PUBLIC RECORD - mpts-uk.org · 2. Dr Aleem Ahmed qualified in 2010 from Manchester University and obtained full GMC registration and a licence to practise in 2011. At the time of

Record of Determinations – Medical Practitioners Tribunal

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PUBLIC RECORD

Dates: 27/01/2020 - 31/01/2020 Medical Practitioner’s name: Dr Aleem AHMED

GMC reference number: 7073986

Primary medical qualification: MB ChB 2010 University of Manchester

Type of case New - Misconduct

Outcome on impairment Not impaired

Summary of outcome

Warning

Tribunal:

Legally Qualified Chair Mr John MacGregor Medical Tribunal Member: Dr Nisreen Hannah Booya, Dr Farah

Yusuf Tribunal Clerk: Miss Fiona Johnston

Attendance and Representation:

Medical Practitioner: Present and represented Medical Practitioner’s Representative: Mr Andrew Hockton, Counsel,

instructed by Medical Protection Society

GMC Representative: Ms Georgina Goring, Counsel


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Attendance of Press / Public In accordance with Rule 41 of the General Medical Council (Fitness to Practise) Rules 2004 the hearing was held in public 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 Impairment - 30/01/2020 Overarching Objective 1. Throughout the decision making process the tribunal has borne in mind the statutory overarching objective set out in section 1 of the 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 member of the profession. Background 2. Dr Aleem Ahmed qualified in 2010 from Manchester University and obtained full GMC registration and a licence to practise in 2011. At the time of events Dr Ahmed was employed as a Specialist Trainee (ST5), Infectious Diseases and General Internal Medicine Specialist Registrar, at the Leicester Royal Infirmary NHS Trust (’the Trust’). He commenced this post in 2015.

3. The allegation that has led to Dr Ahmed’s hearing can be summarised as follows: on the 27 July 2017 Dr Ahmed submitted a mandatory training module certificate to his locum agency Holt Doctors Medical Agency (‘Holt’). The falsified certificate purported to show that he had completed an online course called Mandatory Training including Handbook on 6 June 2017 (the ‘Mandatory Training’). It is alleged that Dr Ahmed falsified the certificate by changing the date on a previous certificate. He had not completed the training or received a genuine certificate.

4. The complaint was raised by Dr G, Deputy Postgraduate Dean for Health Education England – East Midlands. He submitted a Fitness to Practise referral form to the GMC on 18 December 2018.


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The Allegation and the Doctor’s Response

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

1. On 27 July 2017 you submitted a mandatory training module certificate to your locum agency, which stated that you had completed an online course called Mandatory Training including Handbook on 6 June 2017 (the ‘mandatory training’). Admitted and found proved

2. You:

a. did not complete the mandatory training; Admitted and found proved

b. knew that you had not completed the mandatory training; Admitted and found proved

c. falsified the certificate so that it stated you had completed the mandatory training. Admitted and found proved

3. Your actions as described at paragraph 1 were dishonest by reason of paragraph 2. Admitted and found proved

And that by reason of the matters above your fitness to practise is impaired because of your misconduct. Not admitted.

The Admitted Facts 5. At the outset of these proceedings, through his counsel Mr Andrew Hockton, Dr Ahmed made full admissions to the Allegation, as set out above, in accordance with Rule 17(2)(d) of the General Medical Council (GMC) (Fitness to Practise) Rules 2004, as amended (‘the Rules’). In accordance with Rule 17(2)(e) of the Rules, the Tribunal announced these paragraphs and sub-paragraphs of the Allegation as admitted and found proved. Impairment 6. In light of the full admission made by Dr Ahmed, the Tribunal now has to decide in accordance with Rule 17(2)(l) of the Rules whether, on the basis of the facts found proved, Dr Ahmed’s fitness to practise is impaired by reason of his misconduct. Documentary Evidence 7. The Tribunal had regard to the documentary evidence provided by the parties. This evidence included, but was not limited to:


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• Witness statement of Dr A, Responsible Officer (‘RO’) at Holt, dated 3 May 2019;

• Witness statement of Ms B, Head of Compliance and Shared Services at Healthcare Locums Doctors Limited (‘HCL’), dated 21 March 2019;

• Witness statement of Dr Aleem Ahmed, dated 11 November 2019;

• An email from Dr Ahmed to Ms N, dated 27 July 2017, attaching a purported Certificate of Mandatory Training with Handbook, dated 6 June 2017;

• Certificate of Mandatory Training with Handbook awarded to Dr Ahmed, dated 6 June 2016:

• Correspondence between HCL and Holt in relation to the certificate;

• Initial referral from Dr G, dated 18 December 2019;

• Email from Dr G to the GMC dated 5 February 2019, enclosing the notes of a meeting between Dr H and Dr Ahmed;

• Letter from Medical Protection to the GMC, dated 5 July 2019;

• Dr Ahmed’s CV;

• A record of training completed by Dr Ahmed and associated certificates;

• Dr Ahmed’s apology letter to Holt and Confirmation Email, dated 16 October 2019;

• Reflective statements completed by Dr Ahmed;

• Letters and testimonials from various individuals;

• Defence remediation bundle which consists of a series of reflective statements

completed by Dr Ahmed, testimonials and certificates relating to courses that Dr Ahmed has completed.

Evidence 8. The GMC did not call any witnesses. However, the Tribunal had the benefit of the witness statements of Dr A and Ms B. These addressed the factual aspects of the Allegation which were admitted by Dr Ahmed.


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9. Dr Ahmed provided his own witness statement, dated 11 November 2019, and also gave oral evidence at the hearing. 10. The Tribunal also received oral evidence on behalf of Dr Ahmed from the following witnesses:

• Professor C, Consultant & Honorary Professor in Infectious Diseases;

• Dr D, Consultant Ortho-Geriatrician & Clinical Tutor;

• Dr E, Deputy Director of Medical Education;

• Dr F, Specialist registrar in infectious diseases and general internal medicine.

11. The witnesses gave their evidence in a clear and straightforward manner. The Tribunal considers that all of the witnesses, including Dr Ahmed, were credible and reliable. Ms Goring’s submissions 12. Ms Goring addressed the Tribunal on the two-stage process to be adopted. She submitted that the facts found proved in this case amount to serious misconduct, and that Dr Ahmed’s fitness to practise is currently impaired as a result of that serious misconduct. 13. Ms Goring submitted that Dr Ahmed failed to meet the standards set out in Good Medical Practice (‘GMP’) as set out below:

1 Patients need good doctors. Good doctors make the care of their patients their first concern: they are competent, keep their knowledge and skills up to date, establish and maintain good relationships with patients and colleagues, are honest and trustworthy, and act with integrity and within the law.

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.

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.


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b. You must not deliberately leave out relevant information.

14. Ms Goring reminded the Tribunal that the test for misconduct includes an assessment of seriousness. In making its assessment the Tribunal should consider whether the conduct would be described as deplorable by fellow practitioners or members of the public. Ms Goring referred the Tribunal to the guidance contained in Roylance v GMC [2000] 1 AC 311.

15. Ms Goring submitted Dr Ahmed’s misconduct was a serious breach of GMP and that Dr Ahmed’s conduct would be found to be deplorable by fellow practitioners. She submitted that the dishonesty displayed by Dr Ahmed can be described as serious for the following reasons:

• While the falsified certificate was only submitted to Holt on one occasion, Dr Ahmed relied on this document for nearly a year whilst registered with Holt agency. Therefore, it is not correct to characterise the case as an isolated incident. His dishonest was persistent for nearly a year;

• the dishonestly was only accepted by Dr Ahmed once he was confronted about it. He did not self-report or volunteer that he had been dishonest;

• Dr Ahmed’s actions, namely editing a previous certificate (which was one year old) and emailing it to the locum agency, in order to avoid undertaking the required training, were premediated. His actions were not opportunistic.

16. Ms Goring made reference to two authorities in her submissions on impairment:

• CHRE v NMC & Paula Grant [2011] EWHC 927 [Admin]; • Cohen v GMC [2008] EWHC 581 (Admin).

17. Ms Goring submitted that it is essential for doctors to have completed the Mandatory Training. Dr Ahmed himself stated in his reflective piece, dated 26 February 2019, that: ‘Mandatory training is essential for us as doctors, particularly as a locum working in a new environment, to do. It acts as an important yearly refresher in crucial topics that we need to work safely and do our job. Fire safety, moving and handling, safeguarding and other topics are absolutely vital topics that we as doctors working in a large hospital absolutely have to know about… It is simply completely unacceptable for this to not be completed.’ 18. Ms Goring submitted that not being honest about the failure to complete basic training could have placed patients at risk of unwarranted harm.


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19. Ms Goring submitted that Dr Ahmed has developed some insight. However, at various points since proceedings commenced, Dr Ahmed has referred to his actions as ‘cutting corners’, an ‘oversight’ and ‘a mistake’. She recognised that in his evidence to the Tribunal, Dr Ahmed accepted that his actions were much more serious. In her submission, the Tribunal needs to give careful consideration to whether Dr Ahmed now has full insight into the serious nature of his failings. 20. Ms Goring submitted that Dr Ahmed has breached a fundamental tenet of the profession, namely the need for doctors to act with honesty and integrity. It is critical that patients can trust doctors. Ms Goring submitted that given the seriousness of the misconduct, a finding that his fitness to practise is currently impaired was justified on the basis of the impact of his misconduct upon public confidence in the profession and the need to uphold proper professional standards. Mr Hockton’s submission 21. Mr Hockton reminded the Tribunal of the need to adopt a two stage process. Stage one is to consider whether the admitted facts amount to serious misconduct. Stage two is to consider whether such misconduct impairs the Doctor’s fitness to practice. Mr Hockton referred the Tribunal to the case of GMC v Uppal [ 2015] EWHC 1304 (Admin) (‘Uppal’). 22. Mr Hockton stated that Dr Ahmed accepts that his action amount to misconduct and that the misconduct was serious. 23. Mr Hockton then addressed the issue of whether Dr Ahmed’s fitness to practise is impaired. He submitted that in cases of dishonesty it is not automatic that a finding of current impairment will be made. In such cases an individual assessment of current impairment must be undertaken. 24. Mr Hockton submitted that Dr Ahmed acted dishonestly in the past. However, Mr Hockton reminded the Tribunal that its duty was to look at the position before it today as well as the past. Dr Ahmed had given evidence and the Tribunal was given sight of his reflective statements and positive supporting statements and testimonials from colleagues. Dr Ahmed had made full admissions from the outset and credit should be given for those. He has apologised and accepted that he did breach parts of GMP and his conduct did not meet the standard expected of a doctor. He has an otherwise unblemished record. 25. Mr Hockton submitted that Dr Ahmed had been open and honest and has made no attempt to minimise the gravity of his misconduct, nor has he made excuses. However, this was a single act. That is clear from the wording of the Allegation. Dr Ahmed is otherwise of good character. Dr Ahmed’s misconduct has been at the lower end of the spectrum and there has been no issue of patient safety. Dr Ahmed had the knowledge, experience and the qualifications to perform the work undertaken and had completed his


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mandatory NHS training albeit not with the company named on the certificate he submitted. 26. Mr Hockton reminded the Tribunal of the numerous accounts stating that Dr Ahmed was a highly conscientious doctor. A doctor who was in training and under supervision and whose progress was being closely monitored in relation to training requirements. His educational supervisor had no concerns in regard to his clinical practice. Critically, the testimonials and evidence addressed Dr Ahmed’s character. The incident was not representative of his general character. It was a one-off lapse in judgment. 27. Mr Hockton submitted that this was not a case where Dr Ahmed had misrepresented his qualifications and experience in a manner that posed a risk to patient safety. He submitted that Dr Ahmed was a safe, competent doctor who had the relevant qualifications and experience to act as a locum doctor. Indeed, he was overqualified for the locum role he undertook. 28. Dr Ahmed has developed deep insight and reflected on his actions over a period of time. He has expressed remorse and this has been referred to extensively in the evidence from colleagues and in the written testimonials. 29. Mr Hockton submitted that Dr Ahmed’s fitness to practice is not currently impaired and the Tribunal may consider that a warning would send a message to the doctor and the profession that the submission of false certificates is not acceptable. He further submitted that any other sanction would be disproportionate given that the doctor is in training and the consequences that would have. The Relevant Legal Principles 30. The Tribunal reminded itself that at this stage of proceedings, there is no burden or standard of proof and the decision on impairment is a matter for the Tribunal’s judgement alone. 31. 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 serious misconduct. Second, whether the doctor’s fitness to practice is impaired by reason of that misconduct. 32. The Tribunal must determine whether Dr Ahmed’s fitness to practise is impaired today, taking into account his conduct at the time of the events and any relevant factors since then, such as whether he has insight, the matters are remediable or have been remedied, and any likelihood of repetition. 33. The Tribunal had regard to the submissions made by both parties and the case law referred to. Throughout its deliberations, the Tribunal was mindful of its responsibility to uphold the over-arching objective as set out in the 1983 Act (as amended):


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a. to protect, promote and maintain the health, safety and wellbeing of the public; b. to maintain public confidence in the profession; c. to promote and maintain proper professional standards and conduct for members of the profession. The Tribunal’s Determination on Impairment Misconduct 34. In Roylance v General Medical Council (no 2) [2000] 1 AC 311, Lord Clyde described misconduct as:

“…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”. [at p331]

35. The Tribunal bore in mind that not every breach of GMP, and not every falling short of what would be proper in the circumstances, will constitute misconduct. The breach must be serious R (on the Application of Remedy UK Ltd) v GMC [2010] EWHC 1245 (Admin). 36. Mr Hockton candidly accepted that the actions of Dr Ahmed amount to serious misconduct. The Tribunal considers that it was appropriate for this concession to be made given the factual admissions that have been made. 37. Dr Ahmed knowingly submitted a falsified document in order to avoid undertaking mandatory training and therefore acted dishonestly. Such actions cannot be considered trivial or inconsequential. The Tribunal accepts Ms Goring’s submission and concludes that that Dr Ahmed breached a fundamental tenet of the profession, namely that doctors should be honest. 38. In reaching its decision on this issue, the Tribunal had regard to the GMP, which sets out the standards that a doctor must continue to meet throughout their professional career. In particular paragraphs 1, 65, 66, and 71 are relevant to the present case. Dr Ahmed failed to act honestly and with integrity. 39. The Tribunal finds that Dr Ahmed’s conduct fell so far short of the standards of conduct reasonably to be expected of a doctor as to amount to serious misconduct. His actions would be described as deplorable by fellow medical professionals.


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Impairment 40. The Tribunal, having found that the admitted facts amount to misconduct, then went on to consider whether as a result of that misconduct, Dr Ahmed’s fitness to practise is currently impaired. 41. The Tribunal’s task is not to punish Dr Ahmed for past acts. However, the Tribunal does require to take account of past acts and omissions in order to make an informed assessment as to whether Dr Ahmed’s fitness to practise is currently impaired. The test of impairment is expressed in the present tense in relation to the need to protect the public against the acts and omissions of those who are not fit to practice. However, this cannot be achieved without taking account of the way a person has acted or failed to act in the past. 42. The Tribunal took into account the following guidance formulated by Dame Janet Smith in her Fifth Shipman Report, which was applied by the High Court in Council for Healthcare Regulatory Excellence v Nursing and Midwifery Council and Grant [2011] EWHC 927 (Admin) (at paragraph 76), to the extent relevant to the facts of the case:

“Do our findings of fact in respect of the [Doctor’s] misconduct, deficient professional performance, adverse health, conviction, caution or determination show that his/her fitness to practise is impaired in the sense that she/he:

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

b) has in the past brought and/or is liable in the future to bring the medical profession into disrepute; and/or

c) has in the past breached and/or is liable in the future to breach one of the fundamental tenets of the medical profession; and/or

d) has in the past acted dishonestly and/or is liable to act dishonestly in the future?”

43. The Tribunal has also taken into account the guidance provided in Cohen v General Medical Council [2008] EWHC 581 (paragraph 65). The Tribunal has considered: (i) whether the doctor’s conduct is easily remediable, (ii) whether it has been remedied, and (iii) whether it is highly unlikely to be repeated. 44. The Tribunal is conscious that there are some cases where the misconduct is so serious that regardless of any steps taken by the doctor, a finding of impairment


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will be required on the basis of the need to maintain confidence in the profession and to uphold proper professions standards.

45. The Tribunal is also conscious that the misconduct in this case concerns dishonesty. The importance of honesty and integrity on the part of members of a profession, including the medical profession, is well recognised (Bolton v Law Society [1994] 1 WLR 512; Makki v General Medical Council [2009] EWHC 3180 (Admin) at paragraph 43). The Tribunal started from the position that dishonesty constitutes a breach of a fundamental tenet of the profession of medicine (PSA v GMC & Igwilo [2016] EWHC 524). The Tribunal recognises that cases of dishonesty generally lie at the top end of the spectrum of gravity of misconduct (Tait v Royal College of Veterinary Surgeons (2003) 147 SJLB 536, paragraph 13). Accordingly, in many cases, the wider public interest concerns that arise will necessitate a finding that fitness to practise is impaired. 46. However, a finding of impairment does not automatically follow from a finding of dishonesty. As Lang J observed in Uppal:

“not every act of dishonesty results in impairment” (paragraph 27) 47. The Tribunal proceeded on the basis that it will be an unusual case in which dishonesty is not found to impair fitness to practise (GMC v Nwachuku 2017 EWHC 2085, paragraph 48). However, each case will turn on its individual facts and circumstances. 48. As Mr Justice Jay observed in GMC v Chaudhary 2017 EWHC 2561 (paragraph 57):

“First of all…dishonesty is not necessarily a monolithic concept…questions of degree obviously arise - that much must be self-evident - but secondly…dishonesty in an individual does not have to be an all-pervading or immutable trait. A person can be dishonest just on one occasion.”

49. Accordingly, the Tribunal requires to consider not just the nature of the dishonesty that occurred in this case but also the context in which it occurred. The Tribunal gave detailed consideration to the individual factors that arise in this specific case before making a global assessment as to whether a finding of impairment is required. 50. Having considered the specific factors in the present case, the Tribunal has concluded that this is an unusual case. Notwithstanding the finding of dishonesty that has been made, and the significant weight that needs to be accorded to this finding and the public interest limbs of the over-arching objective set out in the 1983 Act, the Tribunal concluded that Dr Ahmed’s fitness to practise is not impaired.


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51. The Tribunal’s reasons for reaching its conclusion can be summarised as follows:

(i) The insight shown by Dr Ahmed;

(ii) Dr Ahmed has apologised and expressed remorse;

(iii) Dr Ahmed’s efforts towards remediation;

(iv) Patients were not put at risk;

(v) The incident is a one-off error of judgment in an otherwise unblemished career;

(vi) There is a very low risk of repetition; and

(vii) In the specific circumstances of this case a finding of impairment is not

required to protect the public or uphold proper professional standards. 52. The Tribunal had at the forefront of its mind the public interest requirements that arise in this case and accorded significant weight to the need to declare and uphold proper professional standards and to maintain public confidence in the profession. The judgment that the Tribunal has reached is based on an holistic consideration of all relevant factors. (i) Insight

53. In the case of CHRE v NMC & Grant [2011] EWHC 927 (Admin), Mrs Justice Cox stated:

“When considering whether fitness to practise is currently impaired, the level of insight shown by the practitioner is central to a proper determination of that issue.” (Paragraph 116).

54. Ms Goring submitted that some insight had been shown by Dr Ahmed. She queried whether full insight had been developed by Dr Ahmed. He had, at various points, referred to his action as “cutting corners”, an “oversight” and a “mistake”. In his oral evidence to the Tribunal, Dr Ahmed accepted that his conduct was much more serious. 55. Mr Hockton suggested that significant insight had been shown by Dr Ahmed into his failings.


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56. In his oral evidence, Dr Ahmed stated that he first became aware that an issue had been identified with the certificate he submitted to Holt in Autumn 2018. He had a telephone call with Dr G, Primary Care Dean and Deputy Postgraduate Dean, on 18 December 2018. The Tribunal finds that Dr Ahmed was aware of the issue with the Mandatory Training certificate at this time but did not admit that he had altered the certificate. The Tribunal makes this finding based on the letter Dr G wrote on 5 February 2018. Dr Ahmed had a meeting with Dr H on 9 January 2019. At that meeting, he admitted that he had falsified the certificate. 57. From 9 January 2019 onwards, he has consistently recognised that what he did was fundamentally wrong. He has not sought to justify or minimise the significance of his actions. He has provided context, including certain family pressures that existed at the time. However, he clearly acknowledged at an early stage that what he did was wrong. 58. In the meeting with Dr H, Dr Ahmed described his actions as a “moment of stupidity”. Dr H records in the note of the meeting that Dr Ahmed admitted altering the year of the certificate and:

“…accepts that it was a serious lack of judgment done at a time of family financial pressures”

59. In terms of a letter dated 5 July 2019, Dr Ahmed’s representatives wrote to the GMC. In that letter, Dr Ahmed accepted the allegation and provided an apology. There is a recognition of the seriousness of the matter. The letter records that the actions were “foolish”. Regret and remorse is expressed. 60. In his oral evidence, Dr Ahmed stated that, in 2017, he considered that he was merely “cutting-corners”. He had the requisite qualifications and viewed the certificate Holt requested as a mere formality. In his evidence to the Tribunal, he was clear that his views since the incident are very different. The views expressed in his evidence are consistent with his witness statement and reflective pieces. 61. In Dr Ahmed’s witness statement, dated 8 November 2019, he offered no excuse for what he did. He acknowledged that his actions were foolish. He stated he was ashamed of what he had done. He readily acknowledged that this was a serious error. He acknowledged the potential impact on public confidence in the medical profession. He stated:

“I fully appreciate that the patients and the public put a lot of trust in their doctors and anything that puts that trust in jeopardy could have a large effect on how the patients and the public view not just me, but more importantly the profession as a whole”

62. Furthermore, he candidly stated that he had let down the profession.


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63. In the first reflective piece, dated 26 February 2019, Dr Ahmed recognises that he let himself down and compromised core values of the medical profession. He did describe this as a “one off moment of madness”. However, he also states that:

“Mandatory training is essential for us as doctors, particularly as a locum working in a new environment, to do. It acts as an important refresher in crucial topics that we need to work safely and do our jobs…it is simply completely unacceptable for this not to be completed”

64. He recognised that he was under pressure at the time. However, he did not offer this as an excuse or a justification for his actions. He outlined that he has looked at every aspect of his character since the events in question. This was consistent with his oral evidence where he talked of the “old” Dr Ahmed and outlined the work that he has undertaken to change significant aspects of his life. He was clear that honesty and integrity are essential qualities in a doctor that should never be compromised. 65. Dr Ahmed provided a series of further reflective pieces. In the reflective statement dated 30 June 2019, he again stated that he took full accountability for his actions and offered no excuse. He states that his actions were incompatible with the values of the medical profession. He described his actions as:

“…a catastrophic act of dishonesty and the most serious error of judgment that I as an individual can make…”

66. In a reflective statement dated 14 May 2019, he states that:

“What I did was quite simply dishonest, stupid and it brought the whole medical profession into disrepute”

67. He describes his actions in 2017 as:

“a colossal error of judgment" 68. Dr Ahmed explained, both in his oral evidence and in his reflective pieces, details of courses he has undertaken. He undertook a course called “Maintaining Professional Ethics”. This was an intensive three-day course which involved small group sessions. Dr Ahmed outlined that this course allowed for deep reflection to take place in relation to his actions in 2017. 69. Dr Ahmed recognises that he had been under stress at the time of the event. A family business was in financial difficulties and he was attempting to provide financial assistance. He provided this information by way of explanation rather than by way of excuse. He recognises that he has a stressful job and work pressures and personal


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pressures may arise in the future. In one of his reflective statements, he observes that:

“Even though I was under extreme pressure at the time, I will be under extreme pressure at other times in my career and I have to hold to higher standards for myself so that I never consider cutting corners or such serious matters just because life gets stressful…”

70. In his oral evidence and in his reflective pieces, he explained the strategies that he has put in place to ensure that he will not make an error of judgment at the times of stress in the future. 71. While Ms Goring is correct to state that the Doctor has variously described his actions as a “moment of stupidity” and a “moment of madness”, these statements need to be viewed in context. Dr Ahmed has taken full responsibility for his actions from an early stage. He has not sought to minimise his actions. He accepts that they were wrong and that they had the potential to jeopardise the critical relationship of trust that exists between doctor and patient. He recognises the importance of the system that was put in place by Holt. It was aimed at ensuring patient safety and any perception that the system is not robust could have catastrophic consequences for public trust in the medical profession and Patient safety could be put at risk. 72. The Tribunal considers that Dr Ahmed has demonstrated deep insight into his actions. It is clear from his oral evidence, witness statement, and the documentary evidence (particularly the reflective statements), that he recognises that his actions on 6 June 2017 were completely unacceptable. He acknowledged that his actions were wrong at an early stage. He has not sought to explain or excuse his behaviour. He has taken responsibility for his actions and has undertaken a period of deep reflection. He has identified underlying issues that contributed to his actions and has taken significant steps towards remediation. (ii) The Doctor has apologised and expressed remorse 73. From an early stage in proceedings, Dr Ahmed has not only accepted his failings but has apologised and expressed remorse. 74. In terms of a letter dated 5 July 2019, from Dr Ahmed’s representatives to the GMC, he accepted the factual allegations. He accepted that his actions were dishonest. Dr Ahmed apologised for his actions. The letter states:

“He fully appreciates how serious the matter is and is deeply sorry for what happened”

75. Dr Ahmed also wrote to Holt apologising for his actions.


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76. In his oral evidence before the Tribunal, Dr Ahmed again expressed shame, regret and remorse for his actions. The Tribunal considers that these expressions were genuine and heartfelt. The Tribunal considers that Dr Ahmed recognises the wider ramifications of his actions in terms of public confidence in the medical profession. The Tribunal considers that this is relevant to the risk of repetition. (iii) The efforts made towards remediation 77. One of the important issues in the present case is the Doctor’s character. He has been found to have committed a dishonest act. That calls into questions his judgment and how he will act in the future. 78. In the present case, the Tribunal considers that the doctor provided evidence that significant steps have been taken to seek to remediate his failings. That is relevant to the assessment which the Tribunal requires to make, namely whether his fitness to practice is currently impaired. 79. The Doctor recognised that one of the potential triggers for his actions was personal stress. Dr Ahmed recognised that his work will likely give rise to stressful situations in the future. He has put in in place safeguards against the effects of stress in the future. 80. For example, he is regularly engaging with his general practitioner. He has also undertaken courses such as mindfulness training. Dr Ahmed explained in his oral evidence that he has sought support from educational supervisors, has engaged with XXX. In addition, he has arranged courses for junior colleagues and international medical graduates in relation to professionalism and ethics to seek to educate others on the importance of maintaining professional standards and of complying with GMP. 81. The Tribunal notes that Dr Ahmed has undertaken a targeted ethics course entitled “Maintaining Professional Ethics”. As outlined above, this is an intensive three-day course that involved small group sessions. It allowed for Dr Ahmed to undertake deep reflection on his actions and the potential impact of his actions on patients and the wider profession. His reflections show that Dr Ahmed has confronted the factors that resulted in him making the significant error of judgment at the heart of the case. Therefore, the Tribunal considers that the steps taken in relation to remediation have gone well beyond merely attending lectures on ethics and probity. 82. The Tribunal also notes that he has put in place a development plan. This covers not just 2019 but also 2020. Dr Ahmed explained that he wishes to continue with the process he has started to ensure there is no chance of any repetition of the incident that occurred in 2017. 83. The Tribunal considers that significant steps have been taken by Dr Ahmed in relation to remediation.


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(iv) Patients were not put at risk 84. Ms Goring submitted that patients were placed at risk of harm as a result of Dr Ahmed's action. He circumvented a procedure that was in place to ensure that patient safety was not put at risk. Dr Ahmed himself accepts that such basic training is essential to ensuring patient safety. 85. Mr Hockton submitted that Dr Ahmed had completed the relevant modules albeit not with the provider named on the falsified certificate. He submitted that Dr Ahmed had the required clinical skills to undertake the locum work and patient safety was not jeopardised. 86. Dr Ahmed had completed all of the modules relevant to the Mandatory Training that he falsified. He explained in his oral evidence that he could have provided alternative evidence to Holt demonstrating that he did not require to undertake any more courses. Moreover, he stated that he could have undertaken the online course, and have obtained a legitimate certificate, in a matter of hours. Dr Ahmed estimated two to four hours would have been required to complete the work. 87. In the specific circumstances of Dr Ahmed’s case, patients were not directly put at risk. He had the knowledge and experience to carry out the locum work. On the evidence before the Tribunal, Dr Ahmed had all of the mandatory training required. That is a relevant consideration for the Tribunal. 88. However, the Tribunal acknowledges that there are wider interests in play. Any perception that mandatory training requirements are of insignificance or that the entire system can be circumvented without any risk of regulatory consequences are factors that weighed heavily with the Tribunal. Therefore, Dr Ahmed’s actions had the potential to jeopardise patient safety. They also had the potential to undermine public confidence in the medical profession. (v) The incident is a one-off error of judgment in an otherwise unblemished career 89. Ms Goring submitted that the Tribunal should not view the present case as a momentary lapse of judgment. The creation of the falsified certificate required planning. It was therefore a deliberate and premeditated act. Mr Hockton submitted that the Tribunal requires to focus on the wording of the Allegation. It concerns a single incident of dishonesty. 90. The Tribunal did not accept Ms Goring’s characterisation of Dr Ahmed’s conduct. 91. Firstly, the allegation only relates to the creation and submission of the certificate. The wording is clear that there is a single incident. Secondly, the Tribunal


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does not consider that this was a premeditated act which required significant planning. Dr Ahmed stated that although he registered with the agency in May 2017, he was not asked to provide any Mandatory Training Certificates at that time. He was only asked to provide these when there was a chance of shifts. There was a telephone call in July 2017 and he was told that to secure the shifts on offer he would need to provide the required documents without delay. His evidence was that, at that point, he opened his previous certificate which he could access on a word document format on his computer. He changed the year at the bottom of the previous certificate awarded to him and sent it to Holt. He did not change any other details. For example, he did not change the day or month. The certificate number was identical to the previous certificate. The score was exactly the same. The Tribunal was satisfied that these factors were consistent with a lapse in judgment over a short period of time as opposed to an act which was premeditated in the sense of requiring significant thought and planning. 92. The Tribunal also considers that the act at the centre of the allegation requires to be put in context. There is no evidence of any previous issues with Dr Ahmed’s character. Moreover, there is no evidence of any issues surrounding Dr Ahmed’s honesty and integrity in the period after the incident set out in the Allegation. 93. The Tribunal considers that the evidence and testimonials from other doctors that know Dr Ahmed are significant. These were not basic documents attesting to Dr Ahmed’s clinical skills. The evidence and testimonials also addressed Dr Ahmed’s character and probity before the event set out in the Allegation and in the following period. 94. A number of individuals attended the Tribunal and gave evidence in relation to Dr Ahmed’s character. Professor C, Consultant and Honorary Professor in Infectious Diseases 95. Professor C is Dr Ahmed’s educational supervisor and supervising consultant. He has known Dr Ahmed since 2016. He stated that Dr Ahmed had been open with him about the present proceedings. Dr Ahmed admitted that he falisfied the certificate from an early stage. Professor C considers that Dr Ahmed has recognised that his actions were wrong. Professor C considers that it was an isolated incident and that there is a low risk of repetition. 96. In addition to his oral evidence, Professor C provided written testimonials dated 2 July 2019 and 2 January 2020. They are in identical terms. He records that Dr Ahmed discussed the allegation in detail with him. In the testimonial, Professor C comments on Dr Ahmed’s integrity and professionalism. Professor C described these as “exemplary”. He stated that:


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“I honestly feel that this was an isolated incident and Dr Ahmed has been a very competent and outstanding doctor who has otherwise been a credit to the Medical Profession”

Dr E consultant physician and geriatrician 97. Dr E stated although he had occasional contact with Dr Ahmed before 2018 his main contact with him has been in the period from August 2018 to date. In his oral evidence he explained that Dr Ahmed was open and candid about the fact he had falsified the certificate. He states that Dr Ahmed was humble and had learned from his errors. Dr E stated that he had no concerns about Dr Ahmed’s honesty or integrity. He considers that Dr Ahmed’s actions in 2017 were out of character. Dr Ahmed is somber and remorseful. He is fully aware of the impact of his actions on patients and other professionals. 98. Dr E provided a letter dated 6 January 2020 which was consistent with his oral evidence. Dr D, consultant ortho-geriatrician and clinical tutor, University Hospitals of Leicester 99. Dr D stated that she has worked closely with Dr Ahmed since September 2018. She was aware of the incident in 2017 and stated that notwithstanding that incident she did not have concerns about Dr Ahmed’s honesty or integrity. She stated that Dr Ahmed was devastated by his actions. She stated that it was out of character for the person she knows. She considers that he has shown deep remorse. That is genuine and sincere. 100. Dr D provided a letter dated 27 December 2019. She explains in the letter that Dr Ahmed had told her about the ongoing regulatory proceedings. The letter states:

“It was a difficult discussion for him during which I felt he showed both insight and genuine remorse for his actions”

Dr F 101. Dr F is a Specialist registrar in infectious diseases and general medicine. He has known Dr Ahmed since 2015. 102. Dr F stated that Dr Ahmed is a well-respected doctor and he also attested to his probity and character. Dr Ahmed had informed Dr F about the incident that forms the basis of the Allegation. Dr F’s position was that this act was out of character. Dr F stated that, in his view, the acid test for him was whether he would trust Dr Ahmed to treat a close family member notwithstanding what he knows about the incident in 2017. He said the answer to that question was unquestionably yes. Dr Ahmed is an individual that Dr F trusts wholeheartedly notwithstanding the fact he is aware of the


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Allegation. He does not think he will ever make a similar mistake. He considers that the remorse expressed is genuine. 103. Dr F also provided a letter dated 8 June 2019. In the letter, he states that:

“I do not think he will ever make a mistake like this again” 104. Ms Goring did not cross-examine any of these witnesses. The Tribunal considers that each of the witnesses was credible and reliable. Other Testimonials 105. In addition to the oral testimony a number of written testimonials were provided. 106. Professor I, consultant nephrologist and honorary professor of medical education provided a written testimonial. She worked with Dr Ahmed in the period from August 2018 to April 2019. She stated that Dr Ahmed had been honest and open about GMC referral. She stated:

“He was open and honest about the events which led to his referral to the General Medical Council and pro-actively came to tell me about these issues when he was informed. My observation was that he reflected in depth on the issues, and actively sought opportunities to learn and to remediate”

107. Dr J, consultant in infectious diseases, provided a letter dated 3 July 2019. Dr J has known Dr Ahmed since December 2015. Dr J stated:

“I feel that this mistake is not at all representative of his professionalism and integrity. I trust him wholeheartedly to continue to work with me and care for my patients”

108. Dr K, infection registrar at the University of Leicester, provided a letter. Dr K has known Dr Ahmed since 2015. In the letter, Dr K states:

“I have read the allegations against Dr Ahmed and find them to be most surprising as I do not find them consistent with my interactions with him…”

109. Dr Ahmed, Infectious Diseases and Virology Trainee (ST5), provided a letter dated 1 July 2019. In the letter, Dr Ahmed states:

“He is an honest doctor and what happened…is not at all a trend from my encounter with him”


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110. Dr L, Acute and General Medicine Registrar, provided a letter in which he describes Dr Ahmed as:

“…reliable and trustworthy” 111. Mr M, director of clinical education/ associate medical director and consultant vascular surgeon provided a letter dated 3 December 2019. Mr M states:

“Very early on he told me of the allegations and of his remorse and stupidity in the act that led to them...We do not condone this behaviour, however Dr Ahmed has shown himself to be a trustworthy individual during the time that I have known him and he is held in high regard within our department”

112. Ms Goring confirmed that no issue was taken by the GMC with the terms of any of the testimonials that have been provided to the Tribunal. 113. The evidence and testimonials above gave the Tribunal a wider appreciation of Dr Ahmed as a person. All of the evidence before the Tribunal strongly indicates that Dr Ahmed is an individual that, prior to the incident in 2017, was of good character. Moreover, since the incident, he has not sought to excuse his actions or diminish their significance. Indeed, he has been completely open and candid with colleagues about his failings and his desire to remediate those failings. There is no suggestion that there have been any issues with his honesty or probity since the incident in 2017. 114. All of the witnesses that attended the hearing were aware of the incident in 2017. They did not condone Dr Ahmed’s actions and recognised that his actions amounted to a serious failing. However, all of the witnesses consider that Dr Ahmed is someone who is otherwise of good character. He was consistently described as honest and trustworthy. The written testimonials were in similar terms. 115. In these circumstances, the Tribunal is confident that Dr Ahmed’s actions in 2017 can properly be characterised as a one-off incident. This was an isolated error of judgment. (vi) There is a very low risk of repetition 116. Dr Ahmed breached a fundamental tenet of the profession. There is therefore an issue in terms of risk of repetition. Notwithstanding the character evidence and testimonials outlined above, it is not possible for the Tribunal to conclude that there is no risk of a similar incident taking place in the future. Where there is a low risk of a serious outcome, this will need to be given due weight by the Tribunal. As Mr Justice Lane observed in GMC v Dr Somuah-Boateng [2017] EWHC 3565:

“…the fact that the finding was one of low risk is not the same as a finding that there was no risk. A finding of low risk in respect of something which, if it occurs


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or re-occurs, would be extremely serious is something that must be given proper weight by the relevant Tribunal. Such a risk is still a material issue.” [paragraph 48]

117. The Tribunal cannot completely rule out the possibility of repetition by Dr Ahmed. However, having considered all of the factors in this case, the Tribunal ultimately concluded that there is an extremely low risk of repetition. (vii) In the specific circumstances of this case a finding of impairment is not required to protect the public or uphold proper professional standards 118. Ms Goring submitted that in the particular facts of this case, the serious incident of dishonesty required a finding that fitness to practice was currently impaired. Mr Hockton did not seek to diminish the seriousness of the actions. He submitted that this was an unusual case and balancing all the factors a finding of impairment was not required. 119. The Tribunal recognises that appropriate consideration needs to be given to the public interest issues that arise in the present case. As Silber J stated in Cohen v General Medical Council [2008] EWHC 581:

“Any approach to the issue of whether…fitness to practise should be regarded as ‘impaired’ must take account of…the collective need to maintain confidence in the profession as well as declaring and upholding proper standards of conduct and behaviour...” [paragraph 62]

120. Similar observations were made by Lang J in Uppal:

“In determining whether a practitioner's fitness to practise is impaired by reason of misconduct, the relevant Tribunal should generally consider not only whether the practitioner continues to present a risk to members of the public in his or her current role, but also 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.” (paragraph 74)

121. The Tribunal has found serious misconduct based on dishonesty. In many cases, the submission of false documents to obtain work will be viewed as undermining something so fundamental to the system of medicine that a finding of impairment must follow (Naheed v GMC [2011] EWHC 702 (Admin); Makky v GMC [2009] EWHC 3180 (Admin) at paragraphs 43 to 44). It will be an unusual case where a finding of dishonesty is made and a tribunal concludes that fitness to practice is not impaired (Professional Standards Authority v Health and Care Professions Council 2014 EWHC


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2723 per Carr J at paragraphs [45] and [46]). As the Court observed in Hassan v GOC [2013] EWHC 1887 (Admin):

“Dishonesty encompasses a very wide range of different facts and circumstances. Any instance of it is likely to impair a professional person's fitness to practise and in that sense is a serious matter."

(at paragraph 39; see also Professional Standards Authority v Health and Care Professions Council 2014 EWHC 2723 at paragraph 51)

122. The Tribunal accepts that where there has been a breach by a doctor of a fundamental tenet of their profession, the efforts made by a doctor to address his problems and reduce the risk of recurrence in the future are potentially of less significance than in other cases such as clinical error (Yeong v GMC [2009] EWHC 1923 (Admin) (“Yeong”) at paragraphs 48 to 51). While this general principle is not in doubt, the Tribunal considers that the precise weight to be accorded to any one factor will be specific to the individual case. Moreover, it is noteworthy that Yeong involved a doctor’s sexual relationship with a patient. It is appropriate to record that the present case arises in different circumstances. 123. The Tribunal has given careful consideration to whether the public interest and the need to protect patients, declare and uphold proper standards of behaviour and maintain public confidence in the profession requires a finding to be made that Dr Ahmed’s fitness to practice is currently impaired. It considered whether a finding of impairment based on Dr Ahmed’s submission of the falsified certificate alone could properly be said to be required to mark the professional unacceptability of such dishonesty. That is particularly so given that the Tribunal has concluded that there is still a risk of repetition albeit the Tribunal considers that risk is very low. A low risk of a serious outcome is still a significant factor that needs to be considered. Moreover, the Tribunal considered whether such a finding was required to ensure that the public can have confidence in the recruitment procedures for locum doctors. The Tribunal has already noted that while no patient was harmed in this particular case, Dr Ahmed’s actions risked the integrity of the entire system of recruitment for locum doctors. 124. The misconduct in the present case is serious. However, this needs to be balanced against the fact the Tribunal has found that Dr Ahmed’s actions can be characterised as a one-off incident. This is not a situation where a Doctor lied about their clinical qualifications or claimed to have greater experience than was actually the case. Moreover, this is not a case where there was significant planning such that the act can be described as premeditated. There was a deliberate attempt to circumvent the regulatory system. However, in the present case, this occurred in circumstances where Dr Ahmed had completed all of the required modules and had all of the required skills. Indeed, he was said to be overqualified for the clinical locum work that was undertaken.


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125. The Tribunal considers that, in this particular case, Dr Ahmed’s attitude to the Allegation, his admission of responsibility at an early stage, the fact that he has developed significant insight into his failings in 2017 and their impact on public trust in the medical profession are highly relevant. He has otherwise been of good character as set out in the witness evidence and testimonials. 126. The Tribunal has also placed weight on the fact that there is a very low risk of repetition. The Tribunal accepts that a low risk of a serious outcome is a relevant factor. However, in this particular case, the Tribunal considers that the risk of any such outcome is extremely low. 127. The Tribunal has also considered the remediation undertaken. It has considered whether the remediation undertaken has addressed the gravamen of the case found proved against the doctor (GMC v Khetyar 2018 EWHC 813). The Tribunal finds that it has. Dr Ahmed committed a serious act of dishonesty. However, he has done much more than merely attend lectures on ethics and probity. He has attended intensive targeted courses and undertaken detailed focused self-reflection. The Tribunal considers that he has taken significant steps to attempt to address his failings and attempt to ensure that no such issues will arise in the future. 128. The Tribunal has balanced the public interests that arise in this case against all other relevant factors. The Tribunal has not given undue weight to any one factor or consideration. The Tribunal’s judgment is based on a holistic assessment of all the factors in Dr Ahmed’s case. 129. The Tribunal recognises that the instinctive response of members of the public and members of the profession, on learning that any doctor has been dishonest, would be that any such behaviour impairs fitness to practise. However, the Tribunal considers that this is an overly simplistic approach to the present case. The Tribunal considers that the well-informed member of the public, and the well-informed member of the profession, would be aware of all of the relevant factors addressed above. In this case, the Tribunal considers that if members of the public, and members of the profession, were aware of the insight Dr Ahmed has shown, the fact that no patient was at direct risk of harm, that there is a very low risk of repetition, that he is viewed as honest and trustworthy by his colleagues notwithstanding the lapse in judgment by him in 2017, and were informed of the significant remedial steps that he been undertaken, the Tribunal considers that they would not conclude that a finding required to be made that Dr Ahmed’s fitness to practice is currently impaired. 130. The Tribunal ultimately concluded that this is an unusual case where the public interest does not require a finding to be made that Dr Ahmed’s fitness to practice is currently impaired.The Tribunal took the view that this was a case that fell just below the threshold for finding the doctor’s fitness to practice is currently impaired.

Conclusion


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131. Ultimately, the Tribunal has concluded that this an unusual case in which, notwithstanding the admission of dishonesty, Dr Ahmed’s fitness to practice is not currently impaired. Determination on Warning - 31/01/2020 132. As the Tribunal determined that Dr Ahmed’s fitness to practise is not impaired it considered in accordance with Section 35D(3) of the Medical Act 1983 and under Rule 17(2)(m) and (n) of the Rules, whether no action should be taken or a warning is required. Submissions 133. After the Tribunal issued its decision on the issue of impairment the Tribunal invited submissions on whether or not a warning should be issued in this case. Submissions on behalf of the GMC 134. Ms Goring submitted that the GMC seek a warning in this case. She directed the Tribunal’s attention to the document ‘General Medical Council Guidance on Warnings’ (February 2018 edition) (‘the Guidance’), specifically paragraphs 10, 14, 16, 20(a)(c)(d) and 24 of that Guidance when making its determination. 135. Ms Goring acknowledged a number of the mitigating factors in this case as outlined by the Tribunal in its determination on impairment. Notwithstanding these mitigating factors, she submitted that Dr Ahmed’s breaches of GMP were so significant that a warning is justified in this case. She reminded the Tribunal this was a case involving dishonesty and she stated that a warning would act as a deterrent and ensure public confidence in the profession is maintained by the demonstration of a formal response by a Tribunal in relation to Dr Ahmed’s misconduct. Submissions on behalf of Dr Ahmed 136. Mr Hockton submitted that Dr Ahmed does not oppose the GMC submission that a warning is appropriate. The Tribunal’s Approach 137. The decision whether or not to issue a warning is a matter for the Tribunal alone to determine, exercising its own professional judgement. In making its decision, the Tribunal had regard to the Guidance, and in particular had regard to paragraphs 10, 11, 13, 14, 16, 20(a)(c)(d), 24 and 25. The Tribunal also considered the sanction guidance. 138. The Tribunal considered the relevant sections of the Guidance are:


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10 ‘The power to issue warnings, together with other powers available to the GMC and to MPTS tribunals, is central to their role of protecting the public which includes protecting patients, maintaining public confidence in the profession and declaring and upholding proper standards of conduct and behaviour.’

11 ‘Warnings […] are a formal response from […] MPTS tribunals in the interests of maintaining good professional standards and public confidence in doctors […]’

13 ‘Although warnings do not restrict a doctor’s practice, they should nonetheless be viewed as a serious response, appropriate for those concerns that fall just below the threshold for a finding of impaired fitness to practise.’

14 ‘[…]Warnings may also have the effect of highlighting to the wider profession that certain conduct or behaviour is unacceptable.’

16 ‘A warning will be appropriate if there is evidence to suggest that the practitioner’s behaviour or performance has fallen below the standard expected to a degree warranting a formal response by […] a MPTS tribunal. A warning will therefore be appropriate in the following circumstances: - there has been a significant departure from Good medical practice […]’

20 ‘The decision makers should take account of the following factors to determine whether it is appropriate to issue a warning. a. There has been a clear and specific breach of Good medical practice or our supplementary guidance. […] c. A warning will be appropriate when the concerns are sufficiently serious that, if there were a repetition, they would likely result in a finding of impaired fitness to practise. Warnings may be an appropriate response to any type of allegation […]; the decision makers will need to consider the degree to which the conduct, behaviour or performance could affect patient care, public confidence in the profession or the reputation of the profession. If the decision makers consider that a warning is appropriate, the warning should make clear the potential impact of the conduct, behaviour or performance in question, accordingly.’

d There is a need to record formally the particular concerns (because additional action may be required in the event of any repetition).


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24 ‘There is a presumption that the GMC should take some action when the allegations concern dishonesty. There are, however, cases alleging dishonesty that are not related to the doctor’s professional practice and which are so minor in nature that taking action on the doctor’s registration would be disproportionate. A warning is likely to be appropriate in these cases. An example of this might include, in the absence of any other concerns, a failure to pay for a ticket covering all or part of a journey on public transport.’

25 ‘In deciding whether to issue a warning the decision maker should apply the principle of proportionality, weighing the interests of the public with those of the practitioner. It is important to bear in mind, of course, that warnings do not restrict the practitioner’s practice and should only be considered once the decision maker is satisfied that the doctor’s fitness to practise is not impaired.’

139. When making its decision the Tribunal exercised its own independent judgement. Throughout its deliberations, the Tribunal had regard to the statutory overarching objective. In that regard, it bore in mind that its power to issue a warning is an important feature of its role of protecting the public, which includes: protecting patients, maintaining public confidence in the profession, and declaring and upholding proper standards of conduct and behaviour. The Tribunal’s Determination on a Warning 140. The Tribunal had regard to the following mitigating factors in this case:

• exceptional steps to remediate his failings; • considerable insight; • genuine expressions of remorse and apology; • extensive reflective material; • testimonials from colleagues, • a very low risk of repetition; and • there is no evidence of previous or subsequent dishonest behaviour.

141. Notwithstanding the mitigating factors in this case the Tribunal was satisfied that, given the nature of its findings in relation to Dr Ahmed’s misconduct, his behaviour fell below the standard expected of a doctor to a degree which warrants a formal response by the Tribunal. There had been clear and specific breaches of GMP which were significant. 142. The Tribunal reminded itself that its decision to find Dr Ahmed’s fitness to practise is not currently impaired was influenced, in part, by the existence of the above mitigating factors and remediation since the index events. Whilst the Tribunal accept that there is a very low risk of Dr Ahmed repeating his misconduct it


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determined that it was necessary to highlight to Dr Ahmed, the public and the medical profession that his misconduct was serious and unacceptable. 143. The Tribunal considered it appropriate and proportionate to issue a warning and was satisfied that failing to do so would not fulfil its duty to:

b. Promote and maintain public confidence in the medical profession, and c. Promote and maintain proper professional standards and conduct for

members of that profession. 144. As the Tribunal outlined in its determination of impairment any dishonesty concerning a doctor is serious. The Tribunal finds the misconduct in this case was just below the threshold for finding Dr Ahmed currently impaired. In these circumstances taking no action would not be a proper response given the public interest issues that arise. 145. Although a warning does not prevent a doctor from practising or place restrictions on their registration, the Tribunal anticipates that the warning will act as a deterrent and reminder to Dr Ahmed and the profession as a whole that his conduct fell below the standard expected and that a repetition is likely to result in a finding of impaired fitness to practise. It considered that it was necessary to reinforce the importance of maintaining proper professional conduct. The Tribunal considered this to be the proportionate response. 146. The Tribunal has therefore determined to issue the following warning in accordance with Section 35D(3) of the Medical Act 1983 and Rule 17(2)(n) of the Rules:

‘The allegation, the facts of which were admitted by Dr Ahmed and found proved by the Tribunal, were as follows:

On 27 July 2017, Dr Ahmed submitted a mandatory training module certificate to his locum agency, which stated that he had completed an online course called Mandatory Training including Handbook on 6 June 2017 (the ‘mandatory training’). Dr Ahmed did not complete the mandatory training. Dr Ahmed knew that he had not completed the mandatory training. He falsified the certificate to show that he had completed the mandatory training. His actions were dishonest.

The Tribunal found that this amounted to serious misconduct. However, in the unusual circumstances of this case, the Tribunal did not find his fitness to practise is currently impaired.


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In this case, Dr Ahmed breached the required standards set out in Good Medical Practice. The following paragraphs are particularly relevant:

1 Patients need good doctors. Good doctors make the care of their patients their first concern: they are competent, keep their knowledge and skills up to date, establish and maintain good relationships with patients and colleagues, are honest and trustworthy, and act with integrity and within the law.

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.

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

The conduct that has been found proved by the Tribunal does not meet the standards required of a doctor. It brought the profession into disrepute and must not be repeated. The standards of honesty and integrity required of doctors are clearly set out in the sections of GMP narrated above. While the Tribunal has found that a finding of impaired fitness to practise is not required for the reasons set out in the determination, it is necessary in response to the serious misconduct that took place in 2017 to issue this formal warning in order that Dr Ahmed and the wider profession are aware that such conduct is unacceptable. It is also necessary that a warning is issued to maintain public confidence in the profession.’

147. This warning will be published on the medical register in line with the publication and disclosure policy, which can be found at www.gmc-uk.org/disclosurepolicy. 148. That concludes this case. Confirmed Date 31 January 2020 Mr John MacGregor, Chair

Documents

PUBLIC RECORD - mpts-uk.org · 2. Dr Aleem Ahmed qualified in 2010 from Manchester University and obtained full GMC registration and a licence to practise in 2011. At the time of