HEARING PARTLY HEARD IN PRIVATE*

Transcription

1 HEARING PARTLY HEARD IN PRIVATE* *The Committee has made a determination in this case that includes some private information. That information has been omitted from this text. BUNGAY, Paul Graeme Registration No: PROFESSIONAL CONDUCT COMMITTEE MAY 2014 MAY 2017** Most recent outcome: Conditions extended and varied for 12 months (with a review)** ** See page 19 for the latest determination. Paul Graeme BUNGAY, a dentist, BDS Lpool 1987, was summoned to appear before the Professional Conduct Committee on 6 May 2014 for an inquiry into the following charge: Charge (as amended) That, being a registered dentist: 1. At all material times, you were the Principal and sole Dental Practitioner at Lydiate Dental Surgery, Lydiate, Liverpool, Merseyside, L31 2LZ ( the Practice ). 2. You held a contract with Sefton Primary Care Trust ( the PCT ) pursuant to which you provided NHS dental services. Investigation by the Care Quality Commission ( the CQC ) 3. In 2012 the Practice was subject to an investigation by the CQC: (a) (b) (c) (d) on 19 March 2012, the Practice was inspected by 2 compliance officers from the CQC who determined: there were major concerns in respect of outcomes 4, 8, 21; there were moderate concerns in respect of outcomes 7, 10; you failed to produce an appropriate action plan to detail how you would implement the improvements required to achieve compliance with the relevant outcomes; you failed to achieve compliance with the relevant outcomes; between 15 August 2012 and 15 November 2012 you failed to facilitate access to inspectors from the CQC in order that they might determine whether or not you had achieved compliance with the relevant outcomes. Investigation by the PCT 4. Between 11 January 2011 and 10 December 2012 the Practice was subject to an investigation by the PCT: BUNGAY, P G Professional Conduct Committee May 2014 May 2017 Page -1/23-

2 (a) (b) (c) (d) (e) Patient Records between 11 January 2011 and 27 April 2012 you failed to facilitate an audit of the Practice to determine whether or not you were operating to the Essential Qualitative Requirements of HTM 01-05; on 27 April 2012, Martin Jones of the PCT undertook the audit of the Practice and determined that you were operating below the Essential Qualitative Requirements of HTM in all 7 areas; you did not have appropriate policies and protocols in place; between 17 August 2012 and 10 December 2012 you failed to facilitate a followup visit by the PCT to determine whether or not you had complied with the Action Plan dated 22 May 2012; by 10 December 2012, you had failed to complete all tasks as outlined in the Action Plan dated 22 May You failed to provide patient records to the PCT in a timely manner when requested by them as part of their investigation. 6. You stored patient records away from the practice premises and in so doing you: (a) (b) (c) Urgent Care compromised patient safety; compromised continuity of care; compromised patient confidentiality. 7. Between 7 September 2012 and 19 October 2012 you failed to put appropriate arrangements in place to ensure your patients could access urgent care if required. Clinical Care and Record Keeping 8. You treated the following patients at the Practice: (a) in relation to Patient 1: (iii) you failed to record a sufficiently detailed medical history for any treatment prior to 6 December 2011; you failed to undertake an assessment of the periodontal condition of Patient 1 s 5 standing lower anterior teeth prior to 7 December 2010; you failed to make a record of any discussion of the treatment options for the 5 lower standing anterior teeth; (iv) you failed to make a record of preventative advice relating to Patient 1 s oral hygiene; (v) (vi) you failed to undertake and/or record any oral disease risk assessment; you failed to record any appropriate recall periods; (b) in relation to Patient 2: you failed to record a sufficiently detailed medical history for any treatment prior to 29 March 2012; BUNGAY, P G Professional Conduct Committee May 2014 May 2017 Page -2/23-

3 you failed to make a record of the fact that Patient 2 was taking bisphosphonates; (iii) you failed to report adequately on the radiograph taken on 28 March 2012; (iv) (v) you failed to undertake and/or record any oral disease risk assessment; you failed to record any appropriate recall periods; (vi) you failed to provide any appropriate periodontal treatment to Patient 2 after 2 October 2006; (vii) you failed to plan appropriate periodontal treatment for Patient 2; (c) in relation to Patient 3; (iii) you failed to record a sufficiently detailed medical history for any treatment prior to 7 February 2012; you failed to monitor adequately the periodontal condition of Patient 3 until 8 February 2012; you failed to undertake and/or record any oral health risk assessment; (iv) you failed to record any recall period prior to 15 February 2012; (v) you failed to assess accurately Patient 3 s periodontal condition on 8 February 2012; (vi) you failed to plan appropriate periodontal treatment for Patient 3 after 8 February 2012; (d) in relation to Patient 4: (iii) (iv) you failed to retain properly Patient 4 s dental records; you failed to diagnose correctly the level of Patient 4 s oral disease in January 2012; you failed to plan treatment for Patient 4 s oral disease; you failed to advise adequately Patient 4 and/or make a record of advice given in relation to fluoride treatment; (e) in relation to Patient 5: you failed to update Patient 5 s medical history prior to the following treatment dates: A. 27 June 2008; B. 9 February 2009; C. 18 November 2009; D. 11 February 2011; E. 19 July 2011; you failed to monitor adequately Patient 5 s periodontal condition prior to 19 July 2011; BUNGAY, P G Professional Conduct Committee May 2014 May 2017 Page -3/23-

4 (iii) you failed to assess accurately Patient 5 s periodontal condition on 20 February 2012; (iv) you failed to plan appropriate periodontal treatment for Patient 5 after 20 February 2012; (v) you failed to record 3 defective restorations on 20 February 2012; (vi) (vii) you failed to plan treatment for the defective restorations; you failed to advise Patient 5 as to the temporary nature of glass ionomers as restorations and/or make a record of such advice; (viii) you failed to undertake and/or record any oral disease risk assessment; (ix) you failed to record any appropriate recall periods; (f) in relation to Patient 6: (iii) (iv) (v) you failed to record a sufficiently detailed medical history for any treatment prior to 5 December 2011; you failed to monitor adequately Patient 6 s periodontal condition prior to 28 September 2011; you failed to undertake and/or record any oral disease risk assessment prior to 4 December 2011; you failed to diagnose correctly the level of Patient 6 s periodontal disease on 22 August 2012; you failed to plan appropriate periodontal treatment; (vi) you failed to record any recall period prior to 22 August 2012; (g) in relation to Patient 7: you failed to record a sufficiently detailed medical history for any treatment prior to 2 August 2010; you failed to record the examination undertaken by you on 7 March 2011 in respect of the Band 3 treatment for which you claimed; (iii) you failed to undertake a Basic Periodontal Examination ( BPE ) on 7 March 2011; (iv) (v) WITHDRAWN you failed to make a record of your periodontal assessment on 7 March 2011; (vi) you failed to monitor adequately Patient 7 s periodontal condition prior to 3 March 2012; (vii) you failed to diagnose correctly the level of Patient 7 s periodontal disease on 3 March 2012; (viii) you failed to plan appropriate periodontal treatment after 3 March 2012; (ix) you failed to record that a root was retained at Patient 7 s LL6; BUNGAY, P G Professional Conduct Committee May 2014 May 2017 Page -4/23-

5 (x) (xi) you failed to undertake and/or record any oral disease risk assessments; you failed to record any recall period; (h) in relation to Patient 8: (iii) (iv) (v) (vi) you failed to record a sufficiently detailed medical history for any treatment prior to 21 February 2012; you failed to monitor adequately Patient 8 s periodontal condition prior to 21 February 2012; you failed to record the presence of an un-erupted wisdom tooth at Patient 8 s UR8; you failed to inform Patient 8 of the un-erupted wisdom tooth at UR8; WITHDRAWN you failed to the temporary nature of glass ionomer used to restore UR6; (vii) you failed to undertake and/or record any oral disease risk assessments; (viii) you failed to record any appropriate recall periods; (xii) you failed to make a record of an appointment with Patient 8 that took place in May or June of 2012; in relation to Patient 9: (iii) (iv) you failed to record a sufficiently detailed medical history at any time; you failed to monitor Patient 9 s periodontal condition prior to 7 November 2011; you failed to undertake and/or record any oral disease risk assessments; you failed to record any appropriate recall periods; (j) in relation to Patient 10: (iii) (iv) you failed to retain properly Patient 10 s dental records; you failed to record a sufficiently detailed medical history prior to 3 August 2010; you failed to monitor adequately Patient 10 s periodontal condition between 3 March 2009 and 19 November 2011; you failed to investigate properly the swelling at Patient 10 s LL6; (k) in relation to Patient 11: you failed to update Patient 11 s medical history appropriately prior to commencing treatment in September 2011; you failed to monitor adequately Patient 11 s periodontal condition prior to 13 September 2011; (iii) you failed to assess accurately Patient 11 s periodontal condition on 13 September 2011; BUNGAY, P G Professional Conduct Committee May 2014 May 2017 Page -5/23-

6 (iv) (v) (vi) you recorded BPE scores in relation to sextants where the patient had insufficient teeth to give rise to a valid score; you failed to plan appropriate periodontal treatment after 13 September 2011; you failed to undertake and/or record any oral disease risk assessments; (vii) you failed to record any recall period prior to 15 December 2011; (l) in relation to Patient 12: (iii) you failed to record a sufficiently detailed medical history for any treatment prior to 10 January 2012; you failed to monitor Patient 12 s periodontal health prior to 10 March 2011; you failed to assess accurately Patient 12 s periodontal health on 20 March 2012; (iv) you failed to plan appropriate periodontal treatment after 20 March 2012; (v) (vi) you failed to undertake and/or record any oral disease risk assessments; you failed to record any appropriate recall periods; (vii) WITHDRAWN (m) in relation to Patient 13: you failed to record a sufficiently detailed medical history for any treatment prior to 22 February 2012; you failed to undertake and/or record any caries risk assessments; (iii) you failed to record any appropriate recall period prior to 22 February 2012; (iv) you failed to offer fluoride treatment and/or advise on the use of fluoride; (n) in relation to Patient 14: (iii) (iv) you failed to record a sufficiently detailed medical history for any treatment prior to 20 February 2012; you failed to monitor the patient s periodontal condition prior to 20 February 2012; you failed to undertake and/or record any oral disease risk assessments; you failed to record any appropriate recall period; (o) in relation to Patient 15: you failed to record a sufficiently detailed medical history for any treatment prior to 20 February 2012; (p) in relation to Patient 17: you failed to record a periodontal assessment in relation to examinations undertaken on: A. 3 August 2010; BUNGAY, P G Professional Conduct Committee May 2014 May 2017 Page -6/23-

7 (q) B. 24 February 2011; C. 20 June 2011; you failed to make a record of a clinical appointment on 14 July 2011 in relation to which you claimed for urgent/occasional treatment; (r) in relation to Patient 19: you failed to record a discussion with Patient 19 in relation to her lesion at LL7; (iii) you failed to undertake and/or record any oral disease risk assessments; (iv) you failed to record any appropriate recall periods. Bitewing Radiographs 9. You failed to take bitewing radiographs in respect of the following patients when such radiographs were required for the purposes of their care: (a) Patient 2; (b) Patient 3; (c) Patient 5; (d) Patient 6; (e) Patient 7; (f) Patient 8; (g) Patient 9; (h) Patient 10; Patient 12; (j) Patient 17. And, by reasons of the facts stated, your fitness to practise is impaired by reason of your misconduct. On 8 May 2014 the Chairman made the following statement regarding the finding of facts: Mr Bungay The Committee has taken into account all the evidence presented to it. It has accepted the advice of the Legal Adviser. In accordance with that advice it has considered each head of charge separately. I will now announce the Committee s findings in relation to each head of charge: 1. Admitted and proved. 2. Admitted and proved. 3. (a) Admitted and proved. 3. (a) Admitted and proved. BUNGAY, P G Professional Conduct Committee May 2014 May 2017 Page -7/23-

8 3. (b) Admitted and proved. 3. (c) Admitted and proved. 3. (d) Proved. A letter was sent to you by the CQC in an attempt to arrange an inspection of your surgery on 15 August 2012, however you state that you were on holiday and did not receive the letter until you returned some time after the date of the proposed inspection. The Committee notes that the CQC had been trying to inspect the premises since March 2012, however, you would not remain present whilst the inspectors attended, citing an illness in the family which prevented your attending for the inspections. Following 15 August 2012, the CQC attempted to carry out the inspection on 7 September 2012, however you stated that you could not be present on that date as you had further family difficulties. You state that you were only given notice of the proposed visit on 6 September, the day before. On 14 September 2012 you were signed off work by your general practitioner and therefore no inspections could take place following that date. You concede that you could have made alternative plans to deal with the family situations that arose during the period alleged. Furthermore, whilst the Committee accepts that you were not aware of the precise date when the visit was due to take place in August, you had been put on notice that it would take place at some point that month. You should therefore not have gone on holiday without making alternative arrangements for the visit. The Committee accepts that you were unwell in September, however you told the Committee that your wife was attending the practice on a daily basis during that period, therefore you could have allowed her to oversee the practice inspection. In the circumstances, the Committee was satisfied that you failed to facilitate the CQC inspection. 4. (a) Amended to substitute the word Qualitative with Quality. Admitted and proved. 4. (b) Amended to substitute the word Qualitative with Quality. Admitted and proved. 4. (c) Admitted and proved. 4. (d) Proved. You should have been aware both the PCT and the CQC wished to make a follow-up visit. You had supplied an address for contact, however you stated had no access to a computer with which to access it. It would have been expected of you to make alternative arrangements to access your address. You did nothing therefore to proactively facilitate these visits when you could have done so. BUNGAY, P G Professional Conduct Committee May 2014 May 2017 Page -8/23-

9 4. (e) Admitted and proved. 5. Admitted and proved. 6. (a) Admitted and proved. 6. (b) Admitted and proved. 6. (c) Admitted and proved. 7. Proved. You state that your wife was working at the practice during the period alleged and she was available to direct patients to two other practices with which you had a long-term reciprocal arrangement. You also state that there was an answer machine message directing patients to an out of hours service. The Committee has seen little evidence that this arrangement was in place. In any event, the Committee was not satisfied that this would have been a satisfactory arrangement. You should have made specific arrangements with the PCT to establish more formal cover during your period of absence. The Committee would have expected to see written evidence of a local arrangement. 8. (a) Admitted and proved. 8. (a) Proved. You have noted lower anteriors mobile. The Committee considers that this notation is merely an observation and does not constitute an assessment of the periodontal condition. An assessment must necessarily evaluate the nature of something. This has not taken place on this occasion. This is not an assessment in accordance with how a reasonable practitioner would perform an assessment in accordance with appropriate standards. 8. (a) (iii) Admitted and proved. 8. (a) (iv) Admitted and proved. 8. (a) (v) Proved. this respect, who recommends Clinical Guidelines in Record Keeping by FGDP.. The Committee was satisfied, therefore, that you failed to 8. (a) (vi) Proved. There is no evidence before the Committee of appropriate recall periods. The Committee considered your description of a recall system which you had instigated using a separate card system, however it was not satisfied that such a system would be in line with NICE guidelines. 8. (b) Admitted and proved. BUNGAY, P G Professional Conduct Committee May 2014 May 2017 Page -9/23-

10 8. (b) Admitted and proved. 8. (b) (iii) Admitted and proved. 8. (b) (iv) Proved. 8. (b) (v) Proved. There is no evidence before the Committee of appropriate recall periods. 8. (b) (vi) Admitted and proved. 8. (b) (vii) Admitted and proved. 8. (c) Admitted and proved. 8. (c) Admitted and proved. 8. (c) (iii) Proved. 8. (c) (iv) Not proved. There is evidence of recall periods in the notes. 8. (c) (v) Admitted and proved. 8. (c) (vi) Admitted and proved. 8. (d) Admitted and proved. 8. (d) Admitted and proved. 8. (d) (iii) Admitted and proved. 8. (d) (iv) Admitted and proved. 8. (e) A. Admitted and proved. 8. (e) B. Admitted and proved. 8. (e) C. Admitted and proved. 8. (e) D. Admitted and proved. 8. (e) E. Admitted and proved. 8. (e) Admitted and proved. 8. (e) (iii) Admitted and proved. 8. (e) (iv) Admitted and proved. 8. (e) (v) Admitted and proved. 8. (e) (vi) Admitted and proved. BUNGAY, P G Professional Conduct Committee May 2014 May 2017 Page -10/23-

11 8. (e) (vii) Admitted and proved. 8. (e) (viii) Proved. 8. (e) (ix) Proved. There is no evidence before the Committee of appropriate recall periods. 8. (f) Admitted and proved. 8. (f) Admitted and proved. 8. (f) (iii) Proved. 8. (f) (iv) Admitted and proved. 8. (f) (v) Admitted and proved. 8. (f) (vi) Not proved. There is evidence of a re-call period in the notes. 8. (g) Admitted and proved. 8. (g) Admitted and proved. 8. (g) (iii) Proved. The Committee was not satisfied that you undertook a BPE. 8. (g) (iv) WITHDRAWN 8. (g) (v) Admitted and proved. 8. (g) (vi) Admitted and proved. 8. (g) (vii) Admitted and proved. 8. (g) (viii) Admitted and proved. 8. (g) (ix) Admitted and proved. 8. (g) (x) Proved. 8. (g) (xi) Proved. There is no recall period in the notes. 8. (h) Admitted and proved. 8. (h) Admitted and proved. 8. (h) (iii) Admitted and proved. BUNGAY, P G Professional Conduct Committee May 2014 May 2017 Page -11/23-

12 8. (h) (iv) Admitted and proved. 8. (h) (v) WITHDRAWN 8. (h) (vi) Admitted and proved. 8. (h) (vii) Proved. 8. (h) (viii) Proved. There is no evidence of appropriate re-call periods in the notes. 8. (h) (ix) Admitted and proved. 8. Admitted and proved. 8. Proved. The Committee does not consider that what is present in the notes indicates that monitoring has taken place 8. (iii) Proved. 8. (iv) Proved. There are no appropriate recall periods in the notes. 8. (j) Admitted and proved. 8. (j) Admitted and proved. 8. (j) (iii) Admitted and proved. 8. (j) (iv) Admitted and proved. 8. (k) Admitted and proved. 8. (k) Admitted and proved. 8. (k) (iii) Admitted and proved. 8. (k) (iv) Admitted and proved. 8. (k) (v) Admitted and proved. 8. (k) (vi) Proved. 8. (k) (vii) Proved. There are no re-call periods in the notes. 8. (l) Admitted and proved. BUNGAY, P G Professional Conduct Committee May 2014 May 2017 Page -12/23-

13 8. (l) Proved. The Committee does not consider that what is present in the notes indicates that monitoring has taken place. 8. (l) (iii) Admitted and proved. 8. (l) (iv) Admitted and proved. 8. (l) (v) Proved. 8. (l) (vi) Not proved. There is evidence of appropriate recall periods in the notes. 8. (l) (vii) WITHDRAWN 8. (m) Admitted and proved. 8. (m) Proved. 8. (m) (iii) Proved. There is no record of appropriate recall periods in the notes. 8. (m) (iv) Admitted and proved. 8. (n) Admitted and proved. 8. (n) Proved. The Committee does not consider that what is present in the notes indicates that monitoring has taken place. 8. (n) (iii) Proved. 8. (n) (iv) Proved. There are no appropriate recall periods in the notes. 8. (o) Admitted and proved. 8. (p) A. Admitted and proved. 8. (p) B. Admitted and proved. 8. (p) C. Admitted and proved. 8. (q) Admitted and proved. 8. (r) Admitted and proved. 8. (r) Proved. BUNGAY, P G Professional Conduct Committee May 2014 May 2017 Page -13/23-

14 8. (r) (iii) Proved. There are no appropriate recall periods in the notes. 9. (a) Admitted and proved. 9. (b) Admitted and proved. 9. (c) Admitted and proved. 9. (d) Admitted and proved. 9. (e) Admitted and proved. 9. (f) Admitted and proved. 9. (g) Admitted and proved. 9. (h) Admitted and proved. 9. Admitted and proved. 9. (j) Admitted and proved. Heads of Charge 8.(g)(iv), 8(h)(v) and 8.(l)(vii) were withdrawn We move to Stage Two. On 9 May 2014 the Chairman announced the determination as follows: Mr Bungay The Committee has considered all the information before it, including the submissions made on behalf of the General Dental Council (GDC) by Ms Barnfather and those made on your behalf by Mr Davy. It has accepted the advice of the Legal Adviser. At all material times you were the Principal and sole Dental Practitioner at Lydiate Dental Surgery, Lydiate, Merseyside, L31 2LZ ( the Practice ). You held a contract with Sefton Primary Care Trust ( the PCT ) pursuant to which you provided dental services. The Committee has found facts proved relating to your dealings with both the PCT and the Care Quality Commission (CQC). In 2012 the Practice was subject to an investigation by the CQC. On 19 March 2012, the Practice was inspected by 2 compliance officers from the CQC who determined there were major concerns in respect of the care and welfare of the people who use services, the cleanliness of the practice and record keeping. The inspectors also noted moderate concerns in respect of safeguarding and the safety and suitability of premises. You failed to produce an appropriate action plan to detail how you would implement the improvements required to achieve compliance in the areas identified. You also failed to achieve compliance in the areas identified. The Committee also found that between 15 August 2012 and 15 November 2012 you failed to facilitate access to inspectors from the CQC in order that they might determine whether or not you had achieved compliance in the areas identified. BUNGAY, P G Professional Conduct Committee May 2014 May 2017 Page -14/23-

15 Between 11 January 2011 and 10 December 2012 the Practice was subject to an investigation by the PCT. During that time you failed to facilitate an audit of the Practice to determine whether or not you were operating to appropriate cross infection control standards. On 27 April 2012 a PCT inspector undertook an audit of the Practice and determined that you were operating below these standards in all aspects. You did not have appropriate policies and protocols in place. You failed to facilitate a follow up visit by the PCT to determine whether or not you had complied with an Action Plan which had been developed and by 10 December 2012 you had failed to complete all tasks as outlined in the Action Plan. In respect of your handling of patient records, the Committee found that you failed to provide patient records to the PCT in a timely manner when requested by them as part of their investigation. You stored patient records away from the practice premises and in doing so you compromised patient safety, compromised continuity of care and compromised patient confidentiality. In respect of urgent care, the Committee found you failed to put appropriate arrangements in place to ensure your patients could access urgent care if required. In respect of clinical care and record keeping, the Committee identified numerous shortcomings in respect of the records of 17 patients. There were a large number of individual failings identified, however there were particular trends of significant failings in the areas of medical history taking, periodontal assessment, risk assessment and recall periods. The Committee also found that you failed to take bitewing radiographs in respect of 10 patients when such radiographs were required for the purposes of their care. The Committee considered that your behaviour fell below what was expected of you by the following paragraphs of Standards for Dental Professionals. 1 Put patients interests first and act to protect them 1.1 Put patients interests before your own or those of any colleague, organisation or business. 1.4 Make and keep accurate and complete patient records, including a medical history, at the time you treat them. Make sure that patients have easy access to their records. 4 Co-operate with other members of the dental team and other healthcare colleagues in the interests of patients 5 Maintain your professional knowledge and competence 5.1 Recognise that your qualification for registration was the first stage in your professional education. Develop and update your knowledge and skills throughout your working life. 5.2 Continuously review your knowledge, skills and professional performance. Reflect on them, and identify and understand your limits as well as your strengths. 5.3 Find out about current best practice in the fields in which you work. Provide a good standard of care based on available up-to-date evidence and reliable guidance. BUNGAY, P G Professional Conduct Committee May 2014 May 2017 Page -15/23-

16 5.4 Find out about laws and regulations which affect your work, premises, equipment and business, and follow them. The Committee had little difficulty in determining that the wide ranging and serious failures arising from the facts of this case, in connection with the associated breaches of these standards, fell far below what is expected of you as a dentist and constitute misconduct. You do not seek to suggest otherwise. The Committee next considered whether your fitness to practise is impaired by reason of your misconduct. The Committee considered that your misconduct is linked closely to the situation you found yourself in at the material time of the allegations. You had been in singlehanded practice at that stage for over 20 years and you concede that you had become professionally isolated. This resulted in practice which was not compliant with current standards at that time and you had fallen behind in many areas, particularly in record keeping, radiography and cross-infection control. There were also personal circumstances which formed part of the context of your misconduct in respect of the CQC and PCT investigations. You were suffering from significant health issues and family crises and your attitude to the PCT, in particular, was shaped considerably by a long standing contractual dispute with the PCT. Therefore the Committee considered that as the misconduct was based in a large part on circumstantial issues, it is amenable to remediation. Nevertheless, the Committee was dismayed by the extent to which you have actually engaged in any remediation. The Committee did consider the fact that you have been suffering from health problems which may have had an impact on the steps you were able to take, although it would still have expected to see more concrete evidence of positive steps taken by you to effect remediation since your suspension in late For example, you could have engaged in shadowing of colleagues, engaged with local professional bodies and taken a more proactive approach to CPD. The Committee noted your financial situation, but none of these activities necessarily incur a financial cost. Therefore you have engaged in very little theoretical remediation and you have not been in a position to engage in any clinical remediation, as you have been suspended. As it stands, the Committee does not have a satisfactory picture of the level of insight you have into your failings and therefore the risk of repetition of your conduct remains, at this moment, high. In the circumstances, the Committee determined that your fitness to practise is impaired by reason of your misconduct. Again, you do not seek to suggest otherwise. The Committee next considered what sanction, if any, is appropriate. In doing so it had regard to the principal of proportionality, balancing your interests against the public interest. The Committee considered that, given the seriousness of the misconduct and risk of repetition, to conclude the case at this stage, with or without a reprimand, would be insufficient. The Committee next considered whether conditions would be sufficient. The Committee had regard to the wide ranging patient testimonials put before it and the fact that there are no patient complaints in issue. You are clearly valued and well respected by your patients. It is apparent to this Committee that you endeavour to do your best for patients in your practice as a dentist. The Committee is of the view that, fundamentally, you are a good practitioner who has struggled to balance the administration and governance of a single handed practice. The Committee also noted that your practice in respect of record keeping did vastly improve, as noted by the GDC s expert witness, shortly before you were suspended from BUNGAY, P G Professional Conduct Committee May 2014 May 2017 Page -16/23-

17 practice. This suggests to the Committee that there is hope that, in a supportive workplace environment, you are capable of attaining the standards expected of you. The Committee noted that many of your deficiencies are related to having been a sole practitioner for a number of years. Furthermore, the Committee considers that the only way in which your practice, attitude and health can improve is if you are allowed to practise on a limited basis. The Committee considered that a series of conditions could be devised which could adequately protect the public and give you the opportunity to remedy your failings. The Committee considers that it would not be in the public interest to prevent a well regarded practitioner from remedying his practice in a safe environment and that, accordingly, to continue your suspension would be disproportionate. The Committee has therefore decided to impose the following conditions on your registration. 1. He must work with a Postgraduate Dental Dean/Director (or a nominated deputy), to formulate a Personal Development Plan, specifically designed to address the deficiencies in the following areas of his practice to accord with current guidance: Record keeping; Periodontal examination, assessment and recording; Radiography; Cross infection control. 2. He must forward a copy of his Personal Development Plan to the GDC within 3 months of the date on which these conditions become effective. 3. He must meet with the Postgraduate Dental Dean/Director (or a nominated deputy), on a regular basis to discuss his progress towards achieving the aims set out in his Personal Development Plan. The frequency of his meetings is to be set by the Postgraduate Dental Dean/Director (or a nominated deputy). 4. He must allow the GDC to exchange information about the standard of his professional performance and his progress towards achieving the aims set out in his Personal Development Plan with the Postgraduate Dental Dean/Director (or a nominated deputy), and any other person involved in his retraining and supervision. 5. At any time that he is employed, or providing dental services, which require him to be registered with the GDC; he must place himself and remain under the supervision of an educational supervisor appointed by the Postgraduate Dental Dean/Director (or a nominated deputy). 6. At any time he is employed, or providing dental services, which require him to be registered with the GDC; he must place himself and remain under the close supervision of a workplace supervisor nominated by the deanery, and agreed by the GDC. 7. He must allow his workplace supervisor to provide reports to the GDC at intervals of not more than 6 months and the GDC will make these reports available to any Postgraduate Dean/Director or Educational Supervisor referred to in these conditions. BUNGAY, P G Professional Conduct Committee May 2014 May 2017 Page -17/23-

18 8. He must keep his professional commitments under review and limit his dental practice in accordance with his workplace supervisor s advice. 9. He must not engage in single-handed dental practice and must only work at premises where another GDC registrant in his category of the Register, who has at least five years of experience of clinical practice, is practising. 10. He must not be responsible for the administration/management of any dental practice. 11. He must engage in dental practice only at a practice he does not own; at premises where another dentist or dentists are working at the same time as him, and with whom he has made personal contact before he starts treating patients. 12. He must not work as a locum or undertake any out-of-hours work or on-call duties. 13. He shall carry out an audit of radiography and record keeping. The audits must be signed by his workplace supervisor. He must provide a copy of this audit to the GDC on a 6 monthly basis. 14. He must notify the GDC promptly of any professional appointment he accepts and provide the contact details of his employer or any organisation for which he is contracted to provide dental services and the Commissioning Body on whose Dental Performers List he is included or Local Health Board if in Wales, Scotland or Northern Ireland. 15. He must allow the GDC to exchange information with his employer or any organisation for which he is contracted to provide dental services, and any Postgraduate Dental Dean/Director, reporter, workplace supervisor or educational supervisor referred to in these conditions. 16. At any time he is providing dental services, which require him to be registered with the GDC, he must agree to the appointment of a reporter nominated by the Deanery and approved by the GDC. The reporter shall be a GDC registrant. 17. He must allow the reporter to provide reports to the GDC at intervals of not more than 6 months and the GDC will make these reports available to any Postgraduate Dental Dean/Director, workplace supervisor or educational Supervisor referred to in these conditions. 18. He must inform the GDC of any formal disciplinary proceedings taken against him, from the date of this determination. 19. He must inform the GDC if he applies for dental employment outside the UK. 20. He must inform within one week the following parties that his registration is subject to the conditions, listed at ( 1) to (19 ), above: Any organisation or person employing or contracting with him to undertake dental work Any prospective employer (at the time of application) The Commissioning Body on whose Dental Performers List he is included or seeking inclusion, or Local Health Board if in Wales, Scotland or Northern Ireland (at the time of application) BUNGAY, P G Professional Conduct Committee May 2014 May 2017 Page -18/23-

19 21. He must permit the GDC to disclose the above conditions, (1) to (20), to any person requesting information about his registration status. These conditions will apply for a period of three years and will be reviewed at the end of that period. In the meantime, the Committee would expect you to engage fully with all those involved in your rehabilitation, including any medical professionals you have been engaging with in connection with this hearing. Any interim order associated with this hearing is hereby revoked. The Committee now invites submissions on whether an immediate order for conditions is necessary. Mr Bungay Having regard to the submissions made on your behalf and those made on behalf of the GDC, the Committee has determined that it is necessary for the protection of the public, otherwise in the public interests and in your own interests to impose the stated conditions immediately. The effect of the foregoing direction and order is the conditions are imposed with immediate effect and, unless you exercise your right of appeal, the conditions will apply for a further period of three years after 28 days have elapsed. That concludes the case for today. On 18 May 2017, at the review hearing the Chairman announced the determination as follows: Mrs Thomas, APPLICATION FOR HEARING TO TAKE PLACE IN PRIVATE At the start of this hearing you made an application under Rule 53 of the Fitness to Practise Rules for aspects of the hearing to be heard in private on the basis that matters relating to Mr Bungay s private and family life would be discussed. Ms Headley made no objection. The Committee acceded to the application. BACKGROUND In 2012 Mr Bungay s Practice was subject to an investigation by the CQC. On 19 March 2012, the Practice was inspected by 2 compliance officers from the CQC who determined there were major concerns in respect of the care and welfare of the people who use its services, the cleanliness of the practice and record keeping. The inspectors also noted moderate concerns in respect of safeguarding and the safety and suitability of the premises. Mr Bungay failed to produce an appropriate action plan to detail how he would implement the improvements required to achieve compliance in the areas identified. He also failed to achieve compliance in the areas identified. The Committee also found that between 15 August 2012 and 15 November 2012 Mr Bungay failed to facilitate access to inspectors from the CQC in order that they might determine whether or not he had achieved compliance in the areas identified. Between 11 January 2011 and 10 December 2012 the Practice was subject to an investigation by the PCT. During that time Mr Bungay failed to facilitate an audit of the BUNGAY, P G Professional Conduct Committee May 2014 May 2017 Page -19/23-

20 Practice to determine whether or not he was operating to appropriate cross infection control standards. On 27 April 2012 a PCT inspector undertook an audit of the Practice and determined that he was operating below those standards in all aspects. He did not have appropriate policies and protocols in place. He failed to facilitate a follow up visit by the PCT to determine whether or not he had complied with an Action Plan which had been developed and by 10 December 2012 he had failed to complete all tasks as outlined in the Action Plan. In respect of Mr Bungay s handling of patient records, the Committee found that he failed to provide patient records to the PCT in a timely manner. He stored patient records away from the practice premises and in doing so, compromised patient safety, continuity of care and patient confidentiality. In respect of urgent care, the Committee found that Mr Bungay failed to put appropriate arrangements in place to ensure that his patients could access urgent care if required. In respect of clinical care and record keeping, the Committee identified numerous shortcomings in respect of the records of 17 patients. There were a large number of individual failings identified, however there were particular trends of significant failings in the areas of medical history taking, periodontal assessment, risk assessment and recall periods. The Committee also found that Mr Bungay failed to take bitewing radiographs in respect of 10 patients when such radiographs were required for the purposes of their care. On 9 May 2014 the Professional Conduct Committee determined that facts it had found proved against Mr Bungay in relation to his dealings with both the PCT and the Care Quality Commission (CQC) amounted to misconduct. It found that his fitness to practice was impaired by reason of that misconduct. Conditions were imposed upon him for a period of 36 months, with a review to take place shortly before the end of the order. Today this Committee has conducted a review of the matter. It has considered all of the evidence before it. It took account of the submissions made by Ms Headley on behalf of the GDC and those made by you. The Committee accepted the advice of the Legal Adviser IMPAIRMENT The Committee considered whether Mr Bungay s fitness to practise remains impaired by reason of his misconduct. The Committee noted that immediately following the initial hearing, Mr Bungay was engaging with the GDC and was taking some steps to comply with the conditions that were imposed upon him, including putting together a Personal Development Plan (PDP). However, his wife fell ill not long after the hearing and unfortunately passed away in May Mr Bungay has been unable to engage with the GDC or the conditions imposed upon him since that time. The Committee noted that he has not worked since September [PRIVATE]. It is clear to the Committee that Mr Bungay has been through a great deal of personal difficulty over the past few years. It fully understands why he has been unable to focus on remediating his past misconduct and complying with the conditions that were imposed upon him in BUNGAY, P G Professional Conduct Committee May 2014 May 2017 Page -20/23-

21 Given that Mr Bungay has not fully remediated his misconduct and that this was accepted by you on his behalf, the Committee therefore finds that at this time, Mr Bungay s fitness to practise remains impaired. SANCTION The Committee next considered what sanction, if any, should be imposed on Mr Bungay s registration. It bore in mind the need to protect patients and the public interest. The Committee also had regard to the principle of proportionality, weighing the interests of the public with his own interests. Ms Headley invited the Committee to consider a continuation of the current order of conditions for a period of 12 months. She put forward a slightly varied set of draft conditions for the Committee to consider. You agreed with Ms Headley that a continuation of the current order of conditional registration would be appropriate. The Committee first considered whether it would be appropriate to terminate the current order and conclude the case with no further action. However in the light of Mr Bungay s continuing impairment it determined that such action would not serve to safeguard patients or the public interest, nor would it be in Mr Bungay s own interests. The Committee next considered whether to continue the imposition of conditions on Mr Bungay s registration. It determined that conditions continue to be appropriate in this case. Mr Bungay has been unable to comply fully, however there were extenuating personal circumstances [PRIVATE]. You have told the Committee that you are hopeful that Mr Bungay will soon be able to re-engage with conditions. You indicated that 12 months would be an appropriate period of time. Taking all of the available information into account, the Committee is satisfied that conditions remain adequate and proportionate. They will serve to safeguard the public and the public interest, whilst facilitating Mr Bungay s safe return to practice. The Committee decided to extend the order of conditions with some minor variations. The following slightly varied conditions are imposed for a period of 12 months and will be reviewed shortly before the end of that period. They will appear against the name of Paul Graeme Bungay in the Dentists Register in the following terms: 1. He must work with a Postgraduate Dental Dean/Director (or a nominated deputy), to formulate a Personal Development Plan, specifically designed to address the deficiencies in the following areas of his practice to accord with current guidance: Record keeping; Periodontal examination, assessment and recording; Radiography; Cross infection control. 2. He must forward a copy of his updated Personal Development Plan to the GDC within 3 months of beginning employment. 3. He must meet with the Postgraduate Dental Dean/Director (or a nominated deputy), on a regular basis to discuss his progress towards achieving the aims set out in his Personal Development Plan. The frequency of his meetings is to be set by the Postgraduate Dental Dean/Director (or a nominated deputy). 4. He must allow the GDC to exchange information about the standard of his professional performance and his progress towards achieving the aims set out in BUNGAY, P G Professional Conduct Committee May 2014 May 2017 Page -21/23-

22 his Personal Development Plan with the Postgraduate Dental Dean/Director (or a nominated deputy), and any other person involved in his retraining and supervision. 5. At any time that he is employed, or providing dental services, which require him to be registered with the GDC; he must place himself and remain under the supervision of an educational supervisor appointed by the Postgraduate Dental Dean/Director (or a nominated deputy). 6. At any time he is employed, or providing dental services, which require him to be registered with the GDC; he must place himself and remain under the *close supervision of a workplace supervisor nominated by the Registrant and agreed by the GDC. 7. He must allow his workplace supervisor to provide reports to the GDC at intervals of not more than 6 months and the GDC will make these reports available to any Postgraduate Dean/Director or Educational Supervisor referred to in these conditions. 8. He must keep his professional commitments under review and limit his dental practice in accordance with his workplace supervisor s advice. 9. He must not engage in single-handed dental practice and must only work at premises where another GDC registrant in his category of the Register, who has at least five years of experience of clinical practice, is practising. 10. He must not be responsible for the administration/management of any dental practice. 11. He must engage in dental practice only at a practice he does not own; at premises at the same time as him, and with personal contact before he starts treating patients. 12. He must not work as a locum or undertake any out-of-hours work or on-call duties. 13. He shall carry out an audit of radiography and record keeping. The audits must be signed by his workplace supervisor. He must provide a copy of this audit to the GDC on a 6 monthly basis. 14. He must notify the GDC promptly of any professional appointment he accepts and provide the contact details of his employer or any organisation for which he is contracted to provide dental services and the Commissioning Body on whose Dental Performers List he is included or Local Health Board if in Wales, Scotland or Northern Ireland. 15. He must allow the GDC to exchange information with his employer or any organisation for which he is contracted to provide dental services, and any Postgraduate Dental Dean/Director, reporter, workplace supervisor or educational supervisor referred to in these conditions. 16. At any time he is providing dental services, which require him to be registered with the GDC, he must agree to the appointment of a reporter nominated by the Deanery and approved by the GDC. The reporter shall be a GDC registrant. BUNGAY, P G Professional Conduct Committee May 2014 May 2017 Page -22/23-

23 17. He must allow the reporter to provide reports to the GDC at intervals of not more than 6 months and the GDC will make these reports available to any Postgraduate Dental Dean/Director, workplace supervisor or educational Supervisor referred to in these conditions. 18. He must inform the GDC of any formal disciplinary proceedings taken against him, from the date of this determination. 19. He must inform the GDC if he applies for dental employment outside the UK. 20. He must inform within one week the following parties that his registration is subject to the conditions, listed at ( 1) to (19 ), above: Any organisation or person employing or contracting with him to undertake dental work Any prospective employer (at the time of application) The Commissioning Body on whose Dental Performers List he is included or seeking inclusion, or Local Health Board if in Wales, Scotland or Northern Ireland (at the time of application) 21. He must permit the GDC to disclose the above conditions, (1) to (20), to any person requesting information about his registration status. *Close supervision is defined as follows. The registrant s day to day work must be supervised by a person who is registered with the GDC in their category of the register or above and who must be on site and available at all times. As a minimum, the registrant s work must be reviewed at least twice a week by the supervisor via one to one meetings and case-based discussion. These bi-weekly meetings must be focused on all areas of concern identified by the conditions/undertakings. These meetings must take place face to face. Source: GDC Glossary of Terms November 2016 BUNGAY, P G Professional Conduct Committee May 2014 May 2017 Page -23/23-