Accusation was made at a fitness to practice hearing for the pair of GPs
Two family doctors have been accused of trying to “conceal” from officials “the true levels” of highly addictive sleeping tablets being prescribed to patients by their GP practice.
The General Medical Council (GMC) has said that Dr Paul Flanigan and Dr Gabrielle McKeever handed out private prescriptions to patients between 2011 and 2015 in order that prescribing levels of potentially dangerous drugs would be “artificially reduced” in an official audit process.
At the time the prescription levels of the drugs at Loy Medical Practice in Cookstown, where Dr Flanigan and Dr McKeever were partners, was under the spotlight.
Efforts were underway to reduce the prescribing of ‘Z’ drugs and benzodiazepines following a meeting in May 2011 with the now defunct Health & Social Care Board (HSCB), where it was agreed the surgery would receive a payment of £507.20 if a reduced prescribing target was achieved.
Setting out the case against the doctors at a fitness to practice hearing yesterday, GMC counsel Chloe Fairley explained that in 2011, the prescribing of benzodiazepines and ‘Z’ drugs in Northern Ireland “was approximately twice the UK average”.
She continued: “The Loy practice had been identified as being in the upper third of all practices in Northern Ireland and that was a position of concern that required review.”
Ms Fairley said the HSCB met with Dr Flanigan and Dr McKeever on May 26, 2011, to discuss medicine management and it was agreed that prescribing of benzodiazepines and ‘Z’ drugs would be reduced by 1% between October and December 2011.
However, concerns were subsequently raised about the number of private prescriptions being dispensed by community pharmacists in the area and an investigation was launched.
The tribunal was told HSCB officials visited two GP surgeries on October 21, 2015, in relation to the investigation, one of which was Loy Medical Practice.
During a meeting at the surgery, in which Dr McKeever was not present, Ms Fairley said Dr Flanigan told officials the new prescribing protocol for the drugs was met with “patient resistance”.
Dr Flanigan said the surgery “introduced the use of private prescriptions to make prescribing rates appear reduced”, said Ms Fairley.
This was despite the fact the patients were entitled to the prescriptions on the NHS.
There is no official record of private prescriptions apart from the physical prescription itself and a note on patient records, the tribunal was told, whereas NHS prescriptions are closely monitored.
Ms Fairley continued: “In terms of dishonesty, the GMC submits that the evidence demonstrates, and it doesn’t appear to be in dispute, that from September 2011 Dr Flanigan and Dr McKeever issued prescriptions…using private prescriptions rather than NHS prescriptions to which the patients were entitled.
“The GMC case is that this was intended to, and did conceal, the true levels of prescribing from the health service and HSCB.
“There was no benefit to the patients themselves in being given a private prescription and in fact there was a detriment as they would have had to pay for the drugs dispensed at the pharmacy.”
However, questioning Diane McKillen, a former HSCB employee who took notes during the October 2015 meeting with Dr Flanigan, counsel representing the GP raised concerns over why the notes didn’t include the alleged explanation of “patient resistance”.
"There is no contemporaneous note made about the doctor stating he prescribed privately as a way of making prescribing rates appear reduced, is there,” asked Matthew McDonagh.
"There is no contemporaneous note of that, no,” replied Ms McKillen.
Mr McDonagh continued: "That motivation would be an important one, wouldn’t it? He didn’t actually say that he prescribed privately as a way of making prescribing rates appear reduced.”
Ms McKillen answered: “He may have said it but I may not have recorded it. I'm not proud of that note but it was never meant to be a full note of the discussion.”
She continued: “I’m not really sure what I chose to note and what I didn’t, to be perfectly honest. Some things I just remembered and the odd thing I made a note of.”
Mr McDonagh asked Ms McKillen why she “would take a note at all” if she was only recording some parts of the conversation “haphazardly”, to which she said: “I was concentrating mostly on what he had to say.”
Dr Flanigan and Dr McKeever have admitted a number of charges made against them in relation to the case, including prescribing patients ‘Z’ drugs using private prescriptions.
However, the tribunal is yet to determine whether the doctors’ actions were dishonest, while counsel representing Dr McKeever has told the tribunal, “there is likely to be a submission of no case to answer” made on her behalf when the hearing resumes.