(Pakistan) Summary of outcome Restoration application refused. No further applications allowed for 12 months from last application.

Transcription

1 PUBLIC RECORD Dates: 11/07/ /07/2018 Medical Practitioner s name: Dr Muhammad Tariq Ishaque GMC reference number: Primary medical qualification: Type of case Restoration following disciplinary erasure MB BS 1997 University of Punjab (Pakistan) Outcome on impairment Summary of outcome Restoration application refused. No further applications allowed for 12 months from last application. Tribunal: Legally Qualified Chair Lay Tribunal Member: Medical Tribunal Member: Mr David Robinson Ms Val Evans Mr Thomas George Tribunal Clerk: Mrs Debra Heaton Attendance and Representation: Medical Practitioner: Medical Practitioner s Representative: GMC Representative: Present and not represented N/A Mr Carlo Breen, Counsel Attendance of Press / Public In accordance with Rule 41 of the General Medical Council (Fitness to Practise) Rules 2004 the hearing was held in public. 1

2 Determination on Restoration - 12/07/2018 Background 1. Dr Ishaque originally qualified in 1997 from the University of Punjab. His case was heard before a Fitness to Practise Panel hearing (the 2012 Panel) which concluded on 3 December The 2012 Panel found that, on three occasions in May and June 2010, Dr Ishaque had used the suffix MRCS (Member of the Royal College of Surgeons) in correspondence with the General Medical Council (GMC) when he knew that he was not entitled to do so. The 2012 Panel found that Dr Ishaque s actions in this respect were both misleading and dishonest. 2. The 2012 Panel also found proved that, in September 2010, Dr Ishaque submitted a curriculum vitae (CV) to the GMC in which he stated that he held four qualifications which he did not have. The 2012 Panel found that Dr Ishaque s actions in this respect were both misleading and dishonest. 3. The 2012 Panel found that in the course of his employment by NHS Grampian, between April and December 2011, Dr Ishaque completed three occupational health questionnaires. In two of these questionnaires, he certified that his date of birth was 11 February 1974 and in another, he certified that it was 11 February The 2012 Panel found that his actions in this respect were misleading. 4. The 2012 Panel found that Dr Ishaque s fitness to practise was impaired, and it determined that his registration should be erased. Dr Ishaque s registration was erased on 8 January Dr Ishaque made an application for restoration to the medical register in a GMC application form dated 11 January The Outcome of Applications Made during the application for restoration 6. The Tribunal refused Dr Ishaque s application that it should adjourn to allow him to undergo an assessment of his professional performance, made pursuant to Rule 24 of the GMC (Fitness to Practise Rules) 2004 as amended ( the Rules ). The Tribunal s full decision on the application is included at Annex A. Documentary Evidence 7. The Tribunal had regard to the documentary evidence provided by the parties. This evidence included, but was not limited to: Transcripts of the hearing before the 2012 Panel Dr Ishaque s application to the GMC for restoration dated 11 January

3 correspondence, letters and notes of telephone calls between Dr Ishaque and the GMC from 12 June 2013 to 30 May 2018, including a GMC direction on 25 May 2018 that Dr Ishaque should undergo an assessment of his knowledge of English, either by the academic version of the International English Language Testing System (IELTS) or the Occupational English Test (OET) An undated document prepared by Dr Ishaque, entitled A Self-reflection/ An Account of Insight A certificate of completion in relation to distance learning modules undertaken by Dr Ishaque between 17 and 18 November 2017 The results of an IELTS test undertaken on 7 June 2018, showing an overall score of 7.0, with individual modules scored as follows: Listening 7:0, Reading 6.5, Writing 6.0 and Speaking 8.0 A joint testimonial letter dated 14 June 2018 from Professor Dr A, Vascular Surgeon, and Professor Dr B, Cardio Thoracic Surgeon, both at the Department of Cardio Vascular Surgery, MediCare Clinical Center (address not stated) Certificate of achievement in relation to Fire Safety dated 18 June Dr Ishaque s reflective statement 8. In Dr Ishaque s written reflection, he acknowledged that he had now accepted the decision of the 2012 Panel and he apologised for his previous failings. He said that he had been wrong to justify his previous actions and he acknowledged that there were no special circumstances. He said that all these chain of events geared due to my sloppy reckless comportment and that this slip-up error of mine was all due to my poor self-handling of medical matters which I now understand in Toto. He also said Certainly, I filled the various papers especially CV in a wrong manner. 9. Dr Ishaque said that he had reflected on what had happened and that he now was a firm believer that a CV is a true reflection of a doctor s career and it should be vigilantly, wisely judiciously written. He said that he had to be always true in my words and take extra cautions while disclosing my personal details like Date of Birth to any well responsible organization. Dr Ishaque said that he had learned his lesson and that he would be vigilant in the future when dealing with anything that is directly related to patient security. He also said that he would never bring the profession into disrepute. Dr Ishaque said that he needed GMC/MPTS guidance as to how he should show that he had kept his skills and knowledge up to date. Witness Evidence 10. Dr Ishaque gave oral evidence at the hearing. He referred to his written Self- Reflection and said that he would give his full attention to avoid similar behaviour in the future. He said that he learned that communications sent by were very 3

4 important and that he had to be careful about his date of birth. He acknowledged the need to keep up medical and professional standards. 11. Dr Ishaque said that he accepted that he had acted dishonestly and accepted the 2012 Panel s findings. He went on to say that he had sent a copy of his CV out without checking it and that the qualifications that he had written in there were in fact his plans for the future at that time, rather than qualifications that he had actually attained. He said that he did not present his CV in the way it should be presented in the UK. Following Tribunal questioning, he later agreed that it would not have been acceptable in another country. 12. Dr Ishaque reminded the Tribunal of the sanctions that had been imposed on his registration before it was erased. He said that his misconduct had not been criminal in nature, and only related to medical matters, and he suggested that he had been unable to gain legal assistance during the 2012 hearing. 13. Dr Ishaque told the Tribunal that he had not worked in a comparable health setting since 2012, but that he had worked in Pakistan, where he was employed as a senior civil servant in law enforcement. Dr Ishaque told the Tribunal that he had been a Chief/Superintendent of Special Branch, a non-uniformed role in intelligence, and that he was later transferred to national crisis management. 14. Dr Ishaque said that he had not been employed in a full time medical position since he was erased, because of his other employment, but that, occasionally, whether for a day or a few hours at a time, he had been doing observations at a hospital and assisting surgeons in routine operations. However, he said that he had not informed the equivalent regulatory medical body in Pakistan of the work that he was doing because he was not responsible for the care of patients, and was just giving a helping hand. He also said that the consultants under whom he had worked had not thought that it was necessary to inform the Pakistan regulatory authorities of the work that he was doing. 15. Dr Ishaque said that he had been undertaking pre- and post-operative work as well as history taking, under the supervision of consultants, one of whom acted as his mentor. He said that this had not been reflected in the testimonial that he had received from Professors A and B because he had just asked them for confirmation that he had worked for them, and was grateful to them for what they had written. He said that there was no suggestion that the testimonial related to any application he had made for a training position. 16. Dr Ishaque said that he had a passion for medical work, and that he treats surgical patients very seriously. He said that he loved working in the operating theatre and that this is the only place where he is relaxed. He said that he believed that he had the ability to practise safely and just needed a chance. 4

5 17. Dr Ishaque acknowledged that he had signed a form on 3 January 2018, sent to him by a locum agency, which included a declaration that he was a registered medical practitioner, when he knew that he was not, at the time of signing. He said that he would not say that he had not read the form, but he had signed it because it had been sent to him. 18. Dr Ishaque said that he had not been able to undertake any Continuing Professional Development (CPD) activities beyond those contained in the hearing bundle, because of financial constraints. He had also not been given any information about free courses. He said that, since he was erased, he had read his medical books and had revised, in order to keep up his medical knowledge. He accepted working part-time in a clinical environment, without keeping his knowledge up to date, through CPD, put patients at risk, but that he found theatre his natural habitat and was where he wanted to be. 19. In Tribunal questions, Dr Ishaque acknowledged that he had given the GMC incorrect postal and addresses, several months after his registration was erased. He was asked what he thought patients would think if they had seen the correspondence he had sent to the GMC, following his erasure. He said that they would not regard it as becoming of a doctor and that they would think that it had been written by an abusive and uneducated person. He said that he had learned some lessons about how to manage his frustration and that he should put his anger or what he described as his displacement reaction to one side. He suggested that, in the future, he might consider attending anger management courses. He said that when he read what he had written later on, he was disturbed by what he had written and that he should not have said what he did. Submissions 20. On behalf of the GMC, Mr Breen opposed Dr Ishaque s application for restoration. He provided the Tribunal with details of the background to Dr Ishaque s case and the circumstances in which he was erased. He told the Tribunal that after he had been erased, Dr Ishaque wrote s using what he described as appalling and disgraceful language, aimed at GMC staff. Mr Breen submitted that the Tribunal should consider the factors set out in the Guidance for doctors on restoration following erasure by a medical practitioners tribunal (the Guidance) and he reminded the Tribunal that the burden of the application for restoration lay on Dr Ishaque. 21. Mr Breen submitted that it was not entirely clear whether Dr Ishaque fully accepted the level of his dishonest conduct, and he suggested that Dr Ishaque had sought to find alternative explanations for it, which had been the concern of the 2012 Panel. Indeed, he drew to the attention of the Tribunal comments made by Dr Ishaque in 2018 since he submitted his application for restoration, in which Dr Ishaque had suggested that his own misconduct had not been as serious as that of others. Mr Breen said Dr Ishaque has shown no, or limited, insight, and had not 5

6 provided any evidence of substance to address his previous conduct. He said that it was not clear what work Dr Ishaque has done or the capacity in which it had been done, either in relation to his government position or in relation to his clinical work. Similarly, Mr Breen submitted that the evidence that Dr Ishaque had kept his clinical skills up to date was unclear, in the absence of a journal or other record of the learning Dr Ishaque had undertaken. Furthermore, Mr Breen said that it was a relevant factor that that Dr Ishaque had not passed the IELTS test. 22. In his submissions, Dr Ishaque acknowledged that the Tribunal would be unable to look behind the findings made by the 2012 Panel, but he said that he had a number of issues to raise about the way that the previous proceedings had been conducted against him. He said that it would be a matter for the Tribunal to consider the circumstances that led to his erasure and the reasons given by the 2012 Panel. He said that he really apologised for what he had done. He said that he accepted that the GMC had acted both in the best interests of patients and in his own best interests. He said that he had made mistakes and that his previous conduct from five years ago was a very serious concern. He said that he had not been able to practise medicine, because of his position in the civil service in Pakistan, and he had unsuccessfully attempted to obtain clinical attachments and other positions, elsewhere. He explained that he had undertaken reading relating to medicine and also actively engaged at a local clinic in his spare time. 23. Dr Ishaque said that he had taken a number of IELTS tests, with varying results. He had been surprised by his IELTS scores and, although he said that he did not wish to criticise the IELTS test, he suggested that the GMC should only be concerned with the quality of his knowledge of medical English. 24. Dr Ishaque submitted that his intemperate language with the GMC shortly after his registration was erased had been due to his frustration, having a bad day, the stress of mob riots and murders in Pakistan and his own feelings of displacement. He said that when he calmed down, he realised that it was not appropriate for an educated man to use such language. 25. Dr Ishaque said that he had made a mistake in submitting his CV in the form that was received by the GMC and that the qualifications on it were those he planned to obtain. He said that he did not want to try to justify what he had done, but that he said that there were cultural differences and he now realised the true values of how the system works in the UK. Dr Ishaque explained at length the clinical matters which had caused him to be first investigated by the GMC and he said that it was all his fault and that he had been very careless, which was not important in his country. He said that if he had been present at all of his hearing in 2012, erasure would not have happened, but he had been unable to obtain leave from his government job to attend the hearing. 6

7 26. Dr Ishaque enquired whether it would be possible for him to have a GMC or MPTS mentor appointed to help him deal with the concerns that had been raised. He also said that he did not have the money to pay for a performance assessment, but it would show the GMC that he can work and practise in the UK health system. He also suggested that he might be able to work with supervision. The Tribunal s Approach 27. The Tribunal reminded itself that its power to restore a practitioner to the Medical Register is a discretionary one which is to be used on the understanding that its primary responsibility is to act in accordance with the over-arching objective as set out in the Medical Act 1983 (as amended). That over-arching objective is the protection of the public and involves the pursuit of the following objectives: a. to protect, promote and maintain the health, safety and wellbeing of the public b. to maintain public confidence in the profession c. to promote and maintain proper professional standards and conduct for members of that profession. 28. The Tribunal also bore in mind that an applicant is not to be restored to the Register unless, in the Tribunal s judgement, the doctor is fit to return to unrestricted medical practice. It took account of the Guidance, in particular to paragraph 10(a) (e) which sets out a number of factors which the Tribunal took into account when deliberating Dr Ishaque s application, as follows: The tribunal will consider a number of factors, including the following: a The circumstances that led to erasure. b The reasons given by the previous tribunal (or committee) for the decision to direct erasure. c Whether you have any insight into the matters that led to erasure. d What you have done since your name was erased from the register. e The steps you have taken to keep your medical knowledge and skills up to date and the steps you have taken to rehabilitate yourself professionally and socially. 29. The Tribunal considered Dr Ishaque s application in accordance with the provisions set out in Section 41 of the Medical Act 1983 (as amended), and Rule 24 of the General Medical Council (Fitness to Practise) Rules 2004 (as amended)(the Rules). It also recognised that it had a duty to apply the principle of proportionality, 7

8 weighing the interests of the public with Dr Ishaque s interests, and to act fairly at all times. 30. In so doing, it took account of all the evidence, both oral and documentary, and the submissions made by Dr Ishaque and those of Mr Breen on behalf of the GMC The Tribunal s decision Previous findings and reasoning 31. The Tribunal first gave consideration to the circumstances that led to erasure and the reasons given by the 2012 Panel for its decision. In the course of a GMC investigation into other matters, which were not ultimately pursued further, Dr Ishaque was found to have sent s to the GMC in which he used the suffix MRCS when he was not entitled to do so. The 2012 Panel was told that, in order to claim membership of the Royal College of Surgeons, Dr Ishaque had to have been successful in all three parts of the intercollegiate examination. It heard that he had passed parts 1 and 2 of the intercollegiate examination, but had made a number of unsuccessful attempts at part The Tribunal also found that, in a CV that he submitted to the GMC, Dr Ishaque included four qualifications, which he did not hold. The 2012 Panel heard that the qualifications which Dr Isaque claimed to hold were: MRCP1 The Royal College of Physicians, UK Jan 2009, an examination that he had failed FRCR1 The Royal College of Radiologists, UK May 2009, an examination that he had failed FRCPath1 The Royal College of Pathologists, UK Nov 2008, an examination that he had not undertaken at all, and MSc (Policy Analysis and Management), Carnegie Mellon University (USA) 2010, when he had not taken any examinations at that university. 33. The 2012 Panel found that Dr Ishaque s actions in using the suffix MRCS in his s and in including qualifications in his CV that he did not hold were misleading. It also decided that they would be regarded as dishonest by the ordinary standards of reasonable and honest people, and that Dr Ishaque would have been aware of this. 34. Dr Ishaque also completed occupational health questionnaires in which he gave different dates for his date of birth. His actions in this respect were found to be misleading. 35. The 2012 Panel decided that Dr Ishaque s dishonest conduct fell seriously short of the standards expected from a doctor, being clear departures from the 8

9 standards set out in Good Medical Practice It also considered that his conduct breached a fundamental tenet of the profession, namely the need to be honest and trustworthy. The 2012 Panel took into account that no patients had been harmed by Dr Ishaque s actions and that there had been no financial gain. Further, it found that Dr Ishaque s dishonesty had been repeated and deliberate. It considered that Dr Ishaque s conduct was detrimental to the public interest and that members of the profession would consider it deplorable. It decided that Dr Ishaque s behaviour amounted to misconduct and reached the threshold of serious professional misconduct. 36. The 2012 Panel concluded that erasure was the proportionate sanction and the only means of protecting the public interest. It expressed its concerns that Dr Ishaque had tried to justify his behaviour in the course of those proceedings. It found that Dr Ishaque had not demonstrated sufficient insight and did not appear to understand the seriousness of his misconduct and the risk it posed to patients and the public interest. It was not confident that there would be no repetition. It therefore was not satisfied that a period or suspension would be proportionate or sufficient to protect the public interest. 37. This Tribunal has not sought to go behind the findings of the 2012 Panel, which it considers were serious. Insight 38. The Tribunal then took into account whether Dr Ishaque has gained insight into the matters which led to his registration being erased, and what he has done since his name was erased. 39. The Tribunal noted that in June 2013, Dr Ishaque submitted a change to his registered address to the GMC which was clearly false, and which he agreed in this hearing was false. This address contained abusive language and insulting comments. The Tribunal was supplied with a translated copy of an sent by Dr Ishaque to the GMC on 11 June 2013, which he also forwarded to particular members of GMC and MPTS staff on 30 June This was a diatribe against the decision that had been taken against him, expressed in foul and abusive language. 40. The Tribunal noted that Dr Ishaque subsequently apologised to the GMC on a number of occasions for this correspondence. He said that he had been really frustrated and was sorry about what had happened but that his language was not acceptable for a member of the medical profession. 41. In his written reflection, Dr Ishaque said that he had made mistakes in the past and that he had learnt the importance of being fair with vigilance in projected important medical statements and I will be careful in the future. The Tribunal also noted that in his reflective statement and in his oral evidence, Dr Ishaque said that 9

10 he accepted the findings of the 2012 Panel. He said that he acknowledged that his dishonest behaviour would affect the trust of patients and colleagues and that his behaviour had been unbecoming of a doctor. He clearly demonstrated a sense of shame for the way in which he had expressed himself to the GMC after he was erased. 42. However, the Tribunal was not clear that Dr Ishaque had genuinely understood and accepted the findings of the 2012 Panel. He referred to a number of concerns regarding the manner in which the 2012 proceedings had been conducted, including the possibility that the outcome might have been different, had he been able to attend the later stages of the 2012 hearing or cross examine witnesses in another way. When discussing his past conduct, much of his account appeared to dwell on mistakes he had made in not checking what had been written, or in not using a proof reader. Additionally, in his oral evidence, he dwelt on the clinical matters that originally caused an investigation to be opened and he suggested that it had not been his fault and that it need never have happened. Dr Ishaque appeared to acknowledge the potential risk to patients of him continuing to work in clinical areas, without undertaking appropriate CPD. He did not appear to show insight into the potential impact of his dishonesty on patients, appearing unduly concerned with establishing that he is a good clinician. 43. Furthermore, although Dr Ishaque talked of understanding why his dishonesty had been fundamentally incompatible with continued registration, he initially suggested that this was due to particular values in the UK, although he later accepted that this would be the same in other countries. He also made comments in his correspondence to the GMC, and during this hearing, about the nature of his misconduct, comparing it to, for example, the outcomes for doctors involved in sexual misconduct. The implication of these comments appeared to the Tribunal to be a suggestion that his own misconduct was not as serious and should therefore have warranted a less serious sanction. 44. In all these circumstances, The Tribunal did not consider that the evidence presented amounted to unequivocal acceptance by Dr Ishaque that he had taken responsibility for what had taken place. 45. Furthermore, notwithstanding his assurance that he would be vigilant in statements he would make in the future, Dr Ishaque had signed a document for a locum agency in 2018 which stated that he was a registered medical practitioner, when he was not. He also said that he had not disclosed his employment with a clinic to the medical regulators in Pakistan, suggesting that he did not need to do so, and relying on what other practitioners had told him to do. The Tribunal took the view that Dr Ishaque had demonstrated that he is, even now, failing to take responsibility for his own actions. 10

11 46. The Tribunal was not satisfied that Dr Ishaque has gained insight into his past behaviour or that he has demonstrated that it would not be repeated. Indeed, it has concluded that the evidence is that these concerns remain. Activities since erasure 47. Dr Ishaque did not provide documentary or other evidence to demonstrate what work he has done since he was erased, or regarding his conduct and character since those events. He told the Tribunal that he had originally left Pakistan on unauthorised leave in order to work as a doctor in the UK and had returned to the Civil Service there when he was erased. Dr Ishaque told the Tribunal that he is a law enforcement officer, and has worked for the Federal Civil Services of Pakistan from January 2012, but the Tribunal was unclear as to the precise nature of his work. He said that when he returned to the UK earlier this year, he had found work in security. 48. Dr Ishaque stated that he had not worked in a health system since his registration was suspended, prior to the proceedings before the 2012 Panel and the Tribunal noted that in the GMC form he completed to apply for restoration, Dr Ishaque stated that he has not been providing medical services in a comparable health system. This was clearly at odds with his oral evidence that he works parttime at a clinic in Pakistan. 49. The testimonial from Professors A and B, the surgeons that Dr Ishaque works with in Pakistan, stated We found him to be a hard working doctor who showed a keen interest jn all aspects of patient care. Dr Ishaque carried out pre-operative assessments of patients as well as routine ward work with a great deal of enthusiasm and common sense. He attended theatre and operating sessions and showed great interest in assisting common, general and major vascular/cardiac surgical procedures. 50. The testimonial went on to state that the surgeons had no hesitation in recommending him for a trainee position. Dr Ishaque suggested that there was a misunderstanding, as he had not been seeking a training position. 51. Dr Ishaque sought to explain to the Tribunal that he works under supervision in the clinic, when the testimonial suggested that he was working with a degree of autonomy. 52. The Tribunal was concerned about the apparent discrepancies between what Dr Ishaque told the Tribunal that he had been doing and the work described in the testimonial. However, in any event, in the light of all the evidence presented, it considered that there was very little objective evidence to show what Dr Ishaque 11

12 has been doing since he was erased, and little to show remediation of his past dishonesty or demonstrate that he has regained his integrity. Keeping medical and clinical skills up to date and steps taken towards rehabilitation 53. Dr Ishaque told the Tribunal that he has not worked in any clinical capacity or medical environment since his registration was erased, and that he has been working as a civil servant since 2012, although this was contradicted by his oral evidence that he works at a clinic in Pakistan, on a part-time basis. He told the Tribunal that he undertakes regular reading and revision, although there was no evidence before the Tribunal, for example in the form of a log, to demonstrate what he had read and what he had learned. 54. The Tribunal acknowledged that Dr Ishaque undertook 15 courses in a range of topics in November It noted that these courses were in respect of nonclinical skills, with the exception of Adult Basic Life Support. There was no other evidence of any courses or other learning undertaken in the period since Dr Ishaque was erased. 55. The Tribunal did not accept that the evidence presented demonstrated a systematic attempt to keep Dr Ishaque s medical knowledge up to date. The Tribunal considered that there appeared to be no structure or focus to Dr Ishaque s activities, and the Tribunal was concerned there was a lack of ongoing CPD over a longer and more sustained period of time. English language 56. On 25 May 2018, the GMC directed Dr Ishaque to undertake an assessment of his knowledge of English. The Tribunal noted that the IELTS scores acceptable to the GMC are at least 7.0 in each testing area (speaking, listening, reading and writing) and a score of at least 7.5 overall. Dr Ishaque took an IELTS test on 7 June His overall score was 7.0, and individual testing areas were scored as follows: Listening 7:0, Reading 6.5, Writing 6.0 and Speaking 8.0. The Tribunal noted that, on the basis of these results, the standard of Dr Ishaque s knowledge of English does not reach the standards required. Conclusion 57. The Tribunal was of the view that, taking into account the matters set out above, Dr Ishaque s insight into the actions which led to his erasure remains limited and that he continues to place his own interests in resuming practice as a doctor ahead of the interests of patients, the profession and the public. Furthermore the Tribunal is concerned that Dr Ishaque s actions and behaviour since 2012 provide ongoing concerns about Dr Ishaque s probity and integrity. Further it was not 12

13 satisfied that Dr Ishaque has kept his skills and knowledge up to date such that he is suitable to return safely to unrestricted practise. 58. The Tribunal is not satisfied that sufficient evidence has been presented for it to be satisfied that Dr Ishaque would not present a risk to patients, if he were to be restored to the register. It has concluded that granting his application would cause confidence in the profession to be undermined and would not properly uphold professional standards of conduct and behaviour. 59. In addition, the Tribunal does not find it conceivable that it would be appropriate to restore Dr Ishaque to the medical register when Dr Ishaque s knowledge of English, as evidenced by his recent IELTS test, does not meet the current standards required by the GMC. 60. In all the circumstances, the Tribunal considered that the statutory overarching objective would be compromised through the restoration of Dr Ishaque s name to the Medical Register. It was of the view that he is not currently fit to practise and that he is not currently a fit and proper person to be restored. 61. Accordingly, the Tribunal determined not to grant Dr Ishaque s application for his name to be restored to the Medical Register. Confirmed Date 12 July 2018 Mr David Robinson, Chair 13

14 ANNEX A 12/07/2018 Application to adjourn and direct a performance assessment 1. In the course of Dr Ishaque s submissions in relation to his application for restoration, he made reference to the possibility that he could undertake a performance assessment. The Tribunal treated this as an application to adjourn and for it to direct him to undertake a GMC assessment of his professional performance. It therefore invited submissions from Dr Ishaque and Mr Breen, on behalf of the GMC. 2. Dr Ishaque submitted that he did not have the money to pay for a performance assessment, but that such an assessment would show the GMC that he can work and practise safely in the UK health system. 3. Mr Breen submitted that the findings made by the 2012 Panel had not involved matters relating to Dr Ishaque s clinical performance and therefore a performance assessment was not relevant to his application for restoration. He said that an assessment report would not impact on the Tribunal s decision whether or not to grant his application for restoration, as it would have to consider the fact that there was no remediation or insight into Dr Ishaque s past conduct. 4. The Tribunal took account of the submissions made. It bore in mind that the onus is on Dr Ishaque to satisfy the Tribunal that he should be restored to the medical register. 5. The Tribunal accepted that it needed to consider whether Dr Ishaque has kept his clinical knowledge and skills up to date, as a factor in the substantive application for restoration. However, the Tribunal bore in mind the nature of the findings made by the 2012 Tribunal, which related to Dr Ishaque s dishonest behaviour, and which did not raise any clinical issues. In the light of these findings, it did not consider that a performance assessment report would inform its overall decision as to whether it should direct that his registration be restored. It also noted that Dr Ishaque had suggested that he would not be able to pay for such an assessment, in any event. In all the circumstances, the Tribunal therefore determined that it would not adjourn for Dr Ishaque to undertake an assessment of his professional performance. 14