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Case study 4
A radiographer (‘the registrant’) received a Simple Caution from the Care Quality Commission (the regulator for health and social care services in England) for carrying out the regulated activity of diagnostic and screening procedures without being registered (contrary to Health and Social Care Act 2008).
A panel of the Conduct and Competence Committee heard that the registrant had accepted the Simple Caution having admitted to conducting scans in his local village hall on private patients for a period of approximately 2 and half years when he was not registered with the Care Quality Commission to provide such services.
The registrant did not attend the hearing however was represented, and in a letter to the panel, accepted that at the time of conducting the scans he had been aware of the need to register with the Care Quality Commission. He said he had made a number of applications for registration however they had all been rejected for what he described as ‘minor and insignificant reasons’. He said he eventually gave up trying to register. The registrant stated he was now employed at an NHS hospital and was no longer carrying out private practice, nor was it ever his intention to do so.
The panel found the facts and the ground (determination made by another regulator responsible for health and social care) of the allegation proven on the basis of the registrant’s admission and the documentary evidence.
When considering whether the registrant’s fitness to practise was impaired, the panel took into account that the registrant had incurred genuine difficulty in registering with the Care Quality Commission. However, it concluded that despite those difficulties he had been aware of the need for registration and had understood that he would be committing an offence if he did not have registration in place. The panel did not accept this was a one off mistake as the registrant had continued the activity for a period of two and half years.
In operating outside of the regulatory framework the registrant had presented a risk to the public. The panel was of the view that the registrant did not understand that the purpose of registering with the Care Quality Commission as a provider is to ensure that clinical practice is conducted within a quality assured framework. For that reason, the panel concluded that if the registrant was to operate as a sole provider in the future there was a risk, albeit low, that he would repeat his behaviour.
Further, in light of the existence of the Simple Caution imposed by the Care Quality Commission, it was the judgment of the panel that the need to uphold proper standards and public confidence in the profession, would be undermined if a finding of impairment was not made.
The panel therefore found the registrant’s fitness to practise to be currently impaired.
When considering what sanction, if any, to impose, the panel bore in mind that the purpose of the sanction is not punitive, but to protect the public interest. It understood that it must act proportionately, balancing the interests of the registrant with those of the public. It considered the range of sanctions available in ascending order of seriousness, starting with the option of taking no further action.
The panel found by way of mitigation, that the registrant had an unblemished record before this case; had admitted his actions to the Care Quality Commission and the HCPC; and had engaged with the process. By way of aggravating factors, it found the registrant’s breach had continued over a significant period of time and had been carried out knowingly.
The panel concluded that to take no further action would not be sufficient in light of the seriousness of the allegation and as the registrant had continued with his actions despite the fact he knew that to do so would contravene the relevant regulations.
The panel then considered a caution order. The panel noted that while the registrant’s actions could not be described as isolated or minor in nature, the risk of repetition was low. The panel also took account of the fact that the registrant had now ceased carrying out scans as a private provider and had given an undertaking that he would register with the Care Quality Commission if he decided to resume such work in future.
The panel concluded that the public interest would be adequately protected by the Simple Caution that had already been imposed on the registrant by the Care Quality Commission, together with a caution imposed on him by his regulator.
The panel decided that a period of three years was the proportionate and appropriate period of time in the circumstances of the case, as this would serve to remind the registrant of his duties if he were to decide to resume private practice in the relatively near future.