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.
Perhaps Dr F had a better understanding than she is credited with of how QOF works.
Whilst it is hard to tell if the circumstances were identical, it is concerning that Dr M is judged to have a ‘genuine belief’ that the entries were correct, but Dr F was not judged to have such a ‘genuine belief’.
I believe most practices would not exception report until very late in the year, because this allows every possible opportunity for the patient to take advantage of the offers, or achieve the required criteria, up until the very last minute.
The other concerning issue here is that it is considered far more important to litter the patient’s health records with multiple entries, and to waste time doing these entries during consultations instead of dealing with patient-centred matters of more urgency, that clog up the system and make information retrieval more difficult, rather than deal with the patients’ agendas and conditions, and only worry about recording repeated offers of (to the patient) less important things, once the need for the exception report has been identified, after the end of the year!
QOF has been broken for years, and this just proves it, and does not appear to prove anything else!
I hope they are able to enjoy the time away from their work. There is a whole world out there, lovely sunny day today.
I’m with Burgin. We are left aboard manning a sinking ship, then the authorities want to rap us over the knuckles for spilling some milk. The F***ing ship is sinking!
Gps overwhelmed with managing patient demand during working hours would probably end up doing administrative work in the dead of the night when sleepless through anxiety or exceptionally early in the morning – so ‘entries had been made between the hours of 22.56 and 04.58’ may not be that unusual!
Adding notes to records does not need to be always written and idientified as in retrospect – as there is a clear audit trail on most clincial systems that shows thae excat changes and times, and who was logged in making them.
Fortunately the tick box medicine is slowly shrinking in terms of percentage of financial renumeration for GPs, so less time will be wasted in pointless administration. Just wish the child immunisation targets would allow parental refusal as allowing parental choice then penalising GPs with near impossible targets to hit makes no sense. Either manadate the vaccines with qualification for benefits or nursery places or allow opting out from parents, you can have neither and then penalise GP income for the allowing choice.