of the SG although it acknowledges that it can depart from its recommendations for good reason. It has borne in mind that the purpose of

the sanctions is not to be punitive, but to protect patients and the wider public interest, although they may have a punitive effect. 24. Throughout its deliberations, the Tribunal has applied the principle of proportionality, balancing Dr Akram’s interests with the public interest. The public interest (as embodied in the overarching objective) includes, amongst other things, the protection of patients, the maintenance of public confidence in the profession, and the declaring and upholding of proper standards of conduct and behaviour. 25. The Tribunal has already given a detailed determination on impairment and it

has taken those matters into account during its deliberations on sanction. The Tribunal’s Determination on Sanction 26. The Tribunal noted in particular the mitigating circumstances in this case as stated above in Mr Hughes’ submissions. 27. The Tribunal considered that the following amounted to the aggravating circumstances in this case:

• Dishonesty is a particularly serious departure from GMP



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• The dishonesty occurred on three occasions in a period spanning November 2014 to February 2015 and again in February 2018 was therefore persistent

• The February 2018 application (which this Tribunal found was a dishonest action) was sent only ten days before the review hearing on 12 February

2018 (when Dr Akram’s ‘locum’ dishonesty was to be reviewed) and therefore the principle of honesty should have been uppermost in her mind

• The lack of demonstrable insight into why the February 2018 application was dishonest and the implication of it being a repetition of dishonesty (notwithstanding that Dr Akram had had almost a year to digest this Tribunal’s decision on facts and had attended a further course in probity during that period)

• The apparent continuing lack of transparency in her dealings with third

parties (as indicated in her email to Dr K on 12 July 2020)

28. The Tribunal worked through the sanctions from the least restrictive upwards, as follows. Undertakings 29. The Tribunal noted that undertakings were not offered in this case, nor were

they appropriate in this case. No Action 30. In coming to its decision as to the appropriate sanction, if any, to impose in Dr Akram’s case, the Tribunal first considered whether to conclude the case by taking no action. 31. The Tribunal considered that there are no exceptional circumstances in which it might be justified in taking no action against a Dr Akram’s registration. The

Tribunal determined that in view of the serious nature of the Tribunal’s findings on impairment, it would be neither sufficient, proportionate nor in the public interest, to conclude this case by taking no action. Conditions 32. The Tribunal next considered whether it would be sufficient to impose conditions on Dr Akram’s registration. It has borne in mind that any conditions imposed would need to be appropriate, proportionate, workable and measurable.

33. The Tribunal XXX, however, it is of the opinion that a period of conditional registration would not adequately reflect the serious nature of Dr Akram’s misconduct; nor, in a case involving dishonesty, could conditions be devised that



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would protect the public interest and maintain public confidence in the medical profession. 34. The Tribunal has, therefore, determined that it would not be sufficient to direct the imposition of conditions on Dr Akram’s registration.

Suspension 35. The Tribunal then went on to consider whether suspending Dr Akram’s registration would be appropriate and proportionate. 36. The Tribunal took account of paragraphs 91 and 92 of the SG:

91 Suspension has a deterrent effect and can be used to send out a signal to the doctor, the profession and public about what is regarded as behaviour unbefitting a registered doctor. Suspension from the medical register also has a punitive effect, in that it prevents the doctor from practising (and therefore from earning a living as a doctor) during the suspension, although this is not its intention. 92 Suspension will be an appropriate response to misconduct that is so serious that action must be taken to protect members of the public and maintain public confidence in the profession. A period of suspension will be appropriate for conduct that is serious but falls short of being fundamentally incompatible with continued registration (ie for which erasure is more likely to be the appropriate sanction because the tribunal considers that the doctor should not practise again either for public safety reasons or to protect the reputation of the profession).

37. The Tribunal noted the suggestion by Mr Hughes that Dr Akram was unable to give oral evidence at the impairment or sanction stages of the hearing due to XXX. However, this suggestion was not supported by XXX 38. The Tribunal took account of paragraph 93 of the SG:

‘93 Suspension may be appropriate, for example, where there may have been acknowledgement of fault and where the tribunal is satisfied that the behaviour or incident is unlikely to be repeated. The tribunal may wish to see evidence that the doctor has taken steps to mitigate their actions’

39. The Tribunal noted Mr Hughes’ submission that Dr Akram has acknowledged fault and that she accepts that the email matter (the application in February 2018) amounted to misconduct but that she has further work to do in respect of the email matter and her

appreciation of her wrongdoing.



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40. However, as indicated above, the Tribunal could not ignore the fact that at the time of her second act of dishonesty in February 2018, Dr Akram was preparing for her review hearing and a possible return to work, where the obligation upon her to act honestly should have been at the forefront of her mind.

41. Moreover, again as indicated above, the Tribunal also noted that Dr Akram sent her email to Dr K the evening before this hearing reconvened in July 2020, where her response to being found again dishonest was to be evaluated. Dr Akram referred to the ‘locum’ incident of misconduct as a ‘breach of contract’ and as ‘mistakes’ but she failed to mention her dishonesty. The Tribunal considered this to be a further example of Dr Akram’s apparent failure to fully disclose her dishonest conduct. The Tribunal considered this email was a prime opportunity for Dr Akram to demonstrate that she has gained full insight into her dishonesty, but she again failed to be fully open to third parties about her background. Accordingly, the Tribunal was not persuaded that Dr Akram has fully acknowledged her misconduct.

42. The Tribunal noted that Dr Akram has attended two probity courses. At the time of the second probity course of misconduct Dr Akram had been in possession of this Tribunal’s determination on facts for almost a year, which should have assisted in her learning and insight. 43. The Tribunal is of the opinion that Dr Akram’s two acts of misconduct were a particularly serious departure from the principles set out in Good medical practice. It considers that Dr Akram’s dishonesty was persistent and noted that on the second

occasion, when it should have been in the forefront of her mind, she again failed to be honest. 44. Following its findings of facts in August 2019 Dr Akram has had a year to gain insight and remediate her misconduct. Dr Akram has failed to satisfy this Tribunal that she understands the dishonesty which led to her misconduct. The Tribunal noted that Dr Akram has had the benefit of legal advice since January 2020 and, whilst she has provided voluminous reflections, she has still not attained full insight. In addition, the Tribunal noted paragraph 52 of the SG which suggests that a doctor is likely to lack insight if they promise to remediate but fail to take the appropriate

steps, or only do so when prompted immediately before a hearing. The Tribunal noted that Dr Akram appears to have adopted such a pattern of behaviour, in that, shortly before each substantive or review hearing, there was a flurry of activity from her in which she attempted yet again to demonstrate her insight. This does not inspire confidence in Dr Akram’s ability to reflect upon her actions. 45. Having determined the facts in relation to the February 2018 application matter, almost a year ago in August 2019 the Tribunal considered that if Dr Akram truly was able to understand her wrongdoing, she should have been able to gain

sufficient insight. Given the length of time, especially since the first Tribunal’s decision in February 2017, this Tribunal considered that it is unlikely that that she



MPT: Dr AKRAM 41

will ever be able to gain full insight into her dishonesty. Therefore, the Tribunal cannot be satisfied that the misconduct is unlikely to be repeated. 46. The Tribunal also took account of paragraph 97 of the SG:

‘97 Some or all of the following factors being present (this list is not exhaustive) would indicate suspension may be appropriate.

a A serious breach of Good medical practice, but where the doctor’s misconduct is not fundamentally incompatible with their continued registration, therefore complete removal from the medical register would not be in the public interest. However, the breach is serious enough that any sanction lower than a suspension would not be sufficient to protect the public or maintain confidence in doctors. b … c … d … e No evidence that demonstrates remediation is unlikely to be successful, eg because of previous unsuccessful attempts or a doctor’s unwillingness to engage. f No evidence of repetition of similar behaviour since incident. g The tribunal is satisfied the doctor has insight and does not pose a significant risk of repeating behaviour.

47. The Tribunal noted that suspension may be appropriate where there has been serious misconduct and a breach of the principles in GMP. It was of the opinion that suspension would go some way towards protecting the public and the reputation of

the medical profession as a whole. 48. The Tribunal considered this was a very serious departure from the principles of GMP. Dr Akram has made previous unsuccessful attempts to remediate her behaviour, her misconduct was repeated not once but took place on four separate occasions and due to her continuing lack of full insight, it cannot be satisfied that her misconduct was highly unlikely to be repeated. It appreciates that there has been no apparent repetition since February 2018 (although there is the matter of her recent email to Dr K) but, given Dr Akram’s lack of insight about that incident the Tribunal

considered this point to be of minimal effect.



MPT: Dr AKRAM 42

49. Taking all these factors together, and acknowledging that Dr Akram has engaged and has made efforts to remediate, the Tribunal has therefore determined that it would be neither appropriate or proportionate merely to suspend Dr Akram’s registration, since such action would be inadequate to protect the public, maintain public confidence in the profession and uphold proper standards.

Erasure 50. It follows then that the Tribunal must consider erasure. 51. It is clear to this Tribunal that, despite the previous Fitness to Practise Tribunal finding Dr Akram’s dishonest behaviour to have been deplorable and reprehensible, Dr Akram has failed to gain full insight into her behaviour. This was most recently evidenced in her email to Dr K, the evening before this hearing.

52. As stated in paragraph 108 of the SG the Tribunal noted that erasure may be appropriate even where the doctor does not present a risk to patient safety, but where this action is necessary to maintain public confidence in the profession. For example, if a doctor has shown a blatant disregard for the safeguards designed to protect members of the public and maintain high standards within the profession that is incompatible with continued registration as a doctor. In the view of the Tribunal the public interest is engaged in this case.

53. Further, (bearing in mind that it was aware that it could depart from the SG for good reason) the Tribunal noted the following factors in Dr Akram’s case as mentioned in paragraph 109 of the SG which states that any of the following factors being present may indicate erasure is appropriate. In particular, sub-paragraphs a, h

and J as follows:

109 Any of the following factors being present may indicate erasure is appropriate (this list is not exhaustive).

a A particularly serious departure from the principles set out in Good medical practice where the behaviour is fundamentally incompatible with being a doctor. … h Dishonesty, especially where persistent and/or covered up (see guidance below at paragraphs 120–128). i … j Persistent lack of insight into the seriousness

54. The Tribunal has borne in mind paragraph 120 the SG:



MPT: Dr AKRAM 43

‘Good medical practice states that registered doctors must be honest and trustworthy, and must make sure that their conduct justifies their patients’ trust in them and the public’s trust in the profession.’

55. The Tribunal concluded that Dr Akram’s repeated misconduct fell far short of meeting this fundamental tenet.

56. The Tribunal has borne in mind paragraph 128 of the SG:

‘128 Dishonesty, if persistent and/or covered up is likely to result in erasure.’ 57. Given Dr Akram’s lack of insight into her dishonesty, which was repeated and spanned a period of four years, the Tribunal considers that she has still not remediated her dishonest behaviour. 58. Balancing all these factors, the Tribunal has determined that Dr Akram’s misconduct is fundamentally incompatible with her continuing to practise medicine.

Therefore, it has determined that, in the particular circumstances of this case, it would not be sufficient nor proportionate merely to suspend her registration. The Tribunal is of the view that the public interest requires that it be made clear that Dr Akram’s repeated dishonest behaviour, as detailed previously, is unacceptable in a member of the medical profession. 59. Although this may be of little comfort to Dr Akram, the tribunal wishes to state that it has reached this decision with some regret given the lack of concerns about her clinical skills and her engagement with the GMC and the MPTS. The basic

issue before the Tribunal was that, although Dr Akram appeared to have developed some insight into the ‘locum’ issue, the fact that she repeated the dishonesty so soon before the review hearing in February 2018 essentially negated what progress she appeared to have made. Dr Akram then, having had some eleven months to reconsider her understanding about dishonesty, failed to demonstrate that she really understood why what she had done in February 2018 was dishonest or the implications of her dishonesty repeating itself (notwithstanding her written reflection of over twenty pages). She also demonstrated by her email to Dr K that she was still prone to not revealing the full picture to third parties. Against this background the Tribunal was being asked to give Dr Akram a further year to develop insight and to

demonstrate her understanding of the concept of dishonesty. However, notwithstanding the many mitigation arguments made by Mr Hughes, the Tribunal concluded that Dr Akram had been given sufficient opportunities to fully remediate and was not confident that she would be able to use a further opportunity to do so due to her repeated failures to develop or demonstrate full insight to date. 60. XXX



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61. The effect of the foregoing direction is that, unless Dr Akram exercises her right of appeal, her name will be erased from the Medical Register 28 days from the date on which written notice of this decision is deemed to have been served upon her. The suspension currently imposed on Dr Akram’s registration shall continue to have effect until the appeal period has concluded. If Dr Akram decides to exercise

her right of appeal, the period of suspension currently imposed on her registration shall continue to have effect until the appeal has been decided. A note explaining Dr Akram’s right of appeal will be supplied to her.

62. That concludes this case.

Confirmed Date 17 July 2020 Mr Robin Ince, Chair



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ANNEX A – 09/04/2019

Service 1. Dr Akram is neither present nor legally represented at this hearing. 2. Mr McBride, Counsel, on behalf of the GMC, provided the Tribunal with a copy of a Service bundle which included a copy of the MPTS Notice o f Hearing dated 6 March 2019, which was sent by Special Delivery to Dr Akram’s registered address and to her email address. He also drew the Tribunal’s attention to an email response from Dr Akram, dated 8 March 2019, in which she referred to this hearing. The

Tribunal noted that Dr Akram currently resides in Saudi Arabia. 3. Mr McBride submitted that, in the circumstances, the Tribunal could be satisfied that service of the Notice of Hearing has been effected. 4. Having considered the evidence before it, the Tribunal is satisfied that all reasonable efforts have been made to serve Dr Akram with notice of this hearing in accordance with Rules 15 and 40 of the GMC’s (Fitness to Practise Rules) Order of Council 2004, as amended (‘the Rules’), and paragraph 8 of Schedule 4 to the

Medical Act 1983, as amended. Proceeding in Dr Akram’s absence 5. Having been satisfied that notice was properly served upon Dr Akram, the Tribunal then considered whether to proceed with this hearing in her absence, in accordance with Rule 31 of the Rules. The Tribunal is aware that the discretion to proceed in the absence of a doctor should be exercised with the utmost care and caution, balancing the interests of the doctor with the wider public interest.

6. Mr McBride invited the Tribunal to proceed with the hearing in Dr Akram’s absence. He referred to the correspondence provided in the Service bundle, including but not limited to:

• An email from Dr Akram to the GMC, dated 8 February 2019, referring to difficulties obtaining leave from her employer in term time;

• An email from Dr Akram to the GMC, dated 19 February 2019, referring to

difficulties in obtaining an exit visa from Saudi Arabia; • An email from Dr Akram to the GMC, dated 26 February 2019, in which Dr Akram requested information regarding postponing this hearing;

• An email from the MPTS to Dr Akram , dated 28 February 2019, setting out the process for applying for a postponement.



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• An email from Dr Akram to the GMC, dated 27 March 2019, agreeing the hearing bundle and stating that she did not wish for a witness to be cross-examined.

• An email from Dr Akram to the GMC, dated 7 April 2019, in which Dr Akram refers to XXX which has prevented her from travelling to the UK.

7. Mr McBride submitted that Dr Akram has, in her correspondence with the GMC, referred to difficulties in obtaining a visa and taking time off as the basis for her non-attendance. He submitted that Dr Akram has not requested an adjournment despite her previous enquiry and it appears that she is content for the matter to proceed in her absence. He further submitted that Dr Akram has not provided

supporting evidence in relation to XXX which she has recently raised and there has been no formal application to adjourn on this basis. Mr McBride submitted that, in all the circumstances, it is fair, just and in the public interest to proceed with the hearing in Dr Akram’s absence. 8. Following these submissions the Tribunal requested that the GMC make further enquiries of Dr Akram in the following terms:

“1. Clarification as to whether Dr Akram seeks an adjournment of today’s hearing [XXX].

2. If so, evidence in writing [XXX] that [XXX] prevents her from travelling and/or attending a hearing in the UK, [XXX].

3. Clarification that, if the hearing is adjourned today, the doctor intends to attend, and will attend, the next hearing. 4. The Tribunal required a response, including evidence [XXX], by 3pm UK time (5pm Saudi Arabia time).”

9. Mr McBride informed the Tribunal that, as requested, the GMC made attempts to contact Dr Akram, via email and telephone. He provided an email from Dr Akram, dated 8 April 2019 at 15:19 in which she stated:

‘I would prefer if the tribunal can be adjourned. I will attend the next meeting [XXX]’

10. In addition to this, as requested by the Tribunal, the GMC made further attempts to contact Dr Akram by e-mail and telephone, to request for Dr Akram to

provide evidence XXX in support of her application to adjourn these proceedings XXX. (As outlined in paragraph 2 of the notification referred to in paragraph 8 above). An e-mail was sent by the GMC at 16:24 yesterday, asking for Dr Akram to



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respond by 10:00 today, to which Mr McBride confirmed she had not responded. Also telephone calls were made by the GMC yesterday at 18:00 approximately and this morning at 09:45, to which there has not been a response. 11. In the absence of a response from Dr Akram the Tribunal went on to determine

whether to proceed in the doctor’s absence on the evidence before it. 12. In considering whether to exercise its discretion under Rule 31 of the Rules the Tribunal has taken account of the following factors identified by the Court of Appeal in R v Haywards and approved by the House of Lords in R v Jones [2002]:

• the nature and circumstances of the doctor’s absence and, in particular, whether the behaviour was deliberate and voluntary and thus a waiver of the right to appear;

• whether an adjournment is likely to result in the doctor attending the proceedings at a later date;

• the likely length of any such adjournment; • whether the Doctor, despite being absent, wished to be represented at the

hearing or has waived that right; • the extent to which any representative would be able to receive instructions

from, and present the case on behalf of, the absent Doctor;

• the extent of the disadvantage to the Doctor in not being able to give evidence having regard to the nature of the case;

• the general public interest and, in particular, the interest of any victims or witnesses that a hearing should take place within a reasonable time of the events to which it relates;

• the effect of delay on the memories of witnesses;

13. The Tribunal had regard to the evidence provided by the GMC. It considered that Dr Akram has interacted thus far and at various times has indicated that she has difficulties in attending this hearing. The reasons given have been XXX which prevents her from travelling, visa issues, and difficulty obtaining time off from her employer. She has been provided with information on how to make an application to adjourn the hearing; however she has only made suggestions that the hearing be adjourned. Dr Akram has not made any formal applications to adjourn the hearing until prompted by the Tribunal to do so, on the first day of the hearing. 14. The Tribunal considered that the ‘assertion’ for an application to adjourn XXX

by Dr Akram has been made very late in the day. It found that Dr Akram had actually failed to make a formal application, as the guidance provided to her informs; although there has been ample time and opportunity. 15. As aforementioned in paragraph 9 above, the Tribunal noted that XXX, yet despite clear requests from this Tribunal she has still failed to provide evidence to support her request to adjourn the hearing.



MPT: Dr AKRAM 48

16. The Tribunal concluded that even if it were to adjourn these proceedings, it could not be satisfied that she would attend in the future, given her apparent ambivalent attitude to the issue of attending this hearing and to her specific failures to make any formal applications for adjournment.

17. The Tribunal has fully considered Dr Akram’s interests and the implications of proceeding in her absence. The Tribunal bore in mind that Dr Akram is aware of this hearing, and that it noted that Dr Akram has provided written comments in the form of her Rule 7 response, and it will have due regard to these. Moreover, her comments have caused the Tribunal to suggest to the GMC that further

documentation might be of assistance to it, in order to contextualise her correspondence with NHS Professionals in early February 2018. 18. In the circumstances, the Tribunal has determined that it is fair, just and in the public interest to proceed with the hearing.

ANNEX B – 09/04/2019

Application under Rule 34(1) to admit further evidence 1. Mr McBride, Counsel, on behalf of the GMC made an application under Rule 34(1) of the Rules to admit further evidence, as requested by the Tribunal, to provide redacted documents relating to Dr Akram’s previous review hearing in 2018. 2. Mr McBride submitted that these documents are potentially relevant in terms of the Tribunal’s consideration, because Dr Akram refers to such documents in

exhibit ‘D1’, where she refers to her current imposed sanction, as well as reference to her applications for work. 3. Mr McBride therefore submitted that Dr Akram is already aware and has seen the documentation before, and indeed refers to it herself. Furthermore, he confirmed that copies of the additional evidence had been sent by to Dr Akram by the GMC at 11:00 this morning. During the course of its deliberations, the Tribunal was advised that Dr Akram has responded to this e-mail agreeing to their production for the Tribunal.

The Tribunal’s Decision 4. The Tribunal had regard to Rule 34(1) of the Rules, which states:

‘Subject to paragraph (2), the Committee or a Panel may admit any evidence they consider fair and relevant to the case before them, whether or not such evidence would be admissible in a court of law.’



MPT: Dr AKRAM 49

5. The Tribunal considered the admissibility of further evidence before it, as to whether it is firstly relevant, and secondly, if it is fair to admit it. 6. The Tribunal reiterated that, as the Tribunal itself raised the issue of such

additional documentation yesterday, it considered this further evidence to be relevant to the Allegation in this case. 7. It had regard to the issues of relevance and fairness and any potential injustice to either party. The Tribunal noted that Dr Akram had agreed to the production of this additional evidence to the Tribunal and it therefore concluded that no injustice would be caused to her. 8. Therefore, the Tribunal acceded to the application for the following further evidence to be admitted in due course.

ANNEX C – 11/04/2019

Consideration of adjournment and extension of current sanction

1. The Tribunal has proposed that the hearing be adjourned. At this stage of the process, the Tribunal has concluded its deliberations on the question of facts. However, given that this is the last listed day and the lateness of the hour, the Tribunal considered it would not have sufficient time to conclude and hand down its written determination on facts today. 2. As such, the Tribunal sought submissions from Mr McBride on the question of adjourning the hearing. Submissions

3. Mr McBride reminded the Tribunal that it was intended that, having made a decision on the facts of the current Allegation before it, the Tribunal was, in any event, to proceed to also consider a review of Dr Akram’s current suspension imposed on 12 November 2018. He submitted that, as Dr Akram’s current suspension is due to expire on 11 May 2019, it would be appropriate for the Tribunal to extend the current sanction. 4. Without asking the Tribunal what its determination has been on the facts, and

with the view that the Tribunal has already been made aware at an earlier stage of the proceedings that a review is due, Mr McBride enquired whether or not the Tribunal was able to confirm if it is to remain “tied” to the review proceedings or not. He stated that, for instance, if no facts have been found proved in the current



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Allegation, the review matter will not be the concern of this Tribunal and therefore other arrangements would be made to address this matter in due course. Tribunal’s Decision

5. In consideration of all the circumstances, the Tribunal had regard to its powers under Rule 29(2) of the Rules. 6. Whilst certainly not desirable, the Tribunal has been unable to conclude its deliberations on the question of facts today. Without confirming the details however, the Tribunal found it appropriate to confirm to Mr McBride that it has found sufficient of the facts proved to invoke consideration of the next stage of the hearing (impairment). 7. The Tribunal therefore decided that it would be appropriate to adjourn this

hearing. Whilst the adjournment is unfortunate, the Tribunal noted that it would afford Dr Akram the opportunity to attend the reconvened hearing and to provide any information she wishes to refer to in advance. 8. The dates on which this Tribunal could reconvene would potentially be within the first two weeks of August 2019, but there are no fixed date/s at present. The Tribunal considered that a listing of three days should be sufficient and adequate to complete the matter, including consideration of the review.

9. The Tribunal noted that Dr Akram’s current suspension is due to expire on 11 May 2019 and it was satisfied that it would not be appropriate to allow the suspension to lapse given that matters in this case remain unresolved. The Tribunal determined to exercise its power under section 35D(5)(a) of the Medical Act 1983, as amended, to extend the current order of suspension for a period of four months from the date on which it is due to expire. It determined that such an extension is necessary, proportionate and in the public interest in order to ensure that appropriate safeguards are in place to cover the intervening period before it can reconvene and conclude its deliberations. The Tribunal did not consider that it would be appropriate for the order of suspension to lapse in that time.

10. When the Tribunal reconvenes, it will resume in camera on the facts; both parties will be instructed as to when to attend. 11. The Tribunal has therefore determined to adjourn the hearing part-heard today.



MPT: Dr AKRAM 51

ANNEX D – 06/08/2019

Application to adduce further evidence Dr Akram’s submissions 1. Dr Akram made an application under Rule 34(1) of the Fitness to Practise Rules 2014 (as amended) (the Rules) to give oral evidence and adduce additional

documentation to the Tribunal prior to it announcing its determination on facts, in accordance with Rule 17(2)(j) of the Rules. 2. She told the Tribunal that she had submitted documents to the GMC, including screenshots of what her application should have looked like, as opposed to what was sent to NHS Professionals. She also stated that she wished to give personal evidence and evidence as to what was in her mind at the time o f the application. Dr Akram also referred to a letter from Mr D of Locum People, with whom she had been corresponding, in relation to a clinical observer ship. (The

Tribunal confirmed that they had received a copy of this letter dated 6 April 2019). 3. Dr Akram told the Tribunal that she returned to the UK on 4 March 2019 but was unable to attend the hearing on 8 April 2019 as XXX and had requested a postponement. XXX. Ms Vanstone’s submissions 4. Ms Vanstone informed the Tribunal that the GMC objects to Dr Akram’s application. She referred the Tribunal to the MPTS circular regarding the case TZ v

GMC [2015] EWHC 1001 (Admin) which the Tribunal had caused to be given to the parties. She stated that the evidence from Dr Akram was not called at the commencement of the hearing as she chose not to attend. She stated that the Tribunal concluded that Dr Akram was aware of the hearing and had an ‘apparent ambivalent attitude’ in not attending. XXX. 5. Ms Vanstone reminded the Tribunal that this is a case of dishonesty based solely on Dr Akram’s submission of an application. She conceded that there is no question of the GMC’s witnesses being undermined, given the nature of the case.

6. Ms Vanstone submitted that Dr Akram provided a written response to the charges by email dated 7 April 2019, which contains a letter in which she sets out her position regarding her dishonesty, therefore, the Tribunal was aware of Dr Akram’s case when it retired to determine the facts.



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The Tribunal’s Decision 7. The Tribunal noted that Dr Akram did not attend the start of the hearing in April 2019 XXX. The Tribunal determined to proceed in Dr Akram’s absence as follows:

’13. The Tribunal had regard to the evidence provided by the GMC. It considered that Dr Akram has interacted thus far and at various times has indicated that she has difficulties in attending this hearing. The reasons given have been [XXX] which prevents her from travelling, visa issues, and difficulty obtaining time off from her employer. She has been provided with information on how to make an application to adjourn the hearing; however she has only made suggestions that the hearing be adjourned. Dr Akram has not made any formal applications to adjourn the hearing until prompted by the Tribunal to do so, on the first day of the hearing. 14. The Tribunal considered that the ‘assertion’ for an application to adjourn [XXX] by Dr Akram has been made very late in the day. It found that Dr Akram had actually failed to make a formal application, as the guidance provided to her informs; although there has been ample time and opportunity. 15. As aforementioned in paragraph 9 above, the Tribunal noted that [XXX], yet despite clear requests from this Tribunal she has still failed to provide evidence to support her request to adjourn the hearing. 16. The Tribunal concluded that even if it were to adjourn these proceedings, it could not be satisfied that she would attend in the future, given her apparent ambivalent attitude to the issue of attending this hearing and to her specific failures to make any formal applications for adjournment. 17. The Tribunal has fully considered Dr Akram’s interests and the implications of proceeding in her absence. The Tribunal bore in mind that Dr Akram is aware of this hearing, and that it noted that Dr Akram has provided written comments in the form of her Rule 7 response, and it will have due regard to these. Moreover, her comments have caused the Tribunal to suggest to the GMC that further documentation might be of assistance to it, in order to contextualise her correspondence with NHS Professionals in early February 2018. 18. In the circumstances, the Tribunal has determined that it is fair, just and in the public interest to proceed with the hearing.’

8. The Tribunal has taken account of the submissions from Ms Vanstone and Dr Akram.



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9. The Tribunal has noted that the exercise of the discretion to adduce fresh evidence between closing speeches and the announcement of the finding of fact is unusual. However, the Tribunal has had regard to the criteria set out by HHJ Gilbart in the case of TZ v GMC regarding whether to exercise that discretion.

10. Dr Akram stated that, as she was not present at the hearing in April 2019 she did not have the opportunity to give oral evidence, in particular, as to what was in her mind at the time of the events which took place on 2 February 2018. The Tribunal also noted that Dr Akram said that she wished to adduce additional documentary evidence, which she said had been sent to the GMC, possibly in relation to her review hearing. Dr Akram also stated that she would want to submit a

copy of a screen shot of what she maintained had accompanied her email to NHS Professionals which set out what jobs she had applied for. The Tribunal noted that this documentary evidence was in existence in April 2019 but was not provided to the Tribunal. 11. The Tribunal next considered the relevance of the new evidence. The Tribunal concluded, that potentially, Dr Akram’s oral and documentary evidence might be relevant, especially her evidence as to what was in her mind at the time she allegedly made her application to NHS professionals on 2 February 2018. The Tribunal notes Ms Vanstone’s submissions that such evidence was contained in

Dr Akram’s letter sent in on 7 April 2019 but considers that this letter does not address all the issues that a Tribunal might have to take account of when dealing with the issue of dishonesty. 12. The Tribunal then considered why this evidence has not been called before. The simple answer is that Dr Akram did not attend the hearing. XXX. 13. Having said that, the Tribunal notes that XXX did not prevent Dr Akram from making written submissions on 7 April 2019 but, bearing in mind that she is

unrepresented and therefore would not necessarily be expected to know what was relevant to the factual issues before the Tribunal, it is of the view that these submissions may not give Dr Akram’s full account. The Tribunal therefore concludes that, although the reasons for her absence remain uncorroborated, this does not work adversely against her. 14. The Tribunal went on to consider what significance this new evidence might have in the context of the ‘draft findings’ of the Tribunal. As Ms Vanstone stated, this was not a matter that she could comment upon but the Tribunal confirms that it has taken this criterion into account and has concluded that, one way or another, the

new evidence might be significant to the draft findings. 15. The Tribunal next considered what effect the admission of the new evidence would have on the conduct of the hearing and in particular on



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a. the need to recall witnesses b. the length of the hearing

16. The Tribunal was satisfied that no witness would need to be recalled. Dr B’s evidence merely dealt with the receipt of the alleged application made by Dr Akram on 2 February 2018 – she gave no evidence in relation to the doctor’s motivation for making such an application. In any event, the Tribunal notes that Dr Akram in her email of 27 March 2019 indicated that she did not want to cross examine Dr B. 17. The Tribunal has also borne in mind that the length of the hearing will be lengthened if the Tribunal accedes to Dr Akram’s application but does not consider that the additional hearing time would be disproportionate.

18. Finally, the Tribunal considered whether, taking matters into account justice would be done if the new evidence was not received and heard. It concluded that, although allowing Dr Akram to give evidence at this very late stage in the proceedings would cause procedural difficulties and recalculation and could have been avoided, not enabling her to fully participate in the proceedings now that she had managed to attend the hearing would not be in the interests of justice. 19. Accordingly, the Tribunal has acceded to Dr Akram’s application.

ANNEX E – 08/08/2019

Consideration of adjournment under Rule 29(2) and extension of current

sanction

1. The Tribunal has handed down its written determination on facts. However, given that this is the last listed day, there is insufficient time to conclude the hearing today. The Tribunal notes that it must also consider a review of Dr Akram’s current suspension imposed on 12 November 2018 and extended on 11 May 2019. Submissions 2. Ms Vanstone reminded the Tribunal that Dr Akram’s current suspension is due

to expire on 10 September 2019. She submitted that it would be appropriate for the Tribunal to extend the current sanction for a period of six months until 10 March 2020. 3. Dr Akram made no submissions in relation to the application to extend the current order.



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Tribunal’s Decision 4. In consideration of all the circumstances, the Tribunal had regard to its powers under Rule 29(2) of the Rules.

5. The earliest the Tribunal can reconvene is 3 February 2020. The Tribunal considered that a listing of five days should be sufficient and adequate to complete the matter, including consideration of the review. Current Suspension 6. The Tribunal noted that Dr Akram’s current suspension is due to expire on 10 September 2019. It was satisfied that it would not be appropriate to allow the suspension to lapse given that an outstanding review has not been addressed and that the Tribunal has been advised by Ms Vanstone that the review will consider

XXX. The Tribunal determined to exercise its power under section 35D(5)(a) of the Medical Act 1983, as amended, to extend the current order of suspension for a period of six months from the date on which it is due to expire. It determined that such an extension is necessary, proportionate and in the public interest in order to ensure that appropriate safeguards are in place to cover the intervening period before it can reconvene and conclude its deliberations. The Tribunal did not consider that it would be appropriate for the order of suspension to lapse in that time. 7. The Tribunal has therefore determined to adjourn the hearing part-heard

today. It will reconvene at the impairment stage on 3 February 2020.

ANNEX F – 04/02/2020

Application to adjourn under Rule 29(2) 1. Mr Hughes made an application to adjourn the reconvened hearing under Rule 29(2), which states:

‘(2) Where a hearing of which notice has been served on the practitioner in accordance with these Rules has commenced, the Committee or Tribunal considering the matter may, at any stage in their proceedings, whether of their own motion or upon the application of a party to the proceedings, adjourn the hearing until such time and date as they think fit.’

Mr Hughes’ submissions 2. Mr Hughes made an application to adjourn Dr Akram’s hearing under rule 29(2).



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3. XXX 4. XXX 5. XXX

6. XXX Mr McBride’s submissions 7. Mr McBride stated that the GMC invites the Tribunal to exercise caution in acceding to the application to adjourn. XXX 8. XXX

9. XXX 10. XXX 11. XXX 12. Mr McBride submitted that the decision to adjourn is ultimately a matter for the Tribunal. XXX

13. XXX The Tribunal’s Approach 14. In consideration of all the circumstances, the Tribunal had regard to its powers under Rule 29(2) of the Rules. 15. The Tribunal also had regard to the Legally Qualified Chair’s advice that it should have regard to the factors derived from the decision in Crown Prosecution Service v Picton [2006] EWHC 1108. The Tribunal has borne in mind the general

need for expedition in the conduct of proceedings. The Tribunal has taken into account that this is the third occasion that this Tribunal has been seized of the matter and, although progress has been made, in that, it has now reached the Impairment stage, it is still dealing with matters of some antiquity, namely the ‘new’ matter from February 2018 and a review of other matters upon which a Tribunal first adjudicated upon in February 2017.

16. The Tribunal has taken into account that, where an adjournment is sought by the Doctor, if not granted, whether the Doctor will be able fully to present her case

and, if not, the degree to which her ability to do so is compromised. XXX



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17. The Tribunal considered the likely consequences of the proposed adjournment. The Tribunal is seized of the matter and any adjournment is likely to be lengthy since its three members have to adjourn to a time when their joint availability coincides.

18. The Tribunal has considered the reason that the adjournment is required. XXX It also considered the history of the case, and whether there have been earlier adjournments, at whose request and why. It reminded itself that, when this Tribunal was first seized of this case on 9 April 2019, it decided to proceed in Dr Akram’s absence but had to adjourn the case during its deliberations on facts. At the resumed hearing on 6 August 2019, Dr Akram attended and the Tribunal decided to reopen the facts stage after which it heard oral evidence from her and then, after deliberation handed down its determination on facts. The Tribunal noted that Dr Akram’s representatives made an application to postpone the hearing on 16 January 2020 as they had only just been instructed but that application was refused by the

MPTS Case Manager. Finally, Dr Akram made a further application to postpone on 30 January 2020, as detailed above, which was also refused by the Case Manager. 19. XXX

20. Finally, the Tribunal exercised caution and acted proportionately, balancing the rights of Dr Akram to a fair hearing against the public interest in a timely disposal of her case.

The Tribunal’s Decision

21. XXX

22. XXX

23. XXX 24. XXX 25. XXX 26. XXX 27. The Tribunal has therefore determined to adjourn the hearing part-heard today. It will reconvene at the impairment stage, XXX on a date to be advised in due

course.



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ANNEX G – 04/02/2020

Application to extend Dr Akram’s current suspension 1. Mr McBride made an application to extend Dr Akram’s current order of suspension, which expires on 9 March 2020. 2. Mr Hughes, in his email dated 3 February 2020 stated:

‘I confirm that Dr Akram has no objection to an extension of her suspension to a date to be determined. This has been discussed with Mr McBride for the GMC.’

The Tribunal’s Decision 3. The Tribunal noted that Dr Akram’s current suspension is due to expire on 9 March 2020. It was satisfied that it would not be appropriate to allow the suspension to lapse given that an outstanding review has not been addressed. The Tribunal noted the review will consider misconduct and XXX.

4. The Tribunal determined to exercise its power under section 35D(5)(a) of the Medical Act 1983, as amended, to extend the current order of suspension for a period of six months from the date on which it is due to expire. It determined that such an extension is necessary, proportionate and in the public interest in order to ensure that appropriate safeguards are in place to cover the intervening period before it can reconvene and conclude its deliberations. The Tribunal did not consider that it would be appropriate for the order of suspension to lapse in that time. Directions

5. XXX. It also directs that this matter be rescheduled for hearing for a total of seven days, on 27-30 April 2020 (four days) and 13-15 July 2020 (three days). 303. The hearing is therefore adjourned.

Documents

PUBLIC RECORD...GMC Representative: Mr Gavin McBride, Counsel, 8-11 April 2019, 3-4 February 2020 Ms Rebecca Vanstone, Counsel 5-8 August 2019, 13-17 July 2020 Attendance of Press