Dr Gordon Skinner called (again) to the GMC

Dr Gordon Skinner was summoned once again to appear before an Interim Orders Panel (IOP) at the GMC at 9.30am on Wednesday 22nd February 2012.

There appears to be a group of 5 GP’s who wrote to the GMC complaining that certain of their patients had been prescribed thyroid hormone when their thyroid function test results were within the reference range (doesn’t matter whether they were at the bottom, the middle or the top of the range or whether or not they were suffering symptoms and signs), and that one patient had a myocardial infarction when she was taking thyroid hormone replacement recommended by Dr Skinner. (PLEASE NOTE: It was the patients own General Practitioner who prescribed the higher doses of levothyroxine and NOT Dr Skinner)

NONE of these patients have complained. All apparently are fit and well, delighted with their treatment and would not have a word said against Dr Skinner.. The patient with the myocardial infarction has told the GMC that she also had a myocardial infarction 4 years ago, when she was on no thyroid hormone replacement, before she was even diagnosed and she is stomping mad that her GP has sent her name to them without even asking her permission. The other 4 patients are also extremely angry that they had not given permission to have their names passed on to the GMC as making a complaint against him.
Below is the Determination given by the GMC:
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Mr Haycroft: The Panel has carefully considered all the information before it including the submissions made by Mr Williams on behalf of the GMC, those made by you on behalf of Dr Skinner, the documentation provided and the advice of the Legal Assessor.

The Panel has fully considered all submissions made and has weighed in the balance all the information before it. The Panel has noted that it is not its purpose to resolve any conflict of information, to determine on matters relating to the efficacy or appropriateness of treatment regimes, or to determine fact. The Panel has also reminded itself of the test it must apply and of its nature, function and powers as well as the GMCs Guidance Good Medical Practice and the Duties of a Doctor contained therein.

The Panel has heard that the GMC has received five letters from medical professionals expressing their concerns about Dr Skinners prescribing practices. It has been provided with details of those concerns. In essence, despite each of the five patients being within the normal range of thyroid function tests, Dr Skinner as gone on to prescribe thyroxine at high levels. As a results of these concerns, a Case Examiner considered the information and reached the decision that Dr Skinner should be invited to appear before the Interim orders Panel. Formal notification of this decision was sent to Dr Skinner by letter dated 10th February 2012.
Mr Williams, on behalf of the GMC submitted that an order of at least conditions would be appropriate to address the new concerns raised in relation to Dr Skinners private endocrine practice.

The Panel has noted the letter dated 15th February 2012 from Radcliffe LeBrasseur, Solicitors, in which it is stated that 4 of the letters were received by the GMC between 17th June and 17th November 2011, but were not copied to them despite the Council being aware that they were Dr Skinners representative. It is further stated that all of the complaints were received by the GMC prior to the conclusion of Dr Skinners Fitness to Practice Review Hearing, which took place on 14 to 17 November 2011.

You submitted that none of the complaints received identify any harm having come to the patients in question and that one patient had expressed her clear disapproval for the course adopted by her general practitioner in making a referral as she was entirely satisfied with the care provided by Dr Skinner. Dr Shilvocks patient had left his practice following his suggestion that he or she discontinue the treatment instituted by Dr Skinner. You have today presented an Email from the patient who was the subject matter of the first of the five complaints, expressing her unequivocal support of Dr Skinner. You submitted that such support was consistent with the large volume of patient testimonials which the GMC has received throughout the course of Dr Skinners Fitness to Practice proceedings.

You submitted that the issue of patients safety has been thoroughly considered by the recent FTP review, the findings of which post date these complaints. That hearing also reviewed D Skinners compliance with the conditions that had been imposed on his practice for a period of some four years and received expert evidence in relation to his practice. The FTP Panel found that Dr Skinner had complied with his conditions and that there was no evidence of patient harm, nor any evidence of misconduct or deficient professional performance. The FTP Panel concluded that his fitness to practice was not impaired.

You submitted on Dr Skinners behalf that each of the complaints that this IOP has received do not raise any new issues. They relate to the prescribing of thyroid replacement therapy for patients who are biochemically euthyroid and the potential for adverse effects for thyroid replacement, which was the central issue considered at the FTP Review where those matters were thoroughly considered by the Panel and disposed of without any criticism of Dr Skinner.

You submitted that the issues raised in these complaints have already been determined and Dr Skinner has born a significant burden for many years in complying with his conditions. You submitted that as the complaints raised no new matters, and in light of the FTPs disposal of those very same concerns in November 2011, there could be no realistic prospect that the material disclosed in these recent complaints could call Dr Skinners Fitness to Practice into question.

You submitted that proportionality should be taken into account and that there is clear evidence that any order of conditions or suspension would directly affect patient care and have an adverse impact on the many patients who are under Dr Skinners care. You submitted that no action should be taken against Dr Skinner.
The Panel has carefully considered the evidence submitted and the submissions you have made on Dr Skinners behalf, in particular that Dr Skinners approach is not followed by the majority of doctors. It notes that Dr Skinner has not adhered to normal prescribing practices of thyroxine and that he has put GPs in a difficult position by advising continuing treatment outwith practice guidelines. The Panel further notes that there is no monitoring of Dr Skinners practice and is concerned by his lack of appraisal and CDP training.

However, on the basis that there has been no demonstrable harm to any of the five patients, and on the basis of the Fitness to Practice determination, the Panel is not satisfied that Dr Skinner may pose a real risk to patients and therefore it is not necessary for the protection of the public, in the public interest or in Dr Skinners own interests to make an order in accordance with Section 41A of the Medical Act 1983 as amended.

In reaching its decision, the Panel has considered its functions and powers and has determined that the information before it today is insufficient to indicate that Dr Skinners Fitness to Practice may be impaired and that he may pose a real risk either to patients or the public interest.
Notification of this decision will be served upon Dr Skinner in accordance with the medical Act 1983 as amended.
The transcripts from The FtP review hearing, are listed below: Day 1 14th November 2011
Day 2 15th November 2011
Day 3 16th November 2011
Day 4 17th November 2011
14-17 November 2011
The transcripts from the first two daysof the FtP review hearing in July 2011, which was adjourned, are listed below:

• Day 1
• Day 2

The official day-by-day transcripts from Dr Gordon Skinner’s General Medical Council Fitness to Practice hearing are listed below.
Special thanks to Julie Cameron for obtaining these transcripts.

Day 1
Day 2

Day 3
Day 4

Day 5
Day 6

Day 7
Day 8

Day 9
Day 10

Day 11
Day 12

Day 13
Day 14

Day 15
Day 16

Day 17
Day 18

Day 19