General Medical Council (GMC) Correspondence

Re: Complaint against David Wright, Chief Medical Officer, Atos Healthcare

I would like to draw your attention to and formally complain over the actions of David Wright, Chief Medical Officer, Atos Healthcare of 4 Triton Square, Regent's Place, London NW1 3HG, who in my view has been:-

1. negligent, in that, in his role as Chief Medical Officer, has failed to ensure appropriate medical procedures are in place in line with his obligations in respect of his duty of care to the dying, the sick, the disabled and their carers. This has caused me actual harm.

2. neglectful or incompetent, in failing to ensure that literature produced by Atos Healthcare aimed at patients should refer to patients and not customers. An example of which is a document "Caring About Customer Service" which misrepresents a patient as a customer. The Department for Work and Pensions (DWP) and Atos Healthcare has a contractual relationship and as such the DWP is a customer of Atos Healthcare. The relationship between a patient and Atos Heathcare is covered by the duty of care which is subject to statute and case law.

3. neglectful or incompetent, in failing to review and apply current medical opinion in respect of "...assessment looks at what an individual can do, rather than simply making a diagnosis of their medical condition...". I refer you to the legal case involving the United States of America, State of California, Department of Insurance and their 2005 settlement with the UnumProvident Corporation. This agreement settles disputes over thousands of claims filed by California policy holders who were unfairly denied benefits by the insurance carrier during the time period between January 1, 1997 and September 30, 2005.

Neither the DWP or Atos Healthcare has written to me to dispute the facts of my case. They have not provided me with a copy of my medical report or provided me with reasons why they refuse to provide me with a copy of my medical report.

I refer you to the memorandum I submitted to the The House of Commons, Works and Pensions Committee, announced on 2 July 2009, inquiry on "Decision making and appeals in the benefits system". This is published on the Parliament website. A review of the written evidence might conclude my experience is not atypical. I draw your attention to the memoranda submitted by the Parliamentary and Health Service Ombudsman e.g. "..DWP and its agencies are the biggest originator of complaints to my Office..." and HH Judge Robert Martin e.g "...medical report under-estimated the severity of the disability...". Please note the DWP relies on Atos Healthcare for their healthcare services.

I attach a letter dated 5 October 2009 to the Care Quality Commission. I am awaiting a reply.

I attach a letter dated 28 September 2009 to Atos Healthcare. I received a letter dated 7 October 2009 informing me that my case has been referred to the Senior Medical Adviser. I am awaiting a reply.

I attach a letter dated 9 October 2009 to the Secretary of State for Work and Pensions. The Minister for Disabled People has replied in a letter dated 28 October 2009. He specifically stated that information provided by patients would be screened to decide whether a face to face examination is required. It is not disputed that this was not done in my case.

I have written to the BMA and in their reply they state "...While we cannot comment on individual cases the BMA does have concerns regarding the use of non-doctors by the Department of Work and Pensions and Atos Healthcare to assess patients for benefits claims. We are seeking a meeting to discuss these issues with Atos...."

I am not against the principle of outsourcing healthcare or other services to commercial companies as long as the services provided are as good as or better than those currently provided and if there is a cost advantage. Atos Healthcare in a written reply has stated that "...the examining practioner would not have access to a customer's NHS medical patient history". Atos Healthcare has stated in a written reply to the Health and Safety Executive (case reference 4177247 handled by Mr J...) that "...The Medical Examination Centre assesses people's functional ability through consultation, discussion and simple physical tests(e.g. reflex)...". As a lay person, I am not qualified to say if this is appropriate for a particular medical condition. I look to the Chief Medical Officer, Atos Healthcare to ensure that Atos Healthcare undertake only those medical examinations where this level of expertise is appropriate. He failed to do this in my case and if seems in many others. I cannot see why he has failed to act in line with medical ethics in this matter. This is the heart of my complaint.

I hope you will review this matter and take the steps needed to address the injustice, pain and suffering being caused by the Chief Medical Officer of Atos Healthcare to the dying, the sick, the disabled and their carers. I am able to submit copies of all correspondence as evidence. If I have sufficient strength and if allowed by my consultants and my GP, I would be willing to attend a hearing in person.

I look forward to hearing from you. Thank you.

Thank you for your letter of 5 November 2009.

Whilst we understand your reasons for writing to us, this issue does not fall within our remit.

Atos Healthcare provides services on behalf of the Department for Work and Pensions. The principal function is to provide medical advice to assist decision makers to reach a conclusion about benefit entitlement. There is no requirement to offer care or treatment unless an emergency arises during a consultation.

Unfortunately, your dissatisfaction with the arrangements for your medical examination is not a matter for the GMC. It is, of course, extremely regrettable if you were inconvenienced or felt unwell as a result of travelling to your examination. The implementation of Government policy by the Department for Work and Pensions is outside the GmC's remit and we note that you have already raised your concerns at local level. This is the appropriate forum. I am sorry that I can not be of any more help to you, but unfortunately, a GMC investigation is not warranted.

Please contact me on my direct dial if you have any questions.

Re: ... Complaint against David Wright, Chief Medical Officer, Atos Healthcare and others

I wrote to you on 5 November 2009 and you replied on 17 November 2009. I accept that the implementation of Government policy by the Department for Work and Pensions lies outside the remit of the GMC. Notwithstanding as the medical procedures must conform to GMC medical standards, I feel the GMC has a role in reviewing whether the standards are being complied with. Atos Healthcare have completed their investigations of my case. I believe their findings provide evidence of medical professional misconduct by Dr David Wright and others which I would like you to investigate and take action on. My case is not unique and is representative of the treatment many patients receive from Atos.

1. I have published all correspondence (desensitised where necessary) on my website http://www.whywaitforever.com/dwpatos.html. I would like to draw your attention to the correspondence between the DWP, Atos and myself, the contract between the DWP and Atos and the unsound medical report that Atos produced. The originals are available from Atos or myself.

2. In the words of the Atos Independent Tier medical investigator, Dr David Wright, Chief Medical Officer, Atos Healthcare of 4 Triton Square, Regent's Place, London NW1 3HG, "is responsible for setting and conveying the agreed Professional Standards that are required within that medical service for the DWP". The Contract between the DWP and Atos refers in many places to the GMC and GMC medical standards.

3. The Independent Tier confirmed that Dr Wright permitted medically unqualified staff to decide on the medical matter of whether a patient (me) should be required to attend a face to face assessment. Dr Wright's misconduct caused me actual injury and could have resulted in my death. Atos has assured the Minister that, in line with the Contract, only medically qualified staff can make this decision. This assurance conflicts with the findings of the Independent Tier.

4. The Independent Tier confirmed that Dr Wright failed to ensure that accurate medical records were kept and so Atos is unable to identify the unqualified individual who Dr Wright allowed to take the decision that a face to face assessment was required. Dr Wright demonstrated gross medical misconduct in that he was well aware that the Contract specifies medical conditions, including patients with cancers, that required handling only by GMC qualified doctors. The Independent Tier evidence highlights the issues and asks the question why a patient such as myself was caused actual injury because of the misconduct by Dr Wright.

5. The Contract between the DWP and Atos specifies that healthcare professionals should undergo Atos training. I requested under the Freedom of Information Act confirmation that the individuals mentioned below were trained. The DWP was not able to confirm this was the case. Dr Wright is guilty of professional misconduct in that he allowed untrained individuals to undertake a medical assessment. The Contract describes this as a assault and must be reported to the DWP. This was not done.

6. Dr Wright has brought the medical professional and the GMC into disrepute. Atos are required under Contract to follow GMC procedures and claim to do so yet Dr Wright allows unqualified staff to make medical decisions that cause injury and distress to patients. If the GMC are not responsible for medical procedures what is to stop anyone misrepresenting the GMC.

7. I would formally like to complain that Mrs Tanya Catherine Andrews (Nursing and Midwifery PIN 97C0338E) misrepresented herself as a doctor qualified to undertake a medical assessment for a cancer patient. She did not undertake the assessment as I insisted I should be seen by a doctor. The GMC should investigate why Dr Wright allowed her to take this action. This individual has not completed Atos training.

8. I would formally like to complain that Dr Ludmila Semetillo (GMC number 6165133) is guilty of professional misconduct in that she undertook a medical assessment for a cancer patient when she is not qualified to do so and not allowed to do so as specified by the GMC rules included in the Contract between the DWP and Atos. This constitutes an assault. This individual has not completed Atos training. I would ask you to review the medical report produced and see if it meets the minimum GMC standard as is required in the Contract between the DWP and Atos. You should note the poor English and as an example the misuse of the word "affect" when "effect" should have been used.

9. Atos has agreed that they provided an unsound medical report to the DWP. I refer you to Dr Bruecker who "advised that the pathology of your condition is not clear from available evidence ... he has arranged for a request to be issued to your GP to provide further information." This is in line with my understanding of the correct GMC procedure and I would like to express my appreciation for his honesty and courage. He has put the patient (me) first. I recommend the GMC interview him as he can provide first hand evidence.

10. I am aware of other patients who on a domicillary visit by an Atos doctor have been surprised that the doctor has stated he is not qualified to complete the assessment. Other Atos doctors, when shown the Contract published on my website and the medical conditions listed which require specialist medical knowledge, have not completed the assessment. It should not be up to a patient such as myself to publish such medical information. I expect the GMC to ensure that the best medical procedures are followed.

I am asking for the GMC to investigate this matter and ensure that Atos "Do no harm" to patients. A medical report is supposed to be produced in all cases. The individual who decided on the face to face interview should be known. The individual who undertook the assessment is known and the qualifications (or lack thereof) of that individual is known. The GMC could review the work of a single Medical Assessment Centre and see whether patients are best served by Atos. The GMC as the medical authority is the only body in a position to do this.

I look forward to hearing from you. Thank you.

Yours sincerely

Dear Mr B...

Thank you for your further letter dated 3 March 2010. Your comments have been noted and placed on file.

Please note that we do have the power to review investigation decisions, including a decision not to refer an allegation for a full GMC investigation. but only where there is reason to believe that the decision may have been wrongly reached or there is new information received which may have led to a different decision. A review would only then be undertaken if the Registrar was satisfied that it was necessary for either the protection of the public, the prevention of injustice to the practitioner or otherwise necessary in the public interest.

Your further correspondence has been reviewed by the Assistant Registrar however we do not have reason to believe that a review of our original decision is warranted. We cannot review the decision simply because you disagree with it. It is open to you to outline reasons why you think our decision has been wrongly reached, but we are otherwise unable to consider this matter further.

If there is new information which may have led to a different decision it would be open to you to submit it for consideration.

We note that you have kindly provided us with the link to your website which contains a large amount of information however in order to consider the matter further we would require you to highlight the key documents in relation to your complaint.

To summarise; we would require your reasons for why our decision is flawed and the specific supporting documents.

We note that you would also like to make a formal complaint about Dr Ludmila Semetillo In order to consider these concerns further we would also require your specific allegations and supporting documents. Please note that your complaint about Mrs Tanya Catherine Andrews should be directed to the Nursing and Midwifey Council

I am sorry that we can be of no further assistance at this time however if you wish to submit your reasons for review as outlined above I would be happy to pass this to the appropriate team for consideration.

Yours sincerely

Dear Ms Munro

GMC Reference: ....

Thank you for your efforts in meeting my previous requests under the Freedom of Information Act. I need to provide evidence to the GMC to support my complaint against Dr David Wright, Chief Medical Officer, Atos Healthcare and against Dr Ludmila Semetillo who works for Atos Healthcare. In order to prove that the documents are as originally produced I would like you to send the documents listed below directly to the GMC as below. Please can you quote the GMC reference ... when you supply these documents.

Please can you supply to ..., Investigation Officer, General Medical Council Fitness to Practise Directorate, St James's Buildings, 79 Oxford Street, Manchester M1 6FQ the following:

1. A copy of the ESA50 form that I orginally completed.

2. A copy of the extract of the Contract between the DWP and Atos Healthcare that you previously supplied to me. I would like the GMC to review the medical standards and the references to the GMC.

3. A copy of the letter dated 7th January 2010 from Ms C..., Team Leader, Customer Relations which was also sent by the Right Honourable Jonathan Shaw MP, Minister for Disabled People to me and which contains implicit criticism of the actions of Dr Ludmila Semetillo who provided unsound medical advice to the DWP in comments made by Atos Medical Manager Dr Bruecker.

4. A copy of the letter dated 15 February 2010 from Mr Geoff Hampshire, the Atos Convenor to the Independent Tier together with File Number ... the Independent Tier Feedback report, in full. This report contains implicit criticism of the actions of Dr Wright who allowed an unqualified individual to take a decision that a face to face assessment was necessary (and failed to keep adequate medical records) which goes against the agreed and contracted for medical procedure which was that this decision, in respect of cancer, should have been taken by a GMC registered doctor. This report contains implicit criticism of the actions of Dr Ludmila Semetillo whose medical report was described using the following phrase "this report does not satisfy Atos Quality standards". Dr Ludmila Semetillo does not appear to know the difference in meaning between "effect" and "affect". She has difficulty in using words referring to gender in particular the use of the words "he", "she" and "they". Dr Ludmila Semetillo knew she was not qualified in neurology and neurosurgery. She should have followed the correct procedure later undertaken by Atos Medical Manager Dr Bruecker. I have asked the GMC if her actions were "misconduct".

Thank you in anticipation.

Department for Work and Pensions
Commercial Directorate

Medical Services Contract
Management Team
North Fylde Central Office
Norcross
Block 3 Room 306
Blackpool
FY5 3TA

Email: DWP.MEDICALSERVICESCORRESPONDENCE@DwP.GSI.GOV.UK

Date: 18 March 2010
Our Ref FOI: 1310-713
Your Ref: DC/1-2VXU9L

Dear Mr B...

Thank you for your Freedom of Information request which was received 12 March 2010. You asked for: Extract of the Contract between DWP & ATOS Healthcare.

You can therefore expect a reply by 13 April 2010 unless I need to come back to you to clarify your request or the balance of the public interest test needs to be considered. You should be aware that we are currently experiencing high levels of requests and we are endeavouring to meet this target date.

If you have any queries about this letter please contact me quoting the reference number above.

Yours sincerely

Michelle Munro, Freedom of Information Officer

Re: FOI Request for information to be sent direct to the GMC

Dear ...,

My medical condition is getting worse. I am suffering 3 fits a day and I do not know how long my strength will hold out. I would like a favour which is to progress the issues previously raised and to put forward the new issues I raise below.

1. Ms Munro wrote to me and said she will send the information to you by the 13 April 2010. Please can you chase her if you have not received all the information by then.

2. Once you have the evidence please can you progress. There is additional evidence. All correspondence I have published on my website http://www.whywaitforever.com/dwpatos.html and the pages linked from this page. The originals on this website can be obtained from Ms Munro if they are required.

3. Please can you ask the GMC to consider the definition of "terminally ill". This is a general point. You can refer to the observations made by the Atos Independent Tier. There is conflict. I, as a patient, cannot be expected be provide an authoritative view. My GP and consultants avoid, rightly, the direct question. They avoid by saying they could be run over by a bus. This conflicts with the needs of the DWP. I suggest a better approach is survivability. As an adult with a primary brain tumour the Secretary of State for Health in Parliament says I have a 12.3% chance of surviving 5 years. In the previous period it was 12.6%. I have survived the 9 months and as the increased number of more and more painful fits I am experiencing my case supports the Secretary of State's figures. Without diazepam my courage would have failed. So the GMC and the DoH have the survivability figures for medical conditions and the DoH, maybe for budget reasons, can decided whether 10% or less or more means terminally ill.

   It could be broken into regions so if survival figures are better in one region than another someone could be regarded as terminally ill in one region and not the other. The DWP could decide without wasting the time of a GP and consultant in more cases. Clearly the current procedure could be followed for special or complex cases.

4. Please can you ask the GMC to consider the 90 minutes travelling time on patients with certain conditions or who are taking medicines. In my case to travel to Highgate I had to use the loo at ..., Tottenham Hale, UCLH and a pub in Highgate. This when I was exhausted and near fainting at times. The GMC could review the DWP Atos contract and protect patients from stress and discomfort for this avoidable cause.

5. Please can you ask the GMC to consider the DWP Atos contract as it affects patients who are not terminally ill but whose medical condition is not stable and is deteriorating. Clearly if my tumour had been removed or reduced though radiotherapy then my case should be reviewed. When the anti-fitting medicine was not yet working and the situation was deteriorating it seems reasonable that the GMC could produce a procedure that would better protect the patient. The Atos Independent Tier is clearly asking for medical clarification which I suggest can only come from the GMC.

This is the first hour in a week, after a hospital visit this weekend and a visit to my GP on Monday when I have a little strength. I do not know if I will have strength again. As each fit gets more painful and as my strength ebbs away, while I fit, I do hope my body will stop fighting the inevitable and let me pass away. Screaming with pain upset everyone and three or fours times a day is ....

I know I am asking you to put your head above the parapet. Whatever you decide to do I appreciate your efforts.

Fare thee well.

Highest regards

In reply please quote: DC/1-4VXU9L

Dear Mr B...

Thank you for your email. I am sorry to hear of your current condition.

As previously stated, whilst we under your reasons for writing to us the implementation of Government policy by the Department for Work and Pensions is out of our remit.

The GMC can only consider specific allegations in relation to individual doctors. We are not a general complaints body however we can look at the issues brought to our attention in order to ascertain whether this would call into question a doctor's fitness to practise and his or her right to remain on the medical register with no restrictions.

Therefore under our procedures we are unable to provide explanations or answer questions in relation to the workings of Atos or the DWP. We note that you have already raised your concerns at a local level which is the most appropriate forum.

We appreciate that you are unhappy with our decision not to investigate your complaint further however I have previously outlined our grounds for a review of our decision. To reiterate, you would need to submit your reasons for why our decision is flawed and the specific supporting documents.

Please note that a review would only then be undertaken if the Registrar was satisfied that it was necessary for either the protection of the public, the prevention of injustice to the practitioner or otherwise necessary in the public interest.

If you wish to make a complaint about an individual doctor we would need the doctor's full name, GMC number if possible and specific allegations in relation to each. That is what you think the doctor did wrong or failed to do with supporting documents if available, otherwise we are unable to consider the matter further.

Please note that our office is no longer located on ... Street. I have provided our new contact details below for your reference however our mail is being redirected from our previous address.

..., Fitness to Practise Directorate, General Medical Council, 3 Hardman Street, Manchester, M3 3AW

I am sorry that we can be of no further assistance at this time.

Yours Sincerely

Complaint against Dr Ludmila Semetillo, GMC number ... for malpractice and assault

14 September 2010

Dear ...
 
Further to your email dated 25 March 2010 reference DC/1-4VXU9L. I apologise for 
the delay. This is due to my medical condition getting worse and the DWP and Atos 
delays in providing evidence.  In our previous correspondence you have asked for evidence.
I now provide you with the evidence of malpractice and assault by Dr Ludmila Semetillo, 
GMC number is ....  I am making specific allegations against Dr Ludmila Semetillo.
I would like you to investigate and take appropriate action against Dr Ludmila Semetillo.
 
I refer you to the Contract (Final Version - 15 March 2005) between the DWP and 
Atos Origin which contains the following.
 
Appendix 1 of Schedule 4 Section 4.12 lists cancer as a medical condition that must be 
referred to a Medical Advisor (GMC registered) for advice. 
 
Schedule 1 Definitions defines:-
 
"Further Medical Evidence"
means medical evidence obtained from a third party such as, but not exclusively, 
a general practitioner or a hospital practitioner and includes, but is not limited to, 
written factual reports, hospital case notes including radiological and pathological 
investigations.
 
SCHEDULE 4 SECTION 4.1 PART 2
 
4.5      Basis of Medical Advice
 
4.5.1    The CONTRACTOR shall ensure that wherever possible all medical reports and
         medical advice:
 
4.5.1.1  is evidence based, that is, there is a consensus of critically evaluated,
         published medical evidence in support of the advice provided by the
         CONTRACTOR;
 
4.5.1.5  is based only on documents that are consistent with one another as to
         the evidence they contain;
 
4.5.1.7  takes full account of and records the effects of pain, fatigue and
         medication on the Claimant's functional capacity or care needs;
 
4.19.1   When obtaining Further Medical Evidence, the CONTRACTOR shall make it clear to
         the author of that evidence that all evidence may be given to the Claimant and that
         the only information that can legally be withheld from the Claimant is that which may
         be harmful to the Claimant's health.
 
All other Atos doctors involved in my case have followed the correct procedure 4.19.1 
and have consulted with my GP and or Consultants.  Dr Ludmila Semetillo did not follow the
best medical practice as set out in the Contract. 
 
I have anecdotal evidence that other Atos doctors when visiting patients with cancer at home 
have refused to carry out the assessment after these clauses in the Contract have been 
pointed out to them. These Atos doctors have agreed they should first consult the patient's GP 
and have agreed that if they were to carry out the assessment they would be guilty of assault.
 
Charge 1. Dr Ludmila Semetillo, GMC number is 6165133 is guilty of malpractice in that instead of 
complying with the contract she carried out an illegal assessment which lasted 1 hour 50 minutes.
She caused me considerable injury and as such in addition to malpractice is guilty of assault.
 
Charge 2. Dr Ludmila Semetillo, GMC number is 6165133 is guilty of malpractice in that the report 
she produced did not comply with the Contract because it is not legible.
 
The Medical Requirements Schedule 4 Section 4.1 has a clause 4.5.1.9 which states:-
 
4.5.1.9 is legible, presented to the AUTHORITY in the English language and understandable 
to those without medical qualifications....

I attach a desensitized transcription of the report ESA85 for you to review. This is available online http://www.whywaitforever.com/dwpatosformesa85.html. This report is NOT understandable to those without medical qualifications. It is critical that a doctor can communicate with a patient.

Please note the grammar, spelling and tardiness. This is supposed to be a professional document. I do not accept errors such as using "She" instead of "He" is ever acceptable. I do not accept the use of the plural form "their" when "his" should be used. It should be noted that the phrase "side affect" is used when the phrase "side effect" should have been used. There has been a recent medical case when notes were passed from one doctor to another, who took over as part of a shift change, and effects were misreported as affects with adverse consequences. She had difficulty with spoken and written English. "He had to submit his driving license." "She suffers with fits..." She did not know what intermittent meant and so did not include the word in the report. I do think it is important to record whether a symptom is constant or intermittent. None of the specialist consultants who have seen me can state when my condition started and yet she can boldly state on page 2 "The condition started 8 years ago".

I hope you now have sufficient evidence to proceed with considering the evidence, take appropriate action and at the least advise the DWP to remove "approval" from Dr Ludmila Semetillo. They refuse to remove "approval" until the GMC has completed its investigation.

Highest regards

Yours sincerely

Mr B...

To: practise@gmc-uk.org

Complaint against Dr Ilias Macheridis, GMC number is 6138922 for malpractice

I would like to complain of malpractice by Dr Ilias Macheridis, GMC number is 6138922
 
I refer you to the Contract (Final Version - 15 March 2005) between the DWP and
Atos Origin.
 
Dr Ilias Macheridis, GMC number is 6138922 is guilty of malpractice in that the IB59 report
that was produced does not comply with the Contract because it is not legible.  
The Medical Requirements Schedule 4 Section 4.1 
 
has a clause 4.5.1.9 which states:-
 
4.5.1.9 is legible, presented to the AUTHORITY in the English language and understandable
           to those without medical qualifications....

I attach a desensitized transcription of the report IB59 for you to review. This is available online http://www.whywaitforever.com/dwpatosformib59a.html. It is critical that a doctor can communicate with a patient.

Please note the grammar, spelling and tardiness. This is supposed to be a professional document. I do not accept errors such as using "farther" instead of "further" is ever acceptable. I do not accept the spelling of "tumour" as "toumor". I do not accept the use of the phrase "to fulfill" when "fulfills" should have been used. These are basic errors.

I hope this is sufficient evidence for you to proceed, take appropriate action and at the least to instruct the DWP to remove "approval" from Dr Ilias Macheridis.

Highest regards

Yours sincerely

Mr B...

General Medical Council
3 Hardman Street, Manchester M3 3AW

Telephone. 0161 923 6200
Email: gmc@gmc-uk.org
www.gmc-uk.org
 
22 September 2010

In reply please quote: KD/1-5Y9IJH

Dear Mr B...

Thank you for your e-mail of 14 September 2010 about Dr Ilias Macheridis.

Our Fitness to Practise procedures focus on the most serious concerns, which call into question a doctor's fitness to practise and right to retain unrestricted registration - that is his or her right to work. In many cases, concerns about a doctor can best be considered at a local level, by the doctor's employer.

From the information that you have provided so far, we cannot identify any issues that would enable us to conduct an investigation into Dr Ilias Macheridis' practice. However we suggest the issues of grammar, spelling and tardiness identified in your complaint should be raised with the DWP and/or ATOS as this would be the most appropriate course of action in the first instance.

I enclose a factsheet that explains more about our decision. The factsheet also provides information about other organisations that may be able to help you.

I am sorry we are unable to assist you further.

Yours sincerely

..., Investigation Officer, Fitness to Practise Directorate
Direct Dial: 0161 923 6...
Email: ...@gmc-uk.org

Enc: Your complaint and the GMC factsheet

The GMC is a charity registered in
England and Wales (1089278) and Scotland (SC037750)
    

Subject: Ref: KD/1-5Y9IJH - Complaint against Dr Ilias Macheridis

23 September 2010
Dear Ms ...

Ref: KD/1-5Y9IJH - Complaint against Dr Ilias Macheridis

Thank you for your letter dated 22 September 2010 about Dr Ilias Macheridis
and the enclosed factsheet dated November 2009 which I presume is
available on the GMC website.

I have raised the matter with Atos Healthcare and received the following
reply from Ms Hilary Brierley, DWP Commercial Management of Medical Services.

======= 
Q3. Atos Healthcare referred your concerns to their Customers Relations 
Medical Adviser Dr N Kaiper-Holmes who reviewed the information. Dr Kaiper-Holmes 
has stated, that Dr Ilias Macheridis has not only acted in accordance with Atos Healthcare's 
Professional Standards but he has agreed with the customer that the latter should 
be regarded as having both Limited Capability for Work within the parameters of 
ESA and LCWRA. 

He has spelt "further" and "tumour" wrong and has put, "to fulfil", rather than 
"fulfils" but the meaning is absolutely explicit and clear. What he may not have done 
is "spellcheck" his reply but the fact that he has correctly spelt "Glioma", "substantial", 

"Deterioration", "criteria" and "communication" indicates to me that his level of 
written English is of a high standard. He has also communicated verbally with the GP 
concerned and had no problems there. 

Dr Ilias Macheridis' Medical Manager has stated that he has successfully completed his training 
in various benefits with Atos Healthcare. She adds that he participates actively in 
any team meetings and presentatians that he attends. Finally, she advises that she 
has no concerns with Dr Ilias Macheridis' ability to communicate in the English language. 
===============================

This letter, in full, is published on my website.
http://www.whywaitforever.com/dwpatosletters.html#DWP20100909F

I disagree with Atos Healthcare.  I believe the standard of English of Dr Ilias Macheridis
is unacceptable for a "professional" doctor who expects to practice in England.
I would like the GMC to independently review the matter.

In my opinion Dr Ilias Macheridis has brought the GMC into disrepute. 

Please can the GMC confirm that it is acceptable for a doctor to practice in England 
whose command of English is of the level shown by Dr Ilias Macheridis?

Dr Ilias Macheridis clearly did not check the work he produced.  Is this the standard
that the GMC expects of a doctor?

Perhaps there is legislation that compels the GMC to register doctors who speak
little or no English.  In which case, please can you let me know which Statutory
Instrument compels the GMC in this matter?  

Does a GMC registered doctor have to be able to speak any English at all?  
My understanding is that it is important for a doctor to be able to communicate with 
a patient.  Is this not the case?

The DWP and Atos provide interpreters for patients.  

Is the GMC suggesting that it is acceptable that doctors might need interpreters?

I look forward to hearing from you.  Please email me as due to my growing
and spreading brain tumour I have difficulties with my right side which are
getting worse.

Yours sincerely
 
Mr B...
    

Dear Mr B...,

Thank you for your email of the 23 September 2010, the contents have been noted
and placed on file.

With reference to the issues raised in your email, we can confirm that the 
requirement for doctors to provide evidence of their English language skills 
is dependent upon their country of origin. Doctors who are nationals of member 
states of the European Economic Area, Swiss Nationals and anyone else with an 
EC Right are not required to provide evidence of their English language skills. 
This is a result of European Union regulation regarding free movement of workers. 
Doctor's from any other country are required to evidence their English Language 
skills. The particular evidence required is dependent on their primary medical 
qualification but generally, it is necessary to achieve required scores in the 
International English Language Testing system (IELTS). 

Further information can be found on the GMC's website:

http://www.gmc-uk.org/doctors/registration_applications/language_proficiency.asp

I hope that this answers your query.

Yours sincerely,
    

Dear ...,
 
Re: Complaint against Dr Ilias Macheridis, GMC number is ... for malpractice
 
Thank you for your email of the 27 September 2010.
It has answered my query in part.
 
It has clarified the general legal position in that, from your letter, 
my understanding is that Doctors who are nationals of the states listed 
do not need to read or write English to practice in England.
 
Nevertheless, this doctor, under the terms of Contract between the DWP 
and Atos, is required to produce an acceptable medical document in English.
A transcription of the IB59 follows:-
================
Medical Services advice minute
 
Customer details
 
Title                       Mr
Surname                     B...
Other names                 M.
National Insurance number   ...
Date of birth               ...
 
Advice to be noted below
 
Dear DM
 
After farther communication with Dr ... (GP of Mr B...)
he let me know that this gentleman suffers from Glioma (brain
toumor), which hasn't yet reached the criteria for Terminal Illness, but it causes
fits that may cause substantial risk and he has been referred to see the top
specialist in the county.
Bearing in mind the recent deterioration and the treatment for the fits, I believe
that it is likely this gentleman to fulfill the LCW/LCWRA criteria for special
circumstances (substantial risk if found capable for work or work related
activities).
I hope you find this helpful
 
Dr Ilias Macheridis
 
(handwritten)
A prognosis of 12 months seems to be reasonable. IM 30/4/2010
 
Name                                          Date 23/04/2010
 
Approved Disability Analyst
 
IB59 MIN Version 10/06
================  
This is available online http://www.whywaitforever.com/dwpatosformib59a.html.
I attach an image of the original document (including the hand written amendments).
 
Please note the grammar, spelling and tardiness. This is supposed to be 
a professional document. I do not accept errors such as using "farther" 
instead of "further" is ever acceptable. I do not accept the spelling 
of "tumour" as "toumor".  I do not accept the use of the phrase 
"to fulfill" when "fulfills" should have been used.  These are basic errors.
 
I believe that the GMC has stated that it is critical that a doctor can 
communicate with a patient and that a doctor as a professional should act 
so that the profession is not brought into disrepute.
 
Please can you confirm that the GMC agrees with the DWP and deems that 
the English in the medical document produced by this Doctor meets or exceeds 
the professional standards of English set by the GMC for medical documents 
required to be produced as part of the duties expected of a doctor.
 
I hope you will now reconsider, take appropriate action and at the least to 
instruct the DWP to remove "approval" from this Doctor.
 
Highest regards
 
Yours sincerely
 
Mr B...
    

Dear Mr B...

Thank you for your email of the 28 September 2010, the contents have been noted and placed on file.

It is not within the General Medical Council's remit to comment on contractual terms between the DWP and Atos Healthcare. I would suggest contacting the department at Atos Healthcare that deals with DWP assessments on 0113 230 9175, or alternatively in writing to:

Wing G, Block 1 Government Buildings, Otley Road, Leeds LS16 5PU

With respect to the content of the 'Medical Services Advice Minute' this is a matter best directed to the DWP, who will have their own guidelines as to what is deemed an acceptable standard of English.

In so far as the GMC is concerned we are not disputing nor concurring with your allegations regarding Dr Ilias Macheridis. We have decided that the issues on their own would not warrant GMC action on his registration status.

I am sorry that we can be of no further assistance.

Yours sincerely,

Dear Ms ...,

Re: Complaint against Dr Ilias Macheridis, GMC number is 6138922 for malpractice

Thank you for your email of the 29 September 2010.

Can you provide me with the specific details of the Parliamentary Act, Rules or Regulations that states that the GMC remit does not cover the medical practices or the medical quality of the medical forms produced by GMC registered doctors working for the DWP and Atos Healthcare?

My understanding of the Contract between the DWP and Atos is that in case of a dispute concerning medical processes and quality of the medical documents produced, such as in this case, the GMC is the independent and qualified authority to make a ruling. I have exhausted the DWP and Atos appeal processes. The DWP and Atos think the document is acceptable. I do not. My understanding is that, under the Contract, it is for the GMC to make a ruling as to whether the document meets or exceeds the GMC defined professional standards for such documents. Does the GMC agree that the IB59 document meets or exceeds the professional standards defined for medical documents?

Can you confirm that the GMC is the statutory body responsible for the quality and professional standards of the medical documents produced by doctors registered by the GMC?

Can you confirm that the GMC regards the DWP IB59 document, as previously attached, as a medical document subject to medical quality standard?

If the GMC is not responsible for the quality and professional standards of the medical forms produced by doctors registered by the GMC, can you let me know which organisation is responsible? If the GMC is responsible can you let me know what appeal processes are available?

Thank you.

4 October 2010

In reply please quote KD/1-5YVGQ0

Dear Mr B...

Thank you for your further correspondence.

We have considered the concerns you have raised about Dr Ludmila Semetillo but I am sorry to inform you that we are still not able to take any action on your complaint under our procedures. This is because your complaint is about a medical report prepared for the purpose of assessing your entitlement to benefit. As there is no evidence that the doctor has acted unreasonably in preparing such a report, and there is no suggestion that his or her fitness to practise might be impaired, we will not be taking any further action.

We believe that the issues you have raised with us would be best dealt with through the processes of the Department of Work and Pensions (DWP). The DWP's advice is that you should initially complain to the manager of the office that dealt with your claim. They will be best placed to discuss your concerns, and advise you as to whether there is any scope for having your case reviewed.

You may like to also direct your complaint to ATOS. I have provided the best address for this below:

Atos, Wing G, Block 1 Government Buildings, Otley Road, Leeds LSl6 5PU

I enclose a factsheet that explains more about our decision. The factsheet also provides information about other organisations that may be able to help you.

Yours sincerely

..., Fitness to Practise Directorate, General Medical Council, 3 Hardman Street, Manchester, M3 3AW

Dear Mr B...,

Thank you for your email of 30 September 2010. Your comments have been noted and placed on file.

We are not disputing your allegations however the GMC is not a general complaints body. Our fitness to practise procedures focus on whether a doctor's fitness to practise is impaired to such an extent that we need to take action on his registration. This means that we are looking to see whether the issues raised are so serious that the doctor should be prevented from working or allowed to work only under certain conditions.

Your initial complaint suggested that the doctor's 'Medical Services Advice Minute' was malpractice for its "grammar, spelling and tardiness". We can only advise that on the basis of the information received, there was insufficient evidence to suggest that the doctor had in fact committed serious or significant breaches of Good Medical Practice, which would warrant a full investigation into their fitness to practice.

I can advise that for all new complaints we receive, the Assistant Registrar will answer a set of standard questions to help determine what type of investigation would be warranted with regards to the allegations that have been made about the doctor. This is called the "Triage Script". If you wish to see a copy of how our decision was made in relation to your complaint about Dr Ilias Macheridis, you can request a copy of the "triage script" through the Freedom of Information Act. This request would need to be put to us in writing. You can write directly to our Information Access Team. Their contact details are as follows:

Information Access Manager
General Medical Council
3 Hardman Street
Manchester
M3 3AW

Email: FOI@gmc-uk.org

You can also request a copy of the guidance used to assist the Assistant Registrar with identifying the most appropriate level for investigating a complaint.

I acknowledge that you have asked us to review our decision with regards to your complaint. We do have the power to review investigation decisions, including a decision not to refer an allegation for a GMC investigation, but only where there is reason to believe that the decision may have been wrongly reached or there is new information received which may have led to a different decision. A review would only then be undertaken if the Registrar was satisfied that it was necessary for either the protection of the public, the prevention of injustice to the practitioner or otherwise necessary in the public interest.

In this case, we do not have reason to believe that a review of our decision is warranted. We cannot review the decision simply because you disagree with it. It is open to you to outline reasons why you think our decision has been wrongly reached, but we are otherwise unable to consider this matter further.

Also if there is new information which may have led to a different decision it would be open to you to submit it for consideration.

You may also wish to write to the Customer Service Manager at:

Customer Service Manager
General Medical Council
3 Hardman Street
Manchester
M3 3AW
Email: customerservicemanager@gmc-uk.org

You may also wish visit our website to obtain further information with regards to the rules and legislation which govern our work:

http://www.gmc-uk.org/about/legislation.asp

Finally, you have asked for details as to which other organisations may be able to review our decisions. The Council for Healthcare and Regulatory Excellence (CHRE) promotes the health and well-being of patients and the public in the regulation of health professionals. They scrutinise and oversee the work of the nine regulatory bodies that set standards for training and conduct of health professionals.

If you wish to contact them, their contact details are as follows:

Council for Healthcare Regulatory Excellence
11 Strand, London WC2N 5HR

Telephone: 020 7389 8030

Website: http://www.chre.org.uk/

You may also wish to consider Judicial Review; however you would need to seek legal advice if you are considering this option.

We recognise the fact that you are dissatisfied with our decision, I am sorry that we are unable to help you any further.

Yours sincerely

... Investigations Officer, Fitness to Practise Directorate
Telephone: 0161 923 6576
Email: ...@gmc-uk.org

Unless otherwise expressly agreed by the sender of this email, this communication may contain privileged or confidential information which is exempt from disclosure under UK law. This email and its attachments may not be used or disclosed except for the purpose for which it has been sent.

If you are not the addressee or have received this email in error, please do not read, print, re-transmit, store or act in reliance on it or any attachments. Instead, please email the sender and then immediately delete it.

General Medical Council
3 Hardman Street, Manchester, M3 3AW
Regents Place, 350 Euston Road, London, NW1 3JN
The Tun, 4 Jacksons Entry, Holyrood Road, Edinburgh, EH8 8AE
Regus House, Falcon Drive, Cardiff Bay, CF10 4RU
9th Floor, Bedford House, 16-22 Bedford Street, Belfast, BT2 7FD
The GMC is a charity registered in England and Wales (1089278) and Scotland (SC037750)

To: GMC Customer Service Manager (customerservicemanager@gmc-uk.org)

Date: 24 August 2011

Dear Sir,

Ref: KD/1-5YVGQ0 - Complaint against Dr Ludmila Semetillo, GMC number 6165133 for malpractice and assault

Further to your letter dated 4 October 2010 reference KD/1-5YVGQ0. I apologise for the delay as my medical condition (brain tumour) became acute. I was emergency admitted to the ... Hospital for a biopsy and treatment for epilepsy, focal fits, seizures etc in mid October 2010. In November 2011 I undertook six weeks of radiotherapy. This has reduced the intensity and size of my brain tumour. After two MRI scans the latest indication is my condition is stable. I have another scan scheduled for 5 September 2011.

I would like the GMC to reconsider the case against Dr Ludmila Semetillo as I would like to put forward additional evidence.

1. The Nursing & Midwifery Council investigated Nurse Mrs Tanya Catherine Andrews and found no case to answer as though this Nurse may or may not have failed to read the case notes they are restricted to deciding whether this "is easily remediable and whether it has been remedied". It is outside their remit to consider the consequences of her mistake. The established and documented medical practice is that the Nurse should have read the case notes, which stated the medical condition was "brain tumour", and handed the case notes to a GMC registered doctor. The GMC registered doctor should have followed the established and documented medical practice and contacted the patient's GP or consultant before deciding on whether a face to face assessment was necessary.

2. Dr Ludmila Semetillo, before undertaking the assessment, should have been aware of the case notes and read that the patient's medical condition was a "brain tumour". She should have followed the established and documented medical practice, cancelled the assessment explaining that a mistake must have happened because she needed to contact the patient's GP or consultant before proceeding. The fact that she continued with the assessment, I suggest, is evidence for malpractice and assault. The further fact that the report she produced recommended I was work capable is counter to that of evidence available from A&E, my neurology consultant and neuro-surgery consultant, at the time, who undertook emergency work at that time to attempt to stabilise my condition. I commend the GMC to contact my GP and consultants to compare their view of the situation with that reported by Dr Ludmila Semetillo. As a lay person I cannot judge medical matters but to me to support the word of Dr Ludmila Semetillo, without access to my medical records, against the documented actions of A&E doctors, my GP and consultants is a gross injustice and brings contempt on the medical profession.

3. I refer you to the GMC Minutes of Investigation Committee (Oral) hearing 4 October 2010 Dr Alexandros Mallios (reference Number: 6137876). See "http://www.gmc-uk.org/static/documents/content/Mallios.pdf".

4. I refer you to the Response, published 7 March 2011, from the GMC by Jane O'Brien, Assistant Director, Standards & Fitness to Practise Directorate to the Letter: Getting welfare to work: Health professionals' advice: the ethics By Edward S Cooper BMJ 2011;342:doi:10.1136/bmj.d1155 (Published 22 February 2011) in which is stated "...Dishonesty in writing reports cannot be justified by reference to the first duty of doctors..." See http://www.bmj.com/content/342/bmj.d1155.full/reply#bmj_el_251102.

5. I refer you to the following GMC document. See "http://www.gmc-uk.org/Confidentiality_disclosing_info_insurance_2009.pdf_27493823.pdf".

6. I am pleased to report that this year after two years and two months the DWP has confirmed that they are now complying with the established and documented medical practice and a GMC registered doctor has contacted my GP and consultants to decide whether a face to face assessment is necessary. Naturally I am happy to comply with the recommendations of medically competent GMC registered practioners with full access to my medical history. I commend the GMC to contact the DWP to confirm that this is the case and that the DWP have implicitly agreed that the actions of Dr Ludmila Semetillo comprised malpractice and assault. The DWP is discussing compensation with me.

I hope you now have the additional evidence to consider as a whole the evidence provided previously and the new evidence as above. I look forward to hearing from you. Thank you.

Regards

Yours faithfully

16 September 2011

In reply please quote: MC/1-5YVGQ0

General Medical Council

Dear Mr Mr B...

Thank you for your emails of 24 August 2011 concerning the General Medical Council (GMC) decision in your complaint.

Having now perused the contents your emails I am satisfied that the decision of the GMC at this time is correct and therefore remains unchanged. Unfortunately your emails do not raise issues that would have resulted in a different decision being reached. As there is no investigation in respect of your complaint, the GMC has no statutory power to request information from any third party organisation.

However, we have the power to review investigation decisions, including a decision not to refer an allegation for a full GMC investigation but only where there is reason to believe that the decision may have been wrongly reached or there is new information received which may have led to a different decision. A review would only then be undertaken if the Registrar was satisfied that it was necessary for either the protection of the public, the prevention of injustice to the practitioner or otherwise necessary in the public interest.

You have referred to a DWP investigation that has concluded that there was malpractice or and assault, and that you are now discussing an out of court settlement. In order for us to consider this further, you will need to send us any evidence you have that supports this such as an notice of successful appeal or a letter of confirmation from the DWP.

Yours sincerely

..., Investigation Manager
Fitness to Practise Directorate
T.  0161 923 6545
E. practise@gmc-uk.org