GP who recorded ‘untrue’ QOF information suspended for three months

A GP who recorded ‘untrue’ QOF information should be suspended for three months, a medical practitioners’ tribunal has ruled.

The Medical Practitioners Tribunal Service (MPTS) panel said that the circumstances which led to Dr Sarah Alam appearing before the tribunal arose out of ‘irregularities’ being identified in information provided by her practice, the Umar Medical Centre in Blackburn, in respect of the QOF scheme.

In 2019, the CCG found evidence to suggest that some patients’ clinical records had been ‘altered
retrospectively’.

An audit identified that 192 of the patients that were exception reported during the period of investigation ‘were not seen by the practice and did not have an appointment’.

The report also identified that towards the end of the 2017/18 financial year, there had been in excess of 40 retrospective entries in patient notes by Dr Alam, with another 6-7 made by another GP partner and one made by another staff member.

On each of the entries, verbal invites had been retrospectively added to the patients’ medical records who were then exception reported for the purposes of QOF.

The report further noted that in many instances these patients were exception reported outside of the normal practice hours, particularly towards the end of the QOF year, when entries had been made between the hours of 22.56 and 04.58.

The CCG referred the matter to NHS England Counter Fraud and the GMC.

The tribunal hearing, which concluded on 8 April, found that Dr Alam’s ‘failure’ to take steps to ensure the accuracy of her entries, particularly in respect of those patient notes where she could have had ‘no genuine belief’ that an invitation had been given, ‘lacked integrity’.

It found that on some of the patient records ‘she recorded information which was untrue and that she knew to be untrue’ and that Dr Alam ‘fell well below the standards expected’ in the GMC’s Good Medical Practice, and her conduct ‘was serious misconduct’.

The tribunal said: ‘This was not conduct that would uphold patient confidence in her or public trust in the profession and was neither honest nor trustworthy behaviour.

‘The tribunal considered that dishonesty is almost always serious and that integrity demands doctors must adhere to the expected standards, even in challenging circumstances, and must prioritise the accuracy of patient information recorded above professional reputational gain.’

The tribunal noted that Dr Alam’s misconduct had not resulted in any harm to patients, but it considered the fact that there was ‘at least the potential for there to be a risk’ if a patient had missed a chronic disease review as a result.

Dr Alam explained that neither she nor the other partners at the practice ‘had experience of either QOF coding or exception reporting’, both of which she understood would be carried out by a practice manager and a senior practice nurse.

The document said: ‘Dr Alam had taken on the responsibility of the QOF lead at the practice and as such the tribunal found she had a professional obligation to ensure that she was competent to carry out that role.

‘By her own admission she accepts that she lacked knowledge and understanding of the QOF. Whilst the tribunal had regard to the particular circumstances of this case, it found that none of those factors excused Dr Alam’s conduct in embarking on the exercise of QOF reporting, without the requisite knowledge to ensure it was done accurately.’

The tribunal determined that Dr Alam’s ‘dishonesty’, while serious, was ‘limited in scope’, was not motivated by financial gain and occurred within the context of a ‘highly stressful period’ of her life both professionally and personally.

It also said that it was confident that Dr Alam had shown that she now recognises the seriousness of her actions and has demonstrated ‘significant and meaningful insight’.

It imposed a period of three months’ suspension. Dr Alam’s registration will be suspended 28 days from the date on which written notification of this decision is served, unless she lodges an appeal.

Another GP at the practice, Dr Mohammed Raouf Alam, Dr Sarah Alam’s brother, was also referred to the MPTS because of irregularities in the QOF scheme. The tribunal found that none of his actions ‘amounted to serious misconduct’.

He had made retrospective entries in the notes of four patients without indicating that they were retrospective entries.

The tribunal said: ‘In respect of two of those patients he had neither informed the other two clinicians concerned that he had done so, nor had he seen those two patients.

‘He had also exception reported patients where he had made retrospective entries to indicate that invitations to chronic disease reviews had been made.’

But the tribunal found that when he amended the notes of four patients he held ‘a genuine belief that invitations would have been given to those patients’.

It said: ‘The tribunal considered that the conduct of Dr Alam fell below, but not seriously below, the standards expected of a competent GP.

‘The tribunal determined that Dr Alam’s conduct although misconduct did not meet the threshold for serious misconduct.

‘Having made a finding that none of Dr Alam’s actions amounted to serious misconduct, the Tribunal was not required to consider whether his fitness to practise was impaired.’

In 2023, two GPs were suspended for 12 months after an MPTS tribunal found that their falsification of QOF records amounted to serious misconduct.